6 Workforce Issues in the Disability Sector

Caroline Mills^[1], Kitty Mach^[2], Jeff Scoble^[3], and Danielle Tracey^[4]

Introduction

The purpose of this chapter is to provide a narrative around workforce challenges and opportunities within the disability sector. The chapter is crafted through reflection on current literature as well as the extensive experience of leadership and work within the disability sector and the lived experience of disability.

First, the chapter will outline and describe the disability sector workforce and the critical importance of the workforce in realising positive outcomes for people with disability. We will then explore what bolsters and hinders recruitment and retention in the disability sector. This chapter also explores the role and impact of Australia’s National Disability Insurance Scheme (NDIS) on workers within the disability sector. The chapter will conclude with practical calls for action.

Keywords

Disability, employment, National Disability Insurance Scheme, worker

The disability sector workforce is central to realising positive outcomes for people with disabilities 

There are 4.4 million people in Australia who live with a disability, equating to one in every six Australians (Australian Bureau of Statistics, 2022). Universal design within our social structures and environments, pioneered by the social model of disability (Barnes, 2019), is fundamental to achieving inclusion for all. Notwithstanding, people with disability report varying support needs and this requires a skilled workforce to maximise participation in a society which has not yet achieved universal design. These reported support needs vary from low support needs (for example, requesting some assistance to do ordinary tasks like shopping), to high support needs (for example, requesting support 24 hours a day for all daily tasks). Supports can also be complex, requiring a professional to have a specific skill set (for example, a person may request a custom wheelchair or a modified vehicle from a specially trained occupational therapist). A summary of supports most commonly provided to people with disability is shown in Table 1.

Table 1: Summary Table of supports that are most provided to people with disability (NDS, 2023):

There is a wealth of research literature confirming that when people with disability receive the right support, this leads to better participation and better outcomes overall, across a range of contexts. For example, an umbrella review of 31 systematic reviews by Strnadová et al. (2023) found that when the right supports were implemented in an educational setting, learning and educational outcomes for students with disability improved. Similarly, when young people with disability were supported to participate in a self-chosen community activity such as swimming, drawing or music, significant improvements were observed in a range of outcomes including motor skills, cognition and affect (Anaby et al., 2020).

To support the attainment of these important outcomes for people with disability in Australia, a diverse and broad workforce is required, encompassing 270,000 workers across 20 occupations (Department of Social Services, 2021). These occupations include disability support workers, allied health professionals, support coordinators and others who, for the most part, require years of extensive specialised training.

A number of professions within the disability sector require specific qualifications, which necessitate years of specific university training and registration with Australia’s Health Practitioner Regulation Agency (AHPRA), for example, becoming an occupational therapist or physiotherapist requires the completion of an approved four year undergraduate or two year masters degree, comprising approximately 1000 hours of clinical placement. Becoming a psychologist involves the completion of an approved six-year period of study involving either a six-year degree in psychology at undergraduate and postgraduate level, or a five-year degree in psychology with one year of supervised practice. In addition, psychologists may undertake additional training to achieve areas of practice endorsement such as Educational and Developmental Psychology or Clinical Psychology.

The largest portion of workers within the disability sector are defined as disability support workers (over 200,000), comprising over 85% of the disability workforce (Department of Social Services, 2021). This role tends to encompass daily life support for people with disability including supporting participation in community social and civic activities (National Disability Services, 2023).

There are no formal qualifications required for disability support workers (Workforce Innovation and Development Institute, 2022). Some have argued for the completion of a relevant certificate four vocational qualification (six months of full-time study) or equivalent to ensure a high-quality workforce of disability support workers. However, even without the need for extensive qualifications, there are significant shortages in this workforce with speculation that 80,000 to 100,000 additional workers will be required by 2025 (Department of Social Services, 2021; NDIS Review, 2023). Hence, the dilemma of the need to ensure a high-quality workforce, while at the same time securing a plentiful supply of workers is challenging. It has been projected that over 350,000 workers will be required across the disability sector to provide a range of supports (Department of Social Services, 2021). If this workforce demand is not met, services for people with disability may be negatively impacted, with flow on impacts to their participation in daily life activities, social activities and work.

