High intensity support refers to NDIS funding for participants with complex health care needs requiring specialized assistance. These supports address high physical needs (like enteral feeding, tracheostomy care, or ventilator support) or high behavioral needs (severe challenging behaviors requiring specialist intervention).

High intensity supports are among the highest-risk NDIS services, requiring registered providers, specialized staff training, and strict quality and safeguarding standards.

This guide explains what qualifies as high intensity support, the three support levels, provider requirements, how to access funding, and what participants and families need to know.

What Counts as High Intensity Support?

The NDIS defines high intensity supports as assistance with daily personal activities that involve higher risk complex health care or behaviors of concern.

High Physical Needs: Complex Health Care

High intensity daily personal activities include:

  1. Enteral feeding support

    • Tube feeding via nasogastric (NG), gastrostomy (PEG), or jejunostomy tubes
    • Preparation of feeds
    • Administration and monitoring
    • Managing equipment and tubing
    • Recognizing and responding to complications

  2. Tracheostomy support

    • Suctioning and airway management
    • Tracheostomy tube care and cleaning
    • Emergency response for blocked airways
    • Equipment management

  3. Ventilator support

    • Non-invasive ventilation (CPAP, BiPAP)
    • Invasive mechanical ventilation
    • Monitoring and troubleshooting
    • Emergency backup procedures

  4. Complex wound care

    • Pressure injury management (Stage 3 and 4)
    • Surgical wound care
    • Wound VAC therapy
    • Debridement and specialized dressings

  5. Urinary catheter management

    • Indwelling catheter care
    • Suprapubic catheter management
    • Monitoring for infections
    • Catheter changes (by qualified nurse)

  6. Complex bowel care

    • Manual evacuation
    • Colostomy/ileostomy care
    • Specialized bowel management programs
    • Managing complex constipation or incontinence

  7. Subcutaneous injections

    • Insulin administration for diabetes
    • Other prescribed injectable medications
    • Monitoring blood glucose
    • Managing hypo/hyperglycemia

  8. Seizure management (severe/complex epilepsy)

    • Rescue medication administration (buccal midazolam, rectal diazepam)
    • Seizure monitoring and recording
    • Emergency response protocols
    • Vagal nerve stimulator management

  9. Severe dysphagia support

    • Modified texture diets
    • Thickened fluids
    • Feeding strategies to prevent aspiration
    • Monitoring for choking or aspiration

  10. Diabetes management (complex)

    • Blood glucose monitoring (multiple times daily)
    • Insulin administration
    • Carbohydrate counting and meal planning
    • Hypoglycemia management

High Behavioral Needs

Behaviors of concern requiring specialist support:

  • Severe self-injurious behavior
  • Aggression toward others
  • Property destruction
  • Behaviors requiring restrictive practices
  • Complex mental health presentations

Note: Behavior support is covered under specialist behavior support services (separate from high intensity daily personal activities).

Three Levels of High Intensity Support

The NDIS categorizes high intensity support into three levels based on complexity, frequency, and risk.

Level 1: Basic High Intensity Support

Characteristics:

  • Occasional or intermittent high intensity support
  • Lower complexity procedures
  • Support worker with specialized training (not always requiring RN)
  • Some decision-making by support worker within protocols

Examples:

  • PRN (as needed) seizure medication administration
  • Simple wound dressing changes (following RN plan)
  • Blood glucose monitoring for stable diabetes
  • Basic dysphagia support (modified textures under SLP plan)
  • Urinary catheter routine care (not changes)

Staff requirements:

  • Certificate III or IV in disability or aged care
  • Specific competency training for the task
  • Supervision by RN or health professional
  • Clear protocols and emergency procedures

Level 2: Intermediate High Intensity Support

Characteristics:

  • Regular, daily high intensity support
  • Moderate complexity procedures
  • Mix of support worker and RN involvement
  • Detailed care plans and protocols required

Examples:

  • Daily enteral feeding administration
  • Regular tracheostomy suctioning and care
  • Multiple daily blood glucose checks with insulin administration
  • Complex wound care following RN plan
  • Frequent seizure management

Staff requirements:

  • Advanced training in specific procedures
  • Direct RN supervision or delegation
  • Competency assessments and ongoing training
  • Emergency response capability

Level 3: Advanced High Intensity Support

Characteristics:

  • Continuous or very frequent high intensity support
  • High complexity, high-risk procedures
  • RN involvement required (often on-site or on-call)
  • Multiple concurrent high-risk supports
  • 24/7 monitoring or intervention capability

Examples:

  • Ventilator support (invasive or non-invasive)
  • Multiple high-risk procedures (e.g., trach + feeding tube + seizures)
  • Complex medical needs requiring RN oversight
  • Participants requiring hospital-level care at home

Staff requirements:

  • Registered Nurses on staff or on-call
  • Highly trained support workers
  • Specialist clinical oversight
  • Emergency response protocols
  • Backup systems and contingency plans

NDIS Practice Standards for High Intensity Support

Providers delivering high intensity daily personal activities must be NDIS registered and certified against the High Intensity Daily Personal Activities module of the NDIS Practice Standards.

What This Means for Providers

Registration requirements:

  1. Quality management systems - Documented policies and procedures
  2. Incident management - Systems for reporting and responding to incidents
  3. Clinical governance - RN or health professional oversight
  4. Staff training and competency - Demonstrated skills in specific high-risk procedures
  5. Participant safeguarding - Protection from harm, abuse, or neglect
  6. Emergency preparedness - Protocols for medical emergencies
  7. Restrictive practices management - If applicable

Skills Descriptors

The NDIS Commission publishes High Intensity Support Skills Descriptors outlining:

  • Required knowledge and skills for each high-risk activity
  • Supervision requirements
  • Training and assessment standards
  • Delegation rules (what RNs can delegate to support workers)

Example: Enteral Feeding Skills Descriptor

Support workers providing enteral feeding must demonstrate:

  • Knowledge of different feeding tubes and administration methods
  • Ability to prepare and administer feeds safely
  • Recognition of complications (blockages, infections, aspiration)
  • Emergency response for choking or tube dislodgement
  • Documentation and reporting
  • Infection control and hygiene

Supervision: RN must develop care plan, assess competency, and provide ongoing oversight.

How to Access High Intensity Support Funding

Step 1: Medical Evidence and Assessments

To access high intensity support, you’ll need:

Medical documentation:

  • Diagnosis and prognosis from specialist or GP
  • Details of complex health care needs
  • Treatment plans and protocols
  • Evidence that supports are ongoing (not short-term)

Functional assessments:

  • Occupational therapy assessment
  • Physiotherapy assessment (if relevant)
  • Speech pathology assessment (for dysphagia)
  • Nursing assessment of care needs

Care plans:

  • Detailed plan for each high-risk activity
  • Developed by appropriate health professional (RN, SLP, OT)
  • Protocols for routine care and emergencies

Step 2: Planning Meeting

At your NDIS planning meeting:

Be specific about needs:

  • Detail each high intensity support required (e.g., “I require enteral feeding support 3 times daily, tracheostomy suctioning as needed, and seizure management with rescue medication”)
  • Explain frequency and duration
  • Provide medical evidence

Link to goals:

  • Living at home (instead of hospital or residential care)
  • Community participation with appropriate health support
  • Maintaining health and preventing complications

Discuss provider requirements:

  • Need for registered provider with high intensity certification
  • RN involvement required
  • Staff training and competency needs

Step 3: Funding Allocation

High intensity support is funded under:

Core Supports: Assistance with Daily Living

  • Daily personal care with high intensity needs
  • Often the largest budget category for participants with complex needs

Capital Supports:

  • Equipment for high intensity support (feeding pumps, suction machines, ventilators)
  • Home modifications for safe care (ceiling hoists, accessible bathrooms)

Capacity Building:

  • Training for family members (if appropriate)
  • Skill development to reduce support needs (if possible)

Typical budget ranges:

  • Level 1 high intensity needs: $50,000-150,000/year
  • Level 2 high intensity needs: $150,000-350,000/year
  • Level 3 high intensity needs: $350,000-800,000+/year

Note: Budgets vary widely based on hours of support needed, complexity, and other disability-related supports.

