Complex Care at Home, in Hospital, or in Residential Care: Making the Call

Choosing where a person with complex care needs lives is rarely an easy decision.

It could follow a hospital admission or a fall. It could come after a major decline in a person’s condition or a slow dawning realisation that the family is unable to provide the support required. Questions about home care, hospital discharge, supported accommodation or residential care become urgent.

For NDIS participants and families, the challenge is often not knowing which option can actually work in practice.

While home may provide familiarity and privacy, it has demands on families and requires a reliable workforce. Supported living may offer consistent staffing, but the person may have less control. The hospital offers clinical support, but it is not necessarily a long-term living arrangement.

The critical question is not just, “Is complex care better at home or in a facility?” It is whether the individual can be supported safely and appropriately in the setting that is right for them.

Start with the person, not the provider

Before comparing home care providers or discussing residential facilities, work with the person to establish what they truly need.

“Complex care” may include help with washing and dressing or administering medication. Some may have a tube for feeding and a catheter, while others may have physical conditions such as motor neurone disease, cerebral palsy and multiple sclerosis.

Others have intellectual disabilities, chronic illness or multiple conditions that affect how they manage their everyday lives.

It isn’t the label that matters – it’s what is true every day that we can describe.

A useful assessment should include:

• What help is required in the morning, afternoon and evening
• Which tasks require specific training or skills
• Whether clinical nursing is required
• Whether registered nurses, allied health professionals or other services are needed
• What happens at night
• What might happen to the person’s condition if they become unwell
• What equipment is currently used
• What modifications the home may require
• How much assistance currently comes from family members
• What the person needs from their living arrangement

Families are then equipped to determine a course of action that is best for the individual. It might not be just a matter of, “Can this person live at home?” but, “What would need to change for someone to be able to live at home?”

Home care can be effective – with the proper systems to support it

Home care does not always require complex formal care.

In-Home Care can also provide support such as disability services, clinical support, allied health and equipment, and informal support (family). An individual may require support workers for personal care and everyday activities, a registered nurse for clinical support, occupational therapy input, and family support to attend appointments or other aspects of everyday life.

The arrangement works when the pieces all fit together.

Think of someone who requires support for transfers, medication at prescribed times, personal care and overnight support. Their home could be suitable for them but only if it was accessible, there were enough trained workers and there was a contingency plan for what happens if their personal worker isn’t available.

Absent these, “home care” can all too easily become “family care”.

A parent who is willing to assist with a few meals and appointments may not be able to provide multiple additional hours of free care per day. A partner may be willing to help for a night or two, but may not be able to be roused repeatedly throughout the night in the long term.

It is often not the availability of family members that determines how far home care can stretch; it is the extent of their willingness and their ability to provide it.

Look closely at the home environment

The home’s configuration can also be an obstacle.

Small bathrooms, narrow doorways, hard beds, or the absence of transfer equipment can be a challenge.

But the right technology and adjustments can help with many tasks and reduce the need for someone else to help.

This may involve an occupational therapist examining how the person manages around their home and advising on the equipment or adjustments that would help them live safely and independently.

The appropriate funding pathway depends on a person’s circumstances and the support being considered. For older people who use Support at Home, for example, assistive technology and home modifications have a separate funding pathway under the AT-HM scheme. Current My Aged Care information states that AT-HM funding is separate from other Support at Home services.

The principle applies to other situations: before deciding that a person requires substantially more paid support, consider whether the home environment is creating unnecessary barriers. A suitable shower setup, transfer equipment, pressure-relieving equipment or accessible bedroom will not remove a person’s care needs, but it can change how those needs are managed safely.The home’s configuration can also be an obstacle.

The night-time question is easy to miss

What really sets people with complex care needs apart from the rest is what happens when you all go to sleep.

Some people may need occasional support, while others may require assistance throughout the night. Those who may need help once during the night will have very different needs from those who need changing, suctioning or close monitoring.

Families should ask providers to explain exactly what overnight support would look like in practice.

Do not assume that “24-hour care” means one worker actively supports the person every minute of the day and night. The arrangement may involve scheduled support, an overnight arrangement, active overnight assistance or a combination of supports, depending on the person’s needs and funding.

For NDIS participants, the applicable support and pricing arrangements also depend on the type of support. The NDIS currently publishes maximum prices for relevant support for the 2026–27 financial year, with the current pricing schedule effective from 24 September 2026.

If a person regularly needs an awake worker during the night, a model designed around occasional assistance may not be sustainable. If they sleep through and require limited assistance, another arrangement may be suitable.

Workforce availability can determine whether the arrangement is workable

A support plan may look strong on paper but can quickly fail if there are not enough available workers to deliver it.

This is especially likely for people with high-intensity support needs or who require workers with particular competencies. Families should therefore ask potential home care providers about recruitment and backup arrangements before making a decision.

Questions worth asking include:

• How many workers are available for the person’s support?
• How are workers trained and assessed for the relevant tasks?
• How is information about the person’s care plan shared?
• What happens if a regular worker is sick?
• How quickly can a replacement be arranged?
• Who is available outside ordinary business hours?
• What happens if the person’s needs increase?

