A family can spend weeks organising a loved one's daily care and still feel unsure about one important question: which parts of that care can the NDIS fund as high intensity support? A urinary catheter change, stoma routine or enteral feeding plan may happen at home, but these tasks can involve clinical risk that ordinary personal care doesn't carry.
The distinction matters. Showering, dressing and help with toileting generally sit within routine daily assistance. Catheter management, complex bowel care, tracheostomy support and other regulated activities require a more specific pathway, appropriate worker competency and clinical oversight. The NDIS Commission describes the relevant skills descriptors as supplementary guidance for providers and workers supporting participants who need complex daily personal supports. NDIS Commission guidance on High Intensity Support Skills Descriptors helps clarify the difference.
Table of Contents
- Understanding High Intensity Support Under the NDIS
- What Qualifies as High Intensity Daily Personal Activities
- Eligibility and Funding Rules for Complex Care
- Continence Care Versus High Intensity Clinical Tasks
- The Assessment and Evidence Gathering Process
- How to Request or Review High Intensity Funding
- Common Questions About High Intensity NDIS Supports
Understanding High Intensity Support Under the NDIS
Consider a participant who relies on a suprapubic catheter, needs a structured bowel program and receives nutrition through a feeding tube. Their family may already have a roster, support workers and medical instructions, yet still wonder whether the NDIS will fund the support, whether a disability support worker can perform the tasks, and who must train that worker.
High intensity support under the NDIS exists for daily personal activities where the task itself carries a higher risk and requires specific clinical knowledge. The formal category is High Intensity Daily Personal Activities, often shortened to HIDPA. It isn't a label for a participant with significant disability, extensive support hours or a complex diagnosis. The classification follows the nature of the activity and the skill required to perform it safely.
The purpose is practical. A participant should receive consistent support from workers who understand the individual's health plan, recognise warning signs and know when to escalate a concern. The worker may perform the task without a nurse physically present every time, but the provider must have the right clinical arrangements, training and competency checks in place.
Australia's disability support system has expanded alongside demand for complex assistance. The national NDIS data dashboard recorded 252,637 total participants in July to December 2022, compared with 219,083 in July to December 2021, representing a 15% increase. National NDIS data shows the broader scheme is substantial, which makes clear documentation and safe workforce practices increasingly important for participants with complex daily needs.
Practical rule: The support isn't high intensity because the person's life is complicated. It's high intensity because the specific daily task carries clinical risk and requires verified skills.
Families are also managing the physical environment around care. A bathroom may need safer access, clearer transfer space or equipment that supports dignity during toileting. For ideas about accessibility planning outside the NDIS clinical pathway, this guide to Dublin bathroom accessibility renovation provides useful design context, although any NDIS funding decision still depends on the participant's own plan and reasonable and necessary requirements.
What Qualifies as High Intensity Daily Personal Activities
The safest way to identify a high intensity activity is to ask, “What exactly does the worker need to do, and what could go wrong if they lack the required skill?” The answer should focus on the task, not only on the person's diagnosis or the number of support hours.
The NDIS Commission's high intensity framework covers daily personal activities such as:
- Enteral feeding and nutrition management: Supporting nutrition through a PEG or nasogastric tube, including following the participant's feeding and safety instructions.
- Complex bowel care: Delivering a structured bowel program that may include digital stimulation or manual evacuation.
- Urinary catheter management: Managing catheter-related tasks, including insertion, changes and care of a suprapubic catheter where the activity falls within the relevant clinical support requirements.
- Tracheostomy care: Supporting the tracheostomy, including suctioning and monitoring for complications.
- Ventilated breathing support: Assisting a participant who relies on ventilator equipment and requires trained monitoring.
- Subcutaneous injections: Delivering injections where the task is included in the participant's support arrangements and the worker has been trained and assessed.
- Severe dysphagia support: Following a participant-specific plan where swallowing difficulty creates a serious safety concern.
- Complex wound care: Supporting wound management that requires more than ordinary skin care or changing a simple dressing.
A support worker shouldn't treat a general online course as enough evidence of competence. The provider needs a participant-specific approach, with training delivered or overseen by an appropriately qualified health professional and competency verified for the actual task. The NDIS Commission's High Intensity Daily Personal Activities supplementary module sets the regulatory context for these high-risk supports.
What usually isn't high intensity
Routine help with showering, dressing, ordinary toileting, changing a pad or preparing a meal doesn't automatically become high intensity because a participant has a serious disability. A worker may still need good manual handling, communication and personal care skills, but those requirements differ from clinical competency for catheter care or enteral feeding.
The distinction can be easy to miss. A participant may need help transferring to the toilet, cleaning themselves and changing a continence aid. That's different from inserting a catheter, managing a suprapubic catheter or carrying out a complex bowel procedure. The clinical task determines the classification, not the participant's support hours alone.
Watch the video below as another general learning resource about high intensity support tasks and safe delivery.
A written support plan should name the task, explain the participant's needs, identify risks and set out escalation steps. It should also make clear which workers have been trained and assessed as competent.
