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Residential Aged Care Financial Hardship Assistance Guidelines

These guidelines have been developed for internal use to assist relevant staff of the Department of Health and Ageing (the Department) in the assessment of individual financial hardship applications, and may be updated from time to time.

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Contents

1. How to Use the Financial Hardship Assistance Guidelines
2. Aged Care Legislation
3. Financial Hardship Provisions
4. Assessment of Applications for Financial Hardship Assistance
5. Financial Hardship Assistance – Administrative Processes
6. Appendices

1. How to Use the Financial Hardship Assistance Guidelines

These guidelines have been developed for internal use to assist relevant staff of the Department of Health and Ageing (the Department) in the assessment of individual financial hardship applications, and may be updated from time to time. Each resident’s situation is unique, and applications are assessed on the applicant’s individual circumstances to determine whether, in the context of legislation and current aged care policy, their circumstances constitute financial hardship.

The guidelines are subordinate to the Act and Principles. This document is to be used as a set of guidelines only and may be amended from time to time.

2. Aged Care Legislation

The Aged Care Act 1997 (the Act) commenced on 1 October 1997 and addresses the need of Australia’s ageing population to access residential aged care. The Act sets out a standardised set of fees, rules and protections that formalise the premise of a quality and accessible user pays system featuring choice and financial stability for residents requiring residential aged care.

The legislation provides that those residents in Australian Government funded residential aged care facilities who can afford to contribute to the cost of their care should do so.

The relevant legislative provisions relating to assessments of applications for hardship supplement are described in Appendix A.

There have been several amendments to the Act since October 1997. The basic principle remains, however, that residents who are able to contribute to their costs of care are asked to do so.

2.1. Class and Individual Hardship

The Act provides for the payment of hardship supplement where residents are experiencing genuine financial hardship in accessing or remaining in residential care. The provisions cater specifically for financially disadvantaged residents in allowing a reduction of aged care fees and accommodation payments where hardship can be demonstrated.

Hardship supplement is not intended to cover the circumstances where a discretionary choice has resulted in financial difficulties. Following are some cases where the hardship supplement would not normally be approved:

• where a personal choice is made not to use a particular asset which could help with the payment of care fees, e.g. investments or savings;
• where money or an asset has been gifted or disposed of;
• where finances or an asset are being earmarked for inheritance purposes; and
• where a person has chosen to accept an extra service place.

Class Hardship (Class A, B, C, D and E) is characterised by an entitlement to a reduction in aged care fees, based on certain financial and/or social characteristics of aged residents. This entitlement is automatically applied. For more detail see 3.2.

Applications for individual financial hardship supplement may be submitted for both residential respite and permanent care. Applications are assessed using the legislation applicable to the resident’s date of entry to residential aged care.
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2.2. Overview of Aged Care Fees and Accommodation Payments

Residents in Australian Government subsidised residential aged care make a contribution, based on their means, towards their daily living costs and accommodation. Residents do this through the payment of daily fees, which are based on their level of income, and, if they have sufficient assets, an accommodation payment.

Standard Resident Contribution

All residents in aged care, including respite residents, may be asked to pay a standard resident contribution towards accommodation costs and living expenses, like meals, cleaning, laundry, heating and cooling.

Note: The Department of Veterans’ Affairs (DVA) pays the standard resident contribution for Australian ex-prisoners of war in Australian Government subsidised residential aged care.

Income Tested Fee

Residents (other than respite residents) may be asked to pay an income tested fee, depending on their income and the level of care they require.

The Department determines a resident’s income tested fee amounts based on a Centrelink or DVA assessment of income information that is provided to them by the resident or their representative. Information on a resident’s total assessable income for the purpose of calculating their aged care fees is then provided to the Department by Centrelink or DVA. Details of income and assets that are included in the assessment are not provided to the Department.

Residents who have income that exceeds the income tested fee threshold may be asked to pay an income tested fee. This fee is paid directly to the aged care home. No resident will pay more than they can afford or more than the cost of their care.

Accommodation Payments

Accommodation payments may be applicable if a resident’s assets exceed the minimum permissible asset level at their date of entry into care. An accommodation bond or charge may be levied in addition to the standard resident contribution and the income tested fee.

Accommodation Bond

An accommodation bond may be payable for residents requiring low level care or residents entering an extra service place. An accommodation bond may be paid as a lump sum payment, by periodic payment or as a combination of the two.