Location is also important.

A participant who lives in a metropolitan area may have access to a larger pool of Care Professionals than someone who lives in a regional or remote community. Even where funding is available, the practical workforce may be limited.

That does not necessarily mean that home is impossible, but the family should understand what is realistically available before assuming that funded support hours will equate to hours of staffed support.

Family capacity needs to be considered

Families are often an invisible part of a complex care arrangement.

A provider may cover certain hours, while a parent, partner or sibling fills the gaps. It may seem manageable at first, but months later, the same family member may be exhausted, missing work and sleeping poorly.

That does not mean that they have failed – it means the arrangement has relied on a level of informal care that is not sustainable.

When considering home care, think about what the family can realistically continue to do for six months or a year. Do not build the plan around the assumption that everyone will always give more.

Respite care can be part of the planning – used regularly to give carers time away from their responsibilities before they reach a crisis point. A resilient support arrangement has an answer.

When a different living arrangement makes more sense

Choosing a residential or supported living option does not mean that home care has failed.

Supported Independent Living, or SIL, is an NDIS home-and-living support that funds support workers to help or supervise a person in their home. Current NDIS guidance describes SIL as funding for support workers to help or supervise participants 24 hours a day, seven days a week. SIL does not cover rent or other day-to-day expenses such as groceries.

SIL may therefore provide a structured support arrangement to someone whose disability-related needs require substantial assistance with their daily living.

Residential aged care is a different scenario – it is a part of the aged-care system and is aimed at people who meet the relevant eligibility requirements.

For older people who access Support at Home, services can include clinical support such as nursing and occupational therapy, independence support such as help with showering and medication, and everyday living services. The person’s funding classification is based on their assessed care needs.

What can supported living or residential care offer?

There may be a larger group of workers, established routines and systems for covering staff absences. It may also provide a ready-made space that has already considered equipment and accessibility requirements.

Social connection can also be a consideration. Some people enjoy having other residents or housemates nearby and the opportunity for shared activities and community participation.

For others, those same elements may feel restrictive.

A person may not wish to share their home and value their ability to make decisions about when they eat, sleep or receive visitors. They may also be strongly connected to their existing neighbourhood.

These preferences matter – and a provider should be able to explain what would change and how the person will retain control of their everyday life.

Ask what happens when things go wrong

The easiest mistake is to assess a care situation based on its best day.

A home-care model may be perfect when every worker arrives and the person’s health is stable, but what happens when the regular worker calls in sick?

What happens when the person develops an infection?

What happens when the equipment breaks?

What happens if a family carer is suddenly unavailable?

Before choosing a provider, ask for clear answers about escalation, backup workers and communication.

A provider should also explain how it responds when the person’s condition changes.

For a person with complex care needs, a good plan is not one where nothing goes wrong. It has a plan for what happens when something does.

The person’s preferences should not become irrelevant

Complex care discussions are frequently conversations between professionals and the family while the person who receives support is a passive party.

Ask what the person wants.

Maybe they want to remain at home because their neighbourhood, friends or routines are important to them. Maybe they want a different environment because they are isolated or it has become more difficult to manage their home.

Communication difficulties do not remove the need to consider their preferences.

Family members, permanent staff and professionals are also aware of the person’s preferences and how to communicate with them.

Instead of using hours of support as the measure, person-centred care is about looking at the whole person, and their relationships, goals, independence, and quality of life.

Choosing a provider: questions worth asking

Once you have a clearer idea of the living arrangement, you can begin to compare providers.

Ask not only about costs but:

What experience do your workers have with this person?

A provider that supports someone who requires medication management, catheter care or enteral feeding should be able to explain how the relevant competencies are addressed.

How do you manage changes in the care plan?

If a doctor, nurse or allied health professional recommends a change, there needs to be a reliable way of communicating it to the people delivering the support.

What happens when a worker is unavailable?

The provider should be able to explain its backup arrangements.

Who provides clinical oversight?

If clinical nursing is required, establish who is responsible and how the relevant health professionals communicate with the support team.

How much choice does the person have?

The person should understand who will be supporting them and have appropriate opportunities to express their preferences.

What happens if this arrangement stops working?

The provider should be willing to discuss how support can be reviewed as needs change.

Do not compare costs without comparing the support

Cost is obviously a consideration, but comparing hourly rates can be misleading.

NDIS pricing arrangements establish maximum prices for relevant NDIS supports for NDIA-managed and plan-managed participants. What actually gets paid also depends on the applicable support and the participant’s funding arrangements.

Similarly, Support at Home operates through assessed funding classifications and individual budgets. Providers set their own prices for services within the program, so comparing provider price lists is important.

That means families should compare the whole arrangement rather than an hourly rate.