Eligibility and Funding Rules for Complex Care
A participant generally needs to show that a recognised high intensity daily personal activity is required as part of their regular disability-related support. The evidence should explain what the task is, why the participant needs it, how often it occurs and why a worker with specialised competency is required.
High intensity daily personal activities are generally funded through the Core Supports budget, within Assistance with Daily Life, subject to the participant's individual plan and the reasonable and necessary criteria. The NDIS doesn't approve a task solely because it appears on a clinical list. The request must connect the activity to the participant's disability-related functional needs and show that the support is appropriate for the NDIS rather than another service system.
| Eligibility Criterion | What It Means for Participants |
|---|---|
| Disability-related need | The daily activity must arise from the participant's disability-related functional limitations, rather than an unrelated short-term health issue. |
| Recognised high intensity task | The request should identify the actual task, such as catheter management, complex bowel care or enteral feeding, rather than using only broad language such as “complex care”. |
| Regular daily support | The evidence should describe the routine, frequency and circumstances in which the activity is required. |
| Reasonable and necessary support | The request should explain how the support relates to the participant's goals, safety, independence and daily functioning. |
| Appropriate funding responsibility | The evidence should distinguish ongoing disability support from acute treatment or hospital care that belongs to the health system. |
| Trained and competent delivery | The provider must be able to show that workers have task-specific training, competency verification and suitable clinical oversight. |
The boundary with the health system can cause anxiety. A participant may need stable, ongoing assistance with a clinical task in their home or community, while a hospital remains responsible for acute treatment, emergency management and hospital-based care. The exact responsibility depends on the circumstances, so families should ask the treating team and NDIS contacts to document the boundary rather than relying on an informal assumption.
Continence needs sit across this boundary too. The NDIS may fund continence products and supports when incontinence directly relates to disability, and the NDIS and Continence Foundation guidance states that a nurse continence specialist assessment is needed as evidence for plan inclusion. NDIS continence guidance also records that over 7.2 million Australians live with incontinence, while a continence source reports that about one in three Australians with disability experience it.
Routine continence products or personal care aren't automatically HIDPA. Catheter management and complex bowel programs may involve high intensity clinical tasks, but ordinary pad changes and toileting assistance usually require a different funding explanation.
Continence Care Versus High Intensity Clinical Tasks
Families often use “continence care” as a broad phrase, but it can describe very different activities. A support worker might help a participant reach the toilet, change a pad and protect fragile skin. Another worker might manage a suprapubic catheter or follow a bowel program involving digital stimulation. Both support dignity, but the clinical risk and competency requirements aren't the same.
| Care Aspect | Routine Continence Care | High Intensity Clinical Tasks |
|---|---|---|
| Typical activity | Toileting assistance, changing pads or pull-ups, cleaning and basic skin care | Catheter insertion or changes, suprapubic catheter care, complex bowel care or clinically complex stoma management |
| Main risk | Falls, skin irritation, loss of dignity or missed personal care needs | Infection, bleeding, tissue injury, blocked equipment, aspiration or deterioration if the procedure is performed incorrectly |
| Worker preparation | Personal care training, communication skills and relevant participant-specific instructions | Task-specific clinical training, competency assessment, documented support plan and appropriate delegation or supervision |
| Funding discussion | Routine personal care or relevant continence consumables, depending on the participant's plan | Assistance with Daily Life high intensity support where the task meets NDIS requirements |
| Example | Helping someone remove a wet pad, wash and apply a skin barrier | Changing a catheter under an individualised clinical plan or carrying out a complex bowel procedure |
Stoma care needs careful description. Emptying or replacing an appliance may be straightforward in one person's routine, while another participant may have skin breakdown, an unusual stoma, leakage complications or a plan requiring clinical judgement. The report should describe the actual activity and risk rather than assuming every stoma-related task has the same classification.
Urinary catheter management is a clearer example of a high intensity clinical task. A worker may need to follow sterile or clean technique requirements, identify blockage or infection concerns, understand the catheter type and know when to contact a nurse or medical service. The same principle applies to complex bowel care, where timing, technique, positioning and escalation instructions matter.
For families looking at non-NDIS clinical options, information about pelvic floor therapy for incontinence may help explain how assessment and rehabilitation can differ from daily support delivery. Therapy doesn't replace a continence assessment or a high intensity support plan when a participant needs catheter or complex bowel management.
Ask the provider: “Which exact task is being funded, who trained the worker, and where is the participant-specific competency recorded?”
The Assessment and Evidence Gathering Process
A strong request begins with an assessment that translates daily care into clear functional and clinical evidence. A registered nurse, continence nurse specialist or relevant allied health professional should describe what the participant needs in practical terms, rather than stating that the person has “complex care”.
Start with the participant's daily routine
Before the assessment, keep a short care record. Note what support occurs, who provides it, how often the task arises, what equipment is used and what happens when trained assistance isn't available. Include near misses, skin problems, blocked equipment, bowel complications or other concerns if they're relevant and documented accurately.
Bring current clinical information, including diagnoses, discharge information, medication details where relevant, catheter or bowel plans, equipment instructions and contact details for treating clinicians. The assessor needs enough context to connect the task to the participant's disability-related functional needs.
