Source: http://clik.dva.gov.au/print/book/export/html/16028
Timestamp: 2019-10-23 06:18:17
Document Index: 458097067

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﻿ 9.2.4 In Care - Assessment Rules
Home > Compensation and Support Policy Library > Part 9 Principles for Determining Pension Rate > 9.2 Residential Situation > 9.2.4 In Care - Assessment Rules
in respite care [4][glossary:,:] More ? [5]
A person is considered to be in Non-Government Subsidised Care [7] if no Australian Government subsidy is payable to the facility in respect of their care and/or accommodation. This generally means that such pensioners are paying the full cost of their accommodation and any care they may receive.
Multi-Purpose Services (MPS) are designed specifically for rural and regional areas, to bring together a range of health and aged care services under one management structure, where traditional styles of services may not usually be viable. However, unlike residential aged care facilities, care recipients are not required to be ACAT [7] assessed and MPS facilities do not receive Australian Government funding for individual residents. Therefore recipients residing in MPS facilities may be eligible to receive rent assistance [7] on the amount of rent they pay to their MPS service provider.
A patient may be classed as a nursing home type patient (NHTP) in a hospital bed either awaiting placement to an approved facility [7] or there long term as there is no appropriate local facility (eg. a remote locality). Any patient who has been in hospital for more than 35 days in a 12 month period, and for whom a doctor has not certified the need for acute care is also a NHTP.
A person is considered to be receiving community-based care, if the person needs, and has been receiving or is likely to receive, a substantial level of care [7] in a private residence for at least 14 consecutive days. A private residence includes all private accommodation arrangements, including Supported Residential Services
providing a substantial level of care [7] needed by the other person in a private residence; and
A person receiving or providing community-based care is considered to be “in-care” and therefore the assessment rules contained in the 9.2.4/In Care Assessment Rules apply [13]. The term “community-based care” is specifically for pension purposes to ensure those who leave their principal home to receive or provide care in these situations, have access to the home exemption rules and rent assistance, subject to other relevant criteria being met. The residential situations are defined in terms of a substantial level of care being received or provided in a private residence, for at least 14 consecutive days. There is no requirement or linkage to any ACAT assessment.
Section 5NC [16] VEA
9.2.4/Respite Care [18]
Section 5NC(8) [16] VEA
Section 5NC(3) [16] VEA
9.2.5/Supported Residential Services [24]
Section 5NC(4) [16] VEA
Aged Care Means Testing Guide – Chapter 5 Home Care [27]
9.2.4/In Care Assessment Rules [13]
For the full definition of respite care, refer to subsection 5NC(8) of the VEA [30].
pensioners residing in nursing homes or hostels that are not approved facility [7];
pensioners residing in an approved facility but who receive accommodation only, require no care and therefore are not receiving Commonwealth Government subsidised care [7].
Care receiver has been assessed by ACAT [7] and is awaiting institutional admission or has been accepted for approved respite care.
Note: For the eligibility requirements and financial assistance for respite care under the Veterans' Home Care (VHC) program, refer to Health Information and Management Note (HIMN) No 05/2007 [33].
As with other forms of aged care, persons requiring respite care must be approved by ACAT [7] in order to gain entry to a Government subsidised facility as a respite care resident. In most cases, a person can have up to 63 days of respite care in a financial year. However, if the ACAT determines it as necessary, extensions of up to 21 days at a time are possible.
Respite care must be for a minimum of 14 consecutive days for a respite couple determination to apply. A person in respite care is considered to be in government subsidised care [7] and therefore the assessment rules, contained in 9.2.4/In Care Assessment Rules [13], should be followed. This means that if one or both members of the couple are in respite care, then they may be determined to be an illness separated couple [7]. In order for the definition of illness separated couple to be met, the couple must be living apart due to the illness or infirmity of one or both members of the couple.
A person in respite care pays a [glossary:basic:] [glossary:fee:] [38] but cannot be asked to pay an accommodation payment, or any means tested fees.