So, what bolsters and hinders worker recruitment and retention in the disability sector?

Recruitment within the disability sector remains challenging (NDIS Review, 2023). Over 75% of disability service providers have reported difficulties in recruiting disability support workers (National Disability Services, 2023), and these difficulties are exacerbated in regional, rural and remote areas of Australia. For occupational therapists, psychologists and speech pathologists, who are reportedly the most difficult staff to recruit, around 90% of providers reported difficulties with recruitment (National Disability Services, 2023). In addition to shortfalls in recruitment, the turnover of workers within the disability sector is up to three times higher than other sectors (NDIS Review, 2023; Workforce Innovation and Development Institute, 2022). Adequate recruitment and retention of workers within the sector is critically important to ensure ongoing supports and positive outcomes for people with disability. To achieve this goal, it is important to understand the underlying factors that may bolster or hinder, some of which are discussed here.

1. Stigma, Discrimination and Perceptions around disability

When workers hold positive perceptions towards disability, they are more likely to make a positive contribution to working in the disability sector. Stevens et al. (2021) reported that workers spoke positively of the people with intellectual disability that they supported, in terms of what the person could achieve, supporting the person’s quality of life and their participation within the community.

Conversely, negative stigma and discrimination about people with disability may limit a worker’s decision to join or remain in the disability workforce, but little has been written or published to allow further understanding of this issue. Disability discrimination is against the law in Australia in line with the Disability Discrimination Act 1992 (Commonwealth of Australia, 1992). Despite this, discrimination and stigma are still widely experienced by people with disability.

An example from lived experience (Kitty’s perspective):

2. Pay and working conditions

Economic remuneration and working conditions can influence decisions by workers to begin working in or continue working in the disability sector (Stevens et al., 2021). The recent Australian State of the Disability Sector report suggests that inadequate pricing of disability supports within the sector as a consequence of the NDIS has exacerbated difficulties with paying staff a fair wage (National Disability Services, 2023). A United Kingdom based study of 120 disability workers interviewed at two time points highlighted the importance of fair pay, but also fair compensation for additional work completed. This included being fairly compensated for work related travel time, overtime or night shifts. Stevens and colleagues (2021) reported that ‘reciprocity’ between employers and employees was important and influenced a worker’s decision to remain in their job. Similarly, a scoping review by Ryan et al. (2021) reported that when a lack of reciprocity was perceived by disability workers, this ‘inequity’ meant that they were more likely to burnout and express a desire to leave. There is an alarming prevalence of unpaid work occurring throughout the disability sector, negatively impacting workers as reported in a survey of 2000 workers by Cortis and van Toorn (2020). This unpaid work often comprises case coordination, case management, advocacy or clinical report writing. This is negatively impacting the well-being of workers and may be driving increased staff turnover (Baines et al., 2019).

3. Support and training for staff

Support and training provided to workers was associated with higher job satisfaction, impacting a worker’s decision to take a particular job or remain in a job (Stevens et al., 2021). When disability workers are provided with clear supervision and support that meets their needs, they were more likely to be satisfied with the job overall and were less likely to leave (Ryan et al., 2021). In line with these findings, an Australian mixed methods study of workers within the disability sector found that workers often felt under-prepared for their roles and wanted more training (Workforce Innovation and Development Institute, 2022). A recent Australian report has called for minimum standards for disability workers, including access to paid training (National Disability Services, 2023). Workplaces and employers have agreed that provision of training for staff is important and have subsequently invested large amounts in training staff on the job (Workforce Innovation and Development Institute, 2022). However, what remains unclear is the type of training that should be offered, the skills or tasks to be targeted with such training, and the outcomes that could be achieved (Workforce Innovation and Development Institute, 2022). These knowledge gaps necessitate evaluation of workplace training programs to ensure they are fit for purpose and achieving intended outcomes.

