What Are High Intensity Supports at Home?

High intensity means a specific trained skill, not simply more care

High intensity supports are ordinary daily supports that carry clinical risk if they are done badly, so the person delivering them has to be trained and assessed for that exact task and has to work to a plan written by a health professional. Enteral feeding through a PEG, complex bowel care, tracheostomy and ventilator support, urinary catheter support, subcutaneous injections, complex wound care, support for severe swallowing difficulty and seizure support all sit in this group.

From the outside the support can look completely unremarkable. Someone has breakfast, has a shower, gets ready for bed. What makes it high intensity is that the method is prescribed, the risks are documented, and the worker on shift has been signed off as competent in that one task rather than being generally experienced.

What sits behind the support when it is set up properly

The NDIS Quality and Safeguards Commission publishes High Intensity Support Skills Descriptors, which set out what a worker needs to be able to do for each of these support types, and registered providers delivering them are audited against an additional module of the NDIS Practice Standards rather than the core standards alone. You can read the Commission's material directly at the NDIS Quality and Safeguards Commission.

In a household that is running well, three things exist behind the support. There is a current plan from the relevant clinician, a speech pathologist for swallowing, a continence nurse for catheter care, a GP or neurologist for seizure management. There is a training and competency record for every worker who appears on the roster for that task. And there is one written procedure that the whole team follows the same way, so the Tuesday worker and the Sunday worker do it identically.

All three are reasonable things to ask to see. A provider who cannot produce them for the specific support you need is not set up for that support, whatever else they do well.

Who is actually allowed to do it

Support workers deliver most high intensity supports, but only after task-specific training and a competency assessment, and with a nurse or the relevant clinician available to supervise, review the plan and update it when the person's needs change. Some tasks stay with a registered nurse. Where the line falls depends on the individual, the task and the delegating clinician's judgement, so it is not a rule you can look up once and apply to everybody.

This is the situation where the difference between roles matters more than usual. Our explainer on who does what at home unpicks the language if it is new to you. The short version is that a delegation from a clinician is what allows a support worker to carry out a clinical task, and that delegation is specific to a named person, a named task and a named worker. It does not travel with the worker to the next house.

How the funding works

High intensity personal care is claimed against your Core supports budget, at line items priced for the higher skill level rather than at a standard personal care rate. The ceilings sit in the NDIS Pricing Arrangements and Price Limits, and the level claimed has to match the support that was actually delivered on the shift.

Two consequences are worth knowing before you compare notes with another family. Your Core budget buys fewer hours at high intensity rates than at standard rates, so an hours figure from someone else's plan tells you very little without knowing the mix behind it. And the funding usually rests on clinical evidence in the plan that names the support, which means an assessment or a report, not a general description of a demanding week.

Nights are the part most families underestimate

A support that is straightforward at nine in the morning is a different proposition at three in the morning. Seizure monitoring, repositioning, suctioning, ventilator alarms and overnight feeds all need somebody awake and competent, which is active overnight support rather than a sleepover, and the two are rostered and priced differently.

If nights are part of the picture, work them out first, because they shape both the roster and the budget more than any daytime hour does. We set out how the two arrangements differ in active and passive overnight support.

Questions worth asking before the first shift

Keep these specific to the task rather than general. A provider can answer yes to "do you do high intensity supports" while having nobody trained in the one you need.

• Which of your workers are signed off for this exact support, and how many of them are on our roster?
• Who is the clinician supervising it, and how often do they review the plan?
• What happens when the trained worker calls in sick on a Sunday?
• Who writes the procedure, and can we see the version in use right now?
• How is a change in the person's condition escalated, and to whom, at 2am?

That last question separates providers more sharply than any of the others. The answer should be a name, a number and a time frame, not a promise that somebody is always available.

Adding it to support that already exists

Plenty of households start with standard in-home support and add a high intensity task later, after a hospital stay or a change in health. That is a normal path, and it is easier when the existing team is stable, because the training and sign-off then attaches to workers who already know the person.

The practical work is sequencing: get the clinical plan first, then the training and competency sign-off, then the roster change, then the claim at the correct line item. Doing it in that order avoids the common mess of a shift being delivered before anyone is authorised to deliver it. You can see how our own in-home support is structured if you are comparing setups.

Frequently asked questions

Do I need a nurse to do high intensity supports at home?

Not always. Many high intensity supports can be delivered by a support worker who has completed task-specific training and a competency assessment, working to a plan written and reviewed by the relevant clinician. Some tasks do stay with a registered nurse. The decision sits with the delegating clinician and depends on the person, the task and the setting, so it is worth asking who has made that call for your situation and when it was last reviewed.

Does high intensity support need extra funding in my plan?

It is claimed from your Core supports budget at line items priced for a higher skill level, so the same dollars buy fewer hours than standard personal care. The NDIS Pricing Arrangements and Price Limits set the ceilings. Funding decisions sit with the NDIA and generally turn on clinical evidence that names the support, so an assessment or report from the treating professional matters more here than a general account of how busy the household is.

How do I check a provider is genuinely set up for it?

Ask for three documents about the specific support you need: the clinical plan it follows, the competency records of the workers on your roster, and the written procedure in current use. Ask how many trained workers cover your shifts, including weekends and nights. Registered providers delivering these supports are audited against an additional module of the NDIS Practice Standards, so this material exists where the setup is real.

What happens if the trained worker is unavailable?

This is the gap that causes most trouble in practice, because the delegation is specific to named workers rather than to the agency as a whole. A provider should be able to name the backup workers signed off for the same task and say plainly what happens if none is available, including whether the support is deferred, escalated to a nurse, or covered another way. Get that answer before you start, not during the first sick day.