Complications to grants of Carer Payment (CP) and/or Carer Allowance (CA) 009-03040080

The hospitalisation provisions allow the carer to claim payments while the care receiver is in hospital.

If the carer is in receipt of CP (adult) and/or CA (adult), there is a limit of 63 hospitalisation days and 63 temporary cessation of care (TCC) (respite) days per calendar year per adult care receiver.

If the carer is in receipt of CP (child) and/or CA (child), there is no limit to the number of hospitalisation days available. However, there is a 63 day limit on TCC respite days for CP (child) and CA (child) - see below for further information on respite. All absences, whether for hospitalisation or respite, must be coded - for example, hospitalisation must be coded so that reviews for child care receivers are correctly undertaken after any consecutive 12 week hospitalisation period.

Where the carer qualifies for CP (child) under the combined care provisions, each child may be in hospital simultaneously or separately for an unlimited number of days.

Where the carer qualifies for CP (child) under the multiple care provisions or they qualify for CP (adult) because they care for a disabled adult and their dependent child, then each child may be hospitalised for an unlimited number of days.

The 63 day limit will still apply to the adult care receiver, that is, the adult care receiver may be in hospital for a maximum of 63 days (either continuous or broken) in one calendar year and still qualify their carer for CP.

When a carer (CP and/or CA adult) has used all of their 63 hospitalisation days for the calendar year, they are then able to utilise their respite allocation, if they still have some of these days available. If a carer's CP and/or CA (adult) has been cancelled due to absences and they reclaim CP and/or CA (all within the same year) when the care receiver returns home, there are no hospitalisation days available for use until the next calendar year. However, if the carer is claiming for a different care receiver in the same calendar year, a new allocation of 63 hospitalisation days is available.

If a care receiver is in hospital at the time of claim, CP and/or CA may be granted if:

• the carer is participating in the care of the care receiver
• upon release from hospital, the care receiver is expected to return to their care at the appropriate residence; and
• it is reasonable that, had the care receiver not been hospitalised, one or more people would qualify for CP and/or CA in respect of the hospitalised person

Granting CP and/or CA may also be appropriate if the carer is actively participating in the care of a care receiver who is in hospital because they are terminally ill and they are not expected to live more than 3 months.

TCC (respite) provisions allow carers to continue to receive CP and/or CA when they take a break from caring, for up to 63 days in each calendar year. These days may be used for any purpose, including formal respite care such as community in-home or residential respite, or informal respite provided by a friend or family member. If a care receiver is in formal or informal respite care at the time their carer lodges a CP and/or CA claim, the carer does not qualify for CP and/or CA and the claim should be rejected as the care receiver is not in their care at the time of claim lodgement. TCC (respite) provisions cannot be applied from the date of lodgement, as the carer has not yet qualified for CP and/or CA.

A carer does not qualify for CP and/or CA until the care receiver returns to the private home. If the care receiver later returns to the private home, the claim can only be backdated to the date when the carer was providing care in the private home (that is, to a date when the care receiver was not in respite).

When a carer accesses respite provisions, it is assumed that an organisation or other person is providing care. However, this is not a legislative requirement.

Note:

• If a carer is using up to one day of the TCC (respite) provisions each week at claim, and have met all other eligibility criteria, they may qualify for CP and/or CA at the time of claim.
• If the carer is paid under the short term care or episodic care provisions, the respite limit will be a pro-rata amount, based on the period CP (child) is being granted

If there is a dispute between 2 carers over the care being provided, see Change of care for Carer Payment (CP) and Carer Allowance (CA) customers.

A carer may lodge a claim for CP and/or CA for a terminally ill care receiver. In some cases, the care receiver may die before the claim can be finalised. Take care so that the correct coding for the new claim and cancellation occurs, to ensure the carer does not receive letters that would be insensitive.

Do not record the death action on the care receiver's record until the CP and/or CA claim is finalised. It may be necessary to suspend the deceased care receiver's payment(s) and inhibit the advices, until the CP and/or CA claim is ready to be finalised. If the date of death is not recent, it is important to calculate the correct arrears owing and to zero out any arrears of CA past the date of death to avoid overpayment.

If the carer is under 18 or over 80 years of age and would normally be referred to a Centrelink social worker, the social worker referral is not required. Make a decision on the evidence available. If in doubt, seek advice from the Carer Helpdesk.

A carer may submit a claim for CP and/or CA on the day the care receiver has passed away. If the customer has contacted on or before the date of death and is considered to be in vulnerable circumstances considering granting from the earlier date. See Intent to claim and vulnerable customers.

If not, the care receiver is assessed as passing away after the claim was submitted. CP and CA can be granted from the date the claim was submitted. See Processing claims for Carer Payment (CP) and/or Carer Allowance (CA).

A carer may lodge a claim for CP and/or CA after the care receiver has died if the customer has contacted on or before the date of death and is considered to be in vulnerable circumstances.

See Intent to claim and vulnerable customers.

If the death action has already been actioned on the care receiver's record before the CP and/or CA claim is processed, the death action must be undone', taking care not to pay arrears past the date of death. Once the claim is finalised record the death action, taking care not to duplicate any lump sum bereavement payments if already paid.

Note: undoing a death action may only be completed by a staff member at APS5 level or above. If a claim for either CP or CA has been lodged after the care receiver dies, it must still be processed.

See Death of care receiver before claim for Carer Payment (CP) and/or Carer Allowance (CA) is finalised.

A carer may lodge a claim for CP for a short period of entitlement and be current on a JSP payment. This scenario can apply if:

• the carer has immediate qualifications and has been receiving a JSP payment, or
• the CP claim is not actioned until after qualification for CP is lost

Service Officers need to action a benefit transfer for the period of CP qualification and have their JSP payment reinstated. All cases must be referred to the Level 2 Policy Help Desk. See Processing Claims for Carer Payment (CP) and/or Carer Allowance (CA).

For any other payment types, contact the Level 2 Policy Help Desk for advice.