Many in the disability sector were looking to the recent Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Commonwealth of Australia, 2023) to make recommendations on minimum training requirements for people working in the sector. It was speculated that such recommendations would lead to the provision of funding for mandatory training to occur. Unfortunately, the Royal Commission failed to make any such recommendations, leaving the sector without a consistent training or qualification standard for some workers.

Workplace supports for workers in the disability sector also encompassed ensuring that workers experienced psychological safety within their workplace (Harries et al., 2020). Psychological safety comprised well-being check-ins with staff at particular time points, and team building with colleagues and supervisors. Supporting workers may be an important component of retaining them in the sector (National Disability Services, 2023), as workers in the disability sector often reported feeling ‘burned out’, with limited access to support and supervision (NDIS Review, 2023; Workforce Innovation and Development Institute, 2022). Workers who perceived that they had more support from their colleagues and from management, expressed higher job satisfaction and less desire to leave (Stevens et al., 2021).

An example from lived experience: (Kitty’s perspective):

Workers in the disability sector who live with disability: Supporting the peer workforce

A significant portion of workers in the disability sector also live with a disability themselves, with around half of disability service providers employing at least one person with disability in their organisations (Mellifont et al., 2023). These workers bring valuable lived experience expertise which can enhance their capacity to perform their roles. Lived experience is increasingly being heralded as an important component in empathy and supports for people with disability. There are increasing calls for services within the disability sector to be co-designed by people with disability to ensure their relevance to the populations they serve. The recent NDIS Review (2023) has highlighted the importance of workers with lived experience of disability in the workforce, termed ‘peer workers’. Peer workers are a critically important and underutilised resource, with the Australian government recommending a targeted strategy to increase the amount of peer workers within the disability workforce as part of their plan to build a more responsive, supportive and capable workforce (NDIS Review, 2023).

An example from lived experience (Kitty’s perspective):

Workers with disability or peer workers can benefit from flexibility and workplace adjustments to enhance their productivity, and if these are provided in a way that meets the person’s needs, workers with disability make excellent employees (Hayward et al., 2019). Adjustments may include additional forewarning before changes or meetings occur, providing organisation charts and contact directories, flexible working arrangements regarding work hours or work locations, job coaching and specialised training. These minor adjustments can make a significant difference in supporting employees with disabilities to thrive in their roles. The recent NDIS Review has recommended trialling an ‘employment concierge’ program which would provide expert individualised advice to peer workers to support them with gaining and maintaining employment (NDIS Review, 2023).

The elephant in the room: The National Disability Insurance Scheme (NDIS) 

The National Disability Insurance Scheme (NDIS) was introduced in Australia in 2013 and represented one of the largest policy changes in disability service provision that Australia had ever seen (Horsell, 2023). Administered by the National Disability Insurance Agency (NDIA), the scheme positioned choice and control for people with disability as central to its design. The NDIS intended to re-position the person with disability from a passive recipient of government disability services to an active ‘customer’ in a thriving disability ‘marketplace’. For the first time in Australia, people with disability could have the power to choose their own disability service providers to meet their needs. This choice and control is facilitated by people with disability receiving an individualised funding package from the NDIA and controlling the funds themselves or with support (Carey et al., 2017). The NDIS was fully implemented across Australia in 2020, but the vision of a thriving ‘marketplace’ for disability support has not necessarily eventuated (McKenzie & Smith-Merry, 2023).

The introduction of the NDIS changed the nature of work in the disability sector in Australia. Employees who previously worked for state run disability services (for example Ageing Disability and Home Care- ADHC in NSW) or larger not-for-profit employers, shifted their employment into smaller organisations or private practices. This has altered the employment landscape across the sector. With an increased number of disability service providers, there is a wide range of employment options on offer. Some workers may have more opportunity to work flexibly within not-for-profit organisations or private practices, with some opting to build their own businesses providing services to NDIS participants, funded by individualised support packages from the NDIA.

