Assessment of circumstances for a couple separated due to illness 277-50070020

Although the definition of an illness separated couple applies if one or both members of the couple are no longer able to live in their home, a couple may only be considered an illness separated couple if they are not residing together or are residing together in a care facility.

Members of a couple who permanently live in an aged care facility that provides low (hostel type) or high level (nursing home type) residential care will be considered illness separated. This will apply regardless of whether they are sharing the same room or different rooms in the care facility, based on increased living expenses incurred (aged care fee structures) and limited ability to ‘pool resources’ which is afforded to couples not residing in a facility.

An illness separated couple may be eligible to receive the following extra assistance:

• a higher rate of payment. Certain allowance and pension customers may receive the equivalent of the single rate of payment. Parenting Payment (PP) and other allowance customers may be eligible for a special rate, which is above the member of a couple rate of payment but less than the single rate. Similarly, a respite care couple are entitled to the single rate of payment, however their rate of Rent Assistance may be affected differently
• single rate of Pharmaceutical Allowance (PhA), where applicable
• single rate of Pension Supplement, where applicable
• as the illness separated rate is higher than the member of a couple rate, the couple can have a higher level of income before their payment reduces to nil by application of the partnered income test. A pensioner couple can also have a higher level of assets before their payment is reduced to nil by application of the partnered assets test
• increased rate of Rent Assistance (RA)

Note: although illness separated couples may be paid a higher rate of payment, equivalent to the single rate of payment, the assessment will still take into account the combined income and assets as if they were a regular member of a couple.

After entering the appropriate 'illness separated' code on the Marital Status (MS) screen, the records of the customer and their partner will stay linked and correctly display as 'member of a couple'.

Members of a couple are considered to be in a care type similar to an aged care facility if they are residing in a:

• retirement village or Supported Residential Service (SRS) that is providing a low level (hostel type), or
• high level (nursing home type) of care

The facility must be providing the care. If an external source, such as Home and Community care, provide the care, which the couple could receive in their own home, the agency would not consider the:

• SRS or Retirement village an aged care facility
• couple illness separated

A couple is considered an illness separated couple where:

• they are unable to live together in their home, and
• the inability to live together:
• is due to illness or infirmity of either or both of them, and
• results in their living expenses being greater or are likely to be greater than otherwise, and
• is likely to continue indefinitely

The agency does not consider a couple separated due to one or both members of the couple accessing approved respite care to be an illness separated couple. This is because approved respite care is for a temporary but definite period.

A couple that does not meet the Illness Separated criteria might meet the criteria for a respite Care couple and receive the higher single rate of payment if they are accessing approved respite care for a period of at least 14 days.

Where a couple meets the illness separated criteria however it has been identified they were previously in respite care, a separate assessment to determine if they met criteria for a respite Care couple retrospectively must be undertaken.

It is not the intention that medical evidence is required for the majority of assessments. A couple, who have left their home due to illness or infirmity, will be accepted as illness separated in situations where:

• it is apparent to Services Australia that the illness or infirmity of one or both members of a couple prevents them from living together, and/or
• there is supporting evidence of illness or infirmity, for example, where the ill or infirm member of the couple:
• permanently lives in an aged care facility that provides low (hostel) or high level (nursing home) residential care, or
• is a patient in a normal hospital ward and has been classified as a nursing home type patient, or
• is residing in a psychiatric facility, or
• has had an Aged Care Assessment Teams (ACAT) assessment that indicates care is needed on an ongoing basis, or
• has current care needs that indicate that the couple cannot live together (this could be based on information the agency already holds on care needs provided to assess entitlement of a carer to receive Carer Allowance (CA) or Carer Payment (CP) in respect of the ill or infirm member of the couple)

The agency may ask the customer to provide supporting evidence from a treating doctor or relevant health professional where:

• the illness or infirmity preventing the couple living together is not apparent, and
• no other supporting evidence is available

Note: it is not necessary for a care situation to exist for the illness separated rate to be paid. An illness separated couple should not be confused with former members of a couple whose relationship has ceased because of ill health.

The Aged Care Act 1997 has 'financial hardship' provisions for people who have difficulty in paying their residential care payments and relevant ongoing expenses. Financial hardship assistance may be available to residents who do not have the income or assets to use to pay their costs of care. Each case is considered individually, based on a resident's financial circumstances. Financial hardship provisions let the agency provide financial assistance for fees and accommodation payments on application.

See Aged Care Financial Hardship Assistance - Overview for more details.

It is likely most couples separated due to illness will have, or be likely to have, an increase in their living expenses. In the residential aged care situation, where one or both members of the couple move to residential aged care, the aged care resident would be subject to a number of residential aged care fees. For more information on aged care fees, the Resources page has an external link to the myagedcare website.

The requirement for customers to pay residential aged care fees is likely to mean their expenses will increase. The illness separated provisions should apply, as the couple would not have the benefit of sharing expenses when living together. For example, for a pensioner couple in receipt of the maximum rate of payment and with no assets, the person moving into aged care would be subject to the basic daily fee. This is a fee they would not have had if the couple had remained together. Their capacity to share expenses is reduced, which the illness separated provisions is intended to recognise. Therefore, where one or both members of a couple are in aged care, illness separated provisions should be applied without further investigation of the couple's financial circumstances.

