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NDIS high intensity supports and high care
High intensity support isn't about how many hours someone needs — it's about tasks carrying enough clinical risk that a worker needs specific, assessed competency to deliver them safely. This series explains the eight skills descriptors that govern it, how competency is actually assessed, what each support involves day to day, and the questions worth asking before you trust anyone with them.
What counts as high intensity support
A person can need twenty-four hours of assistance a day and receive none of it at high intensity. The distinction isn't volume — it's whether getting a particular task wrong could cause serious harm.
The NDIS formalises this through High Intensity Daily Personal Activities, Module 1 of the NDIS Practice Standards. Providers registered for it are audited against that module, and their workers must meet the High Intensity Support Skills Descriptors published by the NDIS Quality and Safeguards Commission.
That document is the most useful tool a family has, and almost nobody mentions it. It sets out exactly what a competent worker should know and be able to do for each support. It's public. You can read it, and you can ask any provider how they meet it.
| Descriptor | What it covers | Commonly needed by |
|---|---|---|
| Complex bowel care | Intervention beyond ordinary assistance — digital stimulation, suppositories, enemas, stoma care | Spinal cord injury, spina bifida, advanced neurological conditions |
| Enteral feeding support | Nutrition, hydration and medication via PEG, PEJ or nasogastric tube | Dysphagia, motor neurone disease, cerebral palsy, post-stroke |
| Dysphagia support | Swallowing difficulties where the risk is aspiration and choking. New in the 2023 revision. | Stroke, Parkinson's, cerebral palsy, dementia |
| Ventilator support | Invasive or non-invasive mechanical ventilation, continuous or overnight | High spinal injury, neuromuscular conditions |
| Tracheostomy support | Surgical airway — suctioning, stoma care, tube security, recognising obstruction | Long-term ventilation, upper airway conditions |
| Urinary catheter support | Indwelling, suprapubic and intermittent catheterisation | Spinal cord injury, MS, bladder dysfunction |
| Subcutaneous injections | Medication into tissue under the skin — insulin, anticoagulants and others | Diabetes and various prescribed regimens |
| Complex wound care | Pressure injuries, surgical and chronic wounds. Upgraded from guidance to a full descriptor. | Reduced mobility, diabetes, pressure risk |
| Epilepsy & seizure support | An additional descriptor with its own updated guidance | Epilepsy, acquired brain injury |
Two structural changes worth knowing
Stoma care no longer stands alone. It was folded into the bowel care, enteral feeding, tracheostomy, ventilator and catheter descriptors, because that's where it actually occurs in practice. Mealtime support moved out of the descriptors into the NDIS Workforce Capability Framework as an additional capability, while dysphagia support became the clinical descriptor. If a provider's documentation still reflects the older structure, that's worth a question.
Training is not the same as competency
This distinction trips up families, and frankly it trips up some providers too.
A worker can complete an enteral feeding course. That's training — it demonstrates they've been taught the general principles. Competency means someone qualified has observed that worker deliver that support, to that specific person, following that person's individual plan, and assessed them as safe.
Training is generic. Competency is specific. And high intensity supports are never generic — two people with PEG tubes may have entirely different regimens, flush protocols and warning signs. A worker competent with one is not automatically competent with the other.
So when a provider says "all our staff are trained in high intensity supports", the follow-up is: trained, or assessed as competent for this person — and who assessed them?
The Commission's recommendations on maintaining competency are specific, and they're the ones to hold a provider to:
- Annual competency assessment for each high intensity support a worker delivers
- Reassessment when the participant's needs change, since competency is assessed against their plan
- Reassessment after three or more months without delivering that support
- Records kept for audit — the provider should be able to produce the evidence
That three-month rule is the question most providers don't expect. A worker signed off in March, rostered elsewhere for five months, then scheduled into your home in September should be reassessed first. Whether that happens depends entirely on the organisation's systems.
Depth of competency beats breadth of promises
Families often confirm a provider can deliver a support, then discover the organisation has exactly one competent worker — who has weekends, sick days and annual leave like everyone else. Ask how many workers are currently assessed for this person's supports, and what happens when the rostered one calls in sick. The answer determines whether you get consistent support or a scramble every few weeks.