This increased flexibility may be advantageous to some workers within the disability sector. The Department of Social Services has identified the need to build a ‘responsive and capable’ disability workforce in their workforce plan (Department of Social Services, 2021), while maintaining high quality disability services for people with disability who receive individualised funding packages (NDIS Quality and Safeguards Commission, 2023). There is a focus on growing the workforce, retaining existing workers and driving innovation and efficiency within the sector.

However, there are several concerns with the implementation and the administration of the scheme that appear to be a hindrance to building and retaining the disability workforce. Prior to the introduction of the NDIS, many organisations relied on ‘block funding’ from state government agencies to deliver their services. Block funding was often tied to delivering a particular service within a particular geographical location. For example, a disability organisation may have been ‘block funded’ to deliver a specific number and type of therapy services (for example, behaviour support) to autistic adolescents (aged 12-18) living in identified local government areas within Western Sydney. This block funding model offered a level of funding certainty to organisations, which allowed for the provision of job security to workers delivering the service, as well as training and development opportunities for staff. However, the block funding model was deemed to be problematic because it did not allow people with disability or their caregivers choice and control in who provided their disability supports, a key important innovation in the design of the NDIS (May et al., 2018). In the above example, a family living outside of the identified local government area would not have been able to access this particular behaviour support service from the disability organisation for their autistic adolescent, even though that may have been their preference or may have met their needs.

Following the introduction of the NDIS, recruitment and retention of workers has been an ongoing challenge within the sector, with fierce competition for high quality staff in various roles (National Disability Services, 2023). This is due in part to a recent large increase in the number of disability service providers. Between 2014 and 2024, there was more than a tenfold increase in the number of registered disability service providers (from just over 2000 to over 20,000) (NDIS, 2024). This increase is likely due to a number of smaller service providers entering the sector after the introduction of the NDIS, leaving larger numbers of service providers competing for staff. Allied health professionals such as occupational therapists, psychologists and speech pathologists, are often seeking greater control and flexibility in their work, opting to become ‘sub-contractors’. When experienced workers are not available or are difficult to attract, some organisations may seek to recruit inexperienced staff members who display potential and provide them with ongoing support and training, building them up to more leadership and career opportunities. This approach may be mutually beneficial for both worker and organisation, offering workers a career path, while allowing the organisation to retain skilled staff members long term.

An example from real-life practice:

Since the introduction of the NDIS, those in the disability sector have needed to adapt to fee-for-service disability service delivery within a ‘marketplace’ (Carey et al., 2021); a departure from traditional ‘block funded’ disability service delivery in Australia. An Australian survey of over 2000 disability workers was conducted in 2020, including primarily disability support workers and allied health professionals (Cortis & van Toorn, 2020). Over 95% of respondents were providing direct services to people with disability as part of their job role, for example providing direct therapy services, or direct support for a person to access the community. Findings from the survey were largely negative with only one in five workers agreeing that the introduction of the NDIS was positive for themselves as a worker. The fee-for-service nature and fluctuations in ‘market demand’ for many NDIS services has resulted in instability in paid hours for many workers, constantly changing hours and a lack of permanency and job security (Cortis & van Toorn, 2020). There is a widely held perception that the NDIS has inadequately priced particular services (National Disability Services, 2023), which has resulted in pricing structures that do not reflect the true cost of service delivery, forcing workers into unpaid overtime (Baines et al., 2019). Pricing structures within the NDIS have resulted in disability service providers delivering individualised supports for people with disability with very thin margins, meaning the price that the provider can charge for the service barely covers the cost. Given that providers cannot bill the NDIS for training, these thin margins leave few resources for paid training. This paucity of funding for paid training and supervision of workers has left many workers unsatisfied in their jobs, some feeling as though they are unable to meet the needs of the people with disability they support (Baines et al., 2019; Cortis & van Toorn, 2020). Recent Australian data has suggested that over 70% of organisations reported that their staff were ‘exhausted’ by constant changes to the NDIS, which have impacted their working conditions (National Disability Services, 2023).

