NDIS Clinical Resources & Updates

Tracheostomy care is classified as a Level 3 High Intensity Daily Personal Activity under the NDIS Practice Standards — the highest risk category, alongside ventilator support. For registered NDIS providers in Perth who support participants with a permanent or long-term tracheostomy tube in community settings, the compliance obligations are significant and the safety stakes are high.

This article explains the NDIS framework for tracheostomy care, what your support workers can and cannot do, what must be in a tracheostomy care plan, and the non-negotiable role of a Registered Nurse in this support area.

Why Tracheostomy Is a Level 3 High Intensity Support

A tracheostomy is a surgically created opening in the neck into the trachea (windpipe), through which a breathing tube is placed. Participants may require a tracheostomy as a result of spinal cord injury, acquired brain injury, neuromuscular conditions, obstructive sleep apnoea, or complex respiratory conditions.

In a hospital setting, tracheostomy care is performed by trained nursing staff with immediate access to emergency equipment and colleagues. In a community setting, this same care must be delivered — often in a participant’s home — by a support team that may include non-nursing workers. The risks of incorrect tracheostomy care in the community include:

• Accidental decannulation (tube dislodgement) — life-threatening within minutes without immediate response
• Mucus plugging — causing acute airway obstruction
• Stoma site infection — serious if untreated, with risk of ascending infection
• Suctioning trauma — tracheal irritation or bleeding from incorrect technique
• Equipment failure — suction machines, ventilators (where co-existing), or humidification equipment
• Delayed emergency response — the community environment means there is no clinical backup unless explicitly planned for

This risk profile is why the NDIS Commission requires the highest level of competency evidence, RN oversight, and care planning rigour for this support area.

What the NDIS Skills Descriptors Require

Under the NDIS High Intensity Support Skills Descriptors (effective February 2025), tracheostomy support applies to participants with an established tracheostomy — meaning the stoma site is well-healed, the airway is patent and stable, and an RN has delivered the care sufficiently to safely delegate specific tasks to a trained support worker.

Support workers may be trained and delegated to:

• Perform routine stoma site cleaning and dressing changes
• Replace tracheostomy ties (in accordance with the care plan and only when trained to do so)
• Remove, clean, and reinsert the inner cannula (where applicable)
• Perform airway suctioning (oropharyngeal and tracheostomy suctioning) to maintain airway patency
• Monitor for signs of stoma site infection, tube dislodgement, or airway obstruction
• Respond to airway emergencies per the written emergency protocol
• Operate and maintain suction equipment and humidification

Support workers must NOT:

• Change the outer tracheostomy tube (this requires an RN or medical officer)
• Manage cuff inflation/deflation without specific RN training and documentation
• Make independent clinical judgements about airway status
• Deliver tracheostomy care without a current, participant-specific care plan from an RN

Additionally, if a participant requires both tracheostomy support and ventilator support, workers must be trained and assessed across both skill descriptors — not just one.

What Must Be in a Tracheostomy Care Plan

The NDIS Practice Standards require a participant-specific tracheostomy management plan developed by a qualified health practitioner (the RN). A compliant tracheostomy care plan must include:

1. Participant identification and their specific diagnosis and tracheostomy indication
2. Tracheostomy tube type, size, and cuff specifications (cuffed or uncuffed, fenestrated or unfenestrated)
3. Suctioning frequency, depth limits, and catheter size
4. Inner cannula change schedule and procedure
5. Stoma dressing and tie replacement procedure — step by step
6. Signs and symptoms of complications: infection, displacement, obstruction, bleeding
7. Escalation pathway — clearly stating who to call and under what circumstances (including 000 triggers)
8. Emergency decannulation procedure if the tube comes out unexpectedly
9. Equipment required (suction machine, replacement tube, sterile supplies) and where it is stored
10. Training requirements for each individual worker — not just a generic list
11. The responsible health practitioner’s name, AHPRA number, signature, and date
12. Review schedule — at minimum annually, or when the participant’s needs change
13. The participant’s communication preferences (many participants with tracheostomies are unable to speak)

Generic care plans — not tailored to the specific participant — do not satisfy NDIS Practice Standards requirements.

The Registered Nurse’s Mandatory Role

Under the NDIS framework, the RN’s obligations in tracheostomy care are more extensive than for most other HIDPA areas:

Before the support begins:

• Conduct a clinical assessment of the participant’s tracheostomy needs
• Determine whether delegation of specific tasks to support workers is clinically appropriate
• Develop the participant-specific tracheostomy management plan
• Train each worker in the specific participant’s tracheostomy needs (not just generic tracheostomy training)
• Formally document the delegation and each worker’s demonstrated competency

During ongoing service delivery:

• Remain contactable for clinical consultation during support delivery
• Conduct annual competency reviews for all workers
• Reassess any worker who has not delivered the support for more than three months
• Reassess any worker when the participant’s tracheostomy needs change
• Review all incidents or near-misses and update the care plan accordingly

In an emergency:

• The care plan must identify the RN as the first clinical contact for worker escalation

For participants with complex tracheostomy needs — including those requiring frequent suctioning, cuff management, or who are co-ventilated — direct RN-delivered care may be clinically required rather than delegated support worker care. This is an assessment the RN must make and document.

NDIS Funding for Tracheostomy Support

Tracheostomy support is funded under two registration groups depending on who delivers the care:

• High Intensity Daily Personal Activities (Group 0107): where a trained and delegated support worker delivers routine tracheostomy care as part of the participant’s daily support — $76.09/hr weekday daytime nationally (2025-26)
• Community Nursing Care — Registered Nurse (Group 0114): where an AHPRA-registered RN delivers the care directly — $123.65/hr weekday daytime nationally (item 01_606_0114_1_1)

For participants with the most complex and acute needs, NDIS funding can support 24/7 clinical nursing care — this is assessed on a participant-specific basis and requires evidence of medical necessity.

