What is high intensity support under the NDIS?
The short answer
High intensity support means daily care that could cause harm if it is done wrong. It covers things like PEG and tube feeding, bowel care, catheter care, tracheostomy and ventilator support, help swallowing, wound care, injections, and seizure medication. Workers must be trained and assessed against the NDIS High Intensity Support Skills Descriptors, and supervised by a qualified health professional. Importantly, a worker is signed off for one particular person — not for the task in general.
"High intensity" sounds like it describes how much support someone needs. It does not. It describes how much risk a support carries if it is done badly — and therefore how carefully the NDIS expects the person delivering it to have been trained.
The supports it covers
The NDIS Practice Standards set out High Intensity Support Skills Descriptors covering:
- Complex bowel care — including digital stimulation and suppository administration
- Enteral feeding — PEG, PEJ and nasogastric feeding and management
- Dysphagia support — assisting people with severe swallowing difficulty, and mealtime management
- Ventilator support
- Tracheostomy management
- Urinary catheter management — indwelling and suprapubic
- Subcutaneous injections
- Complex wound care — including pressure injuries
- Severe or frequent seizure support — including emergency medication
What the higher bar actually requires
Assessed competency, not just training
Attending a course is not enough. A worker must be assessed as competent by an appropriately qualified health practitioner, against the descriptors, for the specific support.
Competency is participant-specific
This is the part most often misunderstood. A worker signed off for one participant's bowel care is not thereby competent for another's. Equipment differs, routines differ, clinical presentations differ. Sign-off is per participant, and it is re-assessed when the person's needs change.
Ongoing clinical supervision
There must be a qualified practitioner — in practice, a registered nurse — who writes the support plan, assesses competency, remains available for escalation, and reviews the arrangement periodically. High intensity support is not something a worker does alone with a laminated instruction sheet.
A documented plan
Every high intensity support runs to a written plan covering the procedure, the equipment, what normal looks like for that person, what abnormal looks like, and exactly what to do when something is abnormal.
How it is funded
High intensity supports are funded from Core Supports, under Assistance with Daily Life. The NDIS Pricing Arrangements set separate, higher price limits for high intensity daily personal activities than for standard personal care, reflecting the training and supervision behind them.
Nursing time itself — a registered nurse attending, assessing, or training and signing off support workers — is generally funded separately. Using nursing hours to train your regular workers is often the better use of the budget: you get continuity of familiar staff with clinical governance behind them, rather than paying nursing rates for every shift.
Questions worth asking a provider
- Who is the supervising registered nurse, and how do I contact them?
- How is worker competency assessed and documented — and is it specific to me?
- How often is competency reviewed?
- How many of your workers are signed off for my supports? (If the answer is one, a single illness leaves you without support.)
- What is the escalation pathway at 2am on a Sunday?
High intensity support with VSG Home Care
VSG Home Care is registered for Assist Personal Activities High and for community nursing care, which means the clinical supervision and the daily support sit with the same provider rather than being coordinated across two.
The NDIS Commission has also attached a condition to our registration requiring a documented risk assessment for any participant who chooses to be supported by a single worker under registration group 0107. We complete that with you before support begins — it is described in full on our about page.
Common questions
The High Intensity Support Skills Descriptors cover complex bowel care, enteral feeding and management, dysphagia support, ventilator support, tracheostomy management, urinary catheter management, subcutaneous injections, complex wound care, and severe or frequent seizure support.
Yes, provided they have been assessed as competent for that specific participant against the High Intensity Support Skills Descriptors, are working to a documented plan, and are supervised by an appropriately qualified health practitioner — usually a registered nurse. Competency is participant-specific and is not transferable between participants.
High intensity daily personal activities is a certification-pathway registration group, meaning registered providers delivering it are audited on site against the relevant Practice Standards. Agency-managed participants must use a registered provider. Plan-managed and self-managed participants may use others, but the competency and supervision expectations still apply.
Looking for an NDIS provider?
VSG Home Care is a registered NDIS provider in Craigieburn serving Melbourne's northern suburbs. The first conversation is free and commits you to nothing.