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Illness Separated and Respite Care Couple

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Last amended: Written determinations required for illness separated or respite couples

Determinations by the Commission under section 5R(5) of VEA and section 5R(6) of VEA are made in writing.

Criteria for regarding a couple as illness separated

The criteria are:

(a) 2 people are members of a couple; and

(b) they are unable to live together in their home as a result of the illness or infirmity of either or both of them; and

(c) because of that inability to live together, their living expenses are, or are likely to be greater than they would otherwise be; and

(d) that inability is likely to continue indefinitely.

Delegates must consider a couple's whole circumstances when considering whether they are unable to continue to live together indefinitely. The decision should therefore be based on an overall assessment of the couple's circumstances and intentions, rather than just their immediate situation.

There is no requirement that illness separated couples provide evidence that their living expenses have increased as a result of their inability to live together. It is automatically accepted that this is the case. This is because the members of the couple are no longer able to share their costs of daily living.

Need for medical evidence

There is no need to obtain medical evidence of illness or infirmity where a couple are no longer living together and one or both members of a couple:    

More ?

Policy Library – Separated as a Result of Illness on an Indefinite Basis

9.3.2/Definitions for Member of a Couple Status

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  • are admitted into an approved residential aged care facility, on a permanent basis, or
  • have been assessed by an ACAT team as requiring care on an ongoing basis, or
  • are a patient in an hospital ward and are classified as a nursing home type patient.

In other cases, further evidence may be required to establish why the couple are unable to live together in their home.

Transition care

For income support purposes, the term transition care is restricted to government subsidised transition care, that is, care funded under the Aged Care Act 1997. The rules outlined below do not cover privately funded transition care arrangements.

Transition care arrangements are short term care arrangements for older people who have been in hospital and require therapy focused care for a limited period of time, to recover skills and aid recovery. A person must have been assessed by an ACAT team as being eligible for at least low level residential aged care on an ongoing basis in order to be eligible for transition care.

Transition care can usually be provided for up to 12 weeks, however in certain circumstances, this may be extended to 18 weeks. People in transition care are required to pay a daily co-payment for their care.

Transition care may provide the time and support a person needs to finalise and access longer term care arrangements. A significant number of DVA clients enter either low or high level residential aged care after discharge from transition care.

When assessing whether the illness separated rules can be applied when one or both members of a couple are in transition care, it is important that a person's whole circumstances and their future intentions are considered. A period in transition care which is known, or is likely, to lead to the person's entry to residential care, rather than a permanent return to the couple's home, can be accepted as meeting the test of “likely to continue indefinitely”. A determination that the couple can be regarded as illness separated can therefore be made.

Illness separated sharing one hostel unit in a retirement village

Where a couple take up residence in a single hostel unit in a retirement village, they may be determined to be an illness separated couple. They must be residents of the hostel part of the village with communal facilities, having been assessed by an ACAT team as requiring low level care.    

More ?

Policy Library – In Care –Assessment Rules

9.2.4/In Care Assessment Rules

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Independent living units in a retirement village

A couple who are living in separate units, which may or may not be connected, in a retirement village, cannot be assessed as being an illness separated couple automatically. This is because couples may take up this form of accommodation as a lifestyle choice, rather than from medical necessity. However, if they are able to satisfy all other requirements for being regarded as illness separated, which is supported by a report from a medical practitioner, then a written determination may be made under section 5R(5) VEA to regard the couple as illness separated.    

Revocation of illness separated determination

The illness separated written determination may be revoked, in writing, if the delegate is satisfied that a couple is living separately and apart for reasons other than illness. Where there has been an irretrievable breakdown in the relationship, then each person is regarded as a [glossary:non :] member of a couple.    

More ?

Policy Library – Definition of Non Illness Separated Spouse

9.3.3/Definitions for Not a Member of a Couple Status

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Approved respite care

Respite is provided for carers who normally provide care to their partner or patient at home on a full time basis. The intention of respite is to provide relief to the carer from their caring duties, by providing short term accommodation to the patient, in an approved facility. Commonwealth legislation provides funding for access to 63 days respite care, per financial year, per patient.    

Private respite care

A member of a couple who funds their own respite care is not considered to be a respite care couple under the VEA and continue to be entitled to the partnered rate of pension. However, rent assistance may be payable for privately funded respite care. Written evidence of date of admission to the facility and discharge and the fees charge is required and other eligibility criteria for the payment of rent assistance must be satisfied.    

More ?

Policy Library – Rent Assistance

Chapter 5.1

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According to Section 179 of the VEA, the Commission is a body corporate under the name of Repatriation Commission.

 

 

According to subsection 5M(3) of the VEA, premises constitute a retirement village if:

  • the premises are residential premises; and
  • accommodation in the premises is primarily intended for persons who are at least 55 years old; and
  • the premises consist of one or more of the following kinds of accommodation:
  • self-care units;
  • serviced units;
  • hostel units; and
  • the premises include communal facilities for use by occupants of the units referred to above.