Provider Compliance Checklist for Tracheostomy Care

Before your organisation commences or continues tracheostomy support for a participant, confirm:

• ✅ Current participant-specific tracheostomy care plan signed by an AHPRA-registered RN
• ✅ Documented individual competency assessment for each worker delivering tracheostomy care
• ✅ Evidence workers have delivered the support within the last three months (or reassessment completed)
• ✅ Emergency decannulation equipment is on site and all workers know where it is
• ✅ Emergency protocol is written into the care plan with 000 triggers clearly stated
• ✅ RN supervisor is identified and contactable during support delivery
• ✅ Annual competency review dates are tracked per worker
• ✅ If participant is co-ventilated: workers are trained across both tracheostomy AND ventilator descriptors

How TrustCare Supports Providers with Tracheostomy Care

TrustCare Support provides NDIS-compliant tracheostomy care services as a B2B clinical partner to registered NDIS providers across Perth. Our services include:

• RN-developed tracheostomy management plans — participant-specific, NDIS Practice Standards-compliant, ready for provider audit use
• Support worker training and competency assessment in tracheostomy care — individual documentation per worker, per participant
• Direct RN-delivered tracheostomy care for participants requiring clinical-level nursing attendance
• Emergency protocol development — ensuring your organisation has a clear, documented escalation pathway
• Clinical governance consultation for providers building or reviewing their HIDPA compliance frameworks

We attend participants under your service agreement, work within your organisational framework, and do not recruit participants away from your organisation.

To refer a participant or discuss tracheostomy clinical support: email referrals@trustcaresupport.com.au or call info@trustcaresupport.com.au.

Sources: NDIS High Intensity Support Skills Descriptors (September 2024, effective February 2025); NDIS Practice Standards — Module 1: High Intensity Daily Personal Activities; NDIS Pricing Arrangements and Price Limits 2025-26; Intensive Care at Home — NDIS Tracheostomy Funding Guide.

In February 2025, the revised NDIS High Intensity Support Skills Descriptors came into full effect, following their publication by the NDIS Quality and Safeguards Commission in September 2024. For registered NDIS providers delivering complex and high intensity supports in Perth and across Western Australia, these changes have direct compliance implications — particularly around who can deliver which supports, what competency evidence you need to hold, and the Registered Nurse’s mandatory role in training and assessment.

What Are the NDIS High Intensity Daily Personal Activities?

High Intensity Daily Personal Activities (HIDPAs) are a defined group of supports that require specialist training, regular competency assessment, and clinical oversight because of the level of risk they carry. They are not delivered by a standard support worker without additional qualification — and if your organisation delivers them without the required framework in place, you are exposed to compliance action by the NDIS Quality and Safeguards Commission.

The current (February 2025) Skills Descriptors define nine HIDPA support areas:

Note: stoma care was integrated into the bowel care, enteral feeding, tracheostomy, ventilator, and catheter descriptors in the 2025 revision and is no longer a standalone area.

What Changed in February 2025?

The February 2025 revision made six significant changes that every provider should be aware of:

1. Dysphagia elevated to a standalone descriptor. Previously embedded in mealtime management guidance, dysphagia now has its own full skills descriptor. Support workers assisting participants with swallowing difficulties must follow an IDDSI-aligned dysphagia management plan, prepared by a speech pathologist and overseen by a health practitioner. This has competency assessment and documentation implications for providers who deliver mealtime support.

2. Complex wound care elevated to a standalone descriptor. Previously listed as guidance, wound care is now a full HIDPA with its own competency requirements. Dressing changes, pressure injury care, and wound assessment are now subject to the full skills descriptor framework — meaning a care plan from a qualified health practitioner (typically an RN) and documented competency assessment for each worker is required.

3. Diabetes management added to subcutaneous injections. The subcutaneous injections descriptor was updated to explicitly include insulin administration and diabetes management. This resolves previous ambiguity about whether insulin assistance required HIDPA-level compliance and clarifies that an RN-developed plan and delegation is required.

4. Stoma care integrated. The standalone stoma care descriptor was removed and integrated across five other support areas. Providers who previously delivered standalone stoma care need to review which descriptor now applies to each participant and update their competency records accordingly.

5. Stronger skills currency requirements. The revised descriptors explicitly require refresher training when: (a) a worker has not delivered the support for more than three months; and (b) when the participant’s support needs change. This places an ongoing obligation on providers to track worker recency — not just initial training.

6. Alignment with NDIS Workforce Capability Framework. Competency must be demonstrated and assessed — attendance at training alone does not satisfy the requirement. This is a significant shift for providers who have relied on certificate-of-attendance records as evidence.

The Registered Nurse’s Role: Mandatory, Not Optional

The NDIS Skills Descriptors use the phrase “appropriately qualified health practitioner.” For clinical HIDPA tasks, this is typically a Registered Nurse. The RN’s obligations across all nine support areas include:

• Developing participant-specific care plans — generic plans do not satisfy the descriptors
• Delivering or overseeing initial training of support workers in the specific participant’s needs
• Assessing and signing off worker competency — the RN must document that competency has been demonstrated, not just that training occurred
• Annual competency review of each worker for each HIDPA they deliver
• Reassessment triggers — the RN must reassess any worker who has been absent from the support for more than three months or where the participant’s needs have changed
• Incident review — the RN reviews adverse events and updates care plans accordingly
• Clinical supervision — remaining available during high-risk support delivery

For ventilator support and tracheostomy care (the two Level 3 supports), the expectation of RN oversight is highest. Where a participant requires ventilator support alongside a tracheostomy, workers must be trained and assessed across both descriptors.