DVA will pay the basic [glossary:fee:] for up to 28 of the 63 days when the person entering residential respite care is the holder of a Gold Card [7] or a White Card [7]. After 28 days, the veteran, war widow/widower is responsible for paying the basic fee.
9.3.2/Illness separated and respite care couple [42]
Aged Care Means Testing Guide – 3.3 Accommodation Costs [44]
9.1.3/The Income Test [47]
VEATP 2013/52 Part 10/Part B [30]
VEA TP 2013/52 Part 10/Part B [30]
Government Subsidised Care is care provided to persons in approved facilities [7].
The government subsidy (also known as “pensioner supplement”), is paid directly to the facility by DH&FS [7] on the behalf of pensioners receiving this care.
Where a care resident pays an accommodation bond [7] more than ten times the annual rate of social security age pension, the pensioner supplement paid by DH&FS [7] to the aged care facility to replace rent assistance is no longer paid.
An illness separated couple is a couple who cannot share a home because of the illness or infirmity of one or both partners. Illness separated couples may be paid the higher single rate of pension. Refer to subsection 5R(5) [30] of the VEA for the full definition.
Illness separated couples entitled to single rate of pension
Where one or both members of a couple are 'in care', they may be determined to be an illness separated couple [7]. Members of an illness separated couple are entitled to be paid the higher single rate [7] of pension.
In order for the definition of illness separated couple to be met, the couple must be living apart due to the illness or infirmity of one or both members of the couple.
VEA → [53]
If the person was previously a homeowner and has retained that home, for the purposes of the pensions assets test the residence the person vacated to enter (or provide) care will continue to be regarded as the person's principal home. The home therefore remains exempt from the assets test assessment and the lower assets value limit applies.
The homeowner rules apply for the following periods:
up to 2 years beginning from the day the person starts to be 'in care',
as long as the person's partner resides in that home,
up to 2 years beginning from the day the partner leaves the home to be 'in care', or from the partner's date of death,
for as long as the aged care resident is paying (or there is a liability to pay) daily accommodation payment [7] or a daily accommodation contribution [7], an accommodation charge [7] or all or part of an accommodation bond [7] by periodic payments and rents out the former home and entered care before 1 January 2017.
In these cases, the home is exempt from the assets test and the rental income is exempt from the income test.
More → [54]
The homeowner rules also apply for up to 2 years while the person is absent from the residence and is personally providing community-based care for another person.
The non-homeowner rules will apply once the exemption period expires. If the person still owns the former home, it may be counted as an asset.
Renting the former home during exemption period
VEA → [55]
If the home is rented out during the exemption period, the home remains an exempt asset, but net rent is counted as income, unless the special rules that apply for some aged care residents are triggered. The special rules mean that any rent received is not assessable, and are triggered where the person entered care before 1 January 2017 and is paying (or there is a liability to pay):
a daily accommodation payment [7] or a daily accommodation contribution [7], and renting out their former home, or
an accommodation charge [7] for high-level care [7] and renting out their former home, or
an accommodation bond [7] wholly or partly by periodic payments and renting out their former home. More → [56]
Selling the former home during exemption period
If the home is sold before the end of the exemption period, the person will be assessed as a non-homeowner. This applies even if another house is purchased with the proceeds of the sale. This is because a house is only able to be exempted from assessment where it is the former principal home of the person entering care. Where the person has never lived in the house, this definition cannot be met and the value of the new house must be included in the pension assessment. However, this does not apply when the partner of the person in aged care still resides in the new house. This is because the continued occupancy of a home by the spouse establishes it as a principal home for both members of the couple and for the partner in care, homeowner status is retained.
Test of “liability to pay”
VEA → [57]
The test to be applied in these cases of former principal home and rental exemption is that the person has a “liability to pay” at least a part of the accommodation costs periodically. This liability to pay arises out of the resident agreement which is regulated under the Aged Care legislation and agreed by both parties. The agreement should specify the frequency of any periodic payments, how they are to be calculated, and any other matters of interest to both parties.