Accommodation Charge

An accommodation charge is a daily amount, and may be payable by residents requiring high level care. The accommodation charge is payable on a sliding scale based on the level of the resident’s assets where a resident has assets above the minimum permissible asset level. The maximum daily accommodation charge is calculated under the User Rights Principles 1997.

Extra Service

Under section 44-30(4) of the Act, a resident who is receiving care on an extra service basis is not eligible for financial hardship assistance.

3. Financial Hardship Provisions

As noted above, there are two types of hardship assistance – Class Hardship (under subsection 44-30(2) of the Act) and Individual Hardship (under sections 44-22, 44-31, 57-14 and 57A-9 of the Act).

3.1. Applications for Individual Hardship Assistance

Financial hardship assistance may be available to residents in genuine financial hardship who do not have income or realisable assets to pay their costs of care due to circumstances beyond their control. Each case is considered on an individual basis, taking into consideration the resident’s overall financial circumstances, including their total income and assets, their eligibility for a pension, and whether any of their assets are unrealisable.

All decisions for individual financial hardship assistance are a reviewable decision under the Act.

The Secretary of the Department of Health and Ageing or the delegate may:

• reduce the amount of standard resident contribution payable; and/or
• set to zero the income tested fee; and/or
• provide assistance in respect of an accommodation bond or accommodation charge.

Commencement Date of Financial Hardship Assistance

The commencement dates for assistance with different fees and accommodation payments may not be the same. Assistance may be dated from the date of a resident’s admission to aged care, from a certain event having taken place, the date from which documentary evidence can be provided, or from the date that an application has been received in the Department.

Cessation Date of Financial Hardship Assistance

The cessation date takes into account the possibility of a resident’s financial circumstances changing over time, and what effect this may have on their capacity to meet their aged care fees. Specifically, a resident’s circumstances may improve to the extent that they are no longer eligible to receive assistance, such as where previously frozen assets become realisable.

Residents are required to inform the Department when their circumstances change in order to avoid any possible overpayment.
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3.2. Classes of Residents Eligible for Hardship Supplement

There are currently five classes of residents who are eligible for hardship supplement under subsection 44-30(2) of the Act and section 21.37 of the Residential Care Subsidy Principles 1997.

Class A:

Class A comprises residents who are under 21 years of age, receive an income support payment and have an income that is less than the single rate of age pension. The amount of hardship supplement for a member of Class A is calculated by subtracting from the applicable rate of standard resident contribution for that care recipient an amount that is equal to 84% of the sum of the resident’s total income, the maximum family tax benefit entitlement for a person of the resident’s age, and any youth disability supplement payable for the resident.

Class B:

Class B comprises residents who are under 16 years of age and whose total income (including any Family Payment or Child Disability Allowance received on their behalf) is less than the basic single rate social security pension amount. The amount of hardship supplement for a member of Class B is calculated by subtracting from the standard resident contribution for that resident an amount that is equal to 84% of the sum of the resident’s total income, the maximum Family Tax Benefit entitlement applicable for a person of the resident’s age and any Youth Disability Supplement paid for the resident.

Class C:

Class C comprises a subset of residents who entered residential care after 30 September 1997 but prior to 20 March 2008, who are; self funded retirees whose income is just above the pension income test cut off. The amount of hardship supplement for a member of Class C is calculated on a sliding scale to reduce the difference between the amount they pay as a standard resident contribution and the amount they would have paid if they had been pre 2008 reform pensioners.

Class D:

Class D comprises residents who entered care prior to 1 October 1997, who lost their Residential Care Allowance (a type of income support payment) due to the introduction of the Act. The amount of hardship supplement for a member of Class D is calculated on an individual basis using information supplied by Centrelink (which incorporates the amount of Residential Care Allowance formerly payable).

Class E:

Class E comprises residents who were receiving low level care on 30 September 1997 and have not moved to an aged care home that was approved as a nursing home prior to 1 October 1997. This supplement is known as the ‘ex-hostel supplement’. The amount of Class E hardship is set at $0.80 and is not indexed.

4. Assessment of Applications for Financial Hardship Assistance

Individual circumstances may be taken into consideration under section 44-31 of the Act and section 21.39 of the Residential Care Subsidy Principles.

4.1. Assessment of a Reduction of the Standard Resident Contribution and Setting the Income Tested Fee to Zero

Financial hardship is taken to occur where a resident is left with less than 15% of the maximum basic single rate pension per fortnight after paying their standard resident contribution and income tested fee and has minimal additional financial resources available to assist them. These resources would be expected to be less than $15,000 (current) before assistance would be considered.

