Social Security Legislation Amendment (Improved Support for Carers) Bill 2009
The Inquiry
1.1
On 19 March 2009 the Senate, on the recommendation of the Selection of
Bills Committee (Report No.4 of 2009), referred the provisions of the Social
Security Legislation Amendment (Improved Support for Carers) Bill 2009 to the
Community Affairs Committee for inquiry and report by 7 May 2009.
1.2
The Committee received 9 submissions relating to the Bill and these are
listed at Appendix 1. The Committee considered the Bill at a public hearing in
Canberra on 28 April 2009. Details of the public hearing are referred
to in Appendix 2. The submissions and Hansard transcript of evidence may be
accessed through the Committee's website at https://www.aph.gov.au/senate_ca.
The Bill
1.3
The Bill makes amendments to the Social Security Act 1991 and the
Social Security (Administration) Act 1999 to improve income support
arrangements for carers of children aged under 16 years with severe disability
or severe medical condition (or with a care load equivalent to that of the care
load associated with caring for a child with severe disability or severe
medical condition).
1.4
The Bill amends the qualification criteria for Carer Payment and Carer
Allowance will be introduced for carer payment paid in respect of a child under
16 years, based on the level of care required rather than the rigid
medical criteria used currently. The amendments include:
-
expanded circumstances in which carers can qualify for Carer Payment,
encompassing 'single', 'multiple', 'combined' and 'exchanged care'
arrangements;
-
access to Carer Payment for short term or episodic caring
circumstances;
-
more sensitive and generous arrangements for carers of children
who have been diagnosed with a terminal condition;
-
provision for the FaHCSIA Secretary to determine a new assessment
for Carer Payment through the Disability Care Load Assessment (Child);
-
provision for the FaHCSIA Secretary to determine a wider range of
treating health professionals;
-
more generous arrangements for carers of children when the child
is in hospital by removing the suspension or cancellation of Carer Payment if a
child is hospitalised for more than 63 days; and
-
automatic qualification for Carer Allowance based on
qualification for Carer Payment.[1]
1.5
A new test, the Disability Care Load Assessment (Child), will be
introduced to assess the level of care required by a child or children because
of their disability or medical condition and the level of care provided to the
child or children by their carer. The Disability Care Load Assessment (child)
will be contained in a new legislative instrument to be known as the Disability
Carer Load Assessment Determination 2009. The Determination will contain the
Disability Care Load Assessment (child), as well as scoring algorithms,
matrices and qualification thresholds.
1.6
As part of the qualification requirements for Carer Payment the carer
must receive a rating of intense under the Disability Care Load Assessment
(child) for the child or children to whom they provide care.[2]
1.7
It is estimated that, in the first year, around 19,000 more carers will
have access to carer payment. The Minister concluded:
...these measures will provide a more flexible and accessible
income support payment for Australians facing some of the toughest
circumstances – caring for a child with severe disability or a severe medical
condition.[3]
Background
1.8
In November 2007 the Carer Payment (child) Review Taskforce reported. The
Taskforce, chaired by Mr Tony Blunn AO, examined the eligibility criteria for
Carer Payment (child), and considered the effectiveness of the payment in
providing a safety net for carers of children with severe disabilities or
medical conditions. The review was commissioned by the Government in response
to concerns raised by carers in the community that the current payment
eligibility requirements were too stringent and, therefore, financial support
was not going to the people who provided care and were most in need.
1.9
The Taskforce found that many carers were ineligible for Carer Payment
(child) because of its overly complex and restrictive qualification
requirements. The Taskforce made 32 recommendations covering a range of matters
around improved financial support through changes to Carer Payment (child)
qualifications. The key to its recommendations was that eligibility should be
assessed based on care needed and care provided, where that care precludes
carers from substantial workforce participation. Importantly, the Taskforce
also talked about increased recognition for carers, increased support for
carers to participate in the workforce and better support for carers more
generally through improved service delivery. The Bill is the first part of the
Government's response to the report.
