Skip to content

Acknowledgments | Letter to the Minister

Chapter 8: Differences Between Payments

In addition to the inconsistency in assessment processes noted above, the Taskforce became aware of a number of areas in which different approaches were evident across payments. The major areas on which this chapter focuses are reviews, terminal conditions, verification of claims by medical or health professionals and equitable access to Carer Payment (child).

Reviews

Most income support payment recipients are reviewed regularly to make sure that they are still eligible for payment. These reviews may cover medical details, circumstances and/or income and assets. The frequency and type of review conducted varies across payment types. The review processes for Carer Payment (child) and Carer Allowance (child) are complex and detailed—the information given below does not cover all the relevant elements but is a summary only. Of particular concern to the Taskforce is the variation and reported lack of coordination in review processes for these two payments, and the difficulty for clients and others in understanding the review processes.

Circumstance reviews are designed to:

These reviews are conducted periodically at different times for both Carer Allowance (child) and Carer Payment (child). For Carer Allowance (child) customers, circumstance reviews are mostly conducted in conjunction with changes in Family Tax Benefit eligibility, although entitlement may be reviewed if a child stops living in the family home for more than 24 hours. For Carer Payment (child) recipients, circumstance reviews are conducted every two years, with the possibility of more frequent reviews for those who qualify on the basis that they care for two or more children with disability who have combined care needs that are at least equivalent to the level of care required by a ‘profoundly disabled child’.

A carer who states that the care receiver’s illness or disability has improved may be subject to a follow-up medical review.

Medical reviews ask the payment recipient to reaffirm the disability or medical condition. For these reviews, carers are sent a letter and new form to complete, including information that must be provided by a medical professional. This usually necessitates another visit to a medical professional, which may involve a significant cost to the carer in terms of both the financial expense and the time taken.

‘We were, however, puzzled at being reassessed by the department, at one stage at six-monthly intervals, for over two years. We were told we were being randomly assessed. Our doctor was very angry at being asked to again fill out forms … at the time we had to pay for extra long appointments as our doctor did not accept Medicare payments for our daughter.’

According to the Guide to Social Security Law, medical reviews for Carer Payment (child) are to be conducted biennially for carers of children who qualify as a ‘profoundly disabled child’, but in practice these reviews may not be conducted. Medical reviews are also to be undertaken every two years from date of grant when payment is made on the basis that the recipient cares for two or more children with disability with combined care needs that are at least equivalent to the level of care required by a child with a profound disability. The Guide to Social Security Law states that the biennial circumstance review for Carer Payment (child) is included as part of the medical review to ensure that the carer is still personally providing
constant care—but, again, in practice this may not occur.46

As mentioned in Chapter 3, Carer Allowance (child) medical reviews are conducted within 12 months of developmental milestones. These are:

There are no periodic reviews for children below the age of three years and four months, as their condition is considered unlikely to improve significantly before they reach this age. Children with disabilities or medical conditions that appear on the Lists of Recognised Disabilities are subject only to a circumstance review at these developmental milestones.

Income and assets reviews are conducted for recipients of Carer Payment (child) in November each year, timed to ensure that carers have received their Tax Assessment Notices. These reviews ask carers to state their income and assets for the next financial year. Carer Allowance (child) recipients are not subject to means testing.

Terminal illness reviews are conducted to determine whether the care receiver is still alive. These reviews are to be conducted for both Carer Payment (child) and Carer Allowance (child) every six months after the grant. Due to the sensitive nature of these reviews, they are conducted as courtesy calls to see how customers are coping with their caring responsibilities and to check that their circumstances still qualify them for assistance.

The information sought differs from that sought during a circumstance review; the main questions asked concern whether constant care is still being provided to the care receiver.

Issues

The Taskforce understands the necessity for reviews but notes the number of concerns and issues raised about them during the consultation process. The main issues identified in submissions were the number of reviews, the necessity for ongoing medical reviews of permanent disabilities or medical conditions, the time-consuming nature of reviews and the lack of sensitivity in the way reviews are conducted.

Although some reviews of circumstances may be conducted over the phone, time-poor carers often stated that reviews were onerous. This is compounded by:

In essence, carers receiving both payments may have multiple circumstance reviews and medical reviews in a short period of time. This situation is exacerbated by the fact that carers may not have a clear understanding of the distinction between the two payments.

