23/10/2026
When community care fails, we all lose hospital access
By Amanda Priest | Endorsed Enrolled Nurse and CEO of HiYa Home Care Co | 23 October 2026
Your child becomes seriously unwell. Your partner has a stroke. Someone you love needs an ambulance. Suddenly, disability funding and aged care policy are no longer distant political subjects. They help determine whether the hospital bed your family needs is available.
I am writing because community care is part of the infrastructure that keeps hospitals working. If that care becomes unsustainable, the consequences travel far beyond the people whose plans were reduced.
I spent 17 years nursing in Queensland Health, across rehabilitation, acute stroke and palliative care. I now run a small community care provider in regional Queensland. I am also a mother of three, with disability and significant health needs in my own family. A prolonged hospital admission for my son brought the patient side of the system painfully close. I now have two sons who are NDIS participants.
Those experiences explain my perspective.
This warning is for the person who has never opened an NDIS plan and assumes none of this concerns them. We all depend on care outside hospital, including when we have never used it ourselves.
The backlog exists already
Queensland’s August 2026 census recorded 1,437 people clinically ready for discharge but awaiting suitable aged care or disability support. That included 1,118 older aged care patients and 319 younger NDIS patients. Wide Bay accounted for 117 people. These are dated census figures, not a live bed count. [1]
Recorded figures. People awaiting discharge are not people who no longer need care. They need an appropriate place and support to receive it.
NSW Health reported on 9 October that more than 1,300 patients were awaiting aged care or NDIS support: the equivalent of one in eight beds accessible from emergency departments. It projected almost 1,700 patients by June 2027 if trends continued. That denominator is not every hospital bed in Australia. [2]
ABC reported that 42 per cent of ambulance arrivals at Queensland’s 26 major reporting emergency departments waited more than 30 minutes for transfer in August 2026. The figure improved slightly against August 2024, while remaining worse than July 2026. Progress and serious pressure can exist together. [6]
These pressures predate the October NDIS reductions. They cannot honestly be presented as proof that those reductions have already caused a surge. They are the conditions into which the reductions are being introduced.
Apparently, a system struggling to discharge people is an excellent place to test whether less community funding will work. I would prefer to see the risk assessment before we volunteer the patients.
The regional picture
This pressure is close to home. The August 2026 census recorded 98 people awaiting discharge across Sunshine Coast HHS: 85 older aged care patients and 13 younger NDIS patients. Central Queensland HHS recorded 56: 42 older aged care patients and 14 younger NDIS patients. Mackay recorded 54, and Wide Bay 117. [1]
These are observed delayed-discharge patients in August 2026. They are not projections of admissions caused by the October reforms.
Across these four health services, that is 325 people awaiting appropriate care outside hospital. These are HHS-wide figures, not a count for Sunshine Coast University Hospital, Rockhampton Hospital or another individual facility. [1]
For regional families, a missing care arrangement can also mean distance from relatives, work and familiar services. The people already waiting are the first to bear the cost. Everyone else depends on those same hospitals when an emergency arrives.
A budget reduction does not reduce a person’s need for care
Affected social, economic and community participation allocations are being reduced by 50 per cent, and improved daily living skills allocations by 10 per cent, through the staged changes beginning in October 2026. These are specified categories, not a blanket cut to every participant’s entire plan. [3]
The amended Act gives the Minister broader power to set percentage reductions through a legislative instrument. Section 34A does not expressly cap that power at 50 per cent; a 99 per cent reduction is within the breadth of the wording, subject to applicable legal constraints. It is not the reduction currently prescribed. The Minister must have regard to participant safety. [3]
More directly relevant is section 34A(5): the determination can operate even where funding is below the cost of reasonable and necessary supports. That is an express legislative provision, not a provider’s gloomy interpretation. [3]
Exclusions and the separate variation pathway for eligible people needing 24-hour care must also be acknowledged. Their practical test is whether necessary support continues safely and without an unfunded gap. A safeguard must do more than look reassuring on a website. [3]
A person’s day is not divided into government budget categories. Personal care, therapy, community participation and family assistance work together. Losing hours outside the home can create additional hours requiring care inside it.
