NDIS high-intensity supports help people who have complex daily support needs. These needs may involve extra health risks. Workers need the right training and skills to provide this support safely.

These supports may include:

• Complex bowel care
• Enteral feeding
• Severe dysphagia support
• Tracheostomy care
• Urinary catheter care
• Ventilator support
• Subcutaneous injections
• Complex wound care

Each person has different needs. Their support must follow an individual plan.

What are NDIS high-intensity supports?

High-Intensity Daily Personal Activities is an NDIS registration group. It covers personal supports that involve complex needs or higher risks.

These supports help people with important daily tasks. They can also help people build skills and live with more independence.

High-intensity support is not just regular personal care provided more often. It requires workers with extra skills, training or experience.

NDIS high-intensity supports must match the person’s needs, choices and support plans.

Which activities are high-intensity supports?

The NDIS Quality and Safeguards Commission lists eight types of high-intensity support.

Complex bowel care

Complex bowel care must follow the person’s bowel care plan.

Workers need to understand:

• The person’s normal routine
• Their support needs
• Possible warning signs
• What to do if something goes wrong
• When to contact a health professional or emergency service

The person should be involved in planning their support. Workers must receive training that relates to that person’s needs.

Enteral feeding and management

Enteral feeding provides nutrition, fluids or medicine through a feeding tube.

The person must have an individual plan. The plan should cover:

• The type of feeding tube
• The feeding routine
• Food, fluid and medicine needs
• Cleaning and equipment care
• Possible risks
• Emergency steps

Workers must receive training for the person’s feeding method and support needs.

Severe dysphagia management

Dysphagia means difficulty swallowing. Severe dysphagia can cause serious risks when a person eats, drinks or takes medicine.

The person’s plan may include:

• Safe food textures
• Safe fluid thickness
• Food preparation steps
• Eating and drinking positions
• Equipment needs
• Personal food preferences
• Warning signs
• Emergency steps

The NDIS Commission states that severe dysphagia training must be provided by a qualified health professional.

Tracheostomy management

A person with a tracheostomy may need help with suctioning, cleaning, monitoring and equipment care.

Workers must know the person’s usual routine. They must also know how to notice a problem and what to do in an emergency.

Training must match the person’s tracheostomy, equipment and support plan.

Urinary catheter management

Catheter support may involve:

• An indwelling catheter
• An intermittent catheter
• A suprapubic catheter

The support plan should explain the person’s catheter type and daily routine. It should also list warning signs and emergency steps.

Workers need training that matches the person’s catheter and support needs.

Ventilator management

Ventilator support must match the person’s breathing needs and equipment.

Workers need to understand:

• The person’s normal breathing and support routine
• How the equipment works
• Warning signs
• What to do if the equipment has a problem
• When to seek urgent help

Workers must receive training before they provide this support on their own.

Subcutaneous injections

A subcutaneous injection places medicine into the tissue under the skin.

The person’s plan should include:

• The prescribed medicine
• The correct dose
• When the medicine must be given
• Storage instructions
• Possible side effects
• Monitoring needs
• Emergency steps

The NDIS Commission requires written or phone orders from the health professional who prescribed the medicine. Workers must also receive suitable training.

Complex wound management

A complex wound can affect many parts of daily life. This may include showering, toileting, movement and positioning.

Workers must follow the person’s wound care plan. They need to know how daily support tasks may affect the wound.

They must also know which changes to report and when urgent help is needed.

You can read more in the NDIS Commission guidance on high-intensity daily personal activities.

Does a nurse need to provide every high-intensity support?

Not always.

Some high-intensity supports may be provided by a trained disability support worker. The worker must have the right skills and training for the person they support.

This does not mean that any support worker can provide high-intensity support.

The right worker depends on:

• The person’s needs
• The risks involved
• The person’s support plan
• The worker’s training and skills
• Advice from health professionals
• The provider’s NDIS registration
• The safety steps in place

Some assessments, plans, reviews and training must involve a qualified health professional.

The person’s support plan should explain who is responsible for each part of their care.

What does safe high-intensity support look like?

Safe NDIS high-intensity supports need more than a written procedure. The whole support system must work well.

An individual support plan

The plan must match the person’s needs. It should not be a general plan used for everyone.

The plan should explain:

• The person’s daily routine
• Their choices and preferences
• Known risks
• Warning signs
• Emergency steps
• Who workers should contact

Involvement from the participant

The participant should be involved in decisions about their support.

Information should be shared in a way they can understand. This may include Easy Read, pictures, translated information or help from a trusted person.

Training for the individual participant

General training may not be enough.

Workers should understand the person’s:

• Equipment
• Daily routine
• Support plan
• Communication needs
• Warning signs
• Emergency steps

Worker skill checks

A provider should check that a worker can provide the support safely.

