Opinion Piece - Where the ATHM Scheme Falls Down

One of the biggest shifts in the Support at Home reforms is the Assistive Technology and Home Modifications (ATHM) Scheme. On paper, the model appears to make sense. Low-risk items (like simple aids) can be arranged directly by providers or care partners, while high-risk items (like scooters or major modifications) require an allied health professional.

But here’s my concern: risk doesn’t actually sit with the equipment - it sits with the consumer.

Funding Tiers under the ATHM Scheme

AT is split into three main tiers (plus “specified needs” allocations):

• Low Tier / Low Risk – e.g., simple aids and equipment (under ~$500). May be arranged directly by providers or care partners.

• Mid Tier / Under Advice – e.g., items up to ~$2,000, often requiring advice from an allied health professional (OT involvement 'recommended').

• High Tier / Prescribed – e.g., powered wheelchairs, scooters, etc. Requires assessment and prescription by an AHP (OT, physio, etc.). Funding up to ~$15,000; higher amounts can be funded with clinical justification.

• Specified Needs Tier – ongoing allocations for people with predictable, recurring AT needs (e.g., continence aids, consumables).

  
  

  *Home Modifications have the same tier amounts, however the high tier of 15k is the maximum amount per lifetime. A prescription is required for all tier home modifications.

  
  

Roles & Responsibilities under the ATHM Scheme

• AHPs: Prescribe 'under advice' or 'prescribed' AT and home modifications, complete functional assessments, provide clinical prescription and wrap-around services i.e. education, training.

• Providers: Sourcing, coordination, budget management and claiming while complying with the ATHM rules.

• Suppliers / AT loan schemes: Provide equipment directly or via state/territory AT loan pools (e.g., EnableNSW).

While this appears reasonable in principle, there are nuances, in my opinion, that are over looked. A person with complex, fluctuating health needs, for example, might face significant risks even with so-called “low-risk” items i.e. a shopping trolley on the ATHM list 'low risk' category.

This is where I believe the RCOT’s “Home adaptations without delay” framework offers a valuable alternative lens. Instead of categorising risk purely by item, it:

• Focuses on the person and their outcomes, not the funding mechanism.

• Recognises three levels of intervention: universal, targeted, and specialist.

• Aligns the complexity of the person’s condition (stable, predictable vs unstable, fluctuating, multiple impairments) with the type of workforce skills and governance needed.

• Encourages positive risk-taking and avoids disproportionate reliance on specialist OT services when they’re not actually needed.

  
  

  

  
  

In practice, this means that the consumer’s stability, predictability, and complexity of health and functional needs should guide the intervention, not just the perceived risk of the equipment itself.

Why this matters for OTs and providers

• It shifts the lens from a compliance-driven process to a person-centred, outcomes-driven practice.

• It reduces bottlenecks in the system by ensuring OTs are involved where truly necessary, while still upholding safety.

• It aligns with the principle of dignity of risk — respecting that older people can make informed choices about how they live, even if that involves some risk.

  
  

My take: The ATHM scheme's access to upfront funds without the need to 'save up' is good in one way (without unpacking the other flaws), but we need to keep advocating for a more nuanced, consumer-centred model. Risk should not be “owned” by the item - it should be understood in the context of the person.

With limited time and quarterly budgets, how can OTs educate providers about this effectively? And is that even our role?

Want to unpack what this means in practice?

Join other OTs at the upcoming ATHM workshop, where we will walk through the scheme, share case studies, and explore how OTs and providers can navigate these changes while keeping the consumer front and centre.

📅 Thurs October 2nd 🔗 Registration here