Describe the task, risk and worker requirements
A useful report should explain:
- The activity: Name the specific task, such as suprapubic catheter care, complex bowel management or PEG feeding.
- The routine: Describe when and how the activity occurs, without inflating or minimising the need.
- The risk: Explain what could happen if an untrained worker performs the task or misses a warning sign.
- The participant's function: Link the need to disability-related limitations and the person's ability to complete the activity independently.
- The support model: Identify training, competency verification, supervision, delegation and escalation requirements.
- The funding rationale: Explain why the requested assistance is disability support and how it fits the participant's goals.
The assessment may occur at home or through a suitable telehealth pathway, depending on the task, the participant's circumstances and the clinician's ability to assess safely. A provider such as Nursing Assessment Australia can conduct a structured continence assessment through AHPRA-registered continence nurse specialists and prepare information for an NDIS planning pathway. The report should remain clinically accurate and participant-specific, not written to guarantee an approval.
Check the finished evidence
Read the report before sending it. Confirm that the participant's name, task, frequency, risks, equipment and requested support all match current circumstances. Ask the clinician to correct unclear wording, especially if “continence assistance” could be mistaken for catheter management or complex bowel care.
A support coordinator can then combine the clinical report with functional assessments, therapy goals, provider information and any relevant discharge documentation. The clearer the connection between the task and the requested support category, the less room there is for the decision-maker to misunderstand the request.
How to Request or Review High Intensity Funding
Start by telling the participant's NDIS planner, Local Area Coordinator or support coordinator exactly what has changed or what the current plan doesn't cover. “We need more personal care” is less useful than “the participant now requires trained assistance with suprapubic catheter management under a participant-specific clinical plan”.
Prepare the request around evidence
A practical request usually includes:
- Clinical assessment report: A nurse or allied health report describing the task, risk, frequency and required worker competency.
- Functional evidence: Information explaining why the participant can't perform the activity safely or independently.
- Support coordinator statement: A concise explanation of the current gap, the proposed support model and the participant's goals.
- Hospital or specialist documents: Discharge summaries or treatment plans where a new diagnosis or procedure has changed daily support needs.
- Care diary: A factual record showing when support is required and what happens if it's unavailable.
- Provider information: Details of the proposed provider's ability to train, supervise and verify workers for the named task.
Ask for the support to be mapped to the correct NDIS category rather than described as a vague nursing request. The funding discussion should identify whether the participant needs routine Assistance with Daily Life, high intensity daily personal activities, continence consumables or another appropriate support.
Use the right review pathway
An unscheduled review may be appropriate after a new diagnosis, hospital discharge, major deterioration or a significant change in the participant's daily care requirements. Contact the NDIS directly or ask a Local Area Coordinator or support coordinator to help submit the request through the available NDIS process.
Keep copies of everything, including the date of the request and attachments. Review timeframes can vary, so ask what interim arrangements are safe while the request is considered. A provider shouldn't deliver an unfunded clinical task on the assumption that approval will arrive later, and a family shouldn't be left without an escalation plan for urgent health deterioration.
If the decision doesn't reflect the documented need, ask for the decision and review options in writing. A support coordinator can help identify missing evidence, clarify the requested support item and prepare a review request. If the participant's condition changes again, submit updated clinical information rather than relying only on the original report.
Keep the language concrete: Name the procedure, the worker skill, the safety risk and the funding gap in separate sentences.
Common Questions About High Intensity NDIS Supports
Can the NDIS fund training for a family member?
The NDIS may fund training for someone to help deliver disability-related continence supports when the training is connected to the participant's needs and meets the relevant funding rules. A clinician should define the task, teach the required method and confirm whether the family member can perform it safely. Family training shouldn't replace a proper clinical plan or create an expectation that relatives must provide complex care without support.
Does every continence task count as high intensity?
No. Toileting, pad changes and basic skin care generally differ from catheter management, complex bowel care and other regulated clinical tasks. The evidence must identify the activity itself, because “continence care” alone doesn't show the worker's required skill level.
What qualifications should a worker have?
The provider should verify competency for the specific participant and task. That normally involves a participant-specific support plan, instruction from an appropriately qualified clinician, observed practice and documented competency, with review or supervision arrangements suited to the risk.
What if needs deteriorate before the next plan review?
Contact the NDIS, Local Area Coordinator or support coordinator promptly and request a reassessment or plan review. Include updated clinical evidence, discharge information and a care diary. If the change creates an immediate health risk, contact the treating health service or emergency service rather than waiting for an NDIS decision.
How do NDIS and health services avoid duplication?
Ask each service to state its responsibility in writing. The NDIS may fund ongoing disability-related assistance in the home, while hospitals and health services manage acute treatment. A shared support plan, clear escalation contacts and accurate handover notes can reduce gaps and prevent two systems from assuming the other is responsible.
If you're ready to clarify a continence-related request, Nursing Assessment Australia provides structured continence assessments for NDIS and aged care participants through AHPRA-registered continence nurse specialists, including a suitability call and referral pathway. Visit Nursing Assessment Australia to review the assessment service and take the next step with clearer clinical evidence.