Issues
1.10
Most submitters, including the Mental Health Council of Australia (MHCA)
and Carers Australia, supported the proposed amendments to the social security
legislation. Carers Australia commented:
We see the introduction of the bill as an important step in
addressing many of the unfair and inequitable rules and provisions that
currently exist in the carer payment system and the broader income support
system.[4]
1.11
National Disability Services also commented positively on the bill:
I strongly think that the direction of this bill is the right
one and in a number of ways it will allow more people to receive carer payment
(child), and streamline the receipt of carer allowance for those who are not
already receiving carer allowance as well.[5]
1.12
However, some concerns were raised in relation to the proposed
amendments.
The assessment
1.13
The Bill provides that, as part of the qualification criteria for Carer
Payment in respect of a child aged under 16 years, a carer must receive a
qualifying rating of intense under the Disability Care Load Assessment (child).
The Disability Care Load Assessment (child) will assess the level of care
required by a child or children because of their disability or medical
condition, and the level of care provided to the child or children by their
carer.
1.14
The Disability Care Load Assessment (child) comprises two components:
-
the Assessment of Care Load questionnaire – to be completed by
the carer; and
-
the Professional questionnaire – to be completed by a treating
health professional, including registered nurses, registered psychologists,
physiotherapists, occupational therapists and Aboriginal health workers.[6]
1.15
Carers Australia commented that the replacement of current assessment
measures for Carer Payment (child) with the new Disability Care Load Assessment
should be a positive change for carers, allowing greater flexibility in the
qualifying criteria for Carer Allowance.[7]
1.16
Submitters noted that the Disability Care Load Assessment Tool was not
available and raised concerns about lack of consultation.[8]
Carers Victoria commented that 'there needs to be transparency about the tool
to be used'.[9]
National Disability Services commented that a tool will need 'to be developed
and shaped with a great deal of care and consultation, but the concept of
measuring disability care load is sound'.[10]
1.17
Carers Australia stated that:
...it is difficult to predict the content or the impact of the
new disability care load assessment as it is not yet publicly available, and we
have concerns around that. Policy will determine much of the new assessment and
it is hoped that Centrelink and FaHCSIA will provide very extensive
consultation processes with relevant parties—with family carers themselves—as
they will play a very significant role in its development.[11]
In particular, Carers Australia noted its concern that the
tool may not capture what it considered to be crucial aspects including the
psychological impact: 'It is not only about hours of support, it is not only
about the sorts of things that you can measure easily like medication,
treatments and therapies but really about looking at the impact of the care'.[12]
NDS commented that the tool should take into account aspects of the environment
in which the carer and the child they care for operate.[13]
In addition, it should take into account:
-
geographical location and the impact of living in rural and
remote regions;
-
the carer's ability to easily access support services, networks
and structures both formal and informal;
-
whether the child has received the appropriate aids and
equipment, such as a wheelchair or lifting system;
-
whether a child needs additional care when growth or other
changes occur, either episodically or longer term; and
-
the impact of challenging behaviours and mental health issues on
the level of care required.[14]
1.18
The Association for Children with a Disability also commented on the assessment
tool and stated that it hoped that the questions will be able to clearly
identify the extent to which parents and family members are caring for their
child. The Association went on to comment that:
We believe that the way in which those questions are couched
will be very important in order to capture, from a family's perspective or a
carer's perspective, the actual care load. It is a lot more difficult to do
that if the questions are not couched correctly than it would be if the
question was: 'How many hours are you providing personal care in a day?' We
feel that a significant focus needs to be placed on those questions so that
they do accurately capture the level of care that is provided.[15]
1.19
The Department of Families, Housing, Community Services and Indigenous
Affairs (FaHCSIA) considered that the introduction of the new assessment is the
'most significant reform' in the bill. The assessment will recognise and assess
the total care load of the child, the care required by the child and the care
provided by the carer. The assessment of care load questionnaire was developed
by the Centre for Health Services Development at the University of Wollongong.