The promise of increased choice, control, dignity and individualised programming for people with disability is a critically important philosophy underpinning the design and original advocacy for the NDIS. Disability service provision should strive to be high quality, respectful and responsive (Baines et al., 2019). However, without a thriving and satisfied workforce, that receives appropriate and fair conditions, as well as training and career opportunities, this cannot be achieved in practice. It is critical that these workforce issues are highlighted and addressed to ensure people with disability receive high quality supports to achieve their potential in their everyday lives.

Calls to Action

This chapter has highlighted some of the positive aspects and challenges related to work in the disability sector. A number of calls to action have been highlighted which may contribute to increased worker recruitment and retention.

Table 2: Summary of Calls to Action:

SDG Alignment

This work at a national level highlights the importance of social research and incorporating a storied, narrative approach that gives voice to vulnerable groups as well as a positive pathway forward to realising SDG social progress.

SDG 8 – Decent Work and Economic Growth

Target 8.5

By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value.

SDG 10 – Reduced Inequalities

Target 10.2

By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

References

Anaby, D., Avery, L., Gorter, J. W., Levin, M. F., Teplicky, R., Turner, L., Cormier, I., & Hanes, J. (2020). Improving body functions through participation in community activities among young people with physical disabilities. Developmental Medicine & Child Neurology, 62(5), 640-646. https://doi.org/https://doi.org/10.1111/dmcn.14382

Australian Bureau of Statistics. (2022). Disability, Ageing and Carers, Australia: Summary of Findings. ABS. Retrieved July, 2024 from https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release.

Baines, D., MacDonald, F., Stanford, J., & Moore, J. (2019). Precarity and Job Instability on the Frontlines of NDIS Support Work. https://futurework.org.au/report/precarity-and-job-instability-on-the-frontlines-of-ndis-support-work/

Barnes, C. (2019). Understanding the Social Model of DisbailityDisability: Past Present and Future. In N. Watson, A. Roulstone, & C. Thomas (Eds.), Routledge Handbook of DisbailityDisability Studies (2nd Ed ed., pp. 12-30). Routledge https://doi.org/https://doi.org/10.4324/9780429430817

Carey, G., Malbon, E., & Blackwell, J. (2021). Administering inequality? The National Disability Insurance Scheme and administrative burdens on individuals. Australian Journal of Public Administration, 80(4), 854-872. https://doi.org/https://doi.org/10.1111/1467-8500.12508

Carey, G., Malbon, E., Reeders, D., Kavanagh, A., & Llewellyn, G. (2017). Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme. International Journal for Equity in Health, 16(1), 192. https://doi.org/10.1186/s12939-017-0682-z

Commonwealth of Australia. (1992). Disability Discrimination Act 1992. https://www.legislation.gov.au/C2004A04426/2018-04-12/text

Commonwealth of Australia. (2023). Royal Commission into Violence, Abuse, Neglect and Exploitation of people with disability: Inclusive education, employment and housing: Summary and Recommendations: Final Report. https://disability.royalcommission.gov.au/publications/final-report-volume-7-inclusive-education-employment-and-housing

Cortis, N., & van Toorn, G. (2020). Working in new disability markets: A survey of Australia’s disability workforce. https://unsworks.unsw.edu.au/entities/publication/a18ae49c-db1e-46c2-85b8-32a42e071501

Department of Social Services. (2021). NDIS National Workforce Plan: 2021–2025. https://www.dss.gov.au/disability-and-carers-publications-articles/ndis-national-workforce-plan-2021-2025

Harries, J., Kirby, N., & Ford, J. (2020). A follow‐up evaluation of the health, wellbeing, and safety outcomes of implemented psychosocial safety interventions for disability support workers. Australian Psychologist, 55(5), 519-533. https://doi.org/10.1111/ap.12447

