High Intensity Daily Personal Activities: What NDIS High Intensity Support Actually Means

There’s a moment that happens in a lot of families, and it usually happens in a hospital corridor.

Someone you love has come through something — a spinal injury, a stroke, a progressive condition reaching a new stage, a complication after surgery. The acute treatment is finishing. And a discharge planner says a sentence that changes the next decade: they’ll need high intensity supports at home.

Nobody explains what that means. You nod, because everyone else in the room seems to know. And then you go home and type it into Google, and what comes back is mostly provider marketing that uses the phrase without defining it.

So let’s define it properly. Not the brochure version — the actual regulatory framework, what it requires of the people who’ll be in your home, and what you should be asking before you sign anything.

The short answer

High intensity support is the NDIS term for personal care and daily living assistance that carries enough clinical risk that an ordinary support worker can’t safely deliver it without specific, assessed training.

It’s not about how many hours of support someone needs. A person can need twenty-four hours of assistance a day and receive none of it at high intensity. It’s about the nature of particular tasks — whether getting them wrong could cause serious harm.

The NDIS formalises this through High Intensity Daily Personal Activities, which sits in Module 1 of the NDIS Practice Standards. Providers registered to deliver these supports 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 thing almost nobody mentions, and it’s the most useful tool a family has. It sets out, in detail, exactly what a competent worker should know and be able to do for each type of high intensity support. It’s publicly available. You’re allowed to read it, and you’re allowed to ask a provider how they meet it.

The eight descriptors

The current descriptors took effect on 1 February 2023, replacing an earlier version. The revision grew the document from 18 pages to 47 — which tells you something about how much the Commission felt needed spelling out.

The eight core areas are:

Complex bowel care. Supporting someone whose bowel function requires intervention beyond ordinary assistance — including digital stimulation, suppositories, enemas, and stoma care. Common for people with spinal cord injury, spina bifida, advanced neurological conditions.

Enteral feeding support. Nutrition, hydration and often medication delivered through a tube directly into the stomach or small intestine — PEG, PEJ, or nasogastric. Covered in depth in its own guide.

Dysphagia support. Supporting someone with swallowing difficulties, where the risk is aspiration — food or fluid entering the airway — leading to choking or pneumonia. This was added as a new descriptor in the 2023 revision, which reflects how seriously the sector now takes mealtime risk.

Ventilator support. Assisting someone who depends on mechanical ventilation, whether invasive or non-invasive, continuously or overnight.

Tracheostomy support. Supporting someone with a surgical airway — suctioning, stoma care, tube security, recognising obstruction.

Urinary catheter support. Indwelling urethral catheters, suprapubic catheters, and intermittent catheterisation, including drainage, hygiene, and spotting infection early.

Subcutaneous injections. Medication administered into the tissue under the skin, most commonly insulin, but also anticoagulants and other prescribed medications.

Complex wound care support. Wounds requiring more than basic first aid — pressure injuries, surgical wounds, chronic ulcers. This was upgraded in the revision from general advice to a full descriptor.

Alongside these sits epilepsy and seizure support, which remains an additional descriptor with its own guidance, updated in the same revision.

A couple of structural changes in the 2023 version are worth knowing, because they explain why older provider documentation sometimes looks different. Stoma care no longer stands alone — it was folded into the bowel care, enteral feeding, tracheostomy, ventilator and catheter descriptors, because in practice it shows up inside all of them. And mealtime support moved out of the descriptors into the NDIS Workforce Capability Framework as an additional capability, while dysphagia support became the clinical descriptor.

The language shifted too. The Commission deliberately replaced words like “management” with “support” — so it’s enteral feeding support, not enteral feeding management. That sounds like semantics until you sit with it. The person isn’t a condition being managed. They’re a person being supported, and in most cases directing their own care.

What “competent” actually requires

Here’s where the descriptors become genuinely useful to families, because they set a bar you can hold a provider to.

