Care receiver permanently enters or temporarily/permanently leaves an institution 009-06040070

If a care receiver permanently enters an institution, they permanently leave the care of their carer. Carers in receipt of Carer Payment (CP) continue to receive payment for 14 weeks from the first date the carer did not provide constant care. In most cases, it will be the day after the person enters the institution.

There is no equivalent provision for Carer Allowance (CA). If a permanent cessation of care occurs, CA should be cancelled from the first date the carer did not provide care and attention.

A self-care unit or hostel providing only meals is not an institution. In addition, an 'institution' does not mean a prison. If the care receiver is imprisoned, the temporary cessation of care rules must be examined to determine if the carer remains qualified for payment.

Wife Pension (WP) customers who were receiving payment level Carer Allowance (CA) on 19 March 2020 were automatically transferred to Carer Payment (CP) (XWP). CP (XWP) carers remain qualified as long as payment level CA continues. The rules for CP if a care receiver permanently enters an institution do not apply to CP (XWP) carers. This means CP (XWP) customers will not continue to receive payment of CP for 14 weeks.

When the carer’s only or last payment level CA is cancelled from the first date the carer stopped providing care and attention, then CP (XWP) will automatically be cancelled. A carer will lose qualification for CP (XWP) permanently if they have a break in payment level CA entitlement after 19 March 2020.

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 Aged Care or Multipurpose Service Facility whilst waiting for a permanent placement. In these situations, the following usually happens:

• The care receiver is admitted to hospital
• An Aged Care Assessment Team (ACAT) assessment occurs
• 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

Care in a hospital whilst awaiting placement would usually be considered a temporary admission. 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 should be considered.

Care in an Aged Care or Multipurpose Service Facility whilst awaiting placement would usually be considered 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.

Note: delegation to use data contained in Aged Care Staff Portal for social security purposes, is limited to staff at the APS4 level or above. See Aged Care Staff Portal (ACSP) - Care Recipient in Context (CRiC).

If a care receiver moves into supported accommodation, entitlement to CP and/or CA will depend on the following factors:

• Has the care receiver moved into the supported accommodation on a temporary or permanent basis? In some cases, the initial move may be temporary with an intention of making a permanent move
• Is the carer continuing to provide constant care (CP) or 20 hours of care per week (CA) and they provide care on a daily basis?
• What care is being provided by the supported accommodation? This can range from very little care to full time care

A care receiver who is permanently admitted to an institution may subsequently leave the institution and return to the care situation on either a temporary or permanent basis.

There may be circumstances where a care receiver temporarily vacates the institution, which is their usual private residence to stay with a carer who is now claiming CP. The private residence of the carer would become the home of the care receiver whilst they are temporarily absent from the institution. The delegate needs to be satisfied that the carer is providing constant care to the care receiver in a private residence that is now considered the home of the care receiver. All other qualification criteria for CP needs to be met including obtaining a qualifying score under the ADAT and Australian residence etc.

To be eligible for CP, the care receiver must need care permanently, or for a minimum period of 6 months. In these cases, as the care receiver has already been residing in an institution, it is likely they have demonstrated they need care permanently.

Where the care receiver has not formally left the institution (for example, they are having a break for social leave) there is nothing in the legislation to prevent continuation of CP for 14 weeks when they return to the institution. However, the policy is that a person is not entitled to a further 14 weeks continuation of CP in these situations.

Although there is no specific time limit in relation to the number of days the care receiver may stay with the carer, care receivers are likely to have to pay more fees to the institution once they have utilised their annual 52 days of ‘social leave’.

In these cases, Service Officers need to determine whether to reclassify the most recent admission to the institution as a temporary admittance. Based on this assessment, Service Officers need to decide if CP can be continued or restored, utilising the Temporary Cessation Care (TCC) provisions where appropriate. A DOC must be created on the carer’s record with the decision on whether the care receiver’s recent admission to the institution has been deemed temporary or permanent.

Where the care receiver was intending, or even trialling, to permanently leave the institution, but this has not worked out, and they return to the institution on a permanent basis the 14 week extension to CP can be applied.

If the care receiver’s total TCC days exceed the allowable 63 days in the calendar year, CP can only be paid for the entire period the care receiver was in the institution if a TCC special circumstances extension is granted.

Note: generally, a decision to continue payment on the basis of ’special circumstances’ would only be made if the reason for ceasing care was outside the control of the carer and consistent with the need for, and provision of, personal care and attention. Delegation to determine special circumstances extensions is at the APS 5/6 level.

If the care receiver was permanently admitted to the institution and the total TCC days for the calendar year did not exceed 63 days, the carer may be able to remain eligible for CA until any remaining entitlement to TCC days has expired.

If the care receiver was temporarily admitted to the institution and the total TCC days for the calendar year did not exceed 63 days, the carer may be eligible to retrospectively access their remaining TCC entitlement, which may allow for the restoration of the CA.

If the care receiver was in the institution for more than 63 days, the TCC provisions would not usually apply. If there are special circumstances involved this must be determined by an APS 5/6 level officer or contact the Level 2 Policy Help Desk for assistance.

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:

• Carer Allowance (CA), their payment will be cancelled
• Carer Payment (CP), 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, 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.

Note: delegation to use data contained in Aged Care Staff Portal for social security purposes, is limited to staff at the APS4 level or above. See Aged Care Staff Portal (ACSP) - Care Recipient in Context (CRiC).

Because a carer's CA is cancelled, subsequent actions by the carer after the care receiver has entered the institution, like commencement of work or study or bereavement, are not relevant.

For CP, the carer can commence work in excess of 25 hours per week during the 14 week period from the date the carer stopped to provide constant care and the care receiver entered an institution, as the usual CP constant care criterion does not have to be met. All of the normal income and assets rules still apply, which means the carer's rate of payment may be affected by the income earned.

If the care receiver passes away during this 14 week period, and the CP recipient and their care receiver were a couple, s198AAA ceases to apply and section 237 (qualification for bereavement payments) may apply instead. A new 14 week bereavement period may start and the carer may be eligible for a LBP. If the carer and the care receiver were not a couple, the carer is not eligible for a LBP, but will continue to receive CP until the 14 week period ends, as adjustment for the loss of income support.

Third parties, including the care receiver, may disclose information regarding a change in circumstances, which may affect the carer’s eligibility for CP and/or CA.

Make sure information relating to the carer is not updated by or disclosed to any party who does not have permission. See Accepting information from and disclosing information to a care receiver or third party.

CP and CA must not be suspended or cancelled if:

• it is just suspected that a carer is no longer eligible for payment or
• Services Australia have received unverified information (for example, tip-off) which suggests the carer may not be eligible

See Accepting information from and disclosing information to a care receiver or third party.