 

 

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) of the VEA for the full definition.

 

 

Aged Care Assessment Team.

Assessment with a member of an Aged Care Assessment Team is required for a person needing the following;

  • access to aged care services through any type of Home Care Package
  • receive services through the Transition Care Program
  • receive certain respite services
  • enter into an government subsidised aged care home

An ACAT will discuss the person's current situation and work out if they are eligible to receive government subsidised aged care services.

If a person can receive aged care services, an ACAT assessment will assist in accessing the right services for the care that is required.

An ACAT assessment is not required for aged care services that are not subsidised by the government. Examples might be services offered by volunteer groups and charitable organisations.

ACAT assessment is not necessary to receive aged care services through some government funded programs such as Home and Community Care, Day Therapy Centres and the National Respite for Carers Program as these organisations deliver these services that have their own, less formal, assessment procedures.

Note: An Aged Care Assessment Team is referred to as an Aged Care Assessment Service (ACAS) in Victoria. Where there is reference to the term ACAT, it intends the Victorian term ACAS to be interchangeable.

Hostel type services, which cater for those people who need middle to lower levels of help with daily tasks and personal care.

Services in this category include:

  • Assistance with the activities of daily living (such as bathing, dressing and eating);
  • Mobility and communication;
  • Meals, including special diets;
  • Certain treatments and procedures;
  • Recreational therapy and rehabilitation support;
  • Assistance in obtaining health and therapy services; and
  • Support for people with cognitive impairments.

Low level care is also known as Category 5-8 care.

According to subsection 5M(3) of the VEA, premises constitute a retirement village if:

  • the premises are residential premises; and
  • accommodation in the premises is primarily intended for persons who are at least 55 years old; and
  • the premises consist of one or more of the following kinds of accommodation:
  • self-care units;
  • serviced units;
  • hostel units; and
  • the premises include communal facilities for use by occupants of the units referred to above.

 

 

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) of the VEA for the full definition.

 

 

A Delegate of the Commission  is a decision-maker who has been delegated authority to exercise the Commission's powers for the administration of pensions under theVEA.

 

 

According to Section 5E(2) of the VEA a person is a member of a couple, if they are:

  • legally married to another person and is not living separately and apart from the other person on a permanent basis; or
  • living in a prescribed registered relationship with the other person (whether of the same sex or a different sex) and is not living separately and apart from that other person on a permanent basis; or
  • all of the following conditions are met:
  • living with another person, whether of the same sex or a different sex;
  • not legally married to that person;
  • in a de facto relationship with that person; and
  • not in a prohibited relationship

The term “partnered” is also commonly used.

A person's 'partner' is someone who is a member of a couple with that person.

An approved facility under the Aged Care Act 1997 is one that has been assessed to meet certain standards of care and accommodation.

Note: Nursing homes and nursing home beds that are fully funded by a State Government do not come under the Aged Care Act 1997.

According to Section 5E(2) of the VEA a person is a member of a couple, if they are:

  • legally married to another person and is not living separately and apart from the other person on a permanent basis; or
  • living in a prescribed registered relationship with the other person (whether of the same sex or a different sex) and is not living separately and apart from that other person on a permanent basis; or
  • all of the following conditions are met:
  • living with another person, whether of the same sex or a different sex;
  • not legally married to that person;
  • in a de facto relationship with that person; and
  • not in a prohibited relationship

The term “partnered” is also commonly used.

Respite care is care provided for one member of a couple in a nursing home or hostel on a temporary basis so that their partner can have a break from providing care.  For care to be recognised as respite care under the VEA, it must be Government subsidised care provided under the Aged Care Act 1997.

A pensioner receiving such care, and their partner (a respite care couple), are entitled to be paid the single rate of pension.

For the full definition of respite care, refer to subsection 5NC(8) of the VEA.

 

 

A respite care couple is a couple who Commission has determined are separated because one person has entered respite care in a nursing home or hostel to give the other member of the couple a temporary break from caring for that person.

Members of a respite care couple are entitled to be paid the single rate of pension.

Refer to subsection 5R(6) of the VEA for the full definition.

 

 

Veterans' Entitlements Act 1986.

Most income support pensions and many of the associated allowances are paid at different rates depending on whether the recipient is partnered or single.  Typically, the partnered rate is lower than the single rate to take account of the economies associated with two persons pooling their resources.

 

 

Rent Assistance is an allowance, which may be paid to a service pensioner or income support supplement (ISS) recipient to assist in meeting the cost of rental accommodation.

To receive rent assistance, a pensioner must be paying rent (other than Government rent) for accommodation in Australia, and the amount paid must exceed a certain threshold.