Carers who care for more than one child with a severe disability or medical condition are subject to reviews for each child.

While it is acknowledged that medical reviews are an integral component of the income support system pertaining to carers and care receivers with a disability or severe medical condition, the use of developmental milestones as trigger points for Carer Allowance reviews can cause difficulties for parents and care givers.

As an example, a carer may care for two children with disability and receive one Carer Payment (child) payment and two Carer Allowance (child) payments. Within a short period of time, they may be subject to separate circumstance reviews for each of the Carer Allowance (child) payments and also for the Carer Payment (child) payment. Medical reviews, in particular, are stressful events for carers, particularly where the child’s disability or medical condition is not likely to change over time.

‘[You have to] explain your situation to different people over and over again. You have your child with you [and they are] listening to your conversations, which only reinforces messages that they have something wrong with them when we are trying to encourage as normal a response to life as possible.’

During medical reviews, carers are required to reaffirm the medical condition of the care receiver. To provide proof of the disability or medical condition requires carers to meet again with medical professionals to complete forms, which involves significant inconvenience and considerable cost to carers.

‘Our biggest concern during this time was the need to fill in forms explaining [the] condition and care requirements. Although this was not very often, the forms were long and required a doctor’s signature. Some medical conditions, and spina bifida is one, will never improve. From a parent’s position, I found this an unnecessary waste of time and money.’

The process adds to the already high demands on carers and exposes care receivers to unnecessary re-examination.

Transitions to school and high school for example, can be a particularly challenging and stressful time for parents of children with disability, who must undergo a number of detailed assessments as part of their introduction to the education system. A child may be required to have formal psychological testing prior to starting school to meet the requirements of the education system as well as an assessment to determine the level of assistance the child may require to participate in the classroom and in daily school routines. Reviews with allied health professionals such as occupational therapists, speech pathologists and early intervention nurses are common at this time. This may not, therefore, be the ideal time to conduct circumstance reviews for the purposes of Carer Payment (child), unless this information can be used as part of the review process.

The Taskforce notes that many of the issues regarding reviews will be resolved by the changes already recommended for the service delivery arrangements and assessment processes.

The Taskforce accepts that reviews are necessary but believes they should have minimal impact on carers. Ideally, review processes should be tailored to the situation of the client, so that where the care receiver’s disability or medical condition is not likely to change, medical reviews are not conducted. The Taskforce acknowledges that this may currently happen for Carer Payment (child) and that tailored arrangements are in place for Carer Payment (adult), where medical reviews are not conducted if a care receiver has a sufficiently high score on the Adult Disability Assessment Tool. Similarly, if a carer is providing short-term, episodic or shared care, the carer may be granted payment for a specific period of time, pending review of both the disability or medical condition and the carer’s circumstances.

In situations where carers are receiving both Carer Payment (child) and Carer Allowance (child), and/or receiving payments for multiple children with disability, reviews should be conducted concurrently to minimise the impact on the client.

Recommendation 28

The Taskforce recommends that an appropriate review regime be developed for carers receiving Carer Payment (child) and Carer Allowance (child).

Terminal conditions

As noted in Chapter 4, there are two ways in which carers of children with terminal illnesses may qualify for Carer Payment (child): first, where a medical practitioner certifies in writing that the child is in the advanced phase of a terminal condition—that is, the child is not expected to live for a period substantially greater than 12 months and will require continuous personal care for the remainder of his or her life because of the condition; and, second, where a medical practitioner certifies that the child meets either the medical or behavioural criteria for payment, one of which is that the child has a terminal condition for which palliative care has replaced active treatment.

To be eligible for Carer Payment (child), continuous personal care must be needed for six months or more. If, however, the child’s condition is terminal and the child’s life expectancy is less than six months, the requirement is for continuous personal care to be provided for the remainder of the child’s life.

For Carer Payment (adult) a terminal illness is ‘where a person is in the final phase of a terminal illness and is not expected to live for more than three months’. This definition is synonymous with the definition of terminal care and palliative care.47

In contrast, Disability Support Pension can be granted without the need for further assessment in certain limited cases where the claimant’s situation is ‘manifest’. One of the criteria for a ‘manifest grant’ of Disability Support Pension is that the person has a terminal illness with a life expectancy of less than two years, with a significantly reduced work capacity during that period. Another ‘manifest’ situation is where the claimant was assessed as a ‘profoundly disabled child’ for the purposes of Carer Payment (child).