The same question belongs in aged care and DVA services wherever a reduction or delay makes home care unworkable: who provides the missing care? I am not claiming an across-the-board cut in those programs without evidence. I am insisting that their service gaps be counted in the same hospital-demand assessment.
A saving that reappears as a hospital cost, unpaid family labour or preventable crisis needs a more honest name.
An accepted need is not a promise of full NDIS funding
People understandably ask: how can funding fall when the need remains, particularly when the NDIS previously paid for it? The answer requires separating a person’s actual care needs from the legal rules determining which supports the scheme funds.
An assessment identifying a need does not automatically establish an entitlement to every requested support or cost. Previous funding does not guarantee the same future allocation. But a reduction is not automatically lawful simply because the Agency calls it a reform: the applicable criteria, evidence, exclusions and review rights still matter.
The NDIS has never been responsible for every health, housing and ordinary living expense. Section 34(1)(e) already requires consideration of what it is reasonable to expect families, carers, informal networks and the community to provide. That does not mean assuming relatives have unlimited time, money or capacity. [13]
The specific October reduction mechanism goes further: section 34A(5) permits a determination to leave funding below the cost of reasonable and necessary supports. A care need can therefore remain while the amount available to meet it is reduced. This is distinct from finding that the need no longer exists. [3]
Further changes commencing on 1 February 2027 expressly connect reasonable and necessary NDIS support with scheme financial sustainability and introduce new sustainability principles. We must distinguish those future provisions from changes already operating in October. [3]
It would be misleading to say the Act automatically makes a participant, their family or the state legally responsible for every unfunded hour. A limit on NDIS funding does not itself create a funded replacement service or guarantee that another system must fill the gap.
Practically, however, someone is left trying. A participant may face fewer supported activities, unsafe gaps or pressure to change living arrangements. A family may lose sleep, employment or savings attempting to provide extra care. A provider may be asked to continue a roster that available funding cannot sustain.
Health and other services may then receive people in crisis. These are risks requiring individual assessment, not inevitable outcomes for every person whose plan changes.
That is why transparency must explain the gap, not merely announce the new total. Which needs remain? Which hours are funded? What is the legal reason for excluding the rest? Who is expected to provide them, have they agreed, and can they actually do it safely?
“Someone else’s responsibility” is not a care arrangement. Nor is a family an emergency funding instrument.
Without a documented handover to real services, responsibility can be separated administratively while consequences remain with the person. That is the effect I am warning about; I am not claiming to know the private motives of decision-makers.
Families need honest warning and time to prepare. Providers need clear funding boundaries and safe transition arrangements. Hospitals need demand forecasts and funded discharge pathways. Failing to disclose the practical consequences leaves everyone less prepared and increases the risk of worse outcomes.
A tenancy agreement cannot cover the night shift
Supported Independent Living, or SIL, funds assistance or supervision across 24 hours. Residents may share workers and receive individual assistance according to need. SIL funds support; housing, rent and ordinary living expenses are separate. Current guidance continues to recognise SIL and shared living arrangements. [4]
There were 7,428 Queensland participants and 36,874 nationally with SIL funding at 30 June 2026. These are funding counts, not a count of residents facing eviction or needing hospital treatment. [4]
In the Profitable NDIS Provider podcast, Shane Stewart describes his former NDIA home and living role and discusses provider sustainability. At about 48:44–49:50 he uses an illustrative case: $15,000 in weekly care costs against $9,000 available. The difference is $6,000 each week. It is an example, not a verified individual case. [5]
Thank you, Tanya Gomez, for pushing back. At about 49:58, you ask where participants go if providers cannot make their funding work. That is the question the public deserves to hear answered. [5]
The discussion about there being no “SIL home” describes the distinction between a home and the support delivered there. It does not announce the abolition of shared homes. But terminology will not settle the night roster.
A tenancy agreement cannot assist someone to the toilet, manage an overnight support need or replace a trained worker. Someone has to be there, and the arrangement has to be sustainable.
Providers cannot absorb recurring losses indefinitely. Families cannot automatically become a replacement workforce. Moving to a different provider does not solve a funding gap if the same gap follows the person.
Not every arrangement will fail. Not every failure will lead to hospital. But a house can remain standing while the care that makes it safe becomes unworkable. That risk deserves measurement before anyone is stranded.