The provider should record this check before the worker provides the support alone.

Clear emergency steps

Workers must know what to do when something changes.

They should know:

• Who to contact
• When to call a health professional
• When to call emergency services
• How to keep the participant informed
• How to record the incident

Clear records and handovers

Good records help the support team notice changes. They also help workers provide steady and reliable support.

Important information should be shared during staff handovers.

Regular reviews

Support plans should be reviewed when the person’s needs change.

A review may also be needed when there is a change to:

• Medicine
• Equipment
• Health
• Daily routine
• Living arrangements
• Risks
• Clinical advice

How are NDIS high-intensity supports funded?

NDIS funding is based on each person’s needs.

A support must meet the NDIS funding rules. It must be reasonable and necessary.

The support should:

• Relate to the person’s disability
• Help the person work towards their goals
• Be effective and helpful
• Offer value for money
• Work with health and other services
• Be an approved NDIS support

The NDIA may look at:

• Reports and other evidence
• The type of support needed
• How often the support is needed
• How many hours are required
• Whether any support is shared
• How the support works with other services

The NDIS Pricing Arrangements include items for High-Intensity Daily Personal Activities. This does not mean that every participant will receive funding for them.

Participants should check their approved plan before starting a service. They can ask the NDIA, a plan manager or a support coordinator for help.

Read the NDIS reasonable and necessary guidance and the NDIS Pricing Arrangements and Price Limits for more information.

Can high-intensity support be provided in SIL?

Yes.

A person living in Supported Independent Living may need regular support, high-intensity support or both.

SIL and high-intensity support do not mean the same thing.

• Supported Independent Living: Help with daily tasks in a person’s home
• High-intensity support: Support that involves complex needs or higher risks
• Specialist Disability Accommodation: Housing designed for eligible people with very high support needs or major physical needs

Participants may also receive NDIS high-intensity supports outside SIL. This depends on their plan, needs and living arrangements.

The NDIA guide to providing Supported Independent Living provides more information.

What should you ask a high-intensity support provider?

Before choosing a provider, ask how its NDIS high-intensity supports are planned and managed.

You can ask:

1. Is the provider registered for the support I need?
2. Does its registration cover my type of high-intensity support?
3. How will I be involved in planning my support?
4. Who will write and review my support plan?
5. Who will train my support workers?
6. How will the provider check each worker’s skills?
7. How will the provider record worker training?
8. What happens if a trained worker is not available?
9. How will staff changes be managed?
10. What will workers do if my needs change?
11. How will incidents be reported?
12. How often will my plan be reviewed?
13. How will information be shared with my health professionals?
14. How will the provider respect my choices and daily routine?

A suitable provider should give clear answers. Its answers should relate to the person who needs support.

What information should be included in a referral?

A useful referral may include:

• The participant’s goals
• Their preferred living arrangements
• The type of support they need
• Current health and support plans
• Risk and emergency plans
• Support times and staffing needs
• Communication needs
• Decision-making preferences
• Equipment used by the participant
• Details of current health professionals
• Review dates
• Hospital discharge or moving dates
• Consent to share relevant information

Only necessary information should be shared.

The participant should know what information is being shared and why. Their privacy must be protected.

The key point

NDIS high-intensity supports are not only about completing a task.

Safe support also requires:

• An individual plan
• Participant choice
• Trained workers
• Worker skill checks
• Clear records
• Good staff handovers
• Regular reviews
• Clear emergency steps

Do not only ask whether a provider offers high-intensity support. Ask how it will provide the support safely for the individual participant.

Frequently asked questions

What is the difference between regular and high-intensity support?

Regular personal support helps with everyday tasks. High-intensity support involves more complex needs or higher risks.

Workers may need extra training, skills or experience to provide high-intensity support.

Are high-intensity supports only provided in SIL?

No.

They may be provided in the participant’s home, shared housing or some community settings. This depends on the participant’s plan and needs.

Are high-intensity supports the same as community nursing?

No.

They are different NDIS registration groups.

Some high-intensity supports may be provided by a trained disability support worker. Community nursing is provided by a nurse.

The right service depends on the person’s needs, plan and clinical advice.

Can every registered NDIS provider deliver high-intensity supports?

No.

A registered provider can only deliver the high-intensity supports listed on its registration certificate.

Who decides whether high-intensity support is funded?

The NDIA decides which supports are funded in a participant’s plan.

The NDIA looks at the person’s needs, evidence and the NDIS funding rules.

Discuss your support needs

Do you need help with a high-intensity support referral?

Contact Nurse Aid Australia to discuss the participant’s needs, current support plans and possible next steps.

This article provides general information only. It does not replace medical advice, a clinical assessment, an approved health plan or emergency instructions.