For each support area, the descriptors describe the knowledge and skills a worker needs: understanding the person’s specific plan, recognising normal from abnormal, performing the support safely, knowing what to do when something goes wrong, documenting accurately, and escalating appropriately.

Crucially, competency isn’t a certificate someone earns once. The Commission recommends:

• Annual competency assessment for each high intensity support a worker delivers
• Reassessment when the participant’s needs change — because the person’s plan is what the competency is assessed against
• Reassessment when a worker hasn’t delivered that support for three or more months, since skills decay
• Records kept for audit, meaning the provider should be able to produce evidence

That three-month rule is the one I’d put in your pocket. It’s the question most providers don’t expect.

Because here’s the practical reality: a worker might be signed off on tracheostomy suctioning in March, be rostered elsewhere for five months, and then be scheduled into your home in September. Under the Commission’s guidance, that worker should be reassessed before delivering the support. Whether that actually happens depends entirely on the organisation’s systems.

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 training course. That’s training. It demonstrates they’ve been taught the general principles.

Competency means someone qualified has observed that worker deliver that specific support, to that specific person, following that person’s individual plan, and assessed them as safe. Training is generic. Competency is specific.

This matters enormously because high intensity supports are never generic. Two people with PEG tubes may have completely different feeding regimens, different flush protocols, different medication schedules, different 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 question is: trained, or assessed as competent for this person specifically — and who assessed them?

The answer tells you a great deal. Good providers have a clinical lead, a registered nurse, or an arrangement with the participant’s treating team to sign off competency. Weaker providers have a training certificate in a file.

How the clinical plan fits

Every high intensity support should be governed by a plan written by an appropriate health professional — a nurse, a dietitian, a speech pathologist, a continence specialist, depending on the support.

That plan is the source of truth. It specifies what’s done, how, when, with what equipment, what to watch for, and what to do if something goes wrong. The support worker follows it. They don’t improvise, and they don’t vary it based on what worked for a previous client.

In a well-run arrangement you’ll see:

• A written, current plan for each high intensity support, signed by the relevant clinician
• That plan physically accessible in the home, not filed in an office
• Workers who can explain the plan rather than just perform it
• A review schedule, and evidence reviews actually happen
• Clear escalation: who to call, in what order, for what
• Documentation after every instance of the support

If you ask to see the plan and there’s hesitation, that’s information. It’s the participant’s plan. They, and the people they authorise, are entitled to it.

Who can deliver high intensity supports

A question families ask constantly: does this need a nurse?

Sometimes yes, often no. The NDIS framework deliberately allows trained and assessed support workers to deliver most high intensity supports under a clinical plan with appropriate oversight. This is a feature, not a loophole. It means someone can live in their own home with consistent support workers who know them, rather than requiring a nurse for every routine task — which would be both unaffordable and, for most people, unnecessarily medicalised.

What varies is the oversight model. Depending on the support and the person’s situation, you might see:

• A registered nurse who assesses competency and provides clinical governance, visiting periodically
• Delegation from the treating health professional with defined boundaries
• Nursing involvement for some tasks and worker delivery for others
• Full nursing delivery where clinical instability makes anything else unsafe

The right model depends on the person’s stability and complexity. What matters is that the model is explicit and documented, not assumed. Ask who provides clinical oversight, how often they’re involved, and what happens if a worker is unsure mid-shift at 2am.

How high intensity support is funded

High intensity daily personal activities are funded from your Core budget, under assistance with daily life. They’re priced at higher rates than standard personal care, reflecting the training and competency required.

A few practical points:

The NDIA funds assessed need, not labels. Having a PEG tube doesn’t automatically generate high intensity funding. The assessment looks at what support you actually require and how complex it is to deliver safely.

Evidence drives the outcome. Reports from the relevant clinician — the dietitian, the continence nurse, the speech pathologist — describing the support required and why it needs trained delivery are what substantiate the funding. Generic reports produce generic funding.