What a ten per cent breakdown could mean
Consider a stress scenario, not a prediction: 10 per cent of the June SIL funding cohort loses sustainable 24-hour care. That means approximately 743 Queenslanders and 3,687 people nationally need replacement arrangements. Queensland is included in the national number. [4]
If all affected people required admission and stayed an average of 90 days, that would generate approximately 66,852 bed-days in Queensland and 331,866 nationally. If those days fell within one year, they would equal an average of 183 occupied beds in Queensland and 909 nationally throughout that year.
Conditional demand, not observed admissions or an official forecast. If only half the affected cohort required admission, these figures would halve. Existing hospital patients may overlap with this cohort; do not simply add it to the backlog.
If every affected person needed a bed at the same time, immediate demand would instead be approximately 743 beds in Queensland and 3,687 nationally. Simultaneous demand and annual average occupancy are different measures.
The missing information is the admission rate, the availability of replacement care, and the length of any hospital stay. Governments should publish those assumptions and model the consequences. We should not have to invent a crisis percentage to get their attention.
The risk is straightforward: community care fails, a crisis brings someone to hospital, and the same missing care prevents discharge. An emergency department then carries patients awaiting ward beds while new emergencies arrive.
The Australasian College for Emergency Medicine links access block and overcrowding with delayed treatment, patient harm and worse mortality outcomes. This does not establish a death toll attributable to these NDIS changes. It establishes why hospital capacity is a safety issue for everyone. [7]
Jai, Aaron and Andy make this question real
Jai Arrow’s public experience with motor neurone disease has brought this question into homes that may never have considered it before. ABC reported his determination to explore trials and medications after announcing his retirement from rugby league in May 2026. [10]
His reported journey to a neurological wellness retreat in Spain illustrates how far a person may travel in search of help. That does not establish the effectiveness of those interventions, or tell us what future care he will need. His private medical decisions remain his own. [10]
But it sharpens a question for every person with MND, famous or otherwise: if they wish to pursue a life-extending option, will they receive a full, individual assessment and an honest explanation of how they could access it?
A person’s ability to travel overseas or seek private care should not determine whether their options are fairly explained in the public system. Public attention should open that conversation for everyone.
The Courier-Mail reported that Queensland father Aaron Reardon was refused an elective tracheostomy at Princess Alexandra Hospital. Subsequent 7NEWS reporting on 11 September confirmed the refusal and reported that Brisbane man Andy Taylor obtained the procedure in London. [11]
The hospital said Aaron’s request received extensive clinical consideration. It said elective tracheostomy for permanent invasive ventilation in MND was not standard practice and carried significant risks without evidence of improved quality of life. That is the hospital’s stated position and belongs in this account. [11]
The same 7NEWS report carried MND Queensland chief executive Stacey Thorpe’s concern about unequal opportunities for people seeking to extend life compared with those seeking VAD. That is a publicly attributed concern, not proof that either man was offered inappropriate VAD. [11]
These experiences demand scrutiny of individual assessment, clinical reasoning and the care required after treatment. Andy’s experience cannot guarantee another person’s outcome. Aaron’s refusal does not by itself establish that funding drove the decision.
Families deserve to understand which barriers arise from the person’s medical condition, which reflect uncertainty about benefit, and which arise from service availability or funding. Those distinctions can change a life.
For someone with children, more time may mean helping with homework, offering advice or simply being present. Their idea of a worthwhile life may include profound physical disability and dependence on others. We must listen to their assessment of their own life.
The care to live must be a real option
An individual discussion of ventilation and tracheostomy must include benefits, burdens, uncertainty and the practical support required afterwards. An operation without a sustainable care pathway is not a complete offer.
Consider a spouse trying to stay employed, care for their partner and raise children. Add overnight assistance, trained workers, equipment and a home that must accommodate changing needs. Informal care cannot expand indefinitely just because an application is waiting in someone’s inbox.
If the only arrangement presented means separation from family or relocation to shared accommodation, that changes the decision. A person is weighing treatment alongside the possible loss of the home and relationships that make them want more time.