Under section 44-31 of the Act, the Secretary may determine that a resident is eligible for a hardship supplement if satisfied that paying the maximum daily amount of resident fees would cause the resident financial hardship. Section 21.39 of the Residential Care Subsidy Principles sets out the matters which the Secretary or delegate must have regard to in assessing a resident’s eligibility for a reduction of the standard resident contribution and/or income tested fee.

These matters include the resident’s income and a consideration of asset holdings, whether or not assets are able to be realised and any other matters the Secretary or delegate considers relevant, such as whether a resident has compromised their own ability to meet their aged care fees. As a basic principle, for example, financial hardship assistance is not provided where a resident has chosen to gift assets which could have assisted with his or her care-related expenses.

The calculation of a resident’s income and expenses is assessed in the same way for both the standard resident contribution and the income tested fee with income and expenses being averaged over a fortnightly period.

Assets are treated in the same way for the purposes of assessing eligibility for a reduction in the standard resident contribution, the income tested fee, the accommodation charge or the accommodation bond.

Single Residents

In assessing an application, the resident’s total income is included in the calculations.

Where a resident is in receipt of an Australian Government income support payment, the associated pension supplement (except for the amount designated for pharmaceutical requirements) is not included in this calculation. This is because some components of the pension supplement were granted to assist with particular expenses and these expenses are not generally taken into consideration in calculating the resident’s entitlement to a hardship supplement. The GST supplement was granted to assist aged pensioners with additional expenses incurred because of the implementation of the Goods and Services Tax. The portion of the pension supplement titled the minimum supplement provides financial assistance with charges such as telephone expenses and utility costs.
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Member of a Couple

Each member of a couple is taken to own 50% of the couple’s income and assets, regardless of who earns the income or who owns the assets. This applies to both same sex and opposite sex couples.

Where one member of a couple remains living in the community, it is reasonable to consider that the resident still has some responsibility towards the payment of expenses related to the home such as the mortgage or rent, property rates and home and contents insurance. These expenses can be taken into consideration.

When assessing asset holdings for a couple where one member remains living in the community, certain assets may be considered to be unrealisable for financial hardship assistance purposes. For instance, it is considered unreasonable to expect a resident to sell items such as their share of jointly owned home contents to meet their aged care fees and charges where they are in use by the partner residing in the community.

Where one member of a couple remains living in the community and either member is not eligible to receive an income support payment, the resident may receive hardship assistance with respect to the couple’s income or assets.

Certain expenses are also considered differently in the case of a couple to that of a single resident. These expenses are discussed in more detail in section 4.3.

Residents with Dependent Children

Residents with dependent children are not eligible to pay income tested fees under paragraph 21.30(1)(d) of the Residential Care Subsidy Principles. This is an automatic entitlement where Centrelink or the DVA has assessed a resident as having a dependent child under section 44-11 of the Act.

For these residents, the resident’s equal share of the family’s net income may be calculated differently from calculations where the resident is a member of a couple. For example, if there are two adults and two dependent children in the family, the resident’s share of income for hardship purposes is the total net income divided by four. Income received by any immediate family member, such as Youth Allowance or Family Tax Benefit A and B, is taken into consideration.

A fee reduction may be approved to leave these residents with an amount equivalent to the maximum basic single rate pension after paying daily fees from their share of the family’s net income.

Younger People in Aged Care

For the purposes of financial hardship assistance, a younger person in aged care is taken to be a person under age pension age. Special consideration is given to these residents on the basis that they may have a lower pension income and have had little or no opportunity to plan or save for residential care costs. The period of residence of a younger person may also be much longer.

A younger person in residential care could be expected to have additional costs associated with their individual social requirements.

Residents Under 21 Years of Age

Residents who are aged between 16 and 21 are automatically entitled to financial assistance. These residents are categorised as Class A residents under subsection 44-30(2) of the Act and section 21.37(1)(a) of the Residential Care Subsidy Principles. These residents may also be granted additional individual financial hardship assistance under section 44-31 of the Act.

Residents between 16 and 21 years of age may have their standard resident contributions reduced by 50%.

Residents who are aged under 16 are automatically entitled to financial assistance. These residents are categorised as Class B residents under subsection 44-30(2) of the Act and section 21.37(1)(b) of the Residential Care Subsidy Principles. These residents may also be granted additional individual financial hardship assistance under section 44-31 of the Act.

Residents under 16 years of age may have their standard resident contribution set to zero.

