Social worker care situations – referrals and assessment of payment claims 003-12060020

Staff should follow the Risk Identification and Referral Model to determine an appropriate referral and further agency support if the carer, care receiver, nominee or third party advises they:

• are affected by family and domestic violence (FDV), and
• require immediate support

Note: if a carer, care receiver, nominee or third party advises someone other than themselves is affected by FDV, staff can provide them with referral options for the person affected by FDV. See Resources page for links to the Family and domestic violence - External Support services intranet page or Payment and Service Finder.

Service Officers should:

• determine basic payment qualification before a social work referral and make sure it is documented in the referral notes
• make sure all referrals to social work contain:
• adequate details of the referral reason
• Treating Health Professional (THP), Adult Disability Assessment Tool (ADAT) or Care Needs Assessment (CAN) scores if relevant
• CRNs of all parties if multiple carers/care receivers are involved

For:

• Carers under 18 years of age, go to Step 2
• Care receivers at risk, go to Step 3
• Capacity to care, multiple carer, disputed care or other complex care situations, go to Step 4
• Complex grief and bereavement, go to Step 5
• Carer Specialised Assessment team (CSAT) for care receiver (child), go to Step 6
• Child Terminal Reviews, go to Step 7
• Carers aged over 80, go to Step 8
• Carer Adjustment Payment, go to Step 9

A referral to a social worker is mandatory for all claimants aged under 18 regardless of the claim outcome. Referral to social work must be made before granting the claim. Service Officers must place the claim on hold pending the outcome of the social work assessment.

The main reasons for social worker involvement in these cases is to make sure the young carer:

• has the physical and emotional capacity to provide the level of care needed, and
• has information about support services and resources

To make an under 18 referral in:

• Process Direct:
• Go to the Carers CSAT Referrals (CLCRF) screen
• Select ‘+’ button to add a new referral.
• Enter the Date of Effect of the claim and today’s date for the Referral Date.
• Referral reason - CCA (Complex care arrangements)
• Referral required - Yes in order for the second panel to populate
• Select ‘CSAT Processing Team - Service Zone Referral’
• Select the zone where the customer lives from the referral details dropdown list. Use Office Locator to find the customer's zone
• Select ‘Under 18 Carer’

• Customer First:
• Select the Social Work guided procedure
• Select CSAT Processing Team – Service Zone Referral
• Select the zone where the customer lives from the referral details dropdown list. Use Office Locator to find the customer's zone
• Select support reason - Under 18 Carer

It is mandatory for social workers to complete a report with a recommendation for these assessments, and upload it to document tools.

If the social worker is unable to speak to the carer within 21 days a Fast Note will be sent advising contact has been unsuccessful. On receipt of the unsuccessful Fast Note, Service Officers must reject the claim FRC. See Rejecting a Carer Payment (CP) claim or Rejecting a Carer Allowance (CA) claim.

If concerns are raised either by the carer themselves or another party, that adequate care is not being provided and the care receiver may be at risk, a referral to a social worker is needed. The Service Officer must refer to social work for a wellbeing review.

Examples of these situations include:

• allegations of:
• family violence
• elder abuse or neglect
• financial abuse
• the care receiver says that they are not being cared for and the care receiver has concerns for their safety if the CP or CA is cancelled

All carer neglect tip off matters are referred to social work under the care receiver at risk category. For more details on carer neglect tip-off reviews, see Reporting, reviewing and actioning reports of carer neglect.

The main reasons for social work involvement in these cases are:

• to conduct a welfare check on the care receiver, assessing risk and providing support
• to conduct a review on the actual care being provided and whether the carer is continuing to provide care in line with eligibility for CP/CA
• to discuss safety planning with the care receiver, if the carer is no longer providing care and there is family violence or abuse present, and before the Service Officer cancels the carer’s CP/CA

Note: Care Receiver at Risk referrals must be made in the care receiver's record. Information contained in these referrals is often sensitive. Service Officers or social workers must not record any information provided or allegations made by the care receiver or third parties in the carer’s record to maintain their privacy and safety.

To make a referral in:

• Process Direct:
• Go to the Carers CSAT Referrals (CLCRF) screen
• Select ‘+’ button to add a new referral
• Enter the Date of Effect of the claim and today’s date for the Referral Date
• Referral reason - CCA (Complex care arrangements)
• Referral required - Yes in order for the second panel to populate
• Select ‘CSAT Processing Team – Service Zone Referral’
• Select the zone where the customer lives from the referral details dropdown list. Use Office Locator to find the customer's zone
• Select ‘Care Receiver at Risk’

• Customer First:
• Select the Social Work guided procedure
• Select CSAT Processing Team – Service Zone Referral
• Select the zone where the customer lives from the referral details dropdown list. Use Office Locator to find the customer's zone
• Select support reason - Care Receiver at Risk

Capacity to care assessments

Concerns may be raised about a carer’s capacity to care if:

• in the course of processing a new claim, it is apparent on the carer’s record that the carer has physical or mental health conditions that may impact their ability to provide care. For example, the carer may be in receipt of DSP, have a reduced work capacity or have provided recent medical certificates
• the carer or a third party may advise that the carer has been diagnosed with a medical condition subsequent to receiving CP/CA

For customers already in receipt of CP/CA, the Service Officer should attempt to contact the customer prior to referring to social work to discuss their changed circumstances. For example, a customer that has been diagnosed with a serious or terminal illness may voluntarily surrender their CP/CA if their circumstances have changed. If the customer wishes to remain in receipt of CP/CA and the service officer has concerns about capacity, advise the carer that a social worker will contact them and refer to a social worker.

