Illness Separated and Respite Care Couple

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:    

• 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.    

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 non member of a couple.    

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 or payment. 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.