For a rapidly progressive condition, a plan based on yesterday’s function can be inadequate before reassessment is complete. Care must arrive while it can still make a difference. A funding approval that comes after the opportunity has passed is excellent paperwork and a terrible outcome.
Bed pressure makes scrutiny of these decisions urgent. I have not established that hospitals are using voluntary assisted dying to clear beds. My concern is that failures of care may shape what a person believes is possible before the formal VAD pathway begins.
Queensland permits only doctors and nurse practitioners to initiate a VAD discussion, and requires them simultaneously to explain available treatment and palliative care options and likely outcomes. Eligibility requires an advanced, progressive condition expected to cause death within 12 months, alongside other criteria. Disability or an unavailable care package alone does not establish eligibility. [8]
That legal structure matters. So does the conversation before the documented conversation.
What has the person already been told? Was a treatment fairly assessed? Was home care described as impossible before anyone tested a workable arrangement? Were they helped to distinguish a treatment that would not benefit them from support that had not been funded?
If someone says they cannot go on, we must understand what they cannot go on with: illness, uncontrolled symptoms, separation from family, an unsafe care arrangement, or months of being told that no one can fund the help they need.
No one should have to prove that their life is worth a properly staffed roster.
Safeguards must begin before the VAD request
Palliative care also requires individual treatment decisions. Concerns about intravenous antibiotics being withheld deserve examination of the actual clinical circumstances, the person’s wishes and the explanation provided. Antibiotics may offer benefit in one situation and impose burdens without meaningful benefit in another. A palliative label is not, by itself, an explanation.
If a person concludes that death is their only bearable option because adequate care appears unavailable, that warrants careful, independent scrutiny. It does not justify assuming their wishes are invalid. It means we must take both their wishes and their unmet needs seriously.
I am calling for an urgent pre-palliative decision framework that supports good palliative care and protects a person’s right to accept or refuse treatment. It should document the relevant options and make the path to accessing them understandable.
That means an individual assessment; benefits, burdens and uncertainty explained; an independent second opinion where a decision is disputed; a realistic account of staffing, equipment, housing and funding; and named responsibility for resolving barriers.
It also means urgent interim assistance where delays threaten safety, independent advocacy where someone feels pressured or unheard, and review of whether unmet care needs or carer exhaustion are influencing an end-of-life request.
I also call for an independent investigation of documented concerns about inadequate disclosure of options, inappropriate VAD conversations and disputed treatment decisions. It must examine the patient journey before the formal request, hear clinicians and families, and distinguish substantiated failures from allegations.
The question is not resolved by saying safeguards exist. The question is whether they protect people whose realistic alternatives have already narrowed because care is missing.
The right to choose more time must come with a fair opportunity to access the care that makes it possible. VAD must never become the only humane option a person can see because the care to live has failed to arrive.
We cannot normalise a system that leaves people waiting
Since COVID, I feel we have become accustomed to hearing that services are overwhelmed, staff are exhausted and patients must wait. My concern about consent also deepened during that period: I saw employment and participation restrictions as coercive, while others defended them as public health protections. That is my personal perspective.
Chomsky’s work made me attentive to how public debate shapes what becomes acceptable. I do not want “there is no care available” to become an ordinary premise in a conversation about whether someone wants to keep living.
Our clinicians cannot compensate indefinitely for missing community services. Their skill cannot produce a safe discharge destination where none exists. Nor should people waiting in hospital be blamed. They are living with the failure first.
Governments must publish consistent delayed-discharge data, supported-household breakdowns, provider withdrawals, hospital demand modelling and the replacement care available. There must be a rapid escalation route and funded interim assistance before families or providers reach collapse.
New beds and staff matter. So do the services that let people leave those beds safely. Both sides of that equation require funding and accountability.
I run a care business, and I have a stake in whether this system works. Readers deserve that disclosure. My argument is that every person has a stake in it. Protecting a particular provider is not the goal; keeping people safely supported is.
I am a nurse, a mother and a provider. I have enough respect for the public to explain the uncertainty, and enough of a rebellious streak to refuse to confuse uncertainty with a reason to do nothing.
We do not need a verified forecast of half the beds being unavailable before acting. We need to protect the people already waiting, prevent avoidable breakdowns and prepare for demand that may follow.