Multiple carer situations

Multiple carer situations involve two or more people claiming to care for each other. For example, a mother with a physical disability is claiming to care for an adult child with an intellectual disability while the adult child is claiming to care for their partner with a mental illness. In these situations, it can be difficult for the service officer to determine which party is caring for whom and their capacity to do so. A social work assessment can assist in determining the care needs of and actual level of care provided by each party.

Disputed care situations

Disputed care occurs when two or more customers claim to be caring for the same care receiver however information in the claim does not meet criteria for two carers to be granted. See Carer Payment (CP) for 2 or more carers in respect of the same care receiver

If there is a dispute in care, before referral to social work, Service Officers should follow the process in Table 2 Change of care for Carer Payment (CP) and Carer Allowance (CA) customers to try to resolve the dispute. If there are indications that Domestic and Family Violence are present or if the dispute cannot be resolved, a referral to social work is required.

Other complex care situations

Other situations may be referred to social work for further assessment after an initial investigation has been undertaken by a Service Officer. These may include situations where the carer:

• does not live with the care receiver and there is doubt that care is being provided
• is claiming for 2 or more children with a disability and support from a social worker may be appropriate

If the Service Officer is unsure if a social work referral is appropriate, they should consult with a social worker in the Carer Specialised Assessment Team (CSAT). Contact details for the CSAT team can be found by searching CT1 in Office Locator.

To make a referral for any of these reasons:

• Process Direct:
• Select > Referrals
• Referral Type: Social Work Service
• Referral Reason: Multiple and Complex needs
• Referral Details: select age bracket
• Add notes in Additional comments
• Finish
• Customer First:
• Social Worker Referral (Guided Procedure)
• Referral Reason: Multiple and Complex Needs
• Referral Details: select age bracket
• Add notes in Additional Information
• Next
• Finish

Referral to a social worker can be made if the care receiver has passed away or been diagnosed with a terminal illness, and the Service Officer identifies a need for social work support.

To make a referral in:

• Process Direct:
• Select referral using the purple actions button
• Select referral type – Social Work Service
• Select ‘Complex Grief and Bereavement’
• Customer First:
• Select the Social Work guided procedure
• Select referral reason - Complex Grief and Bereavement

In some cases, it may be necessary to refer a CP/CA (child) claim or review to CSAT of social workers for further assessment of the child’s care needs. For further information on when it is appropriate to refer to this team see Carer Specialist Assessment Team (CSAT) referrals for Carer Payment (CP) (child)

To make a referral in:

• Process Direct:
• Go to the Carers CSAT Referrals (CLCRF) screen
• Select ‘+’ button to add a new referral
• Enter the Date of Effect of the claim and today’s date for the Referral Date
• Referral reason - CCA (Complex care arrangements)
• Referral required = Yes in order for the second panel to populate
• Select referral reason - CSAT Processing Team – Specialist Assessment
• Select referral detail - IAN4 - CSAT for care receiver (child)
• Customer First:
• Select the Social Work guided procedure
• Select referral reason - CSAT Processing Team - Specialist Assessment
• Select referral details - CSAT for care receiver (child)

Child Terminal Illness reviews are generated 24 months after grant, and every 12 months thereafter. Due to the sensitive nature of the review, a referral to the CSAT social work team is required for the 24 and 36 month reviews. For more information see Terminal illness reviews for Carer Payment (CP) child.

To make a referral in:

• Process Direct:
• Go to the Carers CSAT Referrals (CLCRF) screen
• Select ‘+’ button to add a new referral
• Enter the Date of Effect of the claim and today’s date for the Referral Date
• Referral reason - CCA (Complex care arrangements)
• Referral required = Yes in order for the second panel to populate
• Select referral reason – CSAT Processing Team – Specialist Assessment
• Select referral detail – IAN4 – Child Terminal Review
• Customer First:
• Select the Social Work guided procedure
• Select referral reason - CSAT Processing Team - Specialist Assessment
• Select referral details - Child Terminal Review

A referral to a social worker is required if a carer is aged over 80. This is to ensure that the carer:

• has the capacity to provide the care receiver with the level of care and attention that is required, and
• is accessing the relevant support services and resources

To make a referral in:

• Process Direct:
• Go to the Carers CSAT Referrals (CLCRF) screen
• Select ‘+’ button to add a new referral
• Enter the Date of Effect of the claim and today’s date for the Referral Date
• Referral reason - CCA (Complex care arrangements)
• Referral required = Yes in order for the second panel to populate
• Select referral reason - CSAT Processing Team - Specialist Assessment
• Select referral detail - IAN2 - Over 80
• Customer First:
• Select the Social Work guided procedure
• Select referral reason - CSAT Processing Team - Specialist Assessment
• Select referral details - ‘Over 80’

A referral to the CSAT social work team may be appropriate for carers claiming Carer Adjustment Payment to ensure appropriate services and supports are in place. For more information see Carer Adjustment Payment (CAP) for carers of young children

To make a referral in:

• Process Direct:
• Go to the Carers CSAT Referrals (CLCRF) screen
• Select ‘+’ button to add a new referral
• Enter the Date of Effect of the claim and today’s date for the Referral Date
• Referral reason - CCA (Complex care arrangements)
• Referral required = Yes in order for the second panel to populate
• Select referral reason - CSAT Processing Team – Specialist Assessment
• Select referral detail - IAN3 – Carer Adjustment Payment
• Customer First:
• Select the Social Work guided procedure
• Select referral reason - CSAT Processing Team - Specialist Assessment
• Select referral details - Carer Adjustment Payment

For:

• New Claims (NCL), go to Step 2
• Non New Claims (NNCL), go to Step 3

For an:

• NCL, go to Step 4
• NNCL, go to Step 5

• Once a referral has been created for a NCL, a DOC must be created. See Creating, reviewing and deleting documents (including Fast Notes and DOA DOCs) for more information
• If a customer provides additional information, annotate the existing DOC
• Tell the customer that a social worker will be in contact as soon as possible
• Procedure ends here

• If a customer provides additional information, annotate the existing Note. See Creating, reviewing and deleting documents (including Fast Notes and DOA DOCs) for more information
• Tell the customer that a social worker will be in contact as soon as possible
• Procedure ends here

• Select Transaction icon
• Select the relevant Referral transaction hyperlink
• The Confirm Referral Completion window displays
• Select Confirm to set the referral to Complete
• Procedure ends here

• Select More Options > Referral
• Select the Referral ID from the Recent Referrals table
• The Referral landing page will display, select Next
• The Social Worker Referral page will display, select Next
• The Referral Summary page will display, add notes in the Additional comments field on why the referral is being cancelled
• Select Complete, then Finish
• Procedure ends here

There is no legislative age limits applicable to carers. A social work assessment is mandatory for all customers claiming Carer Payment or Carer Allowance who are aged under 18 at the time of claim, regardless of the claim outcome.

These assessments are:

• allocated via Workload Management (WLM), and
• undertaken by social workers in the local zone footprint

Go to Step 2.

Check if the carer is claiming Carer Allowance, Carer Payment or both.

Review medical reports found in document tools on customer first to obtain details about the care receivers medical condition and care needed.

If another person has been caring for the care receiver recently, social workers may find the medical reports on the previous carer’s record, and may be able to use them under the re-use provisions. See Re-use and re-claim provisions for Carer Payment (CP) (child) and Carer Allowance (CA) (child) claims.

The Adult Disability Assessment Tool (ADAT) score is used by Service Officers to determine eligibility and can provide an indication of the care provided. See Adult Disability Assessment Tool (ADAT) for more details on the ADAT questionnaires and scores.

To view the ADAT score in Process Direct

• Go to the care receivers record
• Key ADAS (Adult Disability Assessment Summary) in the Super Key

To view the ADAT score in Customer First

• Go to the CRS screen and select the care receiver
• Select Disability Assessment Tool (Adult)

Go to Step 3

Consultation with a Social Work Manager (EL2) is mandatory, before:

• contacting a carer aged 13 years and under
• finalising a carer assessment for a carer aged 15 years and under

Is consultation with a Social Work Manager needed?

• Yes, discuss the case with the Social Work Manager and escalate the case to a Social Work Manager consultation
• No, go to Step 4

The purpose of the social work assessment is to:

• assess if the young person has the physical, intellectual and emotional capacity to provide the care needed
• assess if the young person is actually providing the level of care needed to meet eligibility for the Carer Payment and/or Carer Allowance
• make sure both the young person and the care receiver are linked with appropriate support services

The social worker should contact both the carer and the care receiver to discuss the care provided and the young person’s capacity to provide the care. See Resources for more details to support the social workers conversation. This includes examples of caring activities.

It is part of the social workers role to assess if a carer meets the 25 hour rule criteria:

• If the young person is enrolled in school, the social worker should confirm with the school how many hours per week they are needed to attend school
• Travel time must be taken into account when calculating the 25 hour rule
• The social worker must include the method of transport when calculating the time taken to attend school

Young carers may have negotiated alternative timetables with their school to allow them to provide care at home during normal school hours. If this is the case, the social worker should:

• confirm that these are approved absences from school
• discuss with the school the length of this arrangement
• discuss any risks to the young person’s long-term education

If the young person is under the minimum school leaving age and no longer engaged in school the social worker should check that the appropriate education authority has given permission for the young person to leave school.