NDIS Pricing for High Intensity Supports (2025-26)

The NDIS Pricing Arrangements and Price Limits 2025-26 (effective 1 July 2025, updated November 2025) set the following maximum rates for Perth metro:

High Intensity Daily Personal Activities (Registration Group 0107):

• Weekday daytime: $76.09/hr (item 01_010_0107_1_1)
• Saturday: ~$107.08/hr
• Sunday: ~$138.06/hr
• Public holiday: ~$169.03/hr

Community Nursing Care — Registered Nurse (Registration Group 0114):

• Weekday daytime: $123.65/hr (item 01_606_0114_1_1)
• Saturday: $176.47/hr
• Sunday: $202.87/hr
• Public holiday: $229.27/hr

The 2025-26 uplift applied a 3.95% increase to disability support worker rates and a CPI/WPI-weighted increase to nursing rates. Remote areas attract an approximately 40% loading above national rates.

What Providers Should Audit Now

If your organisation delivers any of the nine HIDPA support areas, you should confirm the following are in place:

• ✅ A current, participant-specific care plan from a qualified health practitioner for each HIDPA delivered
• ✅ Documented competency assessments for each worker delivering each HIDPA — with the assessor’s name and credential recorded
• ✅ Evidence that workers have delivered the support within the past three months (or a reassessment if not)
• ✅ A process for RN reassessment when participant needs change
• ✅ Incident records reviewed by a health practitioner
• ✅ Annual competency review dates tracked per worker per HIDPA

How TrustCare Can Support Your Organisation

TrustCare Support works as a B2B clinical partner to registered NDIS providers across Perth. We can:

• Develop HIDPA care plans for individual participants — NDIS-compliant, signed by our AHPRA-registered RN
• Train and assess your support workers across any of the nine HIDPA skill areas — with documented competency evidence you can use for NDIS Commission audit
• Deliver direct RN-level supports (tracheostomy, ventilator, complex wound, subcutaneous injections) for participants requiring hands-on clinical care
• Provide clinical governance support — helping your organisation build HIDPA-compliant policies and workforce competency frameworks

We do not recruit participants away from your organisation. We work within your service framework, attending participants under your service agreement, and reporting back to your team.

To refer a participant or discuss a clinical partnership: submit a referral online or call info@trustcaresupport.com.au.

Sources: NDIS High Intensity Support Skills Descriptors (September 2024, effective February 2025); NDIS Practice Standards — High Intensity Daily Personal Activities Module; NDIS Pricing Arrangements and Price Limits 2025-26 v.1.1; NDS — Revised High Intensity Support Skills Descriptors Now in Effect.

Diabetes affects a significant proportion of NDIS participants — particularly those with obesity-related disability, intellectual disability, or conditions associated with reduced physical activity. For registered NDIS providers, understanding how diabetes management fits within the NDIS funding framework, and what clinical obligations apply to your workforce, is essential for both participant safety and regulatory compliance.

What the NDIS Funds for Diabetes Management

The NDIS funds diabetes management supports when three conditions are met: the participant’s disability makes self-management difficult or unsafe; the support is directly related to the disability (not general health management); and the support is not already covered by Medicare, the Pharmaceutical Benefits Scheme (PBS), or the National Diabetes Services Scheme (NDSS).

NDIS-funded diabetes supports may include:

• Registered Nurse assessment and development of a participant-specific diabetes management plan
• RN-administered insulin injections when the participant’s needs are complex, unstable, or when titration is required
• Blood glucose monitoring assistance (prompting or hands-on) by a trained and delegated support worker
• Training of support workers to safely assist with insulin delivery (insulin pens or pumps) under formal RN delegation
• Assistive technology for diabetes management not covered by the NDSS

The NDIS does not fund:

• Insulin and diabetes medications (covered by PBS)
• Credentialled Diabetes Educators (CDEs) — these are funded through state health systems, not NDIS
• CGM devices that are available through the NDSS
• Standard diabetes health education or treatment (health system responsibility)

Key NDIS line items for diabetes nursing support include Community Nursing Care (Registration Group 0114) and, for delegated support worker assistance with glucose monitoring and insulin, High Intensity Daily Personal Activities (Registration Group 0107, item 01_010_0107_1_1 at $76.09/hr nationally in 2025-26).

The Registered Nurse Role: Not Optional

Under the NDIS High Intensity Support Skills Descriptors (effective February 2025), subcutaneous injections — including insulin administration — are a designated High Intensity Daily Personal Activity. This means:

• A Registered Nurse must develop the participant-specific diabetes management plan before any support worker assists with insulin or blood glucose monitoring
• The RN must train and formally delegate to each support worker — not just arrange a generic training session, but document the specific delegation for the specific participant
• Competency must be demonstrated, not assumed from course attendance
• The RN must conduct annual competency review of all delegated workers, or reassess earlier if the participant’s diabetes management needs change or if a worker has not delivered the support for more than three months
• The RN must remain the clinical supervisor — available for consultation and responsible for plan reviews

As the registered NDIS provider, you bear the organisational responsibility for ensuring this framework is in place before any support worker assists with diabetes-related tasks. If your support workers are assisting with blood glucose monitoring or insulin administration without a current RN-developed care plan and documented delegation, your organisation is operating outside the NDIS Practice Standards.

