Hospitalisation provisions for Carer Payment (CP) and Carer Allowance (CA) 009-06010020

For information about:

• the differences between temporary cessation of care provisions for adults and children, see Temporary cessation of care (respite) and hospitalisation (CLK)
• respite, see Temporary Cessation of Care (respite) provisions for Carer Payment (CP) and Carer Allowance (CA)

When calculating absences, only whole days are counted. That is, periods of 24 hours or more from 12am to 12am (midnight to midnight). The 63 days in total can either be continuous or broken.

The hospitalisation provision is a separate allocation from TCC provisions (or respite). It allows a person to claim or continue to receive CP and/or CA without drawing on their temporary cessation of care (respite) days if either of the following occurs:

• the carer is participating in the care of the care receiver:
• and, upon release, the care receiver is expected to return to the care of the carer at the appropriate residence, and
• it is reasonable to assume that, had the care receiver not been hospitalised, 1 or more people would qualify for CA and/or CP in respect of the hospitalised person. Note: if the care receiver is hospitalised 'indefinitely', the hospitalisation provisions may still be used as long as the care receiver is expected to return to the care of the carer when discharged from hospital. (An 'indefinite' stay in hospital may also qualify the carer and care receiver for payment under the separated due to ill health rules if they are also partners)
• the person is actively participating in the care of a care receiver who is terminally ill

There is no discretion to extend beyond the allowable 63 days hospitalisation provision (for an adult care receiver) for an appropriate special reason as there is with the respite provisions. If the hospitalisation period (for an adult care receiver) exceeds the allowable 63 days, the carer may be eligible to access their respite days for that calendar year (if they have any remaining).

For example, if an adult care receiver is hospitalised for 90 days, it is possible for the carer to use all 63 days for hospitalisation and 27 days respite care in order to remain eligible for a CP and/or CA (assuming the carer has 27 respite days left to use).

When the care receiver enters into TCC, the carer can still get CP and/or CA as long as the period of respite care does not exceed 63 days in a calendar year (this is the approved temporary cessation of care or respite period).

A person receiving palliative care will have an active, progressive and far-advanced disease, with little or no prospect of cure. The aim of palliative care is to achieve the best possible quality of life for the individual patient, their carers and family.

Palliative care services can be provided in the home, in community-based settings like nursing homes, palliative care units, and in hospitals. People who are dying need to be able to move freely between these places in response to their medical care and support needs.

The pattern of care will be different for every individual, and may depend on factors like; geography, services in an area, and the needs and desires of the person, family members and friends.

Before the hospitalisation provisions can be applied, it must be determined that the palliative care is being provided in a hospital.

For hospitalisation absences, if a carer’s CP and/or CA has been cancelled due to hospitalisation absences and they reclaim for the same care receiver (within the same year) once the care receiver returns home, there are no hospitalisation days available until 1 January of the next calendar year.

For respite absences, if a carer's CP and/or CA has been cancelled due to respite absences and they reclaim for the same care receiver (within the same year) the system will not allow hospitalisation days until 1 January of the next calendar year. There is an interim process to allow hospital days to be accessed in the same calendar year where the carer has not already exceeded their allowable 63 hospital day limit.

Temporary Cessation of Care (respite and hospitalisation) rules do not apply to CP (XWP) - Carer Payment (CP) that is paid under grandfathering provisions for ceased Wife Pension carers. However, Temporary Cessation of Care (TCC) (respite and hospitalisation) rules still apply to CA as normal.

When a CP (XWP) carer’s only or last payment level CA is suspended or cancelled for any reason or changed to CA HCC only, CP (XWP) will be automatically cancelled. A carer loses their qualification for CP (XWP) permanently if payment level CA is not reinstated without a gap in entitlement.

Constant care and the 25 hour rule do not apply to CP (XWP). Respite codes that only relate to CP should not be recorded for any TCC days for a carer receiving CP (XWP).

For more information, see Transfer from Wife Pension (WP) to Carer Payment (CP).

A care receiver who has been assessed as 'care awaiting placement' may be in either a hospital or an Age Care or Multipurpose Service Facility whilst waiting for a permanent placement. In these situations, the following usually occurs:

• the care receiver is admitted to hospital
• an Aged Care Assessment Team (ACAT) assessment
• the care receiver is assessed as care awaiting placement and either remains in the hospital or is transferred to an Aged Care or Multipurpose Service Facility on a temporary basis
• the care receiver is transferred to an Aged Care or Multipurpose Service Facility on a permanent basis

If the care receiver is assessed as care awaiting placement and is in a hospital, then the carer should be contacted to clarify whether the care receiver is likely to return home. If the care receiver is likely to return home, the hospitalisation and/or temporary cessation of care provisions would apply.

Care awaiting placement in an Aged Care or Multipurpose Service Facility would usually be considered as a permanent admission to an institution.

When determining the date of admission, consider the advice from the carer and any other relevant factors before making a decision.

If the care receiver is not likely to return home or has been admitted to an Aged Care or Multipurpose Service Facility, and there are no extenuating circumstances, then they are considered to have permanently entered an institution. If the carer receives:

• CA, then their payment will be cancelled
• CP, then section 198AAA of the Social Security Act applies and payment can continue for 14 weeks

The date of cancellation of CA would be from the date that the care receiver was not expected to return home. In most cases, this would not be the date that the care receiver was admitted to hospital, as the initial admission is usually temporary. The date of cancellation would be after admission to the hospital and up to the Aged Care or Multipurpose Service Facility admission date.

Some hospitals, particularly in rural areas, may also contain government funded aged care beds, or a multipurpose service wing. If the care receiver has been admitted to a hospital with multiple facilities such as these, you will need to ascertain whether the care receiver is in a hospital ward, a government-funded aged care bed, or in the multipurpose service wing. The above guidelines should then be applied.

If the carer is hospitalised and is expected to return to the caring duties once released, respite care is to be utilised, as the carer is temporarily not providing care to the care receiver. However, if the balance of respite days exceeds 63 days, and CP cannot be extended for a special reason, CP is to be cancelled.

If the carer is hospitalised and is not expected to return to their caring duties once released, CP is to be cancelled from the first day they did not provide care. (An 'indefinite' stay in hospital may also qualify the carer and care receiver for payment under the separated due to ill health rules if they are also partners).

Note: a social worker referral may be necessary to ensure that the care receiver is continuing to receive adequate care and attention on a daily basis from someone else while their carer is in hospital. The social worker can also provide information to assist Service Officers to determine whether the carer has the physical and/or emotional capacity to deal with the care receiver's care needs when they are discharged from hospital.

If a CP (XWP) carer is admitted to hospital and their only or last payment level CA is suspended or cancelled, for example due to exceeding 63 days respite or the carer is not expected to return to their caring duties, then their CP will be automatically cancelled.

The term hospital is not defined in either the Social Security Act or the Social Security Guide. A hospital is an institution providing medical and surgical treatment and nursing care for sick or injured people. If the rehabilitation facility is attached to a hospital, it would meet the definition of a hospital and the hospitalisation provisions may apply.