Choosing a High Intensity Support Provider

Must Be Registered

Only registered NDIS providers can deliver high intensity supports.

Check provider registration:

  • NDIS Provider Finder (ndis.gov.au)
  • Confirm certification for High Intensity Daily Personal Activities module
  • Verify registration is current

What to Look for in Providers

1. Clinical expertise

  • RN on staff or contracted
  • Experience with your specific needs (e.g., tracheostomy care)
  • Positive references from other participants with similar needs

2. Staff training and competency

  • How do they train staff?
  • Competency assessment processes?
  • Ongoing professional development?
  • RN supervision model?

3. Consistency and reliability

  • Same regular support workers (reduces risk of errors)
  • Backup systems when regular staff unavailable
  • 24/7 on-call support (for emergencies)

4. Emergency preparedness

  • Emergency response protocols
  • Staff trained in CPR and first aid
  • Equipment backup plans
  • Hospital transfer procedures

5. Communication

  • Regular updates to families and health professionals
  • Incident reporting processes
  • Coordination with treating doctors and specialists
  • Documentation systems

Questions to Ask Providers

  1. Are you registered for high intensity daily personal activities?
  2. Do you have RN oversight for participants with [my specific needs]?
  3. What training do support workers receive for [enteral feeding/tracheostomy/etc.]?
  4. How do you assess and maintain staff competency?
  5. What happens in an emergency?
  6. What is your staff turnover rate?
  7. Can you provide references from participants with similar needs?
  8. What are your backup systems if regular staff are unavailable?

Equipment and Consumables for High Intensity Support

Medical Equipment (Capital Supports)

NDIS may fund:

  • Feeding pumps and stands ($1,500-5,000)
  • Suction machines ($800-3,000)
  • Ventilators (Complex, $10,000-50,000+ may be health system responsibility)
  • Oxygen concentrators (usually health system, NDIS may contribute)
  • Patient hoists and slings ($3,000-12,000)
  • Specialized beds ($5,000-15,000)

Consumables (Core Supports)

NDIS funds ongoing supplies:

  • Feeding tube supplies (tubes, syringes, giving sets)
  • Tracheostomy supplies (suction catheters, cleaning supplies)
  • Wound care supplies (dressings, bandages, creams)
  • Catheter supplies (catheters, bags, cleaning supplies)
  • Incontinence products
  • Gloves, hand sanitizer, infection control supplies
  • Diabetes supplies (test strips, lancets, sharps containers)

Budget: Consumables for high intensity needs can range from $5,000-$30,000/year depending on requirements.

Health System vs NDIS Responsibility

Health system funds:

  • Acute medical care and treatment
  • Hospital stays
  • GP and specialist consultations
  • Prescription medications
  • Some medical equipment (ventilators, oxygen therapy)

NDIS funds:

  • Disability-related daily living support
  • Support workers to administer health care
  • Equipment for disability-related needs
  • Consumables for ongoing care

Gray areas:

  • Some equipment and supplies overlap
  • Coordination between health system and NDIS required
  • Advocate if there’s confusion about who funds what

Family Member Training and Support

Can Family Members Provide High Intensity Support?