What Support Workers Can and Cannot Do

Support workers CAN (with documented RN delegation and training):

• Prompt or assist with blood glucose testing — reading meters, documenting results
• Assist with insulin delivery via pen or pump — following the participant’s care plan
• Observe and report on participant wellbeing including signs of blood glucose fluctuation
• Follow the hypoglycaemia management plan steps

Support workers CANNOT:

• Make independent decisions about insulin dose or timing
• Adjust or titrate insulin doses
• Determine whether a participant’s blood glucose requires a clinical intervention
• Substitute for an RN assessment when the participant’s diabetes management needs change

Hypoglycaemia: The Critical Safety Protocol

Hypoglycaemia (blood glucose below 4 mmol/L) is a medical emergency risk in NDIS participants with insulin-dependent diabetes. Every support worker assisting a participant with diabetes must know their participant-specific hypoglycaemia management plan — developed by the GP, diabetes team, or treating RN.

Core protocol (the “15-20 rule”):

1. Recognise symptoms: shakiness, sweating, pallor, confusion, aggression, rapid heartbeat
2. If the participant can swallow safely: give 15–20g of fast-acting carbohydrate (glucose tablets, 150mL juice, or regular soft drink — not diet)
3. Wait 15 minutes and recheck blood glucose
4. If blood glucose remains below 4 mmol/L, repeat
5. Once blood glucose is above 4 mmol/L, give a longer-acting carbohydrate snack
6. Document the episode and notify your RN supervisor
7. Call 000 if the participant becomes unconscious, has a seizure, cannot swallow, or fails to recover

Workers must also recognise hyperglycaemia (high blood glucose): excessive thirst, frequent urination, fatigue, blurred vision. If severe or persistent, this requires escalation to an RN or emergency services.

How TrustCare Support Can Help

TrustCare Support provides NDIS-compliant, RN-led diabetes management support for registered NDIS providers in Perth, WA. Our services include:

• Participant-specific diabetes management plans — developed by our AHPRA-registered RN, aligned to the participant’s treating team
• Support worker training and competency assessment — formal training with documented delegation, annual renewal
• Insulin administration — for participants requiring RN-delivered care (subcutaneous injections, complex insulin regimens)
• Blood glucose monitoring and clinical oversight — for participants with unstable or complex diabetes
• Liaison with GPs, diabetes educators, and the NDSS

We operate as a B2B clinical partner to registered NDIS providers — attending participants under your service framework, contributing to care plans, and ensuring your workforce has the competency evidence it needs for NDIS Commission compliance.

To refer a participant or discuss a partnership: email referrals@trustcaresupport.com.au or call info@trustcaresupport.com.au.

Sources: NDIS High Intensity Support Skills Descriptors (February 2025); NDIS Our Guidelines — Diabetes Management Supports; ADEA National Diabetes Nursing Education Framework 2024–2026; NDIS Pricing Arrangements and Price Limits 2025-26.

TrustCare Support does not contract directly with NDIS participants. We are an AHPRA-registered Registered Nurse service that partners exclusively with registered NDIS providers to fill the clinical nursing gaps in their service delivery.

This distinction matters — and it is the foundation of how our model benefits providers, participants, and the broader NDIS system.

The Problem We Solve for Registered Providers

Registered NDIS providers frequently encounter participants whose care plans include clinical nursing needs that fall outside the scope of their support workers — regardless of how well-trained those workers are. Complex wound management requiring an RN assessment. Insulin administration for a participant with complex diabetes. Tracheostomy care requiring competency assessment and RN oversight. Enteral feeding with a participant whose PEG site has become problematic.

Historically, providers in this situation have had to either refer the participant to a separate provider entirely (disrupting the relationship), attempt to manage within scope (creating compliance risk), or wait for an overburdened community health system.

TrustCare was established to solve this. We embed within your service delivery framework — attending participants under your service agreement, contributing to care plans, and providing the AHPRA-registered clinical nursing care your participants need — without recruiting participants away from you.

How the Partnership Works: Seven Steps

1. Referral submission. Your support coordinator or case manager submits a referral through our online referral form or directly by phone or email. We accept referrals from registered NDIS providers, support coordinators, and plan managers.

2. Clinical intake. Our RN reviews the referral and clinical information within one business day and contacts your team to confirm the scope of support required.

3. NDIS Worker Screening. Before any service delivery commences, we provide evidence of our nurse’s current NDIS Worker Screening Clearance (WA Department of Communities) and AHPRA registration. Both are available to your organisation as the registered provider.

4. Care plan development. Our RN develops a participant-specific care plan — whether for wound care, HIDPA skill area training and delegation, diabetes management, or any other clinical nursing support. The plan is documented and a copy provided to your organisation.

5. Service delivery. Our RN attends the participant under your service agreement. We deliver the nursing component; your support workers continue to deliver the daily personal activity and community access components. The participant’s relationship with your organisation is maintained throughout.

6. Clinical reporting. After every clinical attendance, TrustCare provides a service report to your organisation within 48 hours. This documentation is your evidence of clinical governance compliance for the nursing component of the participant’s supports.

7. Incident notification. If a clinical incident or adverse event occurs, TrustCare notifies your organisation the same business day. As the registered provider, your organisation then reports to the NDIS Commission within the required statutory timeframes. TrustCare supports this process with complete clinical documentation.

What Registered Providers Are Responsible For

When you engage TrustCare Support as your nursing subcontractor, your organisation remains the registered NDIS provider — and retains full regulatory accountability for the participant’s NDIS supports. This means:

• You remain responsible for the participant’s service agreement and NDIS plan implementation
• You must verify our worker screening clearances before service delivery commences (we make this straightforward — evidence is provided proactively)
• You are the organisation responsible for incident reporting to the NDIS Commission
• You maintain WHS obligations to the participant’s environment (safe premises, relevant equipment)
• You are responsible for participant consent to engage TrustCare as a clinical subcontractor

TrustCare’s obligations to your organisation are detailed in our B2B Service Agreement, including our clinical standards, documentation turnaround times, incident notification obligations, and insurance requirements ($10M professional indemnity, $20M public liability).

