The National Disability Insurance Scheme (NDIS) provides essential services and supports for Australians living with disabilities. High-intensity daily personal activities provides support to participants with complex needs. This article outlines the comprehensive requirements for delivering and supporting participants with high-intensity daily personal activities.
1. Overview of High-Intensity Support Services
High-intensity supports are those requiring specialised skills, where training of support workers is overseen by an RN to ensure safe and effective care for participants with complex support needs. Often confused with Community Nursing which is the disability related health supports requiring nursing care to respond to the disability related health needs of a participant where that care is not the usual responsibility of the health system.
High-intensity daily personal activities provide the following supports to participants:
- Complex bowel care
- Enteral feeding and management
- Severe dysphagia management
- Tracheostomy care
- Urinary catheter management
- Ventilation support
- Subcutaneous injections
- Complex wound care
- Management of diabetes and other health conditions
Each activity involves tailored care plans overseen by qualified health practitioners to minimise risks for participants and staff.
NDIS Practice Standards for Registered NDIS Providers
Registered NDIS providers must not provide high intensity daily activity supports that are not set out in their certificate of registration. Registered Provides are required to maintain and demonstrate compliance to the NDIS (Provider Registration and Practice Standards) Rules 2018 and related guidance documents.
Core Principles
Providers delivering high-intensity supports are required to have systems and processes in place to meet the following core principles:
- Person-Centered Supports: Services must be tailored to meet the participant’s needs, preferences, and choices. Staff must always obtain the participant’s consent before providing any High-Intensity supports and make every effort to uphold their right to dignity and privacy
- Risk Management: Implement effective strategies to mitigate risks associated with high-intensity supports.
- Competent Workforce: Staff must possess the required skills and training in participant care plans to deliver complex supports safely. Training must be overseen by a Registered Nurse.
- Monitoring and Reporting: Maintain detailed records of care provided and report any incidents promptly.
- Health and Safety: Ensure that all activities are conducted in a safe and hygienic environment.
Skills Descriptors
The NDIS high-intensity support skills descriptors provide a framework for the competencies required of providers and their staff. These descriptors specify:
- Knowledge of anatomy, health conditions, and intervention techniques.
- Practical skills in administering care, using equipment, and responding to emergencies.
- Ability to collaborate with health practitioners and participants.
Detailed Requirements for Specific High-Intensity Supports and Complex Support Needs
1. Complex Bowel Care
Providers must ensure that staff can:
- Follow hygiene and infection control procedures.
- Recognise changes in bowel habits and administer prescribed interventions such as enemas or suppositories.
- Understand related conditions, such as autonomic dysreflexia.
- Execute actions outlined in participant-specific bowel care plans overseen by health practitioners.
2. Enteral Feeding and Management
Requirements include:
- Familiarity with nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG) feeding systems.
- Competence in monitoring feeding rates, maintaining stoma hygiene, and identifying complications like blockages or infections.
- Adhering to care plans developed by dietitians, speech therapists, or other health professionals.
3. Severe Dysphagia Management
Staff must:
- Follow plans designed by speech pathologists.
- Identify signs of swallowing difficulties, such as coughing or choking, and respond appropriately.
- Prepare and serve food of the correct texture to minimize risks of aspiration.
- Provide emergency first aid as required.
4. Tracheostomy Care
Responsibilities include:
- Maintaining the cleanliness of the stoma site and replacing tracheostomy dressings.
- Conducting routine suctioning to ensure airway patency.
- Monitoring and addressing signs of infection or malfunction.
- Collaborating with health practitioners for oversight and training.
5. Urinary Catheter Management
Key requirements for staff include:
- Replacing and disposing of catheter bags hygienically.
- Monitoring for signs of infection or complications.
- In cases requiring intermittent catheterisation, ensuring health practitioner oversight.
6. Ventilation Support
Providers must ensure staff can:
- Operate ventilators, including assembling components and fitting breathing masks.
- Monitor respiratory health and respond to alarms or malfunctions.
- Follow care plans detailing suctioning and emergency procedures.
7. Subcutaneous Injections and Diabetes Management
For participants needing injections, staff must:
- Administer pre-dosed medications using pens or pumps.
- Measure and administer variable doses under clinical supervision.
- Support diabetes management plans, including monitoring blood sugar levels and managing insulin delivery.
8. Complex Wound Care
Requirements include:
- Knowledge of wound types, dressings, and healing processes.
- Skills in infection prevention, monitoring wound progress, and escalating issues to health practitioners.
Workforce Training and Competency
Providers must demonstrate that their staff, including skilled support workers, have the necessary training and qualifications for high-intensity support. This includes:
- Induction and Ongoing Training: Staff must undergo regular training to stay updated on best practices.
- Clinical Oversight: Health practitioners must provide guidance and a registered Nurse must sign off on staff competencies.
- Emergency Preparedness: Training in first aid, CPR, and emergency response is mandatory.
Support Workers Training RequirementsTo meet the demands of high-intensity support, staff training should include:
- Initial Competency Assessments: Workers must demonstrate understanding and practical skills before delivering care.
- Specialised Training Programs: Tailored to the specific high-intensity activities such as tracheostomy care or enteral feeding and unique to each participant.
- Regular Refresher Courses: Ensuring up-to-date knowledge of procedures, equipment, and emergency protocols.
- Shadowing and Supervision: New workers should shadow experienced staff before independently providing high-intensity supports.
- Health-Specific Knowledge: Training on related medical conditions, infection control, and risk mitigation strategies.
Providers are responsible for maintaining records of staff training and ensuring alignment with the NDIS Practice Standards.
Documentation and Compliance
Providers are required to:
- Develop and maintain individualised support plans for each participant, in collaboration with health practitioners.
- Record all care activities, incidents, and observations systematically.
- Adhere to the NDIS Code of Conduct and report any breaches or risks to the NDIS Quality and Safeguards Commission. The NDIS Commission plays a crucial role in maintaining service quality and participant rights by regulating both registered and unregistered providers.
Quality Assurance and Auditing
Registered providers must meet specific quality and safeguard requirements to maintain registration. Providers must undergo audits by approved quality auditors. These audits assess compliance with:
- The NDIS Practice Standards.
- Skills descriptors for high-intensity support.
- Risk management and participant outcomes.
Auditors evaluate staff competencies, care environments, and incident management systems to ensure high standards of service delivery.
Risk Management Strategies
Effective risk management is crucial for high-intensity support, especially for individuals who require complex support due to health issues, disabilities, or age-related frailty. Providers should:
- Implement infection control protocols.
- Regularly review and update support plans.
- Establish clear procedures for emergencies and adverse events.
- Monitor staff performance and provide additional training as required.
Conclusion
Delivering high-intensity supports under the NDIS requires a commitment to quality, safety, and participant-centred care. By adhering to the detailed requirements outlined in the NDIS Practice Standards and skills descriptors, providers can ensure that participants receive the best possible care tailored to their unique needs.