For all other situations, the assessment of living expenses should only be applied on a very selective case-by-case basis. When assessing if the customer's living expenses have increased, or are likely to increase, due to illness separation, take into account factors such as:

• transportation
• medication, and
• the loss of ability to pool resources

For example, where the customer or their partner have moved to hospital indefinitely or with family for care purposes. It may not be appropriate to apply an illness separated assessment, as this may not result in an increase in living expenses.

'Likely to continue indefinitely' generally means it is highly probable, based on available evidence that the term of the separation is for a period of time that is unknown or unstated. However, in some circumstances it may be difficult to determine whether a situation is likely to continue indefinitely when first making an assessment.

For example, in the case of a partnered customer who has entered a rehabilitation centre, in many situations the treatment will be for a specified period, such as 3 months. Where evidence is given about the length of time the separation is known or stated to be, the partner does not qualify for illness separated.

However, where it is not possible for the centre to determine a specific or defined period of treatment, a Service Officer should look at the full circumstances of each case and may exercise their discretion to pay the customer and partner at the illness separated rate.

This can include psychiatric care, aged care facility, community based care and hospitalisation as a 'nursing home type' patient.

The RA thresholds and maximum rate payable will depend on a customer's circumstances. Customers who are partnered and have to live apart due to ill health or respite care can each be paid the full rate of single RA instead of half of the member of a couple rate.

If a couple do not qualify as an illness separated couple or a respite care couple, they may qualify for RA as a temporarily separated couple.

Note: where couples qualify for RA as a temporarily separated couple, the coding of the relevant temporary relationship qualifier code 'Tmp Sep/Both Left Home' (TEB), 'Tmp Sep/Left Home' (TEC) or 'Tmp Sep/Ptnr Left Home' (TEP) will not adjust their income support payments to the single rate.

Members of a couple who reside together in a Hostel can be regarded as illness separated. When the agency introduced the Carer Allowance (CA) income test on 20 September 2018, it became compulsory to capture the current partner details of a CA claimant/recipient. Illness separated provisions do not affect the rate of payment of CA where the care receiver is their partner. CA is paid at a fixed rate regardless of relationship status.

This type of accommodation can meet the definition of a 'private residence' for CA, providing:

• commercial care arrangements are not in place for the provision of personal care for the care receiver in the Hostel, and
• as long as the carer continues to provide daily personal care

If assessed as a temporarily separated couple, Services Australia will be required to update the couple's relationship status and address details.

Customers claiming or receiving a Centrelink payment would generally not be regarded as an illness separated couple where:

• they are attending a rehabilitation program for a set period, or
• customers who are on probation and have restrictions on where they can reside as part of their parole requirements

They may however be considered as not being a member of a couple under Section 24 of the Social Security Act 1991 and therefore eligible for the single rate of payment. The decision would still be based on individual's circumstances taking into account a lack of ability to pool resources resulting in financial difficulty. See Treatment of a partnered person as single under Section 24 new determinations.

Determining living separately and apart on a permanent or indefinite basis

A person is considered living separately and apart on a permanent or indefinite basis when they are no longer a member of a couple because the relationship has broken down and there is a level of physical and/or emotional estrangement, resulting in one or more parties having no intention to reconcile. An emotional estrangement can occur independently of whether the parties live in the same house or not.

The decision maker must establish if the illness of one member of a couple has led to a breakdown in the relationship and an estrangement between the 2 people. If the relationship has broken down because of the illness, consider whether a ‘genuine’ separation has occurred, as opposed to treating the parties as illness separated, that is, MOD S may need to be issued.

One member of a couple has entered into care

If one member of a couple has entered into care (for example, a residential aged care service), they may be considered to be living separately and apart on a permanent or indefinite basis. That is, if there has been an estrangement or breakdown in the relationship because of the illness.

The type of illness may result in the estrangement/breakdown not occurring immediately. It may break down gradually over time.

This may happen if the partner that has entered into care has an illness that is:

• severe
• debilitating, and
• of a permanent nature. For example:
• Huntington's disease, or
• advanced stages of Alzheimer's disease

Because of illness, the partner that has entered into care may not be able to give the customer:

• companionship
• comfort, and
• physical, intellectual, or emotional support

Under the provisions of living separately and apart in this situation, the relationship may be considered:

• to have broken down, and
• they do not meet the 5 factors that decide they are a member of a couple, as per relevant legislation

There may be flow on impacts to the customer that has entered care.

If the customer entering care is considered to be living separately and apart, their share (as either tenant-in-common or joint tenants) of the principal home continues to be an exempt asset for up to 2 years from the date the customer entered care.

The asset exemption of the principal home ceases after 2 years in care, unless another exemption applies.

The application of living separately and apart can be a sensitive topic for customers. Some elderly couples may not be able to disconnect emotionally from their partner, regardless of the financial impacts.

Making this assessment separates the customer’s records as if they were single.

If a customer strongly believes and states that they are a member of a couple with their partner, do not unlink the records. In these situations, the customer and partner are considered an illness separated couple.

If it is determined the couple are living separately and apart on a permanent or indefinite basis, the individuals:

• are deemed single, and
• paid a single rate of income support payment

The single income and assets test provisions applies.

Note: if a customer in residential Aged Care had a partner living in their former principal home, it would be exempt as an asset for Aged Care Means Test Assessment (MTA). If determination has been made that a customer in residential care is now single, this exemption no longer applies, and the home is an assessable asset.

The Process page contains more details about the specific actions required when considering if the customer is living separately and apart.