Carer Allowance (CA) (adult) when caring in a private home not shared by the carer and care receiver 009-03020040

The carer or care receiver may not co-reside or may have moved address, but care is still being provided. When this occurs, the carer is prompted to provide details of their care circumstances by submitting a Carer Allowance Questionnaire (SA381) or completing a Caring Detail Review for Carer Allowance task online.

When allocated the form or online task for processing, check:

• that the form has been completed correctly (if lodging an SA381)
• the distance between the addresses of the carer and care receiver is reasonable.
  For more details, see Carer Consolidated interventions
• the carer and the care receiver are not living together at both addresses
• the carer is a co-resident if the carer and care receiver are living together at both addresses
• that responses about time spent providing care is reasonable. See the Resources page for more details

After completing these checks and the assessment is for a:

• new claim, go to Step 2
• review following a change of address by the carer or care receiver, go to Step 5

Are both the carer and care receiver Australian residents?

• Yes, go to Step 3
• No, the system will automatically reject the carer as not being residentially qualified when information is coded. See Cancellation or suspension of Carer Payment (CP) and Carer Allowance (CA). Procedure ends here

Is the care receiver in the final stage of a terminal illness and not expected to live for more than 3 months?

• Yes, go to Step 7
• No, go to Step 4

Does the care receiver have a qualifying ADAT score?

• Yes, go to Step 5
• No, the system will automatically reject the Carer based on the ADAT score, once coded. Procedure ends here

Is the care being provided in a home that is the private home of either the carer or the care receiver (or, if this is a shared care case, the home of the other carer)?

Note: if the care is being provided in a home that is the residence of both the carer and the care receiver, this is not the correct procedure. See Eligibility for Carer Allowance (CA) when the care receiver is aged 16 years or over for qualification under section 954 of the Social Security Act.

• Yes, go to Step 7
• No, go to Step 6

Is the care receiver temporarily or indefinitely hospitalised and the carer is participating in their treatment?

See Hospitalisation provisions for Carer Payment (CP) and Carer Allowance (CA) for assistance.

Note: if the care receiver qualifies 2 carers for CA under the shared care provisions, hospitalisation arrangements may lead to complications which must be discussed with the carers.

• Yes, go to Step 7
• No, the carer does not qualify for CA:
• Cancel CA, reason CAA (care and attention requirements not met). This is a manual cancellation code, or
• Reject the claim for Carer Allowance (CA) with a rejection code of 'CNH' (Not living with carer, care not in home of carer or care receiver). This is a manual rejection code
• Record cancellation or rejection details on a DOC
• Procedure ends here

To determine if the carer is being paid at or above the relevant minimum wage, see the Resources page for current minimum wage.

Note: carers may misinterpret this question and view their CP/CA as wages for the care they provide to the care receiver.

Servicer Officers must check if the carer is:

• in receipt of an income support payment. If so, has the carer been reporting earnings from an employer that may be a care provider organisation
• reporting income from any other sources (for example, Other Income screen (OINS))

Is the carer being paid at or above the relevant minimum wage to provide care for the care receiver?

• Yes, go to Step 8
• No, go to Step 9

Staff must attempt to contact the customer to clarify this response. By answering 'Yes' to this question on the form or online, carers will not have provided responses to questions 8-20.

If contact with the customer is successful and they confirm they:

• Answered 'Yes' in error:
• Responses to the required questions cannot be obtained verbally
• Tell the customer that a new SA381 form will be issued to them to complete
• Issue the SA381 form to the carer
• Record details of the conversation and action taken on a DOC and place the review on hold for an appropriate timeframe
• Procedure ends here
• Answered 'Yes' correctly, discuss this with them and advise:
• For a review, their CA will be cancelled 'NDE' (No dependent eligible children) (but reason will display 'Not living with carer, carer paid minimum wages')
• If a new claim, the claim will be rejected with a code 'LPW' (Not living with carer, carer paid award wages)
• This will occur automatically when information is correctly coded into the system. See Cancellation or suspension of Carer Payment (CP) and Carer Allowance (CA) for more details
• Procedure ends here
• Are unsure, refer to the Carer Helpdesk

If unable to contact the carer:

• DOC the record with details of the unsuccessful contact attempts
• code all available information they provided
• the system will automatically cancel their payments. See Cancellation or suspension of Carer Payment (CP) and Carer Allowance (CA)
• procedure ends here

Is someone else receiving CA in respect of, and living with the care receiver?