4.2. Income sources

Income, for financial hardship purposes, is any money, valuable consideration or profits a resident may have earned, derived or received from within, or outside Australia. The following non-exclusive list of income sources can be considered in the assessment of applications for financial hardship assistance:

• income support payments from the Australian Government, such as the age pension, a service pension or an income support supplement;
• superannuation and overseas pensions, income from income stream products such as annuities and allocated pensions;
• deemed (not actual) income from financial investments;
• net income from rental property;
• war widow/widower pensions and some disability pensions;
• net income from businesses, including farms;
• family trust distributions or dividends from private company shares; and
• deemed income from deprived assets above the allowable limit.

4.3. Assessment of Expenses

Certain expenses may be recognised as being essential expenses for the purposes of financial hardship assistance, and can be taken into consideration by the Secretary or delegate. In all cases it is necessary for the applicant or their representative to provide relevant and comprehensive documentary evidence.
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Pharmaceuticals

Documentary evidence of the ongoing nature of pharmaceutical expenses is required, such as three recent consecutive months of itemised accounts/receipts.

Three levels of pharmaceutical costs may be applied to residents. Some residents are concession card holders (as in the case of Australian pensioners), others are considered to be general patients (who hold a Medicare card), and some residents are not eligible to receive any consideration under the Pharmaceutical Benefits Scheme (PBS).

Once a concession card holder spends a specified amount on PBS medications in a calendar year, any PBS medicines purchased for the remainder of the calendar year are provided free of charge. This is known as reaching the concessional PBS Safety Net threshold. For general patients who hold a Medicare card, any PBS medications that are purchased following expenditure of a certain amount receive additional PBS medications at the concessional rate for the remainder of the year. This is known as reaching the general PBS Safety Net threshold. These provisions will be taken into account when assessing pharmaceutical expenditure under the financial hardship provisions.

Where evidence suggests that the concessional Safety Net will be attained by a resident, a fortnightly average of the amount per year that the resident is required to pay for PBS medications prior to attaining the Safety Net may be ascribed to them. Non-PBS medications can also be averaged (using a three month period of expenses), with the averaged fortnightly amount incorporated into the assessment.

Expenses associated with non prescription items such as creams and vitamin supplements may be considered where documentary evidence is supplied showing that such items are recommended by a medical practitioner as essential to the care of the resident.

In assessing applications where a resident has very low realisable assets (less than $2,000 currently), and lacks the capacity to pay high pharmaceutical costs incurred prior to attainment of the Safety Net, short term assistance may be provided until the PBS Safety Net period commences. In this situation, a higher level of assistance for the period prior to attainment of the Safety Net may be approved, and following this point, only assistance for non-PBS medications for the remainder of the year.

Medication dispensing services are provided to permanent residents free of charge by the approved provider. This provision is set out in Item 2.4 (Treatment and Procedures) of Part 2 (Care and services – to be provided to all residents who need them) of Schedule 1 (Specified care and services for residential care services) of the Quality of Care Principles 1997. Where a resident has opted to use an alternative system, the resident may be considered to have voluntarily accepted the need to meet the cost themselves and consideration may not be given to this expense.

Continence Expenses

Low care residents who require products to assist with toileting and continence management may apply for hardship assistance for these additional costs. These goods are provided free of charge by the approved provider to high care residents as set out in Item 3.6 (Goods to assist with toileting and incontinence management) of Part 3 (Care and services – to be provided for residents receiving a high level of residential care) of Schedule 1 (Specified Care and Services for residential care services) of the Quality of Care Principles.

An additional consideration is the Continence Aids Payment Scheme administered by the Department. This scheme assists eligible people who have permanent and severe incontinence to meet some of the costs of continence products. More information regarding this scheme can be found on the Department’s website.

The Stoma Appliance Scheme (SAS), subsidised by the Australian Government, provides stoma-related products free of charge to people who require them. Approved volunteer stoma associations purchase stoma-related products from suppliers and distribute to their members as required. Membership of a stoma association may be considered to be an essential expense which can be taken into consideration under the financial hardship provisions.

Other products may be considered as essential expenditure for the purposes of financial hardship assistance. However, they would need to be similar to those included in the abovementioned schemes to be counted as essential expenditure.

Podiatry Expenses

Podiatry services may be considered to be an essential expense that may be incurred by some low care residents.

