Support Worker, Carer or Nurse: Who Does What at Home?

Three different jobs, one kitchen

A support worker is paid from your NDIS plan to help you do the things you would do yourself if you could. A carer is almost always family or a close friend, usually unpaid, and holds everything nobody rostered on is there for. A nurse is a registered clinician who does clinical work and can delegate some of it, under supervision, to a support worker who has been trained for that specific task.

People use all three words interchangeably, including some providers, and it causes real trouble. The confusion is not linguistic. It decides who is allowed to touch a feeding tube at 6am, and who carries the responsibility if something goes wrong.

The support worker

This is the role most in-home NDIS funding pays for. Showering and dressing, cooking together, medication prompting, the laundry, getting out to the shops, sitting alongside you at an appointment, driving you to a day programme. Practical, daily, ordinary. The skill is not clinical, it is knowing a person well enough to help without taking over.

Support workers are not required to hold a nursing qualification, and most do not. Many hold a Certificate III in Individual Support and first aid, and beyond that the training that matters is task specific: this person's transfer, this person's communication system, this person's seizure plan.

What a support worker can do at the clinical end is not fixed by their job title. It is fixed by what a health professional has trained and delegated to them for one named person. That distinction is the whole answer to most of these questions, and we come back to it below. If you want the day-to-day picture, what in-home support actually looks like walks through a real shift.

The carer

In Australian usage, carer usually means an unpaid family member: a mother, a brother, a partner, sometimes an adult child. It is the role with no roster, no shift end and no handover, and it is the one the NDIS does not fund, because the scheme funds the participant rather than the household.

That does not make carers invisible to the system. The NDIA is required to consider informal supports when it works out what is reasonable and necessary, which is precisely why a carer's honest account of what they do carries weight in a plan conversation. Understating it is a common and expensive mistake.

Carers have their own supports outside the NDIS, through Carer Gateway and through respite arrangements. If you are the carer reading this at 11pm, that is worth a separate conversation from your relative's plan.

The nurse, and high intensity supports

Some supports need clinical oversight regardless of how routine they become. Enteral feeding, tracheostomy care, complex bowel care, urinary catheter management, ventilator support, subcutaneous injections, complex wound care, severe dysphagia management. The NDIS Commission groups these as high intensity daily personal activities and sets out what a provider must have in place to deliver them.

In practice that means a registered nurse assesses the person, writes the plan, trains the workers on that individual's routine, and reviews it. Day to day the task may then be carried out by a trained support worker under that plan, or by a nurse, depending on the person and the risk. The Commission's requirements sit in the NDIS Practice Standards.

None of this is medical advice about your own situation. Which arrangement is right for one person is a clinical judgement made by their treating team, not something an article can decide.

The line is delegation, not seniority

Here is the test that resolves nearly every argument in a household. For any clinical task, ask three things: who assessed this person for it, who wrote the plan, and who trained the worker doing it today. If all three have an answer with a name attached, the arrangement is sound. If any of them is vague, that is the problem, and it is a problem whether the person doing the task is a nurse or not.

It also cuts the other way. A support worker who has been properly trained and delegated a task for one person is not qualified to do the same task for the housemate next door. Training attaches to the individual and their plan, not to the worker's resume.

This is the same logic that governs behaviour support, where a specialist writes the plan and the workers implement it consistently. We covered how that works in what a positive behaviour support plan actually does.

Why this matters to you on a Tuesday

Because it tells you who to call. A roster gap is a provider problem. A change in someone's swallowing or breathing is a clinical problem and belongs with the treating team, not with the coordinator who books shifts. Families lose days ringing the wrong number.

It also tells you what to ask a new provider. Not whether they have nurses on staff, which sounds reassuring and answers nothing, but who assesses, who writes the plan, who trains the workers, and how often that gets reviewed. In our in-home supports that chain is the thing we would want a family to interrogate before signing anything.

Frequently asked questions

Can a support worker give medication?

Often yes, depending on the medication, the route and the training. Prompting someone to take tablets from a pack is common. Anything more involved, such as injections or medication through a tube, sits under high intensity supports and needs a clinical plan and task specific training for that individual. Ask who trained the worker and when it was last reviewed.

Does the NDIS pay family members to be carers?

Only in limited circumstances, and it is the exception rather than the rule. The scheme treats family help as informal support and funds paid workers instead. If a family member is providing something no worker can, raise it with your planner as evidence of need rather than assuming it can simply be paid for.

Do I need a nurse instead of a support worker?

That is a clinical question for the person's treating team, not a preference to choose from a menu. Many high intensity tasks are safely delivered by trained support workers under a nurse's plan and supervision. What matters is that someone qualified has assessed the person, written the plan and trained whoever carries it out.

What is the difference between a carer and a support worker?

A carer is usually an unpaid family member or friend with no roster and no shift end. A support worker is paid from an NDIS plan to deliver agreed supports at agreed times. The words get used loosely, including by services, so it is worth clarifying which one someone means in any conversation about funding.