The young person may undertake some study at home and this would not be considered time away from the care situation if they are available to provide supervision and support to the care receiver if needed during this time.

If there are concerns about the young person’s wellbeing or the level of care provided, the social worker should contact any relevant third parties for further information. This may include:

• the treating health professional
• support agencies involved with either the carer or care receiver including those provided by NDIS or MyAgedCare, and
• any family or friends that may supporting the family

Was the social worker able to contact the young carer?

• Yes, go to Step 6
• No, go to Step 5

Under 18 carer assessments are mandatory, the social worker should:

• make multiple attempts to contact the carer over several days, and at different times of the day
• send a desktop message before each contact if possible. It can be difficult to contact young carers if they are attending school

If a nominee arrangement is in place, the nominee may be contacted if attempts to the carer are unsuccessful.

It may also be appropriate to contact the care receiver especially if the care receiver is the young person’s parent.

Document all attempts to contact each party on the document list.

If all attempts to contact are unsuccessful, the social worker must send a Q164 letter requesting contact within 14 days. If the young carer does not reply after 14 days, generate the CSAT Young Carer Assessment unsuccessful Fast Note. This will advise the Carer Processing Team of the outcome.

Go to Step 6.

The social worker must make a recommendation about eligibility for both carer payment and allowance if applicable. Whilst the social worker makes a recommendation, the Service Officer remains the delegate for the decision.

The social worker should also consider the longer term support needs of the customer and offer Social casework if appropriate. The Resources page has a link to a list of community agencies that may be able to support Young Carers.

Social workers must use the report template to record the carer assessment for under 18 carers.

The report template:

• should be completed with sufficient details to support the social workers recommendation about payment eligibility
• must be uploaded to document tools to enable the delegate to view the report in full. It is not a requirement to record the report in SWIS. See the Resources page for a link to the template and instructions to attach the report to the customers’ record

Once the report has been uploaded, the social worker must generate the CSAT Assessment Finalised Fast Note. This is to tell the Carer Processing Team to finalise the claim.

Go to Step 8.

Recording the referral:

• Area and Location: remains the Social Worker's footprint and Service Centre
• Customer Status: Select Carer
• Referral allocated through Workload Manager: Select Yes
• Referral Source: Select DHS - Processing Team
• Referral Issues: Select Caring Issues, Non-Delegated Assessments - CA/CP and any other relevant option

Recording contacts with customers and other third parties:

• Select the original referral and then select Create a new contact:
• Contact type: Select File/Paper Assessment. (This acknowledges the Social Worker's reading and analysis of the information in preparation for the customer contact)
• Social Work Interventions: Select Other Assistance
• Outcome of Intervention: Select Information Collected and Assessment In Progress
• If contact is made with the customer:
• Contact type: Select Interview in CSC/Face to Face or Phone Interview as appropriate
• Record up to three Social Work interventions: Select Advice DHS Services, Counselling/Support and any other relevant option
• Outcome of Intervention: Select Information Collected and Assessment In Progress
• If contact is made with Treating Health Professional or other third party:
• Contact type: Select Phone Interview or Phone Call (depending on length of call)
• Social Work Intervention: Select Discussion with Third Parties and any other relevant option
• Outcome of Intervention: Select Information Collected and/or Provision of Information

Finalising the Assessment:

• Contact type: Select File/Paper Assessment
• Entitlement decision: Select either Carers Claim recommended U18 or Carers Claim not recommended U18
• Social Work Intervention: Select Eligibility Assessment Undertaken
• Outcome of Intervention: Select Assessment Completed
• If CP and or CA carers is granted add a young carer review, go to Step 9

A social worker must review a young carer after they grant CP and/or CA carers aged 15 and under. They must do this within specific timeframes according to their age.

The purpose of reviewing young carers is primarily:

• for a wellbeing check to assess support needs
• to offer referrals, and
• to make sure care criteria continue to be met for payment eligibility

Review Cycle for young carers

• Carers aged 13 years and under at time of grant must be reviewed 3 months following grant and then at least every 6months
• Carers aged 14 or 15 years at the time of grant must be reviewed 6 months following grant and then at least every 12 months
• Carers aged 16 or 17 years at the time of grant can be reviewed 6 or 12 months following grant at the discretion of the assessing social worker.
• The Program Coordination and Professional Practice team trigger the reviews by obtaining Customer Reference Numbers (CRNs) from the Carers Branch according to the above review cycle

Review Steps

The social worker must contact the young carer and the care receiver if appropriate. If the carer’s parent is not the care receiver, contact with the parent may also help the social work assessment.