NDIS position:

  • NDIS generally will not pay family members to provide support
  • Family members can provide support voluntarily
  • NDIS recognizes many families already provide complex care

What NDIS Will Fund for Families

1. Training for family members

NDIS can fund:

  • RN or health professional to train family members in specific procedures
  • Competency assessments
  • Refresher training
  • Emergency response training

Cost: $200-500 per training session

2. Respite for family carers

Critical for families providing high intensity support:

  • In-home respite (respite worker provides care while family rests)
  • Out-of-home respite (participant stays in respite facility)
  • Emergency respite

Budget: $10,000-50,000/year for families providing significant care

3. Equipment and consumables

NDIS funds all necessary equipment and supplies, whether care is provided by family or paid supports.

Supporting Family Carers

Organizations that help:

  • Carers Australia (1800 242 636)
  • State-based carer support organizations
  • Hospital social workers
  • Support coordinators

Resources:

  • Carer Payment and Carer Allowance (Centrelink)
  • Carer respite services
  • Peer support groups
  • Carer counseling services

Safety and Quality in High Intensity Support

Incident Management

Reportable incidents for high intensity support:

  • Medication errors
  • Aspiration or choking
  • Equipment failure
  • Injury during care
  • Hospital admissions related to care
  • Any serious incident

Provider responsibilities:

  • Report to NDIS Commission within 24 hours (for serious incidents)
  • Investigate and respond
  • Implement preventive measures
  • Review and update care plans

Participant/family responsibilities:

  • Report concerns to provider
  • Contact NDIS Commission if provider doesn’t respond appropriately
  • Keep records of incidents

Restrictive Practices

Some participants with high intensity needs may also have regulated restrictive practices in place (e.g., physical restraint, seclusion, chemical restraint).

If you have restrictive practices:

  • Must be approved by state/territory authority
  • Included in behavior support plan
  • Reviewed regularly
  • Provider must be authorized to use restrictive practices

Goal: Reduce and eliminate restrictive practices over time through positive behavior support.

Transitioning to High Intensity Support

From Hospital to Home

Many participants with high intensity needs transition from hospital to home.

Discharge planning:

  • Hospital discharge planner coordinates with NDIS
  • Equipment and supplies arranged before discharge
  • Provider identified and staff trained
  • Family training completed
  • Emergency protocols in place
  • Trial period with support before full discharge

Timeline: Can take 2-6 months to safely transition from hospital to home with high intensity needs.

From Family Care to Paid Supports

Reasons for transition:

  • Family carer aging or unable to continue
  • Participant’s needs increasing
  • Family burnout
  • Participant wanting more independence

Gradual transition recommended:

  1. Start with occasional respite supports
  2. Introduce regular support workers (few hours/week)
  3. Gradually increase hours as trust builds
  4. Family provides backup and supervision initially
  5. Full transition to paid supports over 6-12 months

School to Adult Services

For young adults with high intensity needs:

  • Planning starts at age 15-17
  • Identify adult service providers
  • Trial placements and providers
  • Skills development for independence (where possible)
  • Coordination between school, health, and NDIS

Costs and Funding Considerations

High Intensity Support Pricing

NDIS Price Guide 2024-25:

Support TypeWeekday DayWeekday EveningSaturdaySundayPublic Holiday
Standard personal care$54.24$63.47$73.00$91.84$117.69
High intensity support$68.40-$103.32$80.10-$120.89$91.80-$138.64$115.38-$174.22$148.06-$223.64

Price depends on:

  • Level of complexity (Level 1, 2, or 3)
  • Provider qualifications (support worker vs RN)
  • Time of day and week
  • Urban vs regional location

Annual Budget Examples

Example 1: Level 1 High Intensity (Seizure Management)

  • 2 hours/day support with seizure training
  • Occasional rescue medication
  • RN oversight (not on-site)

Estimated annual cost: $60,000-90,000

Example 2: Level 2 High Intensity (Enteral Feeding + Tracheostomy)

  • 6 hours/day support
  • 3x daily feeding + routine trach care
  • RN check-ins weekly

Estimated annual cost: $180,000-280,000

Example 3: Level 3 High Intensity (Ventilator + Multiple Complex Needs)

  • 24/7 support (2:1 ratio part of day)
  • RN on-site or on-call 24/7
  • Multiple high-risk procedures

Estimated annual cost: $500,000-800,000+

Is There a Funding Cap?

