Most parts of the NDIS are confusing at first and eventually start to make sense. NDIS high intensity support is the exception. Families hear the term in planning meetings, see it on invoices, and still come away unsure what it actually means or whether their person qualifies.
That matters, because high intensity support is not an upgrade or a premium tier. It is a specific category of complex disability care designed for participants whose daily personal activities involve clinical risk. Getting it right affects who delivers the care, how they are trained, and whether the person receiving support is genuinely safe.
This guide explains the category in plain language, covers how it is funded, and outlines what to look for when choosing a provider.
What high intensity support means in practice
In everyday terms, high intensity support refers to help with daily personal activities that carry a higher level of clinical complexity and physical risk than standard personal care. Where standard support might involve assisting someone with showering, dressing or meal preparation, high intensity support involves tasks where something going wrong could result in serious harm.
The NDIS Quality and Safeguards Commission distinguishes between three tiers of support worker skill:
- Standard covers general daily living assistance such as personal hygiene, household tasks and community access.
- High intensity requires support workers with additional training in specific clinical tasks, delivered under the delegation and oversight of a registered nurse.
- Very high intensity applies where the participant’s clinical profile is unstable or involves multiple complex health needs requiring constant registered nurse oversight.
The distinction is important because it determines the training a support worker must have, the supervision arrangements in place, and the hourly rate the NDIS funds.
High intensity daily personal activities and the support categories
The NDIS recognises eight categories of high intensity daily personal activities:
- Complex bowel care (including manual evacuation, colostomy and ileostomy management)
- Enteral feeding support (PEG, nasogastric and jejunostomy tube feeding)
- Severe dysphagia management
- Tracheostomy management (suctioning, airway monitoring, tube care)
- Ventilator support (CPAP, BiPAP, invasive mechanical ventilation)
- Urinary catheter management (indwelling and suprapubic)
- Subcutaneous injections (including insulin and other prescribed medications)
- Complex wound care (pressure injuries, surgical wound management, wound VAC therapy)
Each of these tasks requires a support worker who has been specifically trained and assessed as competent by a registered nurse. The nurse develops a care plan, delegates tasks to the support worker, and maintains ongoing oversight. This delegation model is central to how high intensity support works under the NDIS. It is not a case of sending a general support worker and hoping for the best.
If your family member needs help with any of these areas, our daily living support in Sydney page outlines how ADCS structures this type of care.
Who is likely to need high intensity support
High intensity support is not defined by diagnosis. It is defined by what a person needs help with day to day. That said, the participants most commonly accessing this category include people with:
- Acquired brain injury requiring PEG feeding, seizure management or complex wound care
- Spinal cord injury requiring catheter management, complex bowel care or ventilator support
- Neuromuscular conditions such as muscular dystrophy or motor neurone disease
- Severe epilepsy requiring rescue medication administration
- Complex physical disability with multiple intersecting health care needs
- Psychosocial disability combined with physical health complexities
Age is not a barrier. Both children and adults access high intensity support. In NSW alone, 230,427 participants held active NDIS plans as at 30 June 2026 (NDIS Quarterly Report Q4 2025-26, published August 2026), and a meaningful proportion of those participants require care that falls into the high intensity category. Across Greater Sydney, families regularly navigate this part of the scheme, particularly those whose loved ones live in supported independent living arrangements or receive home and living support.
How high intensity support is funded and evidenced
High intensity support sits within the Core Supports budget, under the Assistance with Daily Life category. This means:
- There is no separate application or special eligibility test. The funding is included in the participant’s plan based on assessed need.
- The participant does not pay an additional co-payment. Higher complexity means higher funded support hours and rates, not out-of-pocket costs.
- The NDIS Price Guide sets specific hourly rates for high intensity support workers. These rates are higher than standard personal care rates because they reflect the additional training, skill and clinical oversight required.
The funding level (low, intermediate or high) depends on how many of the eight support categories the participant requires and the clinical complexity involved. A participant needing support in one area, such as subcutaneous injections, may sit at a low level. A participant needing PEG feeding, seizure management, wound care and catheter support simultaneously will typically be funded at the high level.
The role of clinical and OT reports
Getting high intensity support into a plan requires clear evidence. The NDIA needs to understand the participant’s clinical needs, the risks involved, and why standard support is not sufficient.