The questionnaire was developed in consultation with carers and paediatric
medical and allied health professionals and was piloted with over 1,200 carers
of children with disability or a medical condition. FaHCSIA advised that:
We went through a fairly robust process under very tight time
frames. Some additional steps, if we had more time, would have been to engage a
broader group of carers. The reassurance we had was that 1,200 carers—so people
who provide care—gave very direct input both in completing the form and in
their comments on a feedback sheet which was then looked at by the expert
reference group. That is the sort of process that we went through, which is
probably a bit more technically oriented. There was certainly no deliberate
exclusion of those other groups.[16]
1.20
In response to concerns about what was included in the assessment, FaHCSIA
indicated that it focuses on what the carer provides but does not look at the
emotional or psychological impact on the carer or the carers ability to access
support services, networks and structures. However, FaHCSIA further commented
that:
In the disability care load instrument, we give an
opportunity for the carer to describe the impact that the child's behaviour,
disability or special needs have on them and how that impacts on the everyday
care that they provide. That can be a trigger for a complex assessment team to
take some further interest in the case if there seems to be a discrepancy
between the measurement of care load and the fact that someone has described
the impact on their life as very significant. I was trying to answer before
about the psychological and emotional impact. While we do not specifically have
another tool which measures that, there is some fail-safe—some sort of device
within the questionnaire—which allows it to be identified and could be referred
to the complex assessment team.[17]
1.21
Other matters that NDS considered should be included in the assessment
were addressed by FaHCSIA which indicated that the impact of living in remote
and rural areas will be taken into account through questions on travel to
appointments. The aids and equipment the child receives will be assess as the
care load for the carer will be greater if these are not available. In relation
to the additional care needs that arise when growth or other changes occur,
these will be taken into account in that a person who did not previously
qualify for a payment may do so because of a change in a child's condition.
FaHCSIA also noted that the impact of challenging behaviours and mental health
issues will be recognised in that 'of the four domains in the questionnaire,
two of them are behavioural, including to do with the child's own behavioural
issues and the amount of intervention, supervision, prompting or whatever is
required by the parent on a regular basis'.[18]
1.22
FaHCSIA also stated that it would be undertaking an evaluation of the
tool from the time of implementation and would also meet with key stakeholders
to explain how it operates.[19]
1.23
FaHCSIA responded to concerns about the definition of 'constant care'
and 'personal care'.[20]
It was stated that while 'constant care' is not defined in the Act 'it is the
term which has been used for the present qualification provisions so it is
understood both by the department and the tribunals as to what that means'. That
is, as 'personally providing care on a daily basis for a significant period
during each day'.[21]
1.24
In response to concerns about the availability of the assessment tool, FaHCSIA
informed the Committee that a draft had been received and would be available
within 24 hours. FaHCSIA provided the Committee with a draft on 29 April.
Episodic care
1.25
The proposed amendments will enable a person to qualify for carer
payment if the person is providing care for someone under 16 who is likely to
require care for a period of three to six months.
1.26
This provision was welcomed as a real benefit to caring families and has
the potential to allow quick access to carer payment in extreme circumstances'.[22]
Carers Australia commented:
These provisions will mean that people across a wider range
of caring situations can be assured of receiving the support they need during highly
stressful life events.[23]
1.27
The Mental Health Council of Australia noted that this provision will be
of particular benefit to carers of children who experience mental illness, due
to the episodic nature of many mental illnesses. However, the MHCA considered
that there would be enormous potential benefits if this provision was extended
to carers of adults with mental illness and would reduce the financial burden
on carers.[24]
The Disability Services Commission also commented that the minimum period of
three months may be too restrictive.[25]
1.28
Carers Australia raised concerns about the need for ongoing assessment
and compliance measures in relation to episodic or short-term payments and the
requirement for a carer to meet measures for ongoing qualification, and review
processes will need to be reasonable.[26]
Carers Victoria commented that the qualification period should be kept open for
two years.