The Taskforce could not discern the reason for these different levels of life expectancy across payment types. For the purposes of administering an income support system, the Taskforce questions the reason for, in one instance, defining a terminal condition as one with a life expectancy of less than three months while in another situation stating that it should be less than two years.

Role of health professionals

In the section on assessment processes (see Chapter 6), the role of health professionals in providing confirmation of and information about the care receiver’s condition and care requirements was outlined. For Carer Payment (child), the child’s treating doctor must complete a medical report form, which includes the medical, behavioural and terminal condition criteria specified in the legislation. For Carer Allowance (child), a different form containing the Lists of Recognised Disabilities and the Child Disability Assessment Tool— which includes a functional assessment of the child’s ability across a number of different domains—must be completed by the child’s ‘treating doctor’, described on the form as ‘a legally qualified Medical Practitioner who has supervised the child’s treatment’. This is called the ‘Treating Doctor’s Report’.

For Carer Payment (adult) and Carer Allowance (adult), the carer must arrange for a health professional assessment form to be completed, which can be done by a medical practitioner, registered nurse, occupational therapist, physiotherapist, member of an Aged Care Assessment Team or Aboriginal Health Worker (in a geographically remote area) currently involved in the treatment of the care receiver. It was noted above that certain groups of health professionals, particularly mental health professionals, are not well represented on this list.

Applicants for Disability Support Pension must get the doctor who normally treats them to complete a Treating Doctor’s Report, which is different from the Treating Doctor’s Report used for Carer Allowance purposes. For Disability Support Pension clients, the Treating Doctor’s Report does not need to be completed if:

The Disability Support Pension application form also asks for any additional doctors’ or specialists’ reports to be attached to the claim form and gives applicants the opportunity to nominate other people who can provide information about the disability, injury or illness, such as a counsellor, social worker, case manager, community health worker, teacher, psychologist, physiotherapist, or specialist other doctors.

For those applying for Sickness Allowance, an approved Centrelink Medical Certificate completed by their treating doctor must be attached to the claim form.

Recommendation 29

The Taskforce recommends that, where appropriate, the government introduce a single treating doctor report/health professional assessment form.

Equitable access

Indigenous carers

In June 2007 there were around 150 Indigenous recipients of Carer Payment (child), which represents around 4.2 per cent of all Carer Payment (child) recipients; and 3,100 Indigenous recipients of Carer Allowance (child), or 2.9 per cent. According to the most recent Census, at 30 June 2006 the Indigenous estimated resident population of Australia was 517,200 or 2.5 per cent of the total population.

These figures seem to indicate that Indigenous Australians have equitable access to Carer Payment (child) and Carer Allowance (child); however, the health status of Indigenous Australians compared with the wider population should be considered in interpreting the data.

The ABS’s 2004–05 National Aboriginal and Torres Strait Islander Health Survey found that Indigenous people overall were almost twice as likely as non-Indigenous people to report their health as fair or poor and that this relative difference was apparent across most broad age groups. The survey also found that 44 per cent of Indigenous children aged 0–14 years had at least one long-term health condition and 9 per cent had multiple conditions.

These conditions included eyesight problems, total or partial hearing loss, asthma, kidney disease and diabetes. Indigenous Australians were admitted to hospital more often than non-Indigenous Australians across all age groups and were more than twice as likely to have visited the casualty or outpatient department of a hospital in the two weeks before the survey.

Inherent in Indigenous culture is the concept that family members and the community look after each other. Because of this, people often may not identify themselves as carers. There are also complex kinship roles and relationships that may impact on caring roles and responsibilities. This may mean they often miss out on services and supports to which they are entitled.48 The Taskforce recognises that the kinship or shared model of care has many benefits for the individual and the community but that this model of care is not well supported by the current system.

During the focus groups, the main issues identified for Indigenous carers were the difficulty in understanding the payments and the forms; language barriers and the ability to access interpreters; literacy skills; and access to resources, particularly health or medical resources, in rural or remote areas.