Hayward, S. M., McVilly, K. R., & Stokes, M. A. (2019). Autism and employment: What works. Research in Autism Spectrum Disorders, 60, 48-58. https://doi.org/10.1016/j.rasd.2019.01.006

Horsell, C. (2023). Problematising Disability: A Critical Policy Analysis of the Australian National Disability Insurance Scheme. Australian Social Work, 76(1), 47-59. https://doi.org/10.1080/0312407X.2020.1784969

May, T., Roberts, J., Webber, M., Spreckley, M., Scheinberg, A., Forrester, M., & Williams, K. (2018). Brief history and user’s guide to the Australian National Disability Insurance Scheme. Journal of Paediatrics and Child Health, 54(2), 115-120. https://doi.org/https://doi.org/10.1111/jpc.13748

McKenzie, K., & Smith-Merry, J. (2023). Responding to Complexity in the Context of the National Disability Insurance Scheme. Social Policy and Society, 22(1), 139-154. https://doi.org/10.1017/S1474746422000562

Mellifont, D., Smith-Merry, J., & Bulkeley, K. (2023). The employment of people with lived experience of disability in Australian disability services. Social Policy & Administration, 57(5), 642-655. https://doi.org/https://doi.org/10.1111/spol.12898

National Disability Services. (2023). State of the Disability Sector Report. https://nds.org.au/images/State_of_the_Disability_Sector_Reports/State_of_the_Disability_Sector_Report_2023.pdf

NDIS. (2024). NDIS National Participant Dashboard. Retrieved 31 March 2024 from https://www.ndis.gov.au/media/7015/download?attachment#:~:text=The%20number%20of%20active%20participants,as%20at%2031%20March%202024.&text=The%20number%20of%20children%20accessing,as%20at%2031%20March%202024.

NDIS Quality and Safeguards Commission. (2023). Workforce Plan 2023-2028: Final Report. https://www.ndiscommission.gov.au/sites/default/files/2023-07/Workforce%20Plan%20-%20accessible.pdf

NDIS Review. (2023). Building a more responsive and supportive workforce. . https://www.ndisreview.gov.au/resources/paper/building-more-responsive-and-supportive-workforce

Ryan, C., Bergin, M., & Wells, J. S. G. (2021). Work-related stress and well-being of direct care workers in intellectual disability services: a scoping review of the literature. International Journal of Developmental Disabilities, 67(1), 1-22. https://doi.org/10.1080/20473869.2019.1582907

Stevens, M., Moriarty, J., Manthorpe, J., Harris, J., Hussein, S., & Cornes, M. (2021). What encourages care workers to continue working in intellectual disability services in England? Interview findings. Journal of Intellectual Disabilities, 25(1), 13-30. https://doi.org/10.1177/1744629519854648

Strnadová, I., Danker, J., Dowse, L., & Tso, M. (2023). Supporting students with disability to improve academic, social and emotional, and self-determination and life-skills outcomes: umbrella review of evidence-based practices. International Journal of Inclusive Education, 1-17. https://doi.org/10.1080/13603116.2023.2221239

Workforce Innovation and Development Institute. (2022). The retention challenge: an exploration of the experience and intentions of recent entrants in the disability sector. https://apo.org.au/node/323252

How to Cite this Chapter

Mills, C., Mach, K., Scobie, J., & Tracey, D. (2025). Workforce Issues in the Disability Sector. In Boddington, E., Chandran, B., Dollin, J., Har, J. W., Hayes, K., Kofod, C., Salisbury, F., & Walton, L. (Eds.). Sustainable development without borders: Western Sydney University to the World  (2025 ed.). Sydney: Western Sydney University. Available from https://doi.org/10.61588/TESB2263

Attribution

Workforce Issues in the Disability Sector by Dr Caroline Mills, Ms Kitty Mach, Mr Jeff Scobie and Prof Danielle Tracey is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International https://creativecommons.org/licenses/by-nc-nd/4.0/