No hard cap, but:

  • Funding must meet reasonable and necessary criteria
  • NDIA reviews high-cost plans closely
  • Must demonstrate supports are disability-related
  • May require independent assessments
  • Hospital or residential care cost comparisons

If your plan is underfunded:

  • Request plan review
  • Provide updated medical evidence
  • Show current funding is insufficient
  • Demonstrate unmet needs
  • Seek advocacy support

Rights and Protections

Your Rights as a High Intensity Support Participant

You have the right to:

  • Safe, high-quality support
  • Registered providers with appropriate skills
  • Choice and control over your supports
  • Dignity and respect
  • Privacy and confidentiality
  • Complain without retaliation
  • Access your health records and care plans
  • Refuse support or treatment

NDIS Quality and Safeguards Commission

Contact the Commission if:

  • Provider is not delivering safe support
  • Incidents are not being managed appropriately
  • Staff lack proper training or skills
  • You experience abuse, neglect, or exploitation
  • Provider is breaching practice standards

Phone: 1800 035 544 Website: ndiscommission.gov.au

Disability Discrimination Act: Protects against discrimination in health care, services, and supports.

State-based safeguarding: Each state has adult safeguarding laws protecting people with disability from abuse and neglect.

Frequently Asked Questions

What happens in an emergency?

Your provider should have emergency protocols including:

  • Staff trained in first aid and CPR
  • Emergency contact numbers (000, family, doctors)
  • Hospital transfer procedures
  • Equipment backup plans

Your responsibility: Keep emergency plans visible and accessible. Update contact numbers regularly.

Can I travel with high intensity support needs?

Yes, but requires careful planning:

  • Discuss with provider well in advance
  • Arrange travel support workers (may be same staff)
  • Transport equipment and supplies
  • Research hospital locations at destination
  • Emergency plans for travel
  • Additional costs may apply

What if my provider can’t find staff?

NDIS thin markets:

  • Some areas have limited high intensity support providers
  • Regional and remote areas particularly affected

Solutions:

  • Request Specialist Support Coordinator
  • Consider providers willing to travel (additional costs)
  • Explore live-in support options
  • Build family capacity with paid respite
  • Advocate to NDIA for market development

Can I manage my own high intensity supports?

Self-management or plan management:

  • Yes, you can self-manage
  • You are responsible for finding and paying support workers
  • Workers must still meet competency requirements
  • RN oversight still required
  • Higher administrative burden

Consider:

  • Do you have time and skills to manage?
  • Can you recruit and train staff?
  • Are you comfortable with HR and payroll?
  • Support coordination can help

Key Takeaways

High intensity support is for complex health care needs:

  • Enteral feeding, tracheostomy, ventilator support, seizures, complex wound care
  • Three levels based on complexity and risk
  • Requires registered providers with specialized training

Safety is paramount:

  • Providers must be NDIS registered for High Intensity Daily Personal Activities
  • RN oversight required
  • Staff training and competency essential
  • Emergency preparedness critical

Funding is available:

  • Core Supports for daily assistance
  • Capital Supports for equipment
  • Capacity Building for training
  • No hard cap, but must be reasonable and necessary

Plan ahead:

  • Get comprehensive medical evidence
  • Detailed care plans from health professionals
  • Link supports to NDIS goals (living at home, community participation)
  • Choose experienced, registered providers

Know your rights:

  • Safe, high-quality support
  • Choice and control
  • Complain to NDIS Commission if needed
  • Access advocacy support

High intensity support enables participants with complex needs to live at home, participate in their community, and maintain health and wellbeing outside of institutional settings. With the right supports and providers, quality of life and independence are achievable.