The resident agreement protects the interest of both the resident and the provider. As such, the preferred method for confirming a “liability to pay” accommodation costs periodically is that the arrangement is part of a valid resident agreement. If the agreement does not indicate periodic payments, but the resident informs DVA of changed payment arrangements with their provider, the delegate should request evidence to that effect. This could be validated by a letter from the facility outlining the specifics of the periodic payment commitments, and/or the resident’s bond or fee statement/s showing actual payments being made and accepted. The delegate may consider that an informal arrangement exists for the payment of some of the amount periodically if they are satisfied with the documentation provided.
It will also be necessary for the parties to enter into a revised resident agreement, meeting the requirements of the Aged Care legislation, and which provides for at least some payment of the accommodation costs by periodic payments.
If the person was not previously a homeowner, has not retained that home, the exemption period has expired, or the person no longer meets the required conditions, the person is a non-homeowner. The high assets value limit applies to non-homeowners.
More → [59]
Pre 1 October 1997 rules
Pensioners who were already residing in hostels, or entered hostels before 1 October 1997 may be assessed under the pre 1 October 1997 nursing home rules (home exempt for two years), or hostel (entry contribution) rules, whichever is to their advantage.
A person who is in care may, in some circumstances, be eligible for rent assistance [7]. Their eligibility may depend on whether or not the accommodation cost is Australian Government subsidised, the type of care they are receiving and whether the rent assistance criteria are met.
Where the person is eligible for rent assistance, only the portion of rent that is payable for their accommodation is treated as rent for rent assistance purposes. If the component cannot be identified, then two-thirds of the total amount paid is treated as rent.
Aged care residents are not eligible for rent assistance. This is because the rent assistance criteria require that a person is not an aged care resident.
A person in respite care is not regarded as an aged care resident. They are therefore eligible for rent assistance, provided that the rent assistance eligibility criteria are met.
Fees payable in respect of home care packages are not considered rent and therefore do not attract rent assistance.
Type of “in care” situation
An approved place in an Australian Government funded aged care facility i.e. Aged care resident
Accommodation not subsidised by the Australian Government, or the State Government for example, community-based care or other Non-Government subsidised care [7]
May be eligible*
Receiving nursing home type care in a hospital
Eligible in respect of any money paid for their accommodation.
May be eligible - in respect of any rent that continues to be payable for the person's usual principal home
*All eligibility criteria must be met for rent assistance to be payable. Where an approved care provider is receiving an Australian Government subsidy in respect of a person, then they will not be eligible for rent assistance.
Assessment of accommodation payments
A lump sum accommodation payment is exempt from assessment under the pension assets test.
The accommodation payment [7] balance is exempt under the assets test [7] while the person remains in care. However, if a person leaves the aged care facility, the refunded amount may be assessed as a financial asset, (depending on what the person has done with the funds), and deeming provisions may apply.
Section 5LA(8) [66] VEA
VEA → (go back) [67]
9.2.7/Entering Care [68]
Section 5L(4) [70] VEA
9.2.2/Non-Homeowner's Basic Assessment Rules [75]
Reference Library – Departmental Instructions – Aged Care Reforms – Homeownership Status
DI/C12/1998 [77]
Section 5N [79] VEA
SCH6-C3 [80] VEA
VEA → (go back) [81]
Rent assistance criteria
Section 5.1.2 Rent assistance eligibility [82]
9.2.4/Types of Care Situations [84]
Impact of leaving care on accommodation bonds and information on deeming provisions
9.2.7/Departure from Aged Care [86]
More → (go back) [87]
Most income support pensions and many of the associated allowances are paid at different rates depending on whether the recipient is partnered [7] or single. Typically, the single rate is higher than the partnered rate since single persons do not benefit from the economies of pooling their resources with another person.
http://clik.dva.gov.au/glossary/acat [88] - defintion of ACAT
http://clik.dva.gov.au/glossary/high-level-care [89] - definition of 'High Level Care'
An accommodation bond is an amount of money paid by Low Level Care [7] and Extra Service Care [7] residents in an aged care facility. An accommodation bond may be paid as a lump sum, or by periodic payments, or a combination of both lump sum and periodic payments.
