Aged care financial hardship assistance - overview 065-05030000

If the enquiry is about:

• Eligibility criteria, go to Table 2
• Progress of hardship claim, including withdrawn claims, go to Step 2
• Explanation or review of decision, go to Step 3
• Care recipient has a valid pre-entry hardship assessment and has now started care, go to Step 4
• Hardship has been granted and there has been a change of circumstances, go to Step 5
• Hardship has been granted and care recipient is changing providers, go to Step 6

Check Document List (DL) for a Fast Note showing the current status of the hardship claim:

• Progress of Claim
• Fin Hardship Progress of claim doc
• This lists any information requested for the assessment and the due date
• GRANT
• Hardship granted
• Includes amount/s of hardship assistance granted and the start/end dates
• REJECT
• Claim rejected
• Assessment completed and result was no entitlement to hardship assistance
• If an explanation or review of decision is requested, go to Step 3
• WITHDRAWN
• Unable to complete the hardship assessment Further information was requested and not given
• See the Progress of claim Fast Note for details of information requested
• If requested information has been provided within 13 weeks of withdrawal, refer to hardship team using Fast Note - select Auto Text – use Aged Care > Hardship > Aged Care Hardship Enquiry
• If information is received more than 13 weeks after withdrawal, a new hardship form is required. If the start date is the same, the original form can be uploaded again with a new signature/date
• Procedure ends here
• No hardship DOC found
• SA462 – Claim for Financial Hardship Assistance will display on the Activity List (AL) screen under Digital Image work items when it has not yet been processed
• There is no new claim activity created for hardship assessments
• If there is no current work item on AL, confirm receipt of SA462 via Document Tools
• If no digital work item has been created on AL, use a Fast Note – select Auto Text – use Aged Care > Hardship > Aged Care Hardship Enquiry
• If form has been lodged more than 28 days ago, refer to hardship team using Fast Note – select Auto Text – use Aged Care > Hardship > Aged Care Hardship URGENT
• Procedure ends here
• Claim for financial hardship has been lodged and unable to resolve enquiry at first contact
• Before a claim can be actioned, all outstanding documentation or information needs to be provided by the care recipient. Refer to Resources Tab / Aged care financial hardship assistance - assessment for further information of evidence required
• Advise the care recipient that there are timeframes for completing claims. Use the following script:
  I can confirm we have your claim for financial hardship. If you have been requested to provide information, it is important that you do so as soon as possible so as not to delay your claim. We will let you know the outcome as soon as it is complete. Thank you for your patience
• For claims where all information has been provided and the assessment has not been completed within 28 days, consider if further escalation is required
• Use Fast Note - select Auto Text – use Aged Care > Hardship > Aged Care Hardship URGENT
• Procedure ends here

If the care recipient/nominee:

• has given or wishes to give more details about a hardship decision:
• check the care recipient’s record to confirm receipt of documents
• once further information is received, refer to the hardship team using Fast Note - select Auto Text – use Aged Care > Hardship > Aged Care Hardship Enquiry
• see Initial contact about a decision and the review of decision process
• wants to request an explanation, see the Customer requests an explanation or applies for a formal review of a decision table
• wants to apply for a formal review, they must lodge a request for review in writing, see Request for an explanation or application for a formal review
• Procedure ends here

Care recipient has a pre-entry hardship assessment and has now entered aged care. This may also include care recipients that are re-entering respite care within a valid hardship period.

Create a Fast Note - select Auto text, use Aged Care > Hardship > Aged Care Hardship Enquiry

• Residential care
• If care recipient has entered care as not low means tell the care recipient/nominee/authorised representative to send the aged care residential agreement to Services Australia to confirm Daily Accommodation Payment amount
• If care recipient has entered care as low means, no further documents are needed
• Home care/respite care
• No further documents needed
• Procedure ends here

Care recipient/nominee/authorised representative contacts to advise a change in circumstances that may affect the ongoing hardship entitlement:

• sale of the former principal home previously assessed as an asset that cannot be sold or borrowed against
• See Sale of principal home for any documents needed
• sale of other property or assets
• any other changes to income and assets
• create a Fast Note - select Auto text, use Aged Care > Hardship > Aged Care Hardship Enquiry
• include a summary of changes advised and any documents given or requested
• the hardship team will reassess or cease the current hardship assessment. See Aged care financial hardship assistance – review/cease/revoke
• Procedure ends here

If a care recipient currently receives hardship assistance and has moved to a new provider, the hardship assistance is reassessed based on the fees and charges agreed with the new provider.

• Residential care
• If care recipient has entered care as not low means ask the care recipient/nominee/authorised representative to send the new aged care resident agreement to Services Australia
• If care recipient has entered care as low means, no further documents are needed
• Home care/respite care
• No further documents needed
• Create a Fast Note - select Auto text, use > Aged Care > Hardship > Aged Care Hardship Enquiry
• Include if a residential agreement has been requested or given
• The hardship team action the transfer of hardship assessment to the new provider when they receive the new residential agreement (if required). See Aged care financial hardship assistance – review/cease/revoke
• Procedure ends here

A care recipient is ineligible for a hardship assessment when they meet 1 of the below:

• have not provided income and assets in a means assessment. See Step 3 for more details
• own assets valued at more than the current hardship threshold (excluding any assets that cannot be sold or borrowed against) See Step 4 for more details
• gifted more than $10,000 in the previous 12 months and/or $30,000 in the previous 5 years. See Step 5 for more details
• started a home care package before 1 July 2014 (and not opted into the post 1 July 2014 scheme). See Step 7 for more details
• is currently receiving residential care under a pre 1 July 2014 assessment scheme and they occupy an extra services place. See Step 7 for more details.

