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Complex Care and High Intensity NDIS Support
“Complex care” is a common term for disability support involving higher health risks or more specialised daily assistance. Under the NDIS, the official term used for many of these supports is High Intensity Daily Personal Activities.
These supports require workers to understand the participant’s individual support plan, recognise risks and know what to do when something changes. The level of support, worker skills and clinical input required will depend on the person and the activity being provided.
What Complex Care Means Under the NDIS
Not every participant who has complex health needs requires NDIS high intensity support. The key difference is what the worker is actually required to do.
Standard personal care may include help with showering, dressing or toileting. High intensity support involves specific daily activities with greater health and safety risks, such as complex bowel care, ventilator management or enteral feeding.
The NDIS Quality and Safeguards Commission has a dedicated High Intensity Daily Personal Activities Practice Standard for these supports.
Registered providers must meet the relevant requirements and ensure workers have the skills and knowledge needed for the participant’s specific support.
8 High Intensity Daily Personal Activities
Complex Bowel Care
Complex bowel care involves more than standard toileting help. The participant should have an individual bowel care plan that explains the support required, possible risks, and what workers need to do if there is a problem. Workers providing this support need training that relates to the participant’s specific bowel care needs.
Enteral Feeding and Management
Some participants receive food, fluids or medication through feeding equipment such as a PEG or other enteral feeding tube. Workers need to understand the participant’s feeding plan, safe equipment use, hygiene requirements, and signs that require medical attention.
Severe Dysphagia Management
Dysphagia means difficulty swallowing. For someone with severe dysphagia, eating and drinking can create serious choking or aspiration risks. Support should follow the participant’s individual mealtime or swallowing plan, including any requirements around food texture, fluids, positioning and signs of difficulty.
Tracheostomy Management
A tracheostomy creates an opening in the neck to help a person breathe. Workers providing tracheostomy-related support need to understand the participant’s equipment, routine care, warning signs, and emergency procedures described in their support plan.
Ventilator Management
Participants who use ventilation equipment may require trained workers to assist with the equipment and respond correctly to alarms or other problems. The exact responsibilities depend on the participant’s individual ventilator support plan.
Urinary Catheter Management
Catheter support can include assistance with catheter equipment, drainage bags, hygiene, and monitoring for problems such as blockage or infection. Workers need to understand what is part of their role and when the participant needs clinical attention.
Subcutaneous Injections
These are injections given into the tissue beneath the skin. Workers providing this support need participant-specific training covering the medication or treatment plan, safe administration, and what to do if something goes wrong.
Complex Wound Management
Complex wound support involves more than basic first aid. Workers may support activities set out in an individual wound management plan and need to recognise changes that should be reported to the appropriate health professional.
High Intensity Workers Need Training for the Participant They Support
A general disability qualification alone does not tell you whether a worker is ready to provide a particular high intensity activity. The worker needs the skills and knowledge relevant to the support they provide and the individual participant.
For registered providers, the NDIS Commission expects participant-specific training where required under the relevant high intensity standard. Training may cover:
- The participant’s support plan
- Equipment used
- Infection control
- Warning signs and risks
- Emergency and escalation steps
- Communication needs
- What the worker is and is not responsible for
Training should be delivered by an appropriately qualified health practitioner or another person who meets the requirements described by the relevant NDIS High Intensity Support Skills Descriptor.
The important question is therefore not simply, “Has the worker completed high intensity training?”
It is:
“Is this worker trained and prepared for the high intensity support I personally need?”
High Intensity Support and Community Nursing Are Different
High intensity support does not always mean a registered nurse must provide every shift.
A trained disability support worker can provide certain high intensity daily activities when the activity is within their role, the right support plan is in place, and they have the required skills.
Community nursing has a different role.
An NDIS-funded nurse may be involved in areas such as:
- Clinical assessment
- Developing or reviewing health support plans
- Nursing procedures
- More complex wound care
- Monitoring changes in health
- Providing clinical advice
- Reviewing whether a support plan remains suitable
For example, a health professional may develop and review a participant’s clinical plan while trained support workers follow that plan during regular daily support.
Some participants therefore use both disability support workers and nursing services, depending on their needs.
How High Intensity Support Is Funded Through the NDIS
The NDIS Pricing Schedule includes separate support items for high intensity personal assistance. These items have higher price limits than comparable standard personal assistance because they require additional skills and meet higher requirements.
For example, under the 2026–27 NDIS Pricing Schedule effective 1 July 2026, the national weekday daytime price limit is:
- Standard self-care support: $73.58 per hour
- High intensity self-care support: $79.60 per hour
Different limits apply for evenings, nights, weekends, public holidays and remote locations.
These are maximum NDIS price limits for the relevant arrangements, not a guarantee that every participant will receive funding at that rate.
The participant’s plan still needs to contain funding that can be used for the support being delivered.
Because NDIS pricing changes, always check the current Pricing Schedule rather than relying on an older figure.
Evidence Helps Show Why Higher Support Is Needed
High intensity funding is not added simply because a participant has a particular diagnosis.
