High Intensity Supports: Provider Obligations

High intensity daily personal activities are complex health related supports that some participants need every day. The NDIS Commission 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. This lesson explains what each involves at a high level, why they carry higher risk, and why this course builds knowledge only. Workers must also be trained and assessed as competent for each participant by a qualified health practitioner and must follow the participant's support plan.

To deliver high intensity daily personal activities, a provider must be registered for the relevant registration group and assessed against the high intensity daily personal activities module of the NDIS Practice Standards, known as Module 1. We can only deliver the specific high intensity supports listed on our certificate. Each support has its own outcome, and the indicators follow a common pattern: the participant is involved in assessment and planning, their health is reviewed by a qualified practitioner, policies and a training plan are in place, and every worker is trained for that participant's needs.

Every worker delivering a high intensity support must be trained for the specific participant's needs by an appropriately qualified health practitioner, or a person who meets the relevant high intensity support skills descriptor. For severe dysphagia management, training must only be delivered by an appropriately qualified health practitioner. This lesson explains the skills descriptors, the difference between completing training and being assessed as competent, how to keep competency records, and when training must be refreshed, for example when the participant's needs or equipment change.

Each participant receiving a high intensity support needs a current plan developed with them and informed by an appropriately qualified health practitioner. The plan explains how the support is delivered, the participant's preferences, the risks, what to monitor, and what to do in an incident or emergency. This lesson explains what a good plan contains, how to involve the participant, how often and when plans should be reviewed, and how to make sure the plan in the home is always the current version. Key points: involve the person, review on change and keep one current version.

Managers are responsible for making sure high intensity supports are delivered as planned, by workers who are competent for that participant. This lesson explains how to roster only competent workers, how to use observation and records to check practice, how to support newer workers, and how to use supervision to discuss confidence, workload and any concerns. It also covers what to do when a competent worker is not available. Key points: check competency records before rostering, observe practice regularly and never ask a worker to perform a support they are not competent in.

Participants receiving high intensity supports can become unwell quickly, so everyone needs to know when and how to escalate. This lesson explains the difference between an emergency that needs triple zero, a change that needs same day health advice and a concern that needs a plan review. It covers what workers should record and report, how incidents link to our incident management system and reportable incident duties, and how managers make sure escalation pathways are clear in every plan. Key points: act early, follow the plan, call for help and record what happened.

This case study follows Tran, a team leader rostering a long weekend for Callum, a participant who needs tracheostomy management and has only three workers assessed as competent for him. Two are on leave and the third calls in sick. The lesson shows how Tran uses the competency register, responds when an untrained worker is offered, activates the contingency plan and learns from the gap. Key points: check the register before every roster decision, never fill a gap with someone who is not competent, escalate early, and build a bigger pool of competent workers.

This case study follows Elena, a service manager, after a near miss in which a worker almost gave a participant's feed using an old version of his enteral feeding plan. The worker noticed the difference just in time. The lesson shows how Elena responds to the near miss, removes old plans, briefs and reassesses workers, checks whether anything must be reported and reviews our document control. Key points: treat near misses seriously, keep one current plan, check competency after regime changes and fix the system rather than blame the worker.