What Providers Most Commonly Refer For

Based on TrustCare’s clinical work with registered providers in Perth, the most frequent referral triggers are:

• Complex wound care — participants with chronic wounds, pressure injuries, or post-surgical wounds requiring RN assessment and dressing management
• HIDPA competency assessment and training — providers who need an RN to train and sign off support workers in one or more of the nine HIDPA skill areas
• Tracheostomy support — participants with established tracheostomies requiring ongoing RN oversight, care plan development, and worker training
• Diabetes management — participants requiring RN-administered insulin or formal RN delegation to support workers for glucose monitoring and insulin assistance
• Catheter management — suprapubic and indwelling catheter care requiring RN assessment and ongoing oversight
• Complex bowel care — RN-developed bowel management plans and worker training/delegation
• Clinical governance — providers seeking to build or review their HIDPA compliance frameworks ahead of an NDIS Commission audit

Getting Started

If you are a registered NDIS provider in Perth with participants who have clinical nursing needs, we would welcome a conversation about how TrustCare can support your service delivery.

Submit a referral online →

Or contact us directly: ✉️ info@trustcaresupport.com.au 📧 referrals@trustcaresupport.com.au

TrustCare Support was established to address a specific and persistent gap in Perth’s NDIS clinical services market: the need for an AHPRA-registered Registered Nurse who can partner directly with registered NDIS providers to deliver the clinical nursing care their participants need — without disrupting the provider’s existing participant relationships.

Who We Work With

TrustCare Support is not an NDIS registered provider. We do not deliver supports directly to participants under our own service agreements. We are an independent AHPRA-registered Registered Nurse service that works exclusively as a B2B clinical subcontractor to registered NDIS providers.

Our referral sources are:

• Registered NDIS providers — who engage TrustCare as their clinical nursing arm
• Support coordinators — who refer participants on behalf of a registered provider
• Plan managers — who coordinate clinical referrals within a participant’s NDIS plan

We serve participants with complex, high intensity, or specialist clinical nursing needs — the participants whose care plans require AHPRA-registered clinical input that falls outside the scope of support workers, even well-trained ones.

Our Clinical Services

High Intensity Daily Personal Activities (all nine HIDPA skill areas):

• Complex Bowel Care — manual evacuation, enemas, stoma care, autonomic dysreflexia risk management
• Enteral Feeding Support — PEG, PEJ, and nasogastric tube care and management
• Dysphagia Support — IDDSI-aligned mealtime management, aspiration risk
• Ventilator Support — community ventilator management, respiratory monitoring
• Tracheostomy Support — stoma care, suctioning, inner cannula management, worker training
• Urinary Catheter Support — IDC, IMC, and suprapubic catheter management
• Subcutaneous Injections — insulin administration, complex medication delivery
• Complex Wound Care — chronic wound management, pressure injury prevention, dressing protocols
• Epilepsy and Seizure Support — seizure management plans, rescue medication training

Assessment and clinical nursing services:

• Continence assessments — adults and children
• Skin and pressure area assessment
• Medication management and administration
• Functional health assessments for NDIS planning

Workforce training and governance:

• HIDPA competency training and formal assessment for support workers across all nine skill areas
• Clinical governance support — helping providers build NDIS-compliant policies and procedures
• Care plan development and review

Why Our B2B Model Matters for Providers

Under the NDIS Practice Standards, registered providers are responsible for ensuring that workers delivering High Intensity Daily Personal Activities have been trained and assessed by a qualified health practitioner, and that the training is current and participant-specific.

TrustCare makes this straightforward. When you engage us:

• We develop the participant-specific care plan that the Skills Descriptors require
• We train and formally assess your support workers — with documented competency evidence you can use for NDIS Commission audit
• We provide clinical service reports within 48 hours of every attendance
• We notify your organisation the same business day if any clinical incident occurs
• We provide worker screening clearance evidence before any service delivery commences

Your organisation remains the registered provider and retains the participant relationship. TrustCare handles the clinical nursing component.

Serving Perth and Surrounds

TrustCare Support currently delivers services across the Perth metropolitan area, including northern suburbs (Joondalup, Wanneroo, Balcatta), eastern suburbs (Midland, Armadale), southern suburbs (Fremantle, Rockingham, Canning Vale), and inner Perth. We are available seven days per week.

For referrals or to discuss a clinical partnership with your organisation:

✉️ info@trustcaresupport.com.au 📧 referrals@trustcaresupport.com.au 🌐 Submit a referral →

Diabetes is one of the most common chronic health conditions seen in the NDIS participant population, and it requires careful clinical management when a participant’s disability makes self-management difficult or unsafe. For registered NDIS providers, understanding the correct framework — who delivers what, under whose oversight, with what documentation — is not just a quality issue; it is a compliance obligation.

Under the revised NDIS High Intensity Support Skills Descriptors (effective February 2025), insulin administration and diabetes management are explicitly included under the subcutaneous injections descriptor. This means a Registered Nurse must be involved before any support worker assists with insulin or blood glucose monitoring tasks.

The Two-Tier Care Model

Tier 1 — Registered Nurse: The RN is responsible for developing the participant’s disability-specific diabetes management plan, including hypoglycaemia thresholds, insulin regimen documentation, blood glucose target ranges, and escalation pathways. When a participant’s diabetes is complex, unstable, or when insulin titration is required, the RN delivers the care directly. The RN is also responsible for training each support worker and formally documenting the delegation — not just providing generic diabetes training, but participant-specific delegation recorded per worker.