Discuss how the young carer is coping with their caring responsibilities.

• Are they managing a balance between caring, education, and their own health and wellbeing?
• Does the young carer have adequate support in place to support their caring role, social and education needs?
• Are further reviews needed? (outside the mandatory review cycle)

The social worker must:

• record in a File Note a summary of the issues above and outcome of the review
• record any sensitive information in SWIS case notes
• make a recommendation that all information indicates that the carer is or is not continuing to meet the care requirements of Carer Payment and/or Carer Allowance
• email SW.PCPP to advise that the review for the carer is complete, or if the review was unable to be completed as the carer could not be contacted

Procedure ends here.

If concerns are raised either by the care receiver themselves or a third party, that adequate care is not being provided and the care receiver may be at risk, a referral to a social worker is needed. These referrals are often made as part of the carer neglect tip-off process, see Reporting, reviewing and actioning reports of carer neglect.

Examples of these situations include allegations of:

• family violence
• elder abuse or neglect
• financial abuse

This also includes disclosure from the care receiver that they are not being cared for, and the care receiver has concerns for their safety if the carer payment/allowance is cancelled.

Care Receiver at Risk Referral received via WLM (Zone Layer)

The referral will state the following: 'Social Work assessment required as part of a review being undertaken by the Customer Critical Response Team (CCRT). Contact must be made with CCRT PSO (log in info) before actioning referral'.

Hold the referral until a final outcome is sent to CCRT.

Care receiver at risk referrals are often sent with little or no notes to protect the informant’s identity or if the allegations are sensitive in nature. The social worker must contact the referring Program Support Officer (PSO) before undertaking the assessment to gain full details of the referral reason.

PSOs must send the care receiver at risk referrals on the care receiver's record for privacy reasons. If social workers identify sensitive information has been placed on the carers record, they are to take appropriate action to remove this information including consulting with the CCRT.

Go to Step 2.

• Contact CCRT PSO (Program Support Officer) to consult about the case, the CCRT PSO will send an email with details of the case
• Remember that the information in the tip-off is an allegation only. Do not share the details of the tip-off with either the carer and/or care receiver. If either the carer or the care receiver asks about the purpose of the contact, tell them a review is being conducted
• Where appropriate social workers should attempt to contact the care receiver followed by attempts to discuss the care situation with the care provider and other relevant third parties
• If a third party made the allegation (and they have provided consent to contact) make attempts to contact them to discuss:
• the concerns raised
• if there are any risk issues in contacting the care receiver
• who else is involved in the care situation
• Assess if contacting the care receiver is appropriate, consider
• risk issues
• any medical conditions that may impact on their ability to contribute to the assessment
• If there are concerns that contacting the care provider may impact the safety of others (for example where the care provider and care receiver reside together and there are concerns for the care receiver’s safety) consult with the SWSM, Carers Specialised Assessment Team, or Program Coordination and Professional Practice
• Note: if a decision to cancel CA/CP is made as part of the review, the care provider will be contacted by the CCRT PSO
• When contacting the care provider and care receiver, explain that this is a carer’s review, follow the assessment and intervention outlined as a guide on the report template

Care receiver at risk assessments involve the social worker assessing the following:

• The welfare of the care receiver including addressing the specific allegations
• If the carer is providing sufficient care to be qualified for CA/CP
• If the carer is no longer providing care and the recommendation is to cancel, the social worker must assess the risk and discuss safety planning with the care receiver for when the carer’s payments are cancelled

The Social Work intervention will involve:

• assessing the risk,
• making a recommendation about payment eligibility, and
• making sure appropriate support services are in place

It may be appropriate to contact third parties to discuss the adequacy of the care being provided or risk issues that have been identified. See Resources for more details to support the social workers conversation. This includes examples of caring activities, third party verification and a link to a list of possible external referrals.

If unable to contact the care receiver or carer, consider the safety and appropriateness of sending a letter inviting contact. If appropriate send a

• Q999 letter for a care receiver
• Q164 for a carer

If the carer does not contact within 21 days of sending the Q164, notify CCRT who will make further attempts to contact them and take action regarding the customers payment cancellation. The social worker should make the care receiver aware of this.

The carer will be contacted by CCRT PSO if a decision to cancel CA/CP is made as part of the review.

Email the social work report and recommendation to the Critical Response Team.

Where there are safety concerns identified, work collaboratively with CCRT to implement the care receiver’s safety plan. When CCRT notifies the carer of payment cancellation and explores other payment options.

Go to Step 3.