The most effective evidence package typically includes:
- A detailed report from the participant’s treating specialist or GP outlining the specific health care needs
- An occupational therapy (OT) functional assessment describing how the condition affects daily personal activities
- A nursing care plan from a registered nurse, specifying the tasks that require delegation to a trained support worker
- Any hospital discharge summaries or allied health reports that support the clinical picture
If your family member is approaching a plan reassessment and you are unsure how to present this evidence, our guide on how to prepare for an NDIS plan reassessment in 2026 walks you through the process. A support coordinator experienced in complex care can also help assemble the right documentation and present it clearly at the planning meeting.
What the new NDIS rules mean for high intensity support
In August 2026, the Australian Parliament passed the NDIS Amendment (Securing the NDIS for Future Generations) Bill 2026. The Bill introduces support determinations, a mechanism that allows the Minister to reduce funding for certain categories of NDIS supports across participant cohorts.
For families of participants with complex needs, the important part is this: high intensity supports have been explicitly excluded from support determinations. The final Senate amendments carved out high intensity supports, along with complex behaviour supports and certain customised technology and hearing supports, meaning the Minister cannot use this mechanism to reduce funding in these areas (Department of Health and Aged Care, August 2026).
In practical terms, this means:
- If your family member’s plan includes high intensity support, that funding category is protected from broad ministerial reductions.
- The exclusion does not mean funding can never change. Individual plan reassessments still apply, and the NDIA can still adjust support based on the participant’s individual circumstances.
- Support determinations can still apply to other categories, including social and community participation and some capacity building supports.
The Bill also creates a new plan variation pathway for participants with high support needs requiring continuous 24-hour care. If a support determination in another category inadvertently affects their overall care, they can apply for a plan variation within 90 days.
For a broader look at how the recent legislative changes affect NDIS plans, our article on the 7 NDIS changes happening between now and April 2027 covers the key points.
How to find a provider who can deliver it safely
Not every NDIS provider is equipped to deliver high intensity support. This is one area where registration, training and clinical governance genuinely matter. Here is what to look for:
- NDIS registration in the right support groups. A provider delivering high intensity support must be registered with the NDIS Quality and Safeguards Commission. Check their registration includes “Assist-Personal Activities” at the appropriate level. ADCS is a registered NDIS provider in Sydney with registration across the relevant support groups.
- A clear clinical governance framework. Ask how the provider manages nursing delegation, support worker competency assessments, and incident reporting. If they cannot explain their clinical governance in plain terms, that is a concern.
- Trained and assessed support workers. Every support worker delivering high intensity tasks must be individually trained, assessed and signed off by a registered nurse for the specific tasks they perform. Ask how the provider documents this and how often competency is reviewed.
- Continuity of staff. Participants with complex needs rely on consistency. A provider that rotates workers frequently, or cannot guarantee the same small team, increases clinical risk and undermines trust.
- Experience with your person’s specific needs. A provider experienced in PEG feeding may not have the same depth in tracheostomy care. Ask specifically about their experience with the support categories your family member requires.
FAQ and Tips
Does my family member need to see a specialist before high intensity support is added to their plan?
Not necessarily a specialist, but the NDIA will need clinical evidence. A detailed GP letter combined with a nursing care plan and OT report is often sufficient. The stronger the documentation, the smoother the planning process.
Can high intensity support be delivered in the family home?
Yes. High intensity support can be delivered wherever the participant lives, whether that is the family home, a supported independent living arrangement, or other accommodation. What matters is that the care environment is safe and that the support worker has access to the equipment and care plans they need.
What happens if my person’s needs change after the plan is approved?
You can request an unscheduled plan reassessment at any time if there is a significant change in the participant’s functional capacity or circumstances. Our guide on understanding your NDIS plan explains how this process works.
Is high intensity support available on weekends and overnight?
Yes. The NDIS Price Guide includes separate rates for evening, weekend, public holiday and overnight support. If your family member requires high intensity support outside standard hours, ensure these line items are included in the plan.
How do I raise concerns about the quality of high intensity support?
If you have concerns about a provider’s delivery of high intensity support, you can raise a complaint directly with the NDIS Quality and Safeguards Commission. You can also speak with your support coordinator about transitioning to a different provider.
High intensity support is one of the most important parts of the NDIS for families navigating complex care. Getting the right provider, the right evidence, and the right funding level makes a real difference to your person’s safety, comfort and quality of life.
If you are looking for a provider in Greater Sydney with experience in complex care, ADCS can help. Start with our daily living support page or get in touch to talk through your family member’s specific needs.