Podiatry services are provided free of charge to high care residents by the approved provider as set out in Item 3.11 (Therapy services) of Part 3 (Care and services – to be provided for residents receiving a high level of residential care) of Schedule 1 (Specified care and services for residential care services) of the Quality of Care Principles.
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Physiotherapy and Other Essential Therapies

Where the physiotherapy is to maintain a resident's level of independence in activities of daily living or short-term, intensive therapy to improve the resident's functions to a level where maintenance therapy will be suitable, payment is the responsibility of the approved provider. This requirement is set out Item 3.11 (Therapy services) of Part 3 (Care and services – to be provided for residents receiving a high level of residential care) of Schedule 1 (Specified care and services for residential care services) of the Quality of Care Principles.

If the therapy is intensive, long-term and rehabilitative, the resident may be asked to meet these costs. Consideration would need to be given to the number of sessions that may be provided under any health insurance fund arrangement before the costs of the therapy could be included in any assessment of essential expenses.

Documentary evidence from a relevant health professional about the level, purpose/expected outcome and likely duration of the therapy should also be supplied. This evidence should be provided by a health professional other than the therapist providing the treatment.

This is also the case for the provision of other essential therapies, such as occupational therapy and speech therapy.

Continuous Positive Airway Pressure (CPAP) Therapy

CPAP is a therapy that is prescribed to people who have sleep apnoea and involves the rental or purchase of a CPAP machine. It is prescribed by a health professional, and may be customised to the resident’s individual needs.

A CPAP machine is not required to be supplied by the approved provider. The costs of provision of CPAP therapy is unlikely to funded by the Oxygen Supplement, as its use is not continuous, and oxygen is not usually required.

Some States and Territories may provide a loan service or subsidy for individuals to access a CPAP machine, and the DVA Rehabilitation Appliance Program covers CPAP machines to eligible card holders. This expense may therefore be considered as an essential expense under the financial hardship provisions where appropriate documentary evidence is supplied.

Mobility Aids

Some mobility aids are required to be provided by the approved provider. Item 3.4 (Goods to assist residents to move themselves) of Part 3 (Care and services – to be provided for residents receiving a high level of residential care) of Schedule 1 (Specified care and services for residential care services) to the Quality of Care Principles states the following aids must be provided for residents receiving a high level of care: crutches, quadruped walkers, walking frames, walking sticks and wheelchairs. Excluded from these categories are motorised wheelchairs and custom made aids.

A reduction in fees may be appropriate in respect of wheelchair repairs and maintenance for wheelchairs or electric scooters and costs of other mobility aids not covered under the Specified Care and Services Schedule.

In the first instance, it is expected that a resident will have investigated his or her eligibility for funding of mobility aids from other sources, such as State Government programs. It would be appropriate to seek documentary evidence of these efforts before considering these expenses. In providing assistance with wheelchairs or electric scooters, the outright purchase of these items is not usually considered. However, consideration may be given to assistance with loan repayments or hire in respect of these items.

In respect of customised wheelchairs, an assessment from a health care professional certifying that a customised wheelchair is necessary for the resident , together with three quotes regarding costs, would be appropriate evidence that it is an essential expense. It may also be requested that the resident provide quotes in order to investigate the option of hiring a suitable customised wheelchair.

Private Health Insurance

Private health insurance is generally not considered an essential expense for residents who hold a Medicare card. Residents holding a Medicare card are able to access medical care through Medicare on the basis of clinical need.

Where a resident is not eligible to enrol in Medicare, consideration may be given to including private health insurance as an essential expense as this group of residents does not have access to affordable health care via Medicare.*
(*Australia may have a reciprocal health care with the resident’s country of origin, in which case the resident may be eligible to enrol in Medicare)

Residents or their partners who pay tax may be able to claim the net medical expenses offset on high out of pocket medical expenses and residential aged care fees. More information, including threshold amounts, can be found regarding this measure on the Australian Taxation Office website.

High Dependency Care Leave

Under subsection 42-1(4) and section 42-2 of the Act, a low care resident requiring a short period of high level care may be eligible to receive high dependency care leave, ensuring that their low care bed remains available for their return. In this instance, residents may be asked to pay daily fees to both facilities and an accommodation charge to the high care facility.

In order for a resident to be eligible to receive high dependency care leave they must have an Aged Care Assessment Team approval for high care, social leave available and a low range Aged Care Funding Instrument appraisal.

Where a resident is unable to pay both sets of daily fees and/or the accommodation charge, consideration may be given to reducing the fees and/or accommodation charge under the financial hardship provisions.
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Expenses Associated with a Resident’s Former Home

Some expenses directly related to a resident’s former home may be considered in the case of a couple, where one member remains in the property. See 4.1 Member of a Couple.

Where a resident’s property could be rented or sold to assist with care-related expenses, expenses related to the former home would only