Some participants need daily support that is closely tied to their health, such as help with a feeding tube, a catheter or a ventilator. The NDIS calls these high intensity daily personal activities. This guide explains the 8 activities, what registration means for providers and what to ask before support starts.
What are high intensity daily personal activities?
They are daily personal supports that carry more risk and need specific skills. The NDIS Commission requires providers supporting participants with these needs to make sure their workers have the skills and knowledge set out in the high intensity support skills descriptors.
What are the 8 high intensity activities?
The NDIS Commission lists these activities:
- Complex bowel care: support for people whose bowel care needs are beyond routine assistance.
- Enteral feeding and management: feeding through a tube, such as a naso-gastric tube, and managing the equipment.
- Severe dysphagia management: supporting people who have serious difficulty swallowing, including how food and fluids are prepared.
- Tracheostomy management: caring for a tracheostomy, the opening in the neck that helps someone breathe.
- Urinary catheter management: including in-dwelling, in-out and suprapubic catheters.
- Ventilator management: supporting someone who uses a ventilator to breathe.
- Subcutaneous injections: giving injections under the skin, as prescribed.
- Complex wound management: caring for wounds that need more than simple first aid.
What does registration mean for these supports?
To be registered for the high intensity daily personal activities group (registration group 104), a provider is assessed against a supplementary module of the NDIS Practice Standards. Registered providers can only deliver the specific high intensity activities set out in their certificate of registration. It is reasonable to ask a provider which activities are on theirs.
How should workers be trained?
The Commission expects workers to be trained for each participant’s specific needs, where relevant by an appropriately qualified health practitioner or someone who meets the skills descriptor. Training for one person’s catheter care does not automatically cover another person’s.
What should a support plan include?
The Practice Standards set out what good support looks like. For each activity, they expect that:
- the participant is involved in assessing their needs and writing their plan
- with consent, a qualified health practitioner reviews their health regularly
- the plan says how risks, incidents and emergencies will be managed
- the provider has policies, procedures and a training plan for the workers involved
What does good severe dysphagia support look like?
For severe dysphagia, the Practice Standards expect providers to identify every participant who needs this support, and to have their needs assessed by qualified health practitioners, with regular reviews if needs change or difficulties are noticed. The participant helps write their plan, which records their needs and preferences for food, fluids, preparation techniques and feeding equipment, and how risks, incidents and emergencies will be handled.
What about enteral feeding?
For enteral feeding, the aim is that each participant receives the nutrition, fluids and medication they need. Workers should be trained for the specific participant, including the type and method of feeding and the feeding regime, by an appropriately qualified health practitioner.
Can family members be trained too?
Sometimes. The NDIS explains that a support worker, family member or friend may be able to provide some disability-related health supports, as long as they are trained by an appropriately qualified health professional, for that task and specifically for the person. For example, a registered nurse can train a worker or family member to help prevent pressure sores and wounds.
How is it different from community nursing?
Some high intensity activities are delivered by trained support workers as part of daily personal support. Others, or more complex parts of them, need a nurse. The NDIS funds disability-related health supports that may be delivered by either, depending on the task and risk. See our community nursing page for nurse-led care.
What should you ask a provider?
- Is this activity listed on your certificate of registration?
- Who trains your workers for my specific needs, and how often is training refreshed?
- Who reviews my plan, and how often?
- What happens in an emergency, and who is on call?
- How will you make sure a trained worker covers leave and sick days?
Related reading: registered vs unregistered NDIS providers and what is supported independent living. For everyday routines, see NDIS personal care.