The care that lets someone else remain at home may be what keeps a hospital bed available for your family. This belongs to all of us.
Sources and image credits
[13] NDIS Act 2013, compilation in force 1 October 2026, s34(1)(e); distinguish current funding criteria from future amendments.
https://www.legislation.gov.au/C2013A00020/2026-10-01/2026-10-01/text/original/epub/OEBPS/document_1/document_1.html
[12] Queensland Health performance directory and Central Queensland HHS regional description.
https://www.performance.health.qld.gov.au/view-performance-by-hhs/central-queensland | https://www.cq.health.qld.gov.au/careers/explore-central-queensland
[10] ABC News, 21 May 2026, Jai Arrow on his diagnosis and treatment plans; news.com.au, 30 May 2026, Spain retreat reporting.
https://www.abc.net.au/news/2026-05-21/jai-arrow-speaks-after-revealing-mnd-diagnosis/106704448 | https://www.news.com.au/sport/nrl/get-stuck-into-this-bastard-jai-arrow-leaves-australia-for-special-treatment/news-story/4e352bd233d15d4833750b6cc506140b
[11] The Courier-Mail, August 2026, MND procedure access; Mel Wightman, 7NEWS, 11 September 2026, Aaron Reardon, Andy Taylor, MND Queensland and hospital response.
https://www.couriermail.com.au/news/queensland/queensland-mnd-patients-blocked-from-lifeextending-surgery-available-overseas/news-story/f4b10d0aa513ee3f53796ec81a410abc | https://7news.com.au/news/logan-father-with-mnd-fights-for-change-after-being-blocked-from-life-extending-surgery-c-22858877
[1] Queensland Government, 2 September 2026. August census and HHS table.
https://statements.qld.gov.au/statements/105986
[2] NSW Health, 9 October 2026. Delayed discharge and projected June 2027 figures.
https://www.health.nsw.gov.au/news/Pages/20261009_04.aspx
[3] NDIS Amendment Act 2026, Schedule 1 Part 4, inserting s34A and s47B; Support Determination 2026, ss5–9; High Support Needs Participants Determination 2026.
https://www.legislation.gov.au/C2026A00066/asmade | https://www.legislation.gov.au/F2026L01332/asmade | https://www.legislation.gov.au/F2026L01331/asmade
[4] NDIA June 2026 quarterly report, participant table; current SIL guidance. Charts use June funding counts.
https://www.ndis.gov.au/media/8793/download?attachment= | https://ndis.gov.au/participants/home-and-living/types-home-and-living-supports/what-supported-independent-living-sil
[5] Profitable NDIS Provider podcast with Shane Stewart, supplied transcript; especially 24:31–24:54 and 48:44–50:24. Publication date not established.
https://www.youtube.com/watch?v=_3Ht2g8Nnh8
[6] ABC News, Janelle Miles and Emma Pollard, 18 October 2026; Janelle Miles, 9 October 2026. Queensland ramping coverage.
https://www.abc.net.au/news/2026-10-18/qld-state-of-the-state-health/107270722 | https://www.abc.net.au/news/2026-10-09/qld-health-ambulance-ramping-data-for-august/107248682
[7] Australasian College for Emergency Medicine, 2020. Access block and patient harm.
https://acem.org.au/News/November-2020/Dangerous-ED-crowding-cannot-be-blamed-on-%E2%80%98GP-type
[8] Queensland Health, legal obligations and VAD eligibility guidance.
https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/voluntary-assisted-dying/information-for-healthcare-workers/obligations-medical-practitioners | https://www.qld.gov.au/health/support/voluntary-assisted-dying/explained/eligibility-criteria
[9] ABC News, Grace Whiteside, 3 April 2023. Historical Bundaberg ED coverage and photograph.
https://www.abc.net.au/news/2023-04-03/bundaberg-emergency-department-wait-times-some-of-qlds-longest/102158394
Publication note: photographs remain the property of their credited rights holders. Attribution does not grant republication rights. Obtain permission or replace them with licensed or author-owned photographs before distributing a new publication. The accompanying graphs are original calculations and graphics. No authenticated Queensland newspaper front-page image has been reproduced. The linked news coverage supplies the reporting context.