‘Most people say they won’t bother applying for Carer Payment (child) … they say it is just too hard, another fight they don’t want to have … they just apply for Carer Allowance (child) … it’s much easier to settle for the $98 allowance than go through the Carer Payment (child) hoops.’

The Taskforce is aware that verifying their identity can, for some people, be problematic due to lack of documents such as birth certificates and driver’s licences. Completing all components of the applications form can also prove to be difficult, with assistance often sought from health clinics or other services.

The infrequency of visiting doctors in remote areas makes completing the current medical report form difficult. Where forms are completed, submitting them in a timely manner can be difficult due to lack of postal services in many communities.

The Taskforce also recognises that Indigenous families are less likely to have a court order or even a less formal parenting plan in place, yet they still may have substantial caring responsibilities which preclude them from seeking employment.

Carers from culturally and linguistically diverse backgrounds

Around 23 per cent of Carer Payment (child) and 20 per cent of Carer Allowance (child) customers were not born in Australia.

Table 4 provides information on Carer Payment (child) and Carer Allowance (child) recipients by country of birth.

Table 4: Carer Payment (child) and Carer Allowance (child) recipients Ranked by country of birth, June 2007
Carer Payment (child) recipients Carer Allowance (child) recipients
Country of birth Number % Country of birth Number %
Australia 2,740 76.7 Australia 87,340 80.0
United Kingdom 146 4.1 United Kingdom 5,105 4.7
Vietnam 85 2.4 New Zealand 2,343 2.1
Lebanon 81 2.3 Vietnam 1,712 1.6
New Zealand 71 2.0 Lebanon 1,265 1.2
Iraq 46 1.3 Philippines 916 0.8
China 35 1.0 China 663 0.6
Philippines 31 0.9 India 492 0.5
Turkey 19 0.5 Iraq 483 0.4
Afghanistan 18 0.5 Malaysia 371 0.3
Fiji 14 0.4 South Africa 371 0.3
Other 286 8.0 Other 8,057 7.4
Total overseas-born 832 23.3 Total overseas-born 21,778 20.0
Total 3,572 100.0 Total 109,118 100

Note: Excludes recipients who are eligible for the Child Health Care Card only.
Source: Centrelink administrative data, 2007.

The Taskforce recognises that similar barriers may exist for carers from culturally and linguistically diverse backgrounds to those facing Indigenous carers, including a perceived reluctance to seek help from beyond the family or community environment, language barriers and literacy issues.

Families from culturally diverse communities who have strong intergenerational and extended family ties have highlighted to the Taskforce the difficulties in being able to secure Carer Payment (child) for other family members due to their residency status or the household income, which may preclude eligibility.

While many of the issues facing carers will be addressed by the recommendations of the review in relation to the eligibility criteria, assessment process and service delivery, the Taskforce is concerned that the particular barriers confronting carers from Indigenous and culturally and linguistically diverse backgrounds may not necessarily be identified.

Carers in rural and remote areas

Parents and other carers who live in rural and remote parts of Australia face particular barriers in accessing assistance, especially services. The need to travel long distances to find help adds not just to the cost of providing care and the costs of disability but also to the possible stress of organising other family members or friends to ‘mind the farm’ while carers are away. Although the cost of patient travel for those in isolated areas is subsidised to some extent, there are no special administrative arrangements for those in rural and remote areas to help them access, or maintain eligibility for, Carer Payment (child).

Recommendation 30

The Taskforce recommends that the government undertake further work to ensure that the barriers facing carers from Indigenous and culturally and linguistically diverse backgrounds in accessing Carer Payment (child) are recognised and addressed.

Recommendation 31

The Taskforce recommends that the government ensure there is effective access to Carer Payment (child) for carers in rural and remote areas.

46Guide to Social Security Law, subsection 6.2.5.51, ‘CP—Reviews (Child with a Profound Disability)’.

47 Ibid, subsection 1.1.T.85, ‘Terminal care and palliative care (CA) (CP)’, and 1.1.T.86, ‘Terminal illness (CA) (CP)’.

48 Carers NSW, media release, 9 October 2007.

Return to top

Chapter 9: Conclusions and Future Directions

Chapter 7: Relationship to Other Payments