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

Item

Example

1

Carer provides daily care

A carer provides daily care and attention to a care receiver as a result of their illnesses and/or disabilities. Two mornings each week a professional nurse also provides specialised care to the care receiver. This care would not affect the claimant's eligibility for CA as the claimant is meeting the daily care and attention qualification.

2

Carer only providing care 4 days a week

If a carer is providing care 4 days a week and a professional nurse provides care on the remaining 3 days per week, the carer would not qualify for CA as the claimant is not providing daily care and attention

Item

Description

1

Care provided does not match the care needs indicated in the ADAT

The Service Officer may notice that the care provided by the carer(s) does not match the care needs outlined in the ADAT process. See Task Card - Assessment A - Verify care provided against ADAT (Below)

For shared care cases:

• When only 1 carer is claiming payment, the assessment below is to be performed using the information provided by the claiming carer
• When both carers are claiming the below assessment is to be performed using the combined information from both carers

Assessment:

• Add up the care needs that are supported by the ADAT. For any category where a part hour is calculated, the part hour is to be rounded down. Part hours are not to be recorded. If the total hours are less than 20 hours, part hours are to be included and calculated. Does this equal 20 hours or more per week?
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. When the information is coded, both the hours stated by the carer and the hours the Service Officer has verified is to be coded. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No - continue
• Considering the care receiver's medical condition and the length of time since the last ADAT, does information about the care receiver's medical condition support the level of care provided? (That is, that the condition is likely to require more care over time). The Service Officer may need to consult a medical dictionary or with a Senior Service Officer, etc.
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No (or unsure) - continue
• Contact the carer to discuss the differences. For example, has medical condition or level of care changed?
• Are the care needs verified?
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No - continue
• Ask the carer to supply current medical evidence such as specialist reports to support their claim. As a last resort, the carer can be asked to supply a new Medical Report (SA332a)
• Are the care needs verified?
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No - The claim will be rejected 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

2

Care seems overstated, care in some areas seems excessive

The Service Officer may consider that that carer may have overstated the amount of care they provide, or that the care receiver requires.

For shared care cases:

When only 1 carer is claiming payment, the assessment below is to be performed using the information provided by the carer who is claiming payment

When both carers are claiming the below assessment is to be performed using the combined information from both carers

Assessment:

• Does the care fall within the range outlined in the 'Verifying care provided is reasonable' table in Assessment B (see link below table)?
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No - continue
• If the categories of care that exceeded the specified ranges were reduced to the maximum levels stated in the table, would the total care provided still total at least 20 hours?
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No - continue
• Does information about the care receiver's medical condition support the level of care stated (refer to medical dictionary, Senior Service Officer, etc.)?
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No (or unsure) - continue
• Contact the carer to discuss the differences. For example, has medical condition or level of care changed?
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No - continue
• Ask the carer to supply current medical evidence such as reports from specialists, physiotherapists and other care agencies to support their claim. Do not ask the carer to provide a new Medical Report (SA332a). Have the care needs been verified?
• Yes - return to Step 6 in Table 3 on the Process page to determine entitlement or if other 'triggers' are present. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different)
• No - The claim will be rejected 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 should occur automatically based on the information coded into the system

3

Time caring does not seem reasonable due to other commitments

It may be that the time the carer claims to spend caring does not seem to be reasonable because of:

• employment (see the EANS screen)
• study (see NSA/AUS/YAL screens)
• Approved Activities (See NSA/YAL/PGA/PEN screens
• the carer's medical condition (see MC/PDI screens)
• other care commitments

For shared care cases:

• When only 1 carer is claiming payment, the assessment below should be performed once using the information provided by the claiming carer
• When both carers are claiming the assessment should be performed using the combined information of both carers

Assessment:

Do not ask the carer questions about their employment, study, approved activities or medical condition, as this is not part of the qualification criteria for this payment. 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 would be a more appropriate payment.

Contact the carer to discuss the situation with them. It may turn out to be no problem at all as the carer may be providing care after work/study/approved activity hours, or the care the carer provides may be compatible with their medical condition/physical capacity.

If the Service Officer is confident that at least 20 hours of daily personal care is being provided each week and the care is provided 7 days a week (by the carer or - if this is a shared care case where both carers claim payment - along with the other carer), return to Step 6 in Table 3 on the Process page to determine entitlement. Code both the hours stated by the carer and the hours the Service Officer has verified. (It is likely that the carer's declared hours and the Service Officer's verified hours will be different).

If not, the claim will be rejected 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.