Consider:

• How many hours are actually required
• Whether support is needed overnight
• Whether two workers are required for particular tasks
• Equipment and home modifications
• Nursing or allied health involvement
• Respite
• Transport or community participation
• The person’s contribution, where applicable
• What happens when regular workers are unavailable

A cheaper arrangement that regularly leaves gaps may place additional pressure on the family. A more expensive arrangement may provide services the person does not actually need.

The useful comparison is between what each option provides and what the person requires.

Hospital discharge needs its own conversation

Being admitted to a hospital can cause families to feel pressured to decide.

If a participant’s support requirements change in the hospital, the contact family should inform the hospital staff and other relevant contacts about the change in support needs. The NDIS recommends talking to your hospital about your support needs. The NDIS also recognises that hospital and NDIS processes can be aligned on discharge planning.

Ask early:

• What has changed medically?
• What support will be needed after discharge?
• Does the person need new equipment?
• Who will train workers?
• Has the existing care plan been reviewed?
• Are current home supports still appropriate?
• What needs to be arranged before returning home?

A hospital discharge should be considered alongside what happens once the person is back in their ordinary environment.

Choosing home is not necessarily a decision for life

Some families worry that if they select home care and it does not work out, they will have let their family member down.

That is not necessarily the case.

A person’s needs may change, and family circumstances, the local workforce and equipment may also change. Support arrangements may need to be reviewed.

One person may be in supported accommodation after many years being supported at home. Someone else might move home after a period being supported through supported living.

A planned move is generally easier to manage than waiting until a crisis leaves the family with very few options.

A practical way to make the decision

If the family remains undecided, the following three lists should be written out.

First: What does the person need?

It could include anything from personal care, medication, overnight and clinical support, participation, equipment or community access.

Second: What is currently available?

Identify the funding, staff, resources, family involvement, clinical support and appropriate providers that can be practically utilised.

Third: What is missing?

Perhaps the missing piece is two more trained workers. Perhaps it is a home modification. Perhaps the family needs regular respite. Perhaps the individual needs a level of clinical support that cannot be safely delivered in the community.

If they can, home may remain an option.

If they cannot, it may be worth exploring another living arrangement.

The aim is to support a life, not just a care schedule.

But the person remains at the heart of the conversation.

Where will they sleep? Who will assist them while showering? Who will take care of their medication? And what happens in an emergency?

Those questions matter.

So do: who will they interact with, what will they do, how much influence will they have, can they sustain meaningful relationships, and will they be given opportunities to get involved in their community?

For one person, the answer may be a carefully organised home-care arrangement supported by skilled workers, equipment, nursing and respite.

For another, supported living may provide greater stability and social connection.

For an older person eligible for aged care, residential aged care or Support at Home may provide appropriate options depending on their assessed needs.

There is no single model.

The most useful decision is one that considers the person’s actual needs, available resources and preferences rather than assumptions around what home or residential care is supposed to mean.

Frequently asked questions

Can someone with complex care needs live at home?

Yes, depending on their individual circumstances. Home may be suitable where the required supports, workforce, equipment, clinical input and home environment can be put in place safely and sustainably.

Does complex care always require a registered nurse?

No. The appropriate workforce will depend on the person’s needs and the tasks concerned. Some supports may be provided by appropriately trained workers, while particular clinical needs may require registered nurses or other qualified professionals.

What types of support can complex care include?

This varies considerably depending on the person. It may include personal care, medication support, wound care, catheter care, continence care, enteral feeding, seizure monitoring, mobility assistance or other high-intensity disability supports.

Is SIL the same as residential aged care?

No. Supported Independent Living is an NDIS support for eligible participants who need assistance with daily living in their home. Residential aged care operates within Australia’s aged-care system and has different eligibility and funding arrangements.

What should I look for in a complex care provider?

Look for a provider that can clearly explain worker competencies, backup arrangements, clinical oversight, communication, medication management, care-plan processes and how the person’s preferences will be respected.

What if our family is exhausted?

Use it as a trigger to review the support arrangement, not as a comment on yourself or the family. Respite and extra support might make the situation easier, and other home and living arrangements can be considered if the present model is no longer working.

What if someone’s needs change?

Take a look at the care plan and talk to the relevant provider and professionals. What was a good support plan six months ago might not be adequate with a dramatic change in health, mobility or behaviour.

What is the single biggest question to ask?

Ask what it would take for someone to safely, sustainably and comfortably live in the environment you are considering.

And then test whether those requirements really can be met.

A Decision That Can Change

There is no reward for keeping someone in their home no matter what, and for someone to go into supported accommodation or residential care should not necessarily be seen as the end of the line in terms of independence.

What would be more relevant is to look at whether the person’s support package is actually functioning in the real world.

Are the required workers available, are they able to support the family without being overburdened, and is the accommodation appropriate?

Can the clinical and disability supports communicate?

What happens at night?

And what happens when things go wrong?

And arguably more crucially, is the balance aligned with how the person wishes to live their life?

The appropriate solution for an NDIS participant will vary from person to person. For some NDIS participants, the option will be complex care in the home.

The decision may also change.

What’s important is to have enough information to make the choice deliberately rather than to wait for a crisis to force you to make it.