Tier 2 — Delegated Support Worker: After formal RN training and documented competency assessment, a support worker can assist with blood glucose monitoring (prompting and reading meters), assist with insulin delivery via pen or pump following the care plan, and observe and report on blood glucose fluctuation signs. The worker cannot make independent dose adjustments or titration decisions. Any blood glucose reading outside the participant’s prescribed range must be escalated to the RN.

Hypoglycaemia — Every Worker Must Know This

Hypoglycaemia (blood glucose below 4 mmol/L) is the highest-acuity acute risk for insulin-dependent participants. Every support worker delivering diabetes support must know the participant’s individual hypoglycaemia symptoms and the response protocol.

Recognition: shakiness, sweating, pallor, confusion, rapid heartbeat, or aggression. Some participants — particularly those with long-standing type 1 diabetes — experience impaired hypoglycaemia awareness and may not show early symptoms.

Response: 15–20g of fast-acting carbohydrate (glucose tablets, 150mL fruit juice, or regular soft drink). Recheck in 15 minutes. Repeat if still below 4 mmol/L. Once recovered, give a longer-acting carbohydrate snack. Document and notify the RN supervisor.

Call 000 if the participant is unconscious, cannot swallow, has a seizure, or fails to recover after two rounds of carbohydrate.

Hyperglycaemia (high blood glucose): watch for excessive thirst, frequent urination, fatigue, and blurred vision. Persistent or severe hyperglycaemia requires escalation to an RN or emergency services.

NDIS Funding for Diabetes Nursing

The NDIS funds diabetes management supports when the support is directly related to the participant’s disability, and not covered by Medicare, the PBS, or the NDSS (National Diabetes Services Scheme). Common funded supports include:

• RN-developed diabetes management plan (Community Nursing Care, Group 0114 — $123.65/hr nationally, 2025-26)
• RN-administered insulin injections for complex or unstable participants
• Support worker diabetes training and delegation by an RN
• Ongoing blood glucose monitoring assistance by a delegated support worker (High Intensity Daily Personal Activities, Group 0107 — $76.09/hr, 2025-26)

The NDIS does not fund Credentialled Diabetes Educators (CDEs) — these are funded through state health departments. However, an RN with diabetes experience can provide all NDIS-funded nursing components.

How TrustCare Can Help Your Participants

TrustCare Support provides RN-led diabetes management services for registered NDIS providers in Perth. Our services include participant-specific care plan development, support worker training with formal competency documentation, direct RN insulin administration, and clinical oversight.

We work within your service framework — not around it. Our documentation and incident reporting supports your NDIS Commission compliance.

Refer a participant: submit a referral online or call info@trustcaresupport.com.au.

See also our in-depth clinical guide: Diabetes Management for NDIS Participants: What Registered Providers Need to Know →

Wound care is one of the most frequently delivered clinical nursing services in NDIS community settings. Whether managing a chronic leg ulcer, a post-surgical wound, or a pressure injury, effective wound care in the community requires not just clinical skill but a compliance framework that meets NDIS Practice Standards.

From February 2025, complex wound care was elevated to a standalone High Intensity Daily Personal Activity (HIDPA) descriptor under the revised NDIS High Intensity Support Skills Descriptors. This change has direct implications for registered providers whose support workers assist with wound dressings or pressure area care.

The TIME Framework: Systematic Wound Assessment

All wound assessments by a community RN should follow the TIME framework — the internationally recognised wound assessment model used in Australian clinical practice:

• T — Tissue type: Identify the predominant tissue in the wound bed. Granulation tissue (red, moist) indicates healing. Slough (yellow/tan) indicates devitalised tissue. Eschar (black) indicates necrosis requiring debridement consideration. Epithelising tissue (pink, fragile) indicates wound closure is progressing.
• I — Infection or inflammation: Look for the signs of local infection: increased pain, warmth, erythema extending beyond the wound margins, purulent exudate, malodour, delayed healing, or unexpected deterioration. Systemic infection (cellulitis, fever, lymphadenopathy) requires urgent medical review.
• M — Moisture balance: Assess exudate volume and character (serous, sanguineous, seropurulent, purulent). The wound should be moist but not macerated. Periwound maceration — softening and breakdown of the surrounding skin — indicates the dressing choice is not managing exudate appropriately.
• E — Edge of wound: Assess wound edges for adherence, undermining, rolled or epibolic edges (which prevent re-epithelialisation), and wound dimensions (length × width × depth in cm, recorded consistently at each visit).

The TIME assessment should be documented at every clinical attendance, including wound photography (with participant consent) to support continuity and clinical review.

NDIS Practice Standards: What Changed in February 2025

The February 2025 NDIS Skills Descriptors change means that complex wound care — including dressing changes, pressure injury management, and wound monitoring — now falls under the HIDPA compliance framework. For registered providers, this means:

• A qualified health practitioner (RN) must develop a participant-specific wound care plan before any support worker delivers wound-related care
• Support workers must be trained and competency-assessed by the RN for the specific participant’s wound care needs
• Competency must be demonstrated and documented — course certificates alone are not sufficient
• Annual competency review is required, and earlier if the participant’s wound needs change or a worker has been absent from the support for more than three months
• Documentation of every wound care visit must be maintained and available for NDIS Commission audit

A generic wound care plan covering “wound dressings in general” does not satisfy these requirements. The plan must be participant-specific and updated when wound status changes.

Dressing Selection: Matching Product to Wound

Dressing selection must be based on wound type, exudate level, and healing phase. Common categories used in NDIS community settings:

Dressing selection must be within the RN’s clinical scope. Support workers do not select dressings — they follow a documented plan prepared by the RN.