The NDIS looks at the disability-related support the person actually needs.
Useful evidence may explain:
- The activity the participant needs assistance with
- How often the support is required
- What happens without the support
- Health and safety risks
- Equipment involved
- The level of worker skill required
- Whether support is needed during the day, overnight, or both
- Relevant recommendations from treating health professionals
Clear evidence helps show why standard personal assistance does not adequately meet the participant’s disability-related needs.
High Intensity Support Can Be Needed During SIL
A participant receiving Supported Independent Living may also need high intensity daily support. These are separate issues.
SIL describes the regular assistance or supervision the participant needs to live at home. High intensity support describes certain higher-risk personal activities that require additional worker skills.
A participant may therefore receive SIL while a registered high intensity provider delivers specific 0104 supports within their wider support arrangement.
The providers involved need clear roles so the participant, family and workers know who is responsible for each part of the support.
24/7 Support Does Not Always Mean 24/7 Complex Care
A participant may need support available around the clock without needing a high intensity activity during every hour of the day. For example, the person may need:
- Standard daily living support during some shifts
- High intensity personal assistance at set times
- Overnight supervision
- Nursing input at specific times
The roster should reflect what support is actually required. This is different from assuming that every worker on every shift needs to provide every high intensity activity.
If a participant requires high intensity assistance at different times across 24 hours, the provider needs appropriately prepared workers available for those activities.
What to Check Before Choosing a High Intensity NDIS Provider
When health risks are involved, choosing a provider based only on availability is not enough.
Check the Provider’s Registration
If you are using an NDIS-registered provider for High Intensity Daily Personal Activities, check that its registration certificate includes 0104 High Intensity Daily Personal Activities relevant to the support being delivered.
NDIA-managed participants must use registered providers for their NDIA-managed supports.
Plan-managed and self-managed participants generally have broader provider choice, although different registration rules apply to certain supports.
Ask About Participant-Specific Worker Training
Do not rely only on a statement that workers are “high intensity trained”. Ask how workers are prepared for your particular support plan, equipment and risks.
Check How Health Changes Are Handled
The provider should know what workers do when the participant’s condition changes, a support plan no longer seems suitable, or urgent medical attention is needed.
Understand Who Provides Clinical Support
If nurses or other health professionals are involved, ask what their role is and how they communicate with the disability support team.
Make Sure Responsibilities Are Clear
The service agreement should clearly explain what the provider is responsible for and which activities require another health or disability provider.
How Hilda Care Can Support Participants With Complex Needs
Participants with complex needs often use more than one type of support. Hilda Care is an approved registered NDIS provider and currently provides services including:
- Personal Care
- Supported Independent Living
- Community Participation
- Household Tasks
- NDIS Transport
- Life skills and daily living support
- Accommodation and tenancy-related supports
Provider Registration Number: 4050126032
Frequently Asked Questions About Complex Care and the NDIS
How many high intensity support areas are there under the NDIS?
The current NDIS High Intensity Daily Personal Activities module lists eight: complex bowel care, enteral feeding and management, severe dysphagia management, tracheostomy management, urinary catheter management, ventilator management, subcutaneous injections and complex wound management.
Is seizure management one of the eight high intensity areas?
No. Epilepsy and seizure management are important disability support needs, but they are not currently listed as a separate High Intensity Daily Personal Activity within the NDIS Commission’s eight Module 1 areas.
Does high intensity support always need to be provided by a nurse?
No. Appropriately trained disability support workers can deliver certain high intensity daily personal activities. Nursing is required where the support itself needs nursing assessment, judgment, or another nursing function.
What is the difference between high intensity support and community nursing?
High intensity disability support usually involves trained workers following an individual support plan for specific daily activities. Community nursing is delivered by qualified nurses and includes clinical nursing care, assessment and other tasks requiring nursing expertise.
Can high intensity support be provided as part of SIL?
Yes. A participant receiving SIL may also require specific high intensity supports. The SIL arrangement and high intensity activities need to be provided by appropriately capable providers and workers.
Do I have to use a registered high intensity provider?
If your relevant funding is NDIA-managed, you must use a registered NDIS provider. Plan-managed and self-managed participants generally have more provider choice. A registered provider can only deliver registered high intensity supports that are included in its certificate.
How do I know if a worker is trained for my support?
Ask the provider how the worker has been trained for your specific high intensity activity, support plan, and equipment, rather than asking only whether they hold general high intensity training.
What should I do if my support needs become more complex?
Speak with your healthcare team and your NDIS contact or support coordinator. Updated evidence can help show how your needs have changed and what additional disability-related support is required.
Get the Right Support for Complex Daily Needs
Complex support works best when every provider understands its role and the workers involved have the right skills to deliver it.
If you need personal care, Supported Independent Living, household assistance, community participation, transport or other Hilda Care services alongside your clinical or high intensity supports, our team can discuss how these services fit into your current NDIS arrangement.
Registered NDIS Provider – 4050126032
Call 1300 440 777 to discuss your support needs.