When "a little different" can tell us a lot: noticing change in complex care
February 30, 2026
|By Careassure
|7 min read
On this page
- When "a little different" can tell us a lot: noticing change in complex care
- The person knows their own usual
- What small changes should workers look for?
- A support worker's observation matters
- What a clear observation looks like
- Why noticing change matters in high-intensity supports
- A simple tool to start the conversation: Know My Usual
When "a little different" can tell us a lot: noticing change in complex care
Someone who usually enjoys breakfast leaves their food untouched. A person who loves a chat is unusually quiet. Someone who normally joins an afternoon activity wants to stay in bed.
On their own, these changes are easy to dismiss. In complex care, they are worth noticing. A small shift in eating, sleep, mood, or movement can be the first sign that a person is in pain, is becoming unwell, or needs something different from their support.
As a registered nurse, I often come back to one question: What is usual for this person? We cannot recognise a change well unless we first understand the person behind the care plan.
The person knows their own usual
There is no single version of "normal" that fits everyone. A participant may use words, signs, a communication device, facial expressions or movement to tell us how they feel. They may have their own eating and sleeping patterns. They may show pain by becoming quiet, unsettled or less interested in something they usually enjoy.
The participant should guide that understanding wherever possible. With their consent, family members and people who know them well can add detail. That knowledge gives a support team context that a list of diagnoses cannot.
That is why I encourage teams to ask simple questions. How is this person on a usual day? What helps them feel comfortable? What do they do when something is wrong?
What small changes should workers look for?
Changes rarely announce themselves. They tend to show up in ordinary routines, so these are the areas I ask teams to keep an eye on. The examples are illustrations only. Every person's usual is different.
| Area | What usual might look like | A change worth reporting |
|---|---|---|
| Communication | Chats at breakfast, uses their device to ask for music | Much quieter, not using their device, new sounds or gestures |
| Eating and drinking | Finishes most meals, has a drink with lunch | Leaves food, refuses drinks, coughs or takes longer to swallow |
| Movement | Walks to the lounge with a frame | Needs more help to stand, stays in bed, guards an arm or leg |
| Sleep and rest | Sleeps through the night, naps after lunch | Awake at night, sleeping far more than usual, hard to wake |
| Mood and interest | Looks forward to the afternoon activity | Withdrawn, irritable or not interested in things they enjoy |
| Signs of discomfort | Settled and relaxed when sitting | Grimacing, rocking, calling out or pulling away when touched |
None of these on its own means something is seriously wrong. What matters is that it is different for this person, and that someone who can act on it hears about it.
A support worker's observation matters
Support workers see people through everyday moments: meals, conversations, activities and rest. They are often the first to notice that something has changed.
They do not have to diagnose the cause. They do need to describe what they saw, promptly tell the right person, and follow the participant's care plan. If someone is in danger, call 000 first.
What a clear observation looks like
| Vague note | Clear note |
|---|---|
| Seemed off today. | "Ate two bites of breakfast and refused a drink. Usually finishes their meal." |
| A bit grumpy this morning. | "Pushed my hand away twice during personal care. This is not usual for them. Told the team leader at 10:15 am." |
| Didn't sleep well. | "Awake and calling out from 1 am to 3 am. Usually sleeps through." |
The clear version tells a nurse or doctor what happened, how it compares with the person's usual, and who has already been told. It also provides the next worker with a clear handover, so they know what to watch for during their shift.
Why noticing change matters in high-intensity supports
For participants with high-intensity needs, such as enteral feeding, severe dysphagia management, tracheostomy care, or complex bowel care, small changes can carry more weight. The NDIS Practice Standards supplementary module for high-intensity daily personal activities requires that a participant's health status be "subject to regular and timely review by an appropriately qualified health practitioner".
Those reviews depend on the information that reaches them. Day-to-day observations from support workers and families give the clinical team something real to review, rather than a general impression that things seem fine.
At Care Assure, our registered nurses prepare complex care plans and oversee the support delivered for participants with high-intensity needs through our NDIS complex care supports in Adelaide. The best plan still depends on people sharing what they notice and listening to the participant. The same habit helps in shared homes too, where several workers on a Supported Independent Living roster each see a different part of a person's day.
A simple tool to start the conversation: Know My Usual
We have made a free Know My Usual Easy Read sheet for NDIS participants, families and support teams. It uses pictures and short questions across three pages:
- Page 1, about me: how I talk, how I eat and drink, how I move and how I sleep.
- Page 2, how I feel: how I show pain, what changes people should look for, what helps me feel better, and who people should tell.
- Page 3, I noticed a change: space for a worker to record what they saw or heard, what the person said, what they did, and who they told.
It can be completed with the participant and someone they trust. Keep it with the person's care information so new or casual workers can read it before a shift. It helps a team discuss a person's usual patterns. It does not replace an individual care plan or clinical advice.
How to Submit: Fill out this document and email the completed PDF to hello@careassure.com.au.
Frequently Asked Questions (FAQs)
- What are caregiver resources for individuals with disabilities?
Caregiver support resources for individuals with disabilities encompass a variety of services and programs designed to assist caregivers in their unique caregiving journey. These resources provide practical assistance, emotional support, and specialised guidance to help caregivers more effectively navigate the challenges of caring for someone with disabilities.
- Who can benefit from caregiver support?
Caregiver support is available to anyone providing care to a person with a disability, regardless of the type or severity of the disability. Whether you are a family caregiver, a professional caregiver, or a friend providing support, these resources are tailored to meet the specific needs of caregivers in this context
- What types of support are available for caregivers?
Caregiver resources offer a wide range of support services, including specialised training programs, assistive technology resources, respite care services, financial assistance programs, and access to disability-specific healthcare professionals. These resources aim to address the unique challenges of caregivers of individuals with disabilities and provide them with the tools and support they need to enhance their caregiving experience.
- How can I access caregiver support resources?
Caregiver support resources can be accessed through various channels, including disability advocacy organisations, government agencies, healthcare providers specialising in disabilities, community centres, and online platforms dedicated to disability support. Many resources are available online, allowing caregivers to access them conveniently from their homes.
- Are caregiver support resources free to use?
Many caregiver support resources for individuals with disabilities are offered free of charge or at a low cost to caregivers. However, some services or programs may have associated fees or eligibility requirements. Researching and inquiring about the price and availability of specific resources is essential before accessing them.
- How do I know which caregiver support resources are right for me as a caregiver?
The right caregiver support resources for you as a caregiver of an individual with disabilities will depend on your unique needs, preferences, and circumstances. It's helpful to explore different options, such as online research, speaking with disability support organisations, consulting with healthcare professionals specialising in disabilities, and seeking recommendations from other caregivers in similar situations.