Social workers must not document any of the following on the carer’s record:

• Decisions about carer neglect and abuse allegations
• Details of the allegations, who has made the allegations and sensitive information provided by the care receiver
• Information regarding the Tip-Off and allegations

Social workers should:

• Record a progress Note/DOC on the carer and care receiver’s record stating: ‘A carer review is currently underway, please refer to SWIS case notes or contact SWO –XXXXXX’
• Record in SWIS case notes, on the respective customer’s record, attempts to contact the carer and care receivers. Use SWIS - referral issues - caring issues - non-delegated assessments – CA/CP. Do not select Carer Specialised Assessment, as this will generate an incorrect report
• Record the report template including social work recommendation into the General SWIS report on the Care Receiver’s record in SWIS not the Carer’s record
• The SWIS report must not be scanned to either party's record

See the Resources page for the report template to use for all care receiver at risk assessments. This must include all SWIS case notes.

Procedure ends here.

Concerns may be raised about a carer’s capacity to care:

• when processing a new claim, it is apparent on the carer’s record that the carer has physical or mental health conditions that may impact their ability to provide care
• for example, the carer may be receiving Disability Support Pension (DSP), have a reduced work capacity or have provided recent medical certificates
• the carer or a third party may advise that the carer has been diagnosed with a medical condition subsequent to receiving CP/CA

These assessments will involve the social worker gaining detailed information about:

• the medical condition and associated care needs of the care receiver
• the level of care actually provided by the carer
• if any other party helps with the care
• the carer’s own medical condition and any impacts this may have on their capacity to meet the needs of the care receiver

These assessments may involve the social worker interviewing the carer, care receiver and any relevant third party services involved to assess the level of care provided.

The social worker must review the medical information available on the customer’s records and make sure that it is consistent with information provided by the carer.

Medical information can be found on document tools or by viewing the CRS screen in Customer First on the carers’ record.

See Resources for more details to support the social workers conversation including examples of caring activities and third party verification sources.

For:

• Multiple care situations, go to Step 2
• Disputed care situations, go to Step 3
• Other complex care situations, go to Step 4

Multiple carer situations involve 2 or more customers claiming to provide care to each other. For example, a mother with a physical disability is claiming to care for an adult child with an intellectual disability, while the adult child is claiming to care for their partner with a mental illness. In these situations, it can be difficult for the Service Officer to determine which party is caring for whom and their capacity to do so.

For carer payment there is no legislative restriction on a carer receiving CP for a care receiver who in turn receives CP for caring for another care receiver. For carer allowance however, an adult care receiver cannot qualify for carer allowance for another adult with a disability but can qualify for dependent children. For more details, see Eligibility for Carer Payment (CP) when a care receiver is aged 16 years or over.

In these situations, the social worker must contact all parties involved to ascertain the level of care they are providing and if they need care themselves. Part of the social worker’s assessment will involve determining the carer’s capacity to provide care if they also have health conditions themselves. It may be appropriate for the social worker to contact Treating Health Professionals or other third parties for details about:

• each person’s care needs
• capacity to provide that care, and
• if they are actually doing so to support the assessment

As these situations involve multiple customers claiming to be providing care, details of the social workers assessment of if care is actually being provided must be documented on each carer’s record. A recommendation is needed if the customer is providing sufficient care for qualification for carer payment/allowance and if they have capacity to do so if they also have medical conditions and need care themselves.

More details to support the social workers conversation including examples of caring activities can be found in the Resources page.

Was the social worker able to contact the customer?

• Yes, go to Step 6
• No, go to Step 5

Disputed care situations occur when 2 or more customers claim to be providing care for the same care receiver, however, information in the claim does not meet the criteria for 2 carers to be granted. See Carer Payment (CP) for 2 or more carers in respect of the same care receiver.

In these situations, the Service Officer will usually discuss the situation with the person lodging the claim and attempt to resolve the dispute. A referral to social work will be made if the dispute cannot be resolved by the Service Officer or if Family and Domestic Violence is indicated.

The social worker must contact each person claiming to be providing care, the care receiver (if appropriate) and any third parties such as support services or treating health professionals that may be able to provide confirmation of who is actually providing care.

Disputed care situations often involve complex family dynamics and may include Family and Domestic Violence or elder abuse. The social worker needs to be mindful of each customer’s privacy when contacting carers and must not disclose the identity of the other claimant.

Disputed care assessments will involve the social worker making a recommendation about which customer is eligible to receive carer payment/allowance. This will involve recommending that one customers’ claim be rejected or their payment be cancelled. As part of a holistic social work assessment, it is important to ascertain the safety of the care receiver/carer when the rejection/cancellation occurs.

More details to support the social workers conversation including examples of caring activities can be found in the Resources page.

Was the social worker able to contact the customer?

• Yes, go to Step 6
• No, go to Step 5

In most care situations, it is generally accepted that constant care is being provided if scores from the customers claim and medical information meet eligibility requirements. If doubt exists about if the claimant is personally providing constant care, further investigation in the form of a social work interview may be appropriate if Service Officer investigations have not been able to ascertain the level of care being provided.

These referrals may include situations where the carer does not reside with the care receiver, or the carer is claiming to provide care for 2 or more care receivers.

The social worker should make attempts to contact the carer, all care receivers and any relevant third parties to assess the level of care actually being provided.