It interacts with your other supports. If you receive Supported Independent Living, high intensity supports are usually built into the roster of care rather than funded as a separate line. The roster should specify which hours involve high intensity support and at what ratio, since some tasks require two workers.

Ratios matter here more than anywhere. Hoisted transfers with complex wound care, or repositioning for someone ventilated, may genuinely need two people. A roster that assumes one worker can safely deliver a two-person task isn’t a cost saving — it’s an incident waiting for a date.

High intensity support versus aged care “high level care”

Worth untangling, because the terms blur and the systems are completely separate.

“High level care” and “high care facility” are language from the aged care system — residential aged care, nursing homes, and the funding framework that sits 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 (1800 200 422) is the starting point.

NDIS high intensity support is for participants in the NDIS — generally people who entered the scheme before 65 — and it’s delivered in the person’s own home, a shared supported home, or specialist housing. It is not a facility model. The whole design intent is that people with very high support needs live in ordinary homes with the clinical support brought to them.

The overlap causes real problems. Younger people with high support needs have historically ended up in residential aged care because the alternative didn’t exist — a situation successive reviews have identified as unacceptable. The expansion of Specialist Disability Accommodation paired with high intensity support in the home is precisely the alternative. If someone has suggested a nursing home for a person under 65 with NDIS funding, it’s worth getting a second opinion before accepting that as the only option.

Twelve questions worth asking a provider

Take these to any provider offering high intensity supports. We’ve published them knowing we’ll be asked them too.

1. Which of the eight skills descriptors are your workers assessed against for this person?
2. Who performs competency assessment, and what are their qualifications?
3. How often is competency reassessed, and what triggers an early reassessment?
4. What’s your policy when a worker hasn’t delivered a support for three or more months?
5. Can I see the clinical plan that will govern this support?
6. Who provides clinical oversight, and how often are they involved?
7. What’s the escalation pathway at 3am, and who actually answers?
8. How many of your workers are competent in this support — what happens if the rostered one calls in sick?
9. What proportion of shifts in this arrangement would be filled by agency staff?
10. How is the support documented, and can I see the records?
11. What’s happened the last time something went wrong with a support like this?
12. Are you registered for Module 1 — High Intensity Daily Personal Activities — and when was your last audit?

That last one is checkable independently. Registration groups are public on the NDIS Provider Register, and the Commission publishes compliance actions. Two minutes of searching is worth more than two hours of reading provider websites. Our registration number is 4050164422.

Question eight deserves emphasis. Families often confirm that a provider can deliver a support, then discover the organisation has exactly one competent worker, who has weekends and annual leave like everyone else. Depth of competency — how many workers can safely cover this — determines whether you get consistent support or a scramble every time someone is unwell.

Warning signs

From enough of these conversations, patterns emerge. Be cautious when you encounter:

• Vagueness about competency. “All our staff are fully trained” with no detail about assessment, assessors or frequency.
• Reluctance to show the clinical plan. There’s no good reason for this.
• A single point of failure. One competent worker, no documented backup.
• No named clinical oversight. If nobody can tell you which clinician governs this support, nobody does.
• Pressure to start before competency is confirmed. The vacancy is their problem, not your emergency.
• Heavy agency use. Rotating unfamiliar workers is a quality problem everywhere, and a safety problem here. Agency workers don’t know the person’s baseline, which is how early deterioration gets missed.
• Documentation that doesn’t exist or can’t be produced. Audit records are required. “We’ll get that to you” repeatedly means no.

None of these is proof of a bad provider. A cluster of them is a reason to look elsewhere.

Where high intensity support actually happens

One of the better developments in recent years is how much of this now occurs in ordinary homes.

Twenty years ago, the assumption was that very high support needs meant an institutional setting. Today a person on overnight ventilation with a PEG tube and complex bowel care can live in a three-bedroom house in the suburbs, with support workers who know them by name, in a home they chose.