Pressure Injury Prevention: A Nursing Obligation

Pressure injuries are a common and preventable harm in the NDIS participant population, particularly for participants with limited mobility, incontinence, poor nutrition, or sensory impairment. The RN’s role includes:

• Risk assessment using a validated tool (e.g., Braden or Waterlow scale)
• Pressure injury prevention plan — specifying repositioning frequency, seating/mattress recommendations, skin care regime, and nutritional considerations
• Grading documentation for any existing pressure injuries (EPUAP/NPUAP grades I–IV)
• Wound care plan for established pressure injuries with staging, treatment approach, and escalation criteria
• Worker education on repositioning, skin checks, and early warning signs

Under the NDIS Practice Standards, the development and review of a pressure injury management plan is within the HIDPA complex wound care descriptor for any worker delivering this care.

When to Escalate

Community RNs must know when a wound exceeds community management capacity. Escalation to a wound specialist, hospital emergency department, or medical officer is indicated when:

• Signs of systemic infection (fever, tachycardia, hypotension)
• Rapidly spreading cellulitis
• Deep tissue injury or suspected osteomyelitis
• Wound with exposed tendon, bone, or joint
• Wound not responding after 4 weeks of appropriate treatment
• Arterial or venous ulcer requiring specialist vascular assessment

How TrustCare Delivers Wound Care in Perth

TrustCare Support provides RN-led wound care services for registered NDIS providers across Perth. Our services include:

• Wound assessments using the TIME framework with photographic documentation
• Participant-specific wound care plans — NDIS Practice Standards-compliant, updated with every significant change in wound status
• Support worker training and competency assessment for wound care tasks — with documentation for provider audit use
• Ongoing dressing management — RN attendance for complex, infected, or deteriorating wounds
• Pressure injury prevention plans — risk assessment, prevention planning, and skin integrity monitoring

We work within your service framework and provide 48-hour clinical reporting after every attendance.

Refer a participant for wound care: submit a referral or call info@trustcaresupport.com.au.

Sources: NDIS High Intensity Support Skills Descriptors (February 2025); Wounds Australia Best Practice Statement; EPUAP/NPUAP Pressure Injury Guidelines.

The NDIS Pricing Arrangements and Price Limits 2025-26 (PAPL) took effect on 1 July 2025, with a minor update (v.1.1) released in November 2025. For providers and subcontractors delivering nursing and high intensity daily personal activity supports, the 2025-26 changes include a notable rate uplift, new specialised support items, and updated requirements relevant to clinical nursing billing.

Overall Rate Uplift

The 2025-26 PAPL applied a 3.95% uplift to disability support worker rates — the increase reflecting weighted movements in the ABS Wage Price Index and Consumer Price Index (applied on an 80/20 weighting basis). Nursing rates were separately adjusted via the CPI/WPI weighted methodology applicable to clinical staff categories.

Remote area loadings remain in place: approximately 40% above national rates for remote areas, and approximately 50% above national rates for very remote areas.

Registration Group 0107 — High Intensity Daily Personal Activities

This group applies when a participant regularly needs care from a support worker trained in High Intensity Daily Personal Activities (HIDPA) — including tracheostomy care, complex bowel management, PEG/enteral feeding, subcutaneous injections, seizure management, complex wound care, ventilator support, and dysphagia support.

National rates (Perth metro, 2025-26):

These rates apply to support workers who have been trained and competency-assessed by a qualified health practitioner (typically an RN) in the specific HIDPA area. It is not sufficient for a worker to have attended a training course — the NDIS Skills Descriptors require documented, demonstrated competency.

Registration Group 0114 — Community Nursing Care

This is the key registration group for Registered Nurse-delivered supports. Three nurse classifications exist:

Enrolled Nurse (EN):

Registered Nurse (RN):

Clinical Nurse (CN/NP — advanced practice): Weekday daytime rate is approximately $143.04/hr (2025-26 estimate; confirm against the official 2025-26 PAPL v.1.1 XLSX for exact figure).

What Community Nursing Care (Group 0114) Covers

Services billable under Group 0114 include:

• Medication management and administration (including Schedule 4 and 8 medications where endorsed)
• Wound care and dressing management
• Tracheostomy care and management
• Catheter management (IDC, IMC, suprapubic)
• Complex bowel care (RN-delivered)
• Chronic condition management including diabetes
• Subcutaneous injection administration
• Pressure injury prevention and management
• RN training and competency assessment of support workers (billable as RN time)
• Development and review of NDIS care plans

Billing Compliance Points

Correct staff classification: Support workers delivering HIDPA supports must be billed under Group 0107, not standard personal care rates. The higher rate reflects the training and competency requirements — billing standard personal care rates for HIDPA delivery creates a compliance risk.

RN training time is billable: An RN’s time spent training support workers in HIDPA skill areas is billable under Group 0114 (RN rates). This is a legitimate cost of the HIDPA compliance model and should be included in participant plan budgets when HIDPA delivery is required.

Non-face-to-face time: The PAPL includes provisions for non-face-to-face time (documentation, care coordination, case conferencing). Ensure your service agreements and billing practices align with the PAPL provisions for non-face-to-face time for nursing attendances.

Support Catalogue as the definitive source: Item codes, rate limits, and billing rules are set out in the NDIS Support Catalogue 2025-26 (available as an XLSX download from the NDIS website). The Catalogue — not this article — is the authoritative reference for billing. Always verify against the current version before billing.