1.29
FaHCSIA responded to Carers Victoria's comments on the qualifying
period:
It is by implication rather than actually specifically being
there. Because you could qualify so long as the care is likely to last between
three to six months, then you would come back and put in a shortened
application if you are one of those people who are having an episodic care
requirement.[27]
The shortened assessment 'would basically assure that other
circumstances remain the same and that you still qualify under income and
assets'.[28]
Exchanged care
1.30
The Bill introduces a new qualification for Carer Payment for 'exchanged
care' situations. The aim is to address the fact that currently parents caring
for children in 'exchanged care' situations may not meet the Carer Payment
qualification requirement for the provision of constant care to the same child
and that care is to be provided in the home of the care receiver. The proposed
changes will allow carers to qualify for Carer Payment despite the fact that
they are not providing constant care to the same care receiver(s) and that the
care receiver may have more than one home.[29]
1.31
Both Carers Australia and Carers Victoria, while commenting that the
proposed legislation recognises complex arrangements for divorced or separated
parents, stated that the provision applies only to the care of two or more
children and not to shared care of a single child who requires an intensive
care load. In the latter case, it was noted that the capacity for either parent
to adequately participate in paid employment is likely to be limited.[30]
Carers Australia also commented that this may act to discourage shared care
arrangements in families of a single child with a disability or illness.[31]
In addition, it does not recognise care shared with other family members, for
example, grandparents.[32]
1.32
Carers Australia stated that the shared care arrangements are a clear
improvement. However, Carers Australia considered that multiple health
professionals should be able to contribute to the qualification process in
cases where treating health professionals may differ as care is shared. This
would more accurately reveal an overall picture of the caring situation.[33]
1.33
In reference to the shared care arrangements FaHCSIA noted that they had
been introduced to recognise that in some families there are a number of children
with a disability: 'While each parent, while separated, has a continuing care
load, it is sometimes for a different child. In the past, those people were
precluded from qualifying, because it was a different child.'[34]
1.34
FaHCSIA continued that:
The issue of shared care remains somewhat problematic
because, as...a full careload, reaching that intense qualification, would
possibly not be realised by all people in a shared care environment. It would
by some. Certainly in conjunction with the 63-day respite rule and other
aspects of qualification, some shared care arrangements, one parent certainly
would be able to qualify for carer payment. But, more realistically, if there
was actually 50-50 shared care for one child neither parent would qualify under
the proposed arrangements, because neither of them would be providing
continuous personal care or meet the qualification...
So, if those parents are precluded from work because of their
unavailability for that work every second week, for example, obviously Centrelink
would look at whatever other assistance can be provided, but it would not be
carer payment under the current proposition.[35]
1.35 FaHCSIA also noted that to be recognised under these
provisions the care arrangements must be determined under one or more registered
parenting plans or parenting orders, which are in force. In addition, for the
purposes of this provision a 'parent' can be a natural or an adoptive parent,
or person who has been granted legal guardianship under state, territory or
Commonwealth law. Accordingly, the proposed exchanged care provisions could
apply to grandparents or other kinship carers who have adopted the
child/children or who have been granted legal guardianship under state,
territory or Commonwealth law and who are party to one or more registered
parenting plans, parenting plans or parenting orders in respect of the
child/children.[36]
1.35
FaHCSIA responded that in relation to multiple health professionals:
There is nothing to stop collaboration. I think we would ask,
though, for a single treating health professional to sign the form in terms of
a practical administrative thing for Centrelink to be able to deal with a form
as opposed to multiple forms. But with regard to multidisciplinary teams who
actually work with children, I think that, in practice, we would probably ask
someone to take the lead but certainly to collaborate and consult would be
fine. The questionnaire should be able to lend itself to that quite readily.[37]
Transitional arrangements
1.36
Carers Australia welcomed the new staged approach to Carer Payment
transitions as it will ease the transition significantly. Transitional
arrangements will be introduced so that if a person qualifies for carer payment
for providing care to someone under 16, they will remain qualified for that
payment for up to three months after the child turns 16.
1.37
The MHCA commented that this arrangement will allow carers more time to
apply for carer payment and stated:
As caring commitments can compete with requirements and
timeframes for the completion of forms and assessments, this is a very valuable
amendment, and one that is strongly supported by the MHCA.[38]
1.38
Carers Australia however argued that consideration needed to be given as
to whether another assessment at this transition point was required as if carers
have qualified for Carer Payment (child) using one set of assessment reports,
surely these could be utilised to qualify them for ongoing payments.[39]
1.39
FaHCSIA informed the Committee that one of the reasons the Taskforce
felt strongly that Carer Payment (child) was not reaching the right group was
the large group of people who became eligible at age 16 under Carer Payment in
respect of a child over 16 compared to those who were becoming eligible below
that age. The proposed arrangements will make the assessment for the child much
closer to that of an adult, 'so in essence the overall nature and underpinnings
of the reform are to ease that transition'.