• Yes:
• New claim will be rejected, or payment cancelled with a code of 'LCR' (Not living with carer, co-residing carer receiving CA). This occurs automatically when information is correctly coded based on checks performed by the system. However, check that the rejection has resulted from the activity
• Note: in the case where a carer is currently receiving CA, but is not a co-resident, and a carer who is a co-resident claims CA, the CA of the carer who is non co-resident is to be cancelled 'Other' (reason code 'OTH') even if they still provide care. Send a manual Q134 letter to this carer to avoid a system generated letter which may appear insensitive. For example, if CA is cancelled via the Care Details (CDCR) screen by coding zero days care or zero percentage of care, this will generate a letter stating the carer is cancelled as they are no longer providing care. This letter could appear insensitive to carers who are still providing care, but no longer qualify for CA
• No, go to Step 10

Is there only one carer caring for the care receiver?

• Yes, see Step 1 in Table 2
• No, see Step 4 in Table 2

Has the carer advised on the form/online task they provide daily care?

• Yes, go to Step 3
• No, go to Step 2

If the carer is providing personal care

• 6 days per week:
• Code a regular absence of 1 day per week, using the Temporary Cessation of Care workflow. See Table 2 > Steps 4 and 5 of Temporary Cessation of Care (respite) provisions for Carer Payment (CP) and Carer Allowance (CA), for more details
• Go to Step 3
• less than 6 days per week:
• The carer does not qualify for CA
• Update Care Details (CDCR) screen with the days
• CA will cancel/reject
• Procedure ends here

Does the carer provide at least 20 hours of personal care per week?

• Yes, see Step 1 in Table 3
• No, the carer does not quality for CA
• The claim will be rejected, or payment cancelled with a code of 'LPC' (Not living with carer, <20 hours personal care).
• This will occur automatically, based on the information coded into the system, when the activity is finalised.
• Procedure ends here

For CA shared care, only the care provided by 2 carers can be used to meet the daily care provisions. A third (or more) carer may also provide care, but the care provided by the third carer cannot be used to make sure the daily requirements are met. If the 2 carers are not providing care for at least 6 days per week, that is, they are using more than one day of TCC (respite) each week at claim, they would not be regarded as providing daily care.

Non-co-resident carer sharing the care with another non-co-resident carer

• If only one non-co-resident carer is claiming or receiving CA, and they are sharing the care with another non-co-resident carer who would qualify to receive CA, but may not have claimed, the other non-co-resident carer's time also counts towards the minimum 20 hours care and attention that must be provided to the care receiver each week
• If a non-co-resident carer is claiming or receiving CA and, they are sharing the care with a co-resident carer who does not receive CA for the care receiver and has not claimed CA for the care receiver.
• The hours of care by the co-resident do not count towards the minimum 20 hours care and attention that must be provided to the care receiver each week and,
• The non-co-resident is required to provide care at least 6 days per week, and
• The TCC provisions apply to any day when the non-co-resident does not provide care
• If 2 non-co resident carers are claiming CA, between them they must provide personal care on a daily basis for a total of at least 20 hours per week

Non-co-resident carer sharing the care with a co-resident carer

• If a non-co-resident carer is claiming or receiving CA, and the care is being shared with a co-resident carer who does not receive CA for the care receiver and
• the co-resident carer has not claimed CA for the care receiver:
• the hours of care by the co-resident do not count towards the minimum 20 hours care and attention that must be provided to the care receiver each week, and
• the non-co-resident is required to provide care on at least 6 days per week, and
• the TCC provisions apply to any day when the non-co-resident does not provide care

Note: if a co-resident carer is qualified for CA under section 954, it is not possible for a non-co-resident carer, to be qualified for CA under section 954A, in relation to the same care receiver. This is the case even if the non-co-resident carer is providing the required care and attention to the care receiver.

Three or more carers

Where there are 3 or more carers caring for the same care receiver, and 2 of them claim a share of CA, those 2 carers may qualify for CA even though a third person is providing care - as long as the 2 qualifying carers meet the daily care and attention requirements.

Note: When speaking to the carer claiming CA, do not refer to the other carer by their name unless the carer has given these details. Until this has occurred, refer to them as ‘another carer’ or ‘the other carer’.