More details to support the social workers conversation including examples of caring activities can be found in the Resources page.

Was the social worker able to contact the customer?

• Yes, go to Step 6
• No, go to Step 5

Carer referrals often relate to either a new claim or a customer already receiving a payment. It is important that the social worker make sufficient effort to gather the information needed to prevent overpayments or incorrect decisions being made.

Social workers must make multiple attempts to contact all parties involved before finalising the referral. This may include the current carer and/or new claimant, the care receiver and nominee if applicable. All contacts must be documented on the record.

If there is a new claim involved, the social worker is to send a Q164 letter to the new claimant requesting contact.

If attempts to contact those involved have been unsuccessful and the letter has not been responded to after 14 days, the social worker must generate a CSAT Assessment Finalised Fast Note, so that the Carer Processing Team can process the outstanding claim.

Go to Step 6.

Capacity to care assessments must be documented on the carer record with a recommendation in a document and details of the assessment in a SWIS case note or general report.

Multiple Carer and Disputed Care Assessments may need to be recorded on multiple records if the recommendation affects the payments of more than one customer.

The social worker must be careful not to breach privacy and avoid recording one customer’s information on the record of another customer. This is particularly important if the care receiver has disclosed family violence or carer neglect issues, as these allegations must not be recorded on the carer’s record. In this instance, the social worker should create a DOC on the carer’s record that refers the Service Officer to the care receives record where full details can be recorded.

Most Carer Assessments will need a report to be written due to the complexity of the care situation and the amount of information gathered from multiple parties. If the assessment is not complex or sensitive, the social worker can record the information on a DOC on the document list.

Any adverse decision needs a report to make sure that all information that has informed the rejection or cancellation of a payment is recorded for use in any future appeals.

If it is the social worker’s assessment that the carer does not have capacity to provide care, the social worker must generate a CSAT Assessment Finalised Fast Note. This will be allocated to the Carer Processing Team to action the outstanding claim or cancel the payment as per social work recommendation.

Procedure ends here.

A social work referral is mandatory for all cases where the carer is over 80 years of age

Over 80 carer assessments are:

• referred via WLM, and
• are allocated to social workers holding the national layer skill tag

Carer’s over 80 years of age are generally referred to social work after the grant of their claim.

A Service Officer may refer a case before determining the claim if there are concerns about the:

• vulnerability,
• wellbeing, or
• capacity of carer or care receiver

The purpose of social work assessment where the carer is over 80 years of age is:

• to provide a professional assessment of the carers’ capacity to provide care, explore the personal and professional supports in place, and
• help connect them to other services where needed

Go to Step 2

Check if the carer is claiming Carer Allowance, Carer Payment or both.

The carer may not be aware of the difference between Aged Pension and Carer Payment. If the customer has been transferred to Carer Payment, and this is not what the customer actually wanted, speak with the referring Service Officer.

The social worker should review:

Process Direct-

Customer First - the medical reports found in document tools to obtain information about the care receiver’s medical condition and care needed.

If another person has been caring for the care receiver recently, the medical reports may be found on the previous carer’s record and able to be used under the re-use provisions to calculate the Adult Disability Assessment Tool (ADAT) score.

Service Officers can use the ADAT score to determine eligibility and can provide an indication of the care provided. See Adult Disability Assessment Tool (ADAT) for more details about the ADAT questionnaires and scores.

To view the ADAT score in:

Process Direct

• Go to the care receiver’s record
• Key ADAS (Adult Disability Assessment Summary) in the Superkey

Customer First

• Go to the CRS screen and select the care receiver
• Select Disability Assessment Tool (Adult)

If the care receiver has passed away or entered residential care, the outstanding social work assessment can be finalised without further action.

The social worker should complete all actions for payment eligibility, and update the record to reflect the care circumstances. If this has not occurred, contact the referring Service Officer or consult with a member of the CSAT team.

Is the social worker able to contact the customer?

• Yes, go to Step 3
• No, go to Step 4

Before the call, the social workers must send a desktop message before attempting to contact the customer.

The customer may not be expecting the call from a social worker. It is important that they:

• clearly introduce themselves, and the purpose of the call
• ask permission to ask some questions, and
• tell the customer that some of the information provided will be documented on their record

The social work assessment should include an assessment of the following:

• The care receivers’ current medical condition and their care needs
• The care being provided by the carer
• The carer’s own health and capacity to provide care
• Identify the formal and informal supports that may be helping with the care
• Provide information and referral to any further support services that may be appropriate

See Resources for more details to support the social workers conversation including examples of caring activities and a list of external support services.

Go to Step 5

The social worker must:

• make multiple attempts to contact the carer over several days and at different times of the day
• make sure that a desktop message is sent before contact if possible

If a current nominee arrangement is in place, the nominee may be contacted if contact attempts to the carer is unsuccessful. All attempts to contact must be documented.