Prior to claiming financial hardship, care recipients are encouraged to look at accessing other means of financial support. This includes:

• the care recipient’s entitlement to income support
• whether the care recipient has access to financial assistance from other sources such as Home Equity Access Scheme (HEAS)

Where there is a current Assurance of Support (AoS) Agreement in place, evidence will be required to determine why the assurer (the sponsor) cannot continue to support the assuree (the care recipient):

• the assurer may have had changes in their circumstances (for example, they are no longer employed) resulting in an inability to continue providing financial support.
• where support can no longer be provided a detailed statement is required from the assurer explaining why they can no longer provide the agreed financial support under the AoS Agreement
• the statement may include information such the assurer’s income and assets as well as any expenses that prevents them from continuing to support the care recipient under the AoS agreement

Is the care recipient eligible for hardship assistance?

• Yes,
• for Home Care go to Step 2
• for Permanent residential care or residential respite care, go to Step 3
• No, procedure ends here

• All home care hardship applicants must have an Aged Care Assessment Team (ACAT) approval
• This includes claims for hardship assistance lodged before entry to care

Check if there is a current home care ACAT.

In ACMPS:

• go to Assessment & Events tab..
• under Assessment Details check the following fields:
• Approved Care Level
• Date of Approval
• Approval End Date

If there is no ACAT approval Service Officers can do one of the following:

• Warm transfer the care recipient/nominee/authorised representative to My Aged Care. See the Warm transfer to My Aged Care table in My Aged Care General Service Offer (MACGSO) for assistance
• Offer to book a face-to-face appointment with an Aged Care Specialist Officer (ACSO) if there is one available in their area who can start the assessment process. See Aged Care Specialist Officer (ACSO) for information on arranging a referral to an ACSO if required

Go to Step 3

• All hardship assistance applicants must have a current means assessment. See Aged Care means assessment for details on when a verbal assessment can be completed
• Information needed to complete the means assessment depends on the care type:
• Home care – all income details needed
• Residential care and respite care – all income and asset details needed
• Care recipients currently assessed as means not disclosed (MND) are not eligible for hardship assistance

Check if the care recipient has a current means assessment.

To confirm current home care details, go to care recipient record in ACMPS and review:

• Means Testing Data tab
• assessed income and assets under Means Tested Assessments
• source of the means test data is CLK or DVA

To confirm current residential/respite care details, go to care recipient record in Aged Care Staff Portal (ACSP) and review:

• Care recipient > Event Summary
• Means Testing > Resident Contribution type
• Fees and charges > Fees and charges detail

If there is no current means assessment check if:

• the means assessment can be completed verbally, or
• an Aged Care Calculation of your cost of care form is needed

For information on completing a means assessment and when a form is needed, see Aged Care means assessment.

Is the care recipient eligible for hardship assistance?

• Yes, go to Step 4
• No, procedure ends here

Information needed to complete the means assessment depends on the care type:

• Home care – all income details needed
• Residential care and residential respite care – all income and asset details needed

In Customer First, update income and asset details given by the care recipient/ nominee/authorised representative.

For further information on updating income and assets, see:

• Coding of income and assets for Centrelink payments and services
• Aged care reviews – reassessments and updates

After the income and assets update:

• recommend the applicant complete an estimate of the aged care fees on the My Aged Care website using the updated income and assets information
• Using the fee estimator assists the applicant to decide if a hardship assistance claim is still needed
• The Resources page has a link to the My Aged Care website

See Aged care financial hardship assistance - assessment for further information including current and historical thresholds

Go to Step 5.

A care recipient is generally not eligible for hardship assistance if they have gifted more than:

• $10,000 in the previous 12 months, or
• $30,000 in the previous 5 years

If the care recipient has gifted amounts over the threshold, a hardship assistance claim may be considered if:

• the care recipient lacked the capacity to give informed consent when the gift was made
• legal proceedings to recoup the funds have started, and
• evidence of the legal proceedings is given

Is the care recipient eligible for hardship assistance?

• Yes, go to Step 6
• No, procedure ends here

Consider all other financial circumstances of the care recipient.

Money on loan to a private trust or company

• Income is deemed on the outstanding loan amount:
• regardless whether the care recipient is a trust or company controller or non-controller
• If the care recipient has handed over control of a private trust or company:
• all assets held by the trust or company are considered gifted and subject to the gifting rules

Rental property (sole owner)

• When a care recipient is the sole owner of a rental property, the asset value is considered when assessing for hardship:
• unless it meets other criteria for exemption such as an asset that cannot be sold or borrowed against
• If the care recipient prefers to rent rather than sell the property, it is considered that the care recipient can sell the property to relieve the financial hardship

See Aged care financial hardship assistance - assessment for information on how to process financial hardship assessments.

A care recipient who initially entered care before 1 July 2014 is not eligible for hardship when they occupy an extra services place. Extra Service aged care places provide a significantly higher standard of residency, meals and services for care recipients.

See Aged care financial hardship assistance - assessment for information on checking if a care recipient occupies an extra service place.