- Structured ≠ daily life
- Performance varies
- document both observed and carer-reported function
- Can do ≠ can do safely
- Safety ≠ capacity
- a task performed in the room may be unsafe at home
- Quantify time & supervision
- Language = funding
- not just impairment — this produces adequate budgets
An FCA that doesn't reflect dementia-specific performance variability, safety-capacity distinctions, and the correct NDIS support categories will produce a plan that fails the client before support even starts.
Four FCA Challenges Specific to Dementia
These are not standard OT assessment issues they are specific to cognitive impairment and must be actively addressed:
Performance variability
Document carer-reported daily function alongside observed assessment performance. Where they diverge, explain why and why carer report is the more accurate indicator.
Time of day effects
Note the time of assessment. Significant diurnal variation means a 10am assessment may substantially overestimate function for a client with afternoon sundowning.
Safety vs capacity
A patient may retain motor capacity for a task (using a stovetop, handling finances) while being unable to do so safely without supervision. Document both dimensions separately.
Cognitive-functional mapping
Identify which cognitive domain drives each functional limitation executive dysfunction driving meal-planning failure, prospective memory failure driving medication risk. This is more compelling to the NDIA than a general dementia reference.
FCA Findings to NDIS Support Category Mapping
Expand each domain to see the corresponding NDIS category and the key quantification requirement:
Category 1 — Daily Life. Specify the level of assistance (prompting / physical guidance / full care) and the time required per day. "45 minutes of direct support daily for morning routine" is funded; "requires support with personal care" is not specific enough.
Category 1 — Daily Life. Specify which tasks require support and the frequency. Do not lump all domestic support into a single line. Safety risks (stovetop, sharp objects) must be named.
Category 1 — Daily Life. Distinguish between needing daily medication supervision versus needing blister pack setup only. Note high-risk medications (anticoagulants, insulin) as these affect the competency requirement for support workers.
Category 4 — Community Participation. Specify which activities and what support level: accompanied transport, supported community access, or full escort.
Category 4 — Community Participation and potentially Category 6. Recommend speech pathology input via Category 15 — Improved Daily Living if communication impairment is present.
Category 1 — Daily Life and potentially Category 9 — Improved Living Arrangements for home modifications. Document exit-seeking, falls, cooking safety, and financial management risks each with a consequence statement.
Language That Produces Adequate Funding
The NDIA funds what it can see. Specific, quantified language is the difference between an adequate plan and one that requires immediate review.
“Requires support with personal care and domestic tasks due to cognitive impairment.”
No quantification, no consequence, no specific safety risk.
“Requires 45 minutes of direct support daily for morning routine including dressing, hygiene, and medication administration. Left unsupervised, client has been found undressed or having missed medications on multiple occasions in the past month.”
Recommending assistive technology medication dispensers, door alarms, simplified appliances that substitutes for direct support hours shows the NDIA a well-structured plan and often produces better overall funding outcomes than direct hours alone.