If all attempts to contact are unsuccessful, a Q164 letter is to be sent requesting contact within 14 days. If contact has not been made after 14 days, the social worker must generate the CSAT Payment Suspension Fast Note to have the carer payment/allowance suspended pending social work contact.

Go to Step 5

If the outcome is favourable, record the social work assessment in a document on the customers’ record. Use the following Doc template:

• Doc Title:
• SW REC: (Grant/Reject) (continue/cancel) Carer (Allowance/Payment)
• Text:
• Social worker recommends (Grant/Continuation) (rejection/cancellation) of Carer (Payment/Allowance)
• Consideration has been given to the overall wellbeing of the carer and care receiver
• They presently access the following services; (for example, ACAT, GP and Homecare)
• They have the following informal supports (for example, family and friends)
• Carer stated that (he/she) was physically capable and has capacity to continue in the caring role
• Carer has stated that further support from outside services is/is not needed at present
• (SW to include details of referrals provided/offered to carer if they are accepted or declined)

If the customer’s claim has not been granted, complete a CSAT Assessment Finalised Fast Note to advise the Carer Processing Team of the decision.

Is the decision an adverse one?

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

The social worker must write a social work report and attach it to the document tools if they have assessed that:

• care is not being provided, or
• the carer does not have the capacity to provide the care

See Resources page for a copy of the report template and how to attach it to the customers’ record.

Complete a CSAT Assessment Finalised Fast Note with the recommendation to reject or cancel the carer payment or allowance for the carer processing team to action.

If during the social work interview, it is identified that care is no longer provided because the care receiver is entering hospital or a care facility indefinitely, a social work report is not needed. The social worker should make sure that appropriate action is taken in regards to payment eligibility by contacting the Carer Processing Team.

Go to Step 7

• Recording the referral
• Area and Location: remains the local footprint or smart centre
• Customer Status: Select Carer
• Referral allocated through Workload Manager: Yes
• Referral Source: Select DHS - Processing Team
• Referral Issues: Select Caring Issues, Non-Delegated Assessments - CA/CP and any other relevant option
• Recording contacts with customers and other third parties (if needed)
• Select the original referral and then select Create a new contact
• Contact type: Select File/Paper Assessment (This acknowledges the social worker reading and analysis of the information in preparation for the customer contact)
• Social Work Interventions: Select Other Assistance
• Outcome of Intervention: Select Information Collected and Assessment In Progress
• Contact type: Select Phone Interview
• Record up to three Social Work interventions: Select Advice DHS Services, Counselling/Support and any other relevant option
• Outcome of Intervention: Select Information Collected and Assessment In Progress
• Finalising the assessment
• Contact type: Select File/Paper Assessment
• Entitlement decision: Select Carers Claim Recommended O80 or Carers Claim Not Recommended O80
• Social Work Intervention: Select Eligibility Assessment Undertaken
• Outcome of Intervention: Select Assessment Completed

Procedure ends here.

A referral to the CSAT social work team can be made for a Carer Specialised Assessment (CSAT). This is if the Service Officer identifies that the Care Needs Assessment may not be accurately reflecting the level of care needed for a child care receiver.

Carer Payment (child) claims rely on information provided in the Medical report completed by the:

• Treating Health Professional (THP), and
• Care needs assessment (CNA) completed by the carer

In some situations, the carer would qualify based on the THP report, however, does not achieve a qualifying CNA score.

Carer Specialised Assessments involve social workers collecting more details about the care provided to help the delegate in making a determination for Carer Payment. See Carer Specialist Assessment Team (CSAT) referrals for Carer Payment (CP) (child).

Only CSAT social workers conduct Carer Specialised Assessments (CSATs). If a social worker has received a referral via an incorrect WLM category, contact the CSAT SWSM or a member of the CSAT team. To contact the Carers Specialist Assessment Social Work Team, use code CT1 in Office Locator.

SWIS - CSAT social workers are the only staff that can select the Carer Specialised Assessment option in SWIS. This is because it generates a report specific to CSAT assessments. If a social worker has incorrectly generated one of these reports, request a SWIS deletion.

When a claim is lodged for Carer Payment (child), the Treating Health Professional (THP) will identify if the child has a terminal illness with a life expectancy that is likely to be 24 months or less. Once the terminal indicator has been coded, a review will be generated after 2 years and every year following if the condition has not changed.

Due to the sensitivity of these situations, a referral is made for a social worker from the CSAT team to contact these carers at the 24 and 36 month reviews.

The social work will identify if the child’s condition has changed and if it is appropriate for a review to be undertaken.

If the child’s condition has not changed or they are nearing the end of life, CSAT social workers can recommend that the review be postponed.

See Terminal illness reviews for Carer Payment (CP) child.

The Carer Adjustment Payment is a payment for families following a catastrophic event involving a young child under 7 years of age.

Due to the sensitive nature of these families’ circumstances, a social work referral may be made to offer support and referral to external services.

See Carer Adjustment Payment (CAP) for carers of young children.