Aged care financial hardship assistance - overview 065-05030000

Financial hardship (hardship) assistance is available to care recipients who do not have sufficient means to pay aged care fees and/or accommodation payments due to circumstances beyond their control (for example, difficulty in selling their home or where they have used all funds paying aged care fees).

Agreeing to an accommodation payment above their means or giving away assets are not beyond a care recipient’s control.

Hardship assistance is available for:

• Home care (post 1 July 2014 only)
• Permanent residential care (both pre and post 1 July 2014 assessment schemes)
• Residential respite care

Note: hardship assistance is not available under the aged care legislation for pre 1 July 2014 home care, multipurpose services, transition care or short term restorative care.

Hardship assistance reduces fees and/or accommodation payments:

• The reduction amount is dependent on the care recipient’s income and assets after essential expenses and assets that cannot be sold or borrowed against are considered
• If hardship is granted at the maximum rate, fees and/or accommodation payments can reduce to zero

Hardship assistance is:

• not paid directly to the care recipient
• paid as an additional subsidy to the service provider with the monthly funding claim

The hardship subsidy amount is:

• equal to the fee reduction amount, and
• cannot exceed the maximum fee or, for accommodation hardship, cannot exceed the maximum accommodation supplement, otherwise payable

The length of the hardship assistance depends on the care recipient’s circumstances:

• Up to 3 years from the date of assessment in addition to any backdated period
• See Aged care financial hardship assistance – assessment

Services Australia also processes hardship claims for care recipients getting a Department of Veterans’ Affairs (DVA) income support payment.

See Aged Care Specialist Officer (ACSO) for information on booking an interview with an ACSO.

There are no Australian residency requirements for hardship assistance.

A care recipient must have at the start date of hardship period:

• assets valued at less than the current financial hardship asset threshold, including those that the care recipient can sell or borrow against
• income of less than 15% of the basic Age Pension amount (excluding supplements per fortnight) after essential expenses are deducted
• not gifted more than the allowable threshold
• completed a Calculation for your cost of care (means assessment)

See the Financial hardship current and historical thresholds – assets and income table on the Resources page of Aged care financial hardship assistance - assessment for current assets and fortnightly income thresholds.

Other means of financial support

Before claiming financial hardship, care recipients are encouraged to access other means of financial support. This may include:

• reviewing the care recipient’s entitlement to income support
• claiming income support hardship assistance, e.g. via the Home Equity Access Scheme

The aged care system validates when a care recipient is not eligible for financial hardship assistance when a care recipient:

• chooses not to have their means assessed and is deemed as means not disclosed (MND), or
• has no valid means assessment

Home care – post 1 July 2014

The care recipient is receiving (or will receive) care under the post 1 July 2014 assessment scheme. This includes care recipients who started care before 1 July 2014 and have opted in, or are considering opting in, to the post 1 July 2014 scheme. Eligible fees are:

• Basic daily fee (BDF)
• If the home care package level increases during the hardship period, the care recipient continues to pay the same BDF rate
• If no home care package is assigned to the care recipient when the claim is assessed, the highest ACAT approved care level is used to calculate any hardship entitlement
• Income tested care fee (ITCF)

Home care – pre 1 July 2014

The care recipient started receiving home care before 1 July 2014 and has not opted in and are not considering opting in to the post 1 July 2014 assessment scheme (grandparented):

• Not eligible for hardship assistance
• Home care recipients under the pre 1 July 2014 scheme can negotiate lower fees with the provider
• Section 60-2(2)(c) of the Aged Care (Transitional Provisions) Act 1997

Respite residential care

• BDF only
• Hardship assistance is not available for the booking fee or additional service fees

Permanent residential care – post 1 July 2014

Care recipient started receiving care under the post 1 July 2014 scheme. Includes pre 1 July 2014 care recipients who have opted in to the post 1 July 2014 scheme:

• BDF
• Means tested care fee (MTCF)
• Accommodation related fees:
• Daily accommodation contribution (DAC)
• Refundable accommodation deposit (RAD)
• Daily accommodation payment (DAP)

Permanent residential care – pre 1 July 2014

Pre 1 July 2014 care recipients occupying an Extra Services Place are not eligible for hardship assistance.

Care recipient entered residential care before 1 July 2014 (did not opt in to the post 1 July 2014 scheme) and not occupying an extra services place are eligible for:

• BDF
• Income tested fee (ITF)
• Accommodation related fees:
• accommodation charge
• accommodation bond

Before applying:

• the care recipient must complete an aged care means assessment
• home care hardship assistance claims must have an Aged Care Assessment Team (ACAT) approval before applying
• Residential or respite care hardship assistance claims do not need ACAT approval before applying

Hardship claims

• To apply for hardship assistance, a care recipient, nominee or authorised representative must complete the Aged Care Claim for financial hardship assistance (SA462) – see the Resources page for a link to this form.
• Photocopies of supporting documentation are accepted. Certified copies are not needed
• A letter is sent to the care recipient, nominee (if applicable) and aged care service provider with the outcome of the hardship assistance claim
• If hardship assistance is granted, the outcome letter includes:
• fee type and amount of hardship assistance
• date the hardship assistance stops
• Services Australia sends the outcome letter within 28 days from the date the claim is received

Note: the outcome letter is sent within 28 days of receiving the additional information if Services Australia requests additional information from the applicant.

Pre entry hardship claims

• Care recipients can lodge a hardship claim before entry into care
• The pre entry claim provides an estimate of hardship assistance the care recipient may be eligible to receive
• When the care recipient enters care, Services Australia reassesses and codes the hardship assessment based on the confirmed:
• aged care fees, charges, and
• circumstances of the care recipient

See Aged care financial hardship assistance - assessment for more information.

Nominee, authorised representative or provider completes claim

A care recipient can have a claim for hardship assistance made on their behalf by:

• a Centrelink correspondence nominee. Go to the Nominee Link Summary (NOLS) screen in Customer First to confirm nominee status. See Accepting and disclosing information
• an aged care nominee for a DVA care recipient. See Aged care request for a nominee or executor for details on how to confirm the nominee status
• an authorised representative including:
• an Enduring Power of Attorney, Power of Attorney (Financial)
• a person/organisation holding an administrative or financial order
• the aged care service provider currently providing (or will provide) care to the care recipient

Unable to sign

• The Director of Nursing at the aged care residential care service can sign the claim form if:
• a care recipient is unable to sign the claim form, and does not have an authorised representative
• A letter from a doctor, hospital or social worker confirming the care recipient is unable to sign due to the nature of their medical condition must be lodged with the claim form

Deceased

• If a care recipient is deceased, only the administrator or executor of the estate can legally act on behalf of the estate
• The applicant must provide evidence they are the administrator or executor of the deceased estate

Ongoing hardship assistance

If a care recipient needs ongoing hardship assistance:

• It is important that Services Australia receives a new hardship assistance claim before the end of the current hardship assistance period
• This is to ensure any hardship assistance payment is continuous
• The hardship assistance end date is advised in the hardship claim outcome letter
• No end date reminder letters are sent

Note: before the hardship end date, Services Australia may review a care recipient’s circumstances to confirm ongoing eligibility in the current hardship assistance period. For example, hardship may be reviewed to confirm if the care recipient still has a protected person residing in the principal home.