That’s not a small shift. It’s 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 shared homes, built into the roster of care
• In Specialist Disability Accommodation, particularly High Physical Support dwellings with ceiling hoists and backup power
• In a person’s own home with drop-in or live-in support
• In short term respite, which requires the respite provider to hold the same competencies — a point families often discover too late when booking a break
• In medium term accommodation after a hospital discharge, where supports are often newest and least established

That respite point is worth dwelling on. Families providing high intensity support themselves frequently can’t access a break, because respite providers in their area aren’t competent in the specific supports. If that’s your situation, 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?”

What changes when support becomes high intensity

Families moving from standard personal care into high intensity support often expect the main difference to be clinical. It isn’t, mostly. The clinical tasks become routine faster than anyone anticipates. What genuinely changes is everything around them.

Rostering gets less flexible. With standard personal care, a provider can cover a sick call from a wide pool. With high intensity support, the pool is only as deep as the number of workers assessed competent for that person. Expect less last-minute flexibility, and expect good providers to be honest about it rather than promising coverage they can’t reliably deliver.

Documentation increases significantly. Every instance of a high intensity support should be recorded. This feels bureaucratic until the first time it matters — when a pattern in the notes reveals a developing infection three days before anyone would otherwise have noticed. The notes are a clinical instrument, not paperwork.

Handovers carry more weight. The shift change becomes the highest-risk moment of the day. Information that doesn’t transfer accurately is information lost. Watch how handovers are conducted when you visit; it’s one of the most revealing things you can observe.

Your own expertise gets complicated. Family members who’ve delivered these supports for years are often more skilled than any worker who arrives. That expertise is enormously valuable, and it can also become a source of friction — particularly when a worker follows the written plan in a way that differs from how the family has always done it. The resolution is usually to get the family’s refinements written into the plan by the clinician, so the knowledge is captured rather than contested.

Equipment becomes a logistics operation. Consumables, replacement parts, supplier accounts, delivery schedules, backup supplies for public holidays. Ask any prospective provider how they manage consumables and what happens when something runs short on a long weekend. The answer separates the organised from the hopeful.

And the person’s own authority has to be actively protected. This is the one that matters most. As support becomes more clinical, there’s a quiet gravitational pull toward treating the person as a set of procedures. Good high intensity support resists that constantly: the person directs their own care wherever they can, chooses timing where timing is flexible, and remains the author of their day. A worker who performs faultless bowel care while talking over the person’s head has got the important part wrong.

Where to start

If you’re at the beginning of this, three things are worth doing in order.

Get the clinical plans in place first. Before you talk to providers, make sure each high intensity support has a current written plan from the appropriate clinician. Everything else is built on these. Without them, competency can’t be properly assessed and funding can’t be properly justified.

Then get the evidence into your NDIS plan. Clinician reports describing what support is required, why it needs trained delivery, and what the risks are if it’s delivered badly. Specificity wins here, as it does everywhere in the scheme.

Then compare providers on competency depth, not on warmth. Everyone is warm in the first meeting. Not everyone can tell you how many of their workers are assessed for complex bowel care, who assessed them, and when they’re due for reassessment.

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We deliver high intensity supports across NSW, including complex bowel care, enteral feeding, catheter support, dysphagia support, epilepsy and seizure support, and complex wound care — within SIL homes, SDA dwellings, respite and people’s own homes. If you’d like to talk through what a particular situation needs, call 1300 271 824. We’ll give you a straight answer, including when the honest answer is that a nursing model would serve you better than ours.

General information only. This guide explains what high intensity supports involve and how they are governed — it is not clinical guidance and must not be used in place of a plan written by a treating health professional. The High Intensity Support Skills Descriptors are published and periodically revised by the NDIS Quality and Safeguards Commission; confirm current requirements at ndiscommission.gov.au. In an emergency, call 000.