Guides to each high intensity support
Written for participants and families choosing a provider — what each support involves day to day, what can go wrong, who's allowed to deliver it, and what to ask. None of these replace the clinical plan written by a treating health professional.
High Intensity Daily Personal Activities Explained
The foundational guide: the regulatory framework, all eight descriptors, how competency is assessed and maintained, how it's funded, NDIS versus aged care high-level care, and twelve questions to ask any provider.
Enteral Feeding (PEG) Support at Home
PEG, PEJ and NG tubes, how feeds are delivered, the daily routine, medication through the tube and why it's riskier than it looks, complications and escalation, and what the first three months really feel like.
Complex Bowel Care Support
What complex bowel care involves, dignity and privacy in a shared home, recognising autonomic dysreflexia in spinal cord injury, and building a routine that fits around a life.
Urinary Catheter Support at Home
Indwelling, suprapubic and intermittent catheterisation, infection prevention and early warning signs, equipment and supplies, and travelling with a catheter.
Dysphagia and Mealtime Support
Texture-modified diets and thickened fluids, positioning, aspiration risk, the role of the speech pathologist, and keeping mealtimes social rather than clinical.
Tracheostomy and Ventilator Support
Living at home with a surgical airway or mechanical ventilation — suctioning, equipment redundancy, power failure planning, and what 24/7 support really requires.
Epilepsy and Seizure Support in Supported Living
Seizure management plans, emergency medication, accurate recording, night-time monitoring, and balancing safety against independence.
Complex Wound and Pressure Care
Pressure injury prevention and staging, repositioning regimens, equipment, and why early detection is the whole game.
Positive Behaviour Support and Restrictive Practices
How behaviour support plans work, what counts as a restrictive practice, authorisation and reporting requirements, and reduction planning that actually reduces.
NDIS high intensity support versus aged care "high level care"
These terms blur constantly, and the systems behind them are entirely separate.
"High level care" and "high care facility" come from the aged care system — residential aged care, nursing homes, and the funding framework behind them. If you're searching those terms and you're over 65 without an existing NDIS plan, aged care is likely your system, and My Aged Care on 1800 200 422 is the place to start.
NDIS high intensity support is for NDIS participants — generally people who entered the scheme before 65 — and it's delivered in the person's own home, a shared supported home, or specialist disability housing. It isn't a facility model at all. The entire design intent is that people with very high support needs live in ordinary homes, with clinical support brought to them.
The overlap causes real harm. Younger people with high support needs have historically ended up in residential aged care because the alternative didn't exist locally — something successive reviews have identified as unacceptable. Specialist Disability Accommodation paired with high intensity support in the home is that alternative. If someone has suggested a nursing home for a person under 65 with NDIS funding, get a second opinion before accepting it as the only path.
Where high intensity support happens
Twenty years ago, very high support needs were assumed to mean an institutional setting. Today a person on overnight ventilation with a PEG tube and complex bowel care can live in a suburban house with workers who know them by name, in a home they chose. That shift is the difference between being a patient and being a person who happens to need clinical support.
In practice, high intensity supports show up across every home and living arrangement:
- In supported independent living homes, built into the roster of care — which should specify which hours involve high intensity support and at what ratio, since some tasks genuinely need two workers
- In High Physical Support SDA dwellings, with ceiling hoists, backup power and structural provision for assistive technology
- In a person's own home, with drop-in or live-in support
- In short term respite — where the respite provider needs the same competencies, a point families often discover too late when trying to book a break
- In medium term accommodation after a hospital discharge, when supports are newest and least established
That respite point deserves emphasis. Families delivering high intensity support themselves frequently can't get a break, because respite providers in their area aren't competent in the specific supports. Ask early and ask specifically — "do you have workers assessed for complex bowel care and enteral feeding?" is a very different question from "do you do respite?"
Ask us the hard questions
We deliver high intensity supports across NSW — complex bowel care, enteral feeding, catheter support, dysphagia support, epilepsy and seizure support and complex wound care — with competency assessed against each person's individual plan rather than in general. Bring the twelve questions from our first guide. We'll answer all of them.
Or enquire online and we'll call you back within one business day.