Key Links

• NDIS Pricing Arrangements and Price Limits 2025-26 →
• NDIS Support Catalogue 2025-26 (XLSX download) →
• NDIS High Intensity Support Skills Descriptors (February 2025) →

TrustCare Support delivers community nursing care under Registration Group 0114 for registered NDIS providers in Perth. To discuss how our nursing subcontractor model fits within your participant budgets, contact us at referrals@trustcaresupport.com.au or info@trustcaresupport.com.au.

The NDIS Quality and Safeguards Commission released the revised High Intensity Support Skills Descriptors in September 2024, with the updated requirements taking full effect on 1 February 2025. For registered NDIS providers delivering complex care in Perth and across Western Australia, understanding these changes is essential — non-compliance with the skills descriptors framework can expose your organisation to NDIS Commission enforcement action.

What Are the High Intensity Support Skills Descriptors?

The Skills Descriptors are supplementary guidance to NDIS Practice Standards Module 1: High Intensity Daily Personal Activities (HIDPA). They specify what a support worker must know and be able to demonstrate before delivering each type of high intensity support, and what role a qualified health practitioner — typically a Registered Nurse — must play in training, assessment, and ongoing oversight.

They are not optional guidance. They form part of the NDIS Practice Standards framework that registered providers must comply with.

The Nine HIDPA Support Areas (Current — February 2025)

The current descriptors cover nine support areas:

1. Complex Bowel Care — including manual evacuation, digital stimulation, enemas, suppositories, and stoma care (integrated from the former standalone stoma descriptor)
2. Enteral Feeding Support — PEG, PEJ, and nasogastric tube feeding, with stoma care integrated
3. Dysphagia Support (newly standalone in 2025) — IDDSI-aligned mealtime management, aspiration risk, texture modification
4. Ventilator Support — community ventilator management, respiratory monitoring, alarm response
5. Tracheostomy Support — suctioning, inner cannula care, stoma site management, emergency decannulation
6. Urinary Catheter Support — IDC, IMC, and suprapubic catheter care
7. Subcutaneous Injections — now explicitly includes insulin administration and diabetes management (updated in 2025)
8. Complex Wound Care (newly standalone in 2025) — dressing changes, pressure injury management, wound monitoring
9. Epilepsy and Seizure Support — seizure management plans, rescue medication administration (midazolam, diazepam)

Note: the former standalone stoma care descriptor was integrated into the bowel care, enteral feeding, tracheostomy, ventilator, and catheter descriptors. The total count is nine areas (not 10 as per earlier versions of the guidance).

What Changed in February 2025?

1. Dysphagia elevated to standalone. Previously embedded in general mealtime management, dysphagia now has its own full descriptor. If your support workers assist participants with swallowing difficulties, they now require training and documented competency against the dysphagia descriptor — not just general mealtime support training.

2. Complex wound care elevated to standalone. Wound dressing changes and pressure injury management are now a full HIDPA. An RN-developed care plan and documented worker competency is required for any support worker delivering wound care.

3. Diabetes management added. The subcutaneous injections descriptor was updated to explicitly include insulin administration. If your workers assist with blood glucose monitoring or insulin, the HIDPA subcutaneous injections framework now unambiguously applies.

4. Stoma care integrated. The standalone stoma care descriptor was removed. Check which descriptor now applies to each participant who receives stoma care and update your competency records accordingly.

5. Stronger skills currency. Workers must be reassessed if: (a) they have not delivered the support for more than three months; (b) the participant’s needs have changed. Providers should have a system for tracking when workers last delivered each HIDPA and flagging when reassessment is due.

6. Competency must be demonstrated. The descriptors are explicit: course attendance does not equal competency. Each worker must demonstrate the required knowledge and skills to an assessor — typically the RN — and that demonstration must be documented.

The Registered Nurse’s Core Obligations

Across all nine HIDPA areas, the RN must:

• Develop the participant-specific care plan (generic plans are non-compliant)
• Train and assess each worker in the specific participant’s needs
• Document the delegation and each worker’s demonstrated competency
• Conduct annual competency reviews per worker per HIDPA area
• Reassess workers who have been absent from the support for 3+ months or whose participant’s needs have changed
• Be the clinical supervisor — available for consultation during high-risk support delivery
• Review incidents and update care plans accordingly

For tracheostomy and ventilator support (the two highest-risk supports), RN oversight intensity is highest. For participants who require both, workers must be trained and assessed against both descriptors.

Compliance Action for Registered Providers

NDIS Commission compliance activity in Western Australia has increased scrutiny of HIDPA delivery. Providers found to be allowing workers to deliver high intensity supports without the required RN-developed plan and documented competency may face:

• Compliance notices requiring immediate remediation
• Civil penalty proceedings for persistent or serious non-compliance
• Conditions placed on NDIS registration
• Suspension or revocation of registration in serious cases

How TrustCare Supports Your HIDPA Compliance

TrustCare Support provides RN-led HIDPA training, competency assessment, and care plan development for registered NDIS providers across Perth. We can:

• Develop participant-specific care plans for any of the nine HIDPA areas
• Train and formally assess your support workers — with documentation for NDIS Commission audit
• Deliver direct RN clinical attendance for participants requiring hands-on nursing care
• Provide clinical governance support for providers building or reviewing their HIDPA compliance frameworks

To discuss your organisation’s HIDPA compliance or refer a participant: submit a referral or contact us at info@trustcaresupport.com.au / referrals@trustcaresupport.com.au.

Sources: NDIS High Intensity Support Skills Descriptors (September 2024, effective February 2025); NDIS Practice Standards — Module 1: High Intensity Daily Personal Activities; NDIS Quality and Safeguards Commission; NDS — Revised High Intensity Support Skills Descriptors Now in Effect.