If you run a SIL house or support people with complex health needs, you’ve probably asked this question: does this task need a nurse, or can our support workers do it? Under the NDIS, the answer depends on the type of high intensity support, the participant’s needs, and whether your workers have been properly trained and signed off for that person. Getting it right is what a good high intensity supports nurse working with NDIS providers is there for.
This guide explains the high intensity supports in plain English, what a nurse needs to do, what trained support workers can safely take on, and how training and sign-off work.
At Home Based Health, our nurses visit participants at home and in SIL houses across south-east Melbourne, including Moorabbin and Clayton South, and we train the support workers who care for them day to day.
What are high intensity supports under the NDIS?
High intensity supports are complex health-related tasks that need specific skills and training to deliver safely. The NDIS Commission’s High Intensity Daily Personal Activities module lists eight of them:
- Complex bowel care
- Enteral feeding and management (PEG and other feeding tubes)
- Severe dysphagia management
- Tracheostomy management
- Urinary catheter management
- Ventilator management
- Subcutaneous injections
- Complex wound management
Providers delivering these supports are expected to make sure workers have the skills described in the Commission’s High Intensity Support Skills Descriptors.
When do you need a nurse for high intensity supports under the NDIS?
A nurse is needed for anything that involves clinical assessment, judgement or a change to the plan. In practice, that usually means:
- Assessing the participant and writing or reviewing their care plan for the support
- Tasks that are complex or unstable, for example a new stoma, a wound that isn’t healing, or a feeding tube that keeps dislodging
- Changes in health, like signs of infection, a change in bowel pattern or a new swallowing concern
- Training and assessing support workers as competent for that participant
- Reviewing the plan regularly, and after any hospital stay or incident
Under the Nursing and Midwifery Board’s decision-making framework, the registered nurse who delegates a task is responsible for deciding whether that delegation is appropriate, and for checking and recording the outcome.
What can trained support workers do?
Once a nurse has assessed the participant, written the plan and trained the team, many routine, predictable parts of a high intensity support can be delegated to support workers. Examples might include giving a scheduled PEG feed, routine catheter bag changes, or following an established bowel care plan.
What matters is that:
- The task is routine and stable for that participant
- The worker has been trained for that person, not just in general
- The worker has been assessed as competent and signed off
- There’s a clear plan that says when to stop and call the nurse
The NDIS Commission’s guidance is clear that training should be specific to the participant. For enteral feeding, for example, training should match the person’s feeding type, method and regime.
How does training and sign-off work?
A good training process usually looks like this:
- Assessment: the nurse assesses the participant and writes a support plan.
- Training: the nurse trains the support workers on that plan, in the home, with the participant where appropriate.
- Competency sign-off: each worker shows the nurse they can do the task safely and is signed off.
- Escalation plan: everyone knows the signs that mean “stop and call”.
- Review and refresh: the nurse reviews the plan and refreshes training regularly, and whenever the participant’s needs change or new staff start.
Training isn’t a one-off certificate. Staff change, and participants’ needs change, so the plan and the training need to keep up. You can read more about how we run sessions in our post on high intensity support skills training in Melbourne.
Why it helps when the same nurse visits and trains
At Home Based Health, we do both the nursing visits and the support worker training. The good thing about that is the nurse who knows the participant is also the one training the team. Our nurse Bridgette runs training sessions for house teams, and because she’s seen the participant herself, the training is built around that person, not a generic checklist.
It also means there’s one clinician who knows the plan, notices changes early and can update the training straight away, rather than waiting for a separate trainer.
How is it funded under the NDIS?
The NDIS funds disability-related health supports at different levels. Under the NDIS Operational Guidelines, intermediate level supports are where a registered nurse delegates tasks in three disability-related health support areas, and high level supports are where a nurse delegates tasks in four or more areas. These levels affect the support worker level funded in the plan.
Nurse assessment, care planning and training may also be funded, depending on the participant’s plan. Funding is decided by the NDIA and is never guaranteed, so it’s worth talking to the participant’s support coordinator early.
Talk to us about nursing support
If you support someone with high intensity needs and you’re not sure what needs a nurse, we’re happy to talk it through. We can assess, write the plan, train your team and keep visiting. Learn more about our in-home nursing services, or refer now:
- NDIS participants: NDIS Referral Form
- Non-NDIS (private, Home Care Package, DVA, TAC, insurer): Referral Form
FAQs
Can a support worker do PEG feeding under the NDIS?
Routine, scheduled PEG feeds can often be delegated to a support worker once a nurse has assessed the participant, written the plan and trained and signed off the worker for that person. Anything outside the plan, like tube problems or signs of infection, goes back to the nurse.
How often should high intensity support training be refreshed?
There’s no one rule for everyone. Training should be reviewed regularly and refreshed when the participant’s needs change, after a hospital stay, or when new staff join the team.
Does the NDIS pay for a nurse to train support workers?
It can, depending on what’s in the participant’s plan. Nurse assessment, care planning and training are often part of disability-related health supports, but funding is decided by the NDIA and isn’t guaranteed. Talk to the participant’s support coordinator.