Aged Care Means Testing [93]
Source URL (modified on 14/10/2014 - 11:10am): http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/92-residential-situation/924-care-assessment-rules
[1] http://clik.dva.gov.au/user/login?destination=node/16028%23comment-form
[2] http://clik.dva.gov.au/user/login?destination=node/16101%23comment-form
[3] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn179
[4] clikpopup://DEF/Respite care
[5] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn180
[6] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn181
[8] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn182
[9] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn183
[10] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn184
[11] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn185
[12] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn186
[13] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/92-residential-situation/924-care-assessment-rules/care-assessment-rules
[14] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn187
[15] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn188
[17] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn179
[18] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/92-residential-situation/924-care-assessment-rules/respite-care
[19] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn180
[20] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn181
[21] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn182
[22] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn183
[23] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn184
[24] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/92-residential-situation/925-special-residence-assessment-rules/supported-residential-services
[25] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn185
[26] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn186
[27] http://clik.dva.gov.au/compensation-and-support-reference-library/aged-care-means-testing/5-home-care
[28] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn187
[29] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn188
[31] http://clik.dva.gov.au/user/login?destination=node/16139%23comment-form
[32] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn189
[33] http://clik.dva.gov.au/health-procedure-library/health-information-and-management-notes-himn/year/2007/052007
[34] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn190
[35] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn191
[36] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn192
[37] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn193
[38] clikpopup://DEF/Basic Fee
[39] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn194
[40] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn195
[41] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn189
[42] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/93-relationship-status/932-member-couple/illness-separated-and-respite-care-couple
[43] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn190
[44] http://clik.dva.gov.au/compensation-and-support-reference-library/aged-care-means-testing/3-residential-aged-care-fees-and-payments/33-accommodation-costs
[45] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn191
[46] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn192
[47] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/91-income-and-assets-test-principles/913-income-and-assets-tests/income-test
[48] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn193
[49] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn194
[50] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn195
[51] http://clik.dva.gov.au/user/login?destination=node/16023%23comment-form
[52] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn196
[53] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn197
[54] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn198
[55] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn199
[56] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn200
[57] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn201
[58] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn202
[59] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn203
[60] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn204
[61] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn205
[62] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn206
[63] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn207
[64] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn208
[65] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn196
[66] clik://LEGIS/VEA/section 5LA(8)
[67] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn197
[68] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/92-residential-situation/927-departure-principal-home/entering-care
[69] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn198
[70] clik://LEGIS/VEA/section 5L(4)
[71] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn199
[72] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn200
[73] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn201
[74] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn202
[75] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/92-residential-situation/922-basic-principles-assessment/non-homeowners-basic-assessment-rules
[76] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn203
[77] http://clik.dva.gov.au/compensation-and-support-reference-library/departmental-instructions/1998/c121998-aged-care-reforms
[78] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn204
[79] clik://LEGIS/VEA/section 5N
[80] clik://LEGIS/VEA/Point SCH6-C3
[81] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn205
[82] http://clik.dva.gov.au/compensation-and-support-policy-library/part-5-income-support-allowances-and-benefits/51-rent-assistance/512-eligibility-criteria-rent-assistance
[83] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn206
[84] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/92-residential-situation/924-care-assessment-rules/types-care-situations
[85] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn207
[86] http://clik.dva.gov.au/compensation-and-support-policy-library/part-9-principles-determining-pension-rate/92-residential-situation/927-departure-principal-home/departure-aged-care
[87] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn208
[88] http://clik.dva.gov.au/glossary/acat
[89] http://clik.dva.gov.au/glossary/high-level-care
[91] http://clik.dva.gov.au/user/login?destination=node/15996%23comment-form
[92] http://clik.dva.gov.au/book/export/html/16028#tgt-cspol_part9_ftn209
[93] http://clik.dva.gov.au/compensation-and-support-reference-library/aged-care-means-testing
[94] http://clik.dva.gov.au/book/export/html/16028#ref-cspol_part9_ftn209