Contact the carer who is claiming CA to clarify:

• the number of days the other carer provides care, and
• the number of hours of care they provide

Based on this information and the care receiver’s condition(s), is the daily care (at least 6 days per week) and care of at least 20 hours per week being provided?

• Yes, go to Step 7
• No, go to Step 6

Note: When speaking to the non-claiming carer, do not refer to the other carer by their name unless the carer has given these details. Until this has occurred, refer to them as ‘another carer’ or ‘the other carer’.

Contact the non-claiming carer to clarify:

• the number of days they provide care, and
• the number of hours of care they provide

Explain to the carer that they can test their eligibility to CA under the shared care provisions.

Go to Step 7.

Do the carers provide personal daily care 7 days a week? (Carers using no more than 1 day of TCC (respite) each week at claim, are regarded as providing personal daily care).

• Yes, go to Step 8
• No, CA will be cancelled. On the Care Details (CDCR) screen, code the 'Shared Care' field with either:
• LOH - Hours too low. Care is provided on a daily basis, but less than 20 hours care is provided per week, or
• NDC - No daily care. Care is nor provided on a daily basis and at least 20 hours care is provided per week, or
• CNM - Care requirements not met. Care is not provided on a daily basis and less than 20 hours care is provided per week

Is the combined personal care and attention provided by both carers at least 20 hours of personal care per week?

• Yes, see Step 1 Table 3
• No, the carer does not quality for CA. Update the Care Details (CDCR) screen Shared Care: field on the CDCR screen with 1 of 3 codes:
• 'LOH' if the care is provided on a daily basis, but the 2 carers together do not provide 20 hours per week
• 'NDC' if the 2 carers together provide 20 hours per week of care, but the care is not provided on a daily basis
• The claim will reject with a reason of 'Not living with carer < 20 hours personal care' ('LPC') or 'Not living with carer, care not on daily basis' ('LDC'). This occurs automatically based on the information coded into the system

Does the care provided meet the care needs listed on the Adult Disability Assessment Tool (ADAT) and other sources?

Note: this is determined by checking the answers provided by the carer(s) to the Carer Allowance Questionnaire - Carer not living with the person being cared for (SA381) and seeing if they represent care provided in the same categories that the health professional indicated on the medical report that care was required.

A 'cross check' table is available at Step 1 of the Assessment A task card.

• Yes, go to Step 2
• No, more investigation is required. See the Resources page

Is the care provided within the reasonable limits as defined in the table in the Assessment B task card?

• Yes, go to Step 3
• No, more investigation is required. See the Resources page

Does the care the carer claims to provide seem reasonable, given any other commitments the carer may have?

These may include, among other things:

• employment
• study
• approved activities
• the carer's medical condition
• other care commitments

If the carer has indicated on the Carer Allowance Questionnaire (SA381) that an organisation is also providing care this may also need to be discussed with the carer. Discussion should only occur if there is doubt that the carer is providing the care indicated in the form.

Note: the employment, study, approved activities, medical condition, and other care commitments of the carer are not part of the qualification criteria for this payment. Do not ask questions of the carer to gather information about these. However, if this information is volunteered, or is on the carer's record already, it can be considered when assessing the carer's circumstances. If the carer is on an income support payment consider if Carer Payment (CP) would be a more appropriate payment.

• Yes, go to Step 4
• No, more investigation is required. See Example 1 on the Resources page

Is the carer over 18 years and under 80 years of age?

• Yes, and all other criteria have been addressed, go to Step 5
• No, and the assessment is for a:
• New claim, refer the carer to a social worker. Once the social worker assessment is complete, go to Step 5
• Review, record all details then finalise the review. Procedure ends here

Is this a shared care case where both carers are claiming?

• Yes, go to Step 6
• No, record the details provided in the SA381

Note: the date of effect of a shared care decision is the day that the section 981 decision is made. See Shared care for Carer Allowance (CA). for more details.

The percentage of payment each carer receives will be determined by dividing the care each carer provides by the total combined hours of care provided.

For example, carer A provides 9 hours care per week and carer B provides 12 hours care per week. The percentage of care is worked out as a percentage of the total number of hours of care provided.

Total hours of care = 21

• carer A will receive 43% of payment (9/21 x 100 = 43)
• carer B will receive 57% of payment (12/21 x 100 = 57)

When the claim for each carer is coded, the appropriate percentage is to be coded in the Care %: field on the CDCR screen