1.40
FaHCSIA also noted that the transitional arrangements will give carers a
longer period to have a new assessment done under the adult disability
assessment tool. Furthermore:
This amendment, however, will not apply to grants provided on
a short-term or episodic basis or for a care provider to a child with a
terminal condition; there are some different rules around that. Qualification
for carer payment for care provided on a short-term or episodic basis may
continue for the duration of the term or the episode, so even if the care
receiver does turn 16 then they still get it for whatever period. So, if the
doctor said, 'This is a five-month thing,' they will get the full benefit even
if they turn 16 the day after. They would be able to get it for the five months
without any requirement there.[40]
1.41
Witnesses also commented on the proposed arrangements for carers of children
when the child is in hospital. The amendments will enable carers to continue
receiving Carer Payment and Carer Allowance whilst the care receiver is in
hospital as long as they continue to participate in the care of the child.
Currently, access to Carer Payment is suspended or cancelled if a child is hospitalised
for more than 63 days.
1.42
The MHCA, while supporting the removal of the 63 day restriction for
children, commented that if the care receiver is an adult, the restriction
applies. The MHCA saw no clear reason to apply the restriction only to carers
of adults and considered that it should be removed.[41]
Centrelink
1.43
Carers Australia commented on the requirement for Centrelink staff to
understand the new provisions:
It is absolutely essential that all Centrelink staff have an
adequate understanding of the new provisions and can pass this knowledge on to
carers. That is probably one of our largest concerns, in that often policy does
not keep pace with the training that is required of the people that have to
deliver services, and we have concerns that in some Centrelink offices there is
still a long way to go for those staff to truly understand the impact of caring
on individual carers.[42]
1.44
Carers Australia went on to state that it met regularly with Centrelink
senior management to discuss the impact of caring on carers when they are
required to attend Centrelink and that Carers Australia was happy to provide
Centrelink staff with training about improving their understanding that 'some
of their customers are going through really tough times'.[43]
1.45
FaHCSIA responded that it had been working with Centrelink to identify
how the proposed bill will impact on carers in order to prevent negative
experiences and develop solutions to any problems as appropriate. FaHCSIA indicated
that Centrelink will:
-
issue new Carer Payment forms as soon as possible after the
legislation is passed;
-
provide onsite servicing at major paediatric hospitals for a
number of weeks from the date that legislation is passed;
-
stream any claim forms lodged prior to the 1 July 2009
implementation date to facilitate speedy assessment from 1 July 2009 when staff
will be available to process claims; and
-
establish new specialist carer assessment teams to undertake the
assessment of Carer Payment in respect of a child aged under 16 years.[44]
1.46
FaHCSIA and Centrelink are also working together to coordinate
complementary communication strategies to inform carers of the proposed changes
to Carer Payment.
1.47
In evidence, FaHCSIA also responded to Carers Australia's offer of
training and commented:
We will talk to Centrelink about that. I think they usually
welcome overtures from Carers Australia, and they have quite frequent
interactions with groups. I think the reference and training tools that they
are developing probably have aspects of what Carers Australia were asking for.
So we will take that up with them. I think it is an excellent suggestion.[45]
Conclusion
1.48
The Committee welcomes the proposed amendments to the Carer Payment (child)
arrangements. The arrangements will ensure that more carers who are unable to
support themselves because of the demands of caring for children with
disability or medical conditions are receiving financial support.
1.49
The Committee notes the concerns raised in relation to consultation
processes. The draft Disability Care Load Assessment (Child) Determination 2009
is now available. As the determination contains the assessment questionnaires, the
Committee considers that all peak groups should be invited to provide comments
on the draft before the implementation of the new regime.
1.50
The Committee also considers that there is great benefit in Centrelink
and Carers Australia working together to improve Centrelink's understanding of
the concerns and needs of carers of children with disability or medical
conditions.
Recommendation
1.51
The Committee recommends that the Social Security Legislation Amendment
(Improved Support for Carers) Bill 2009 be passed.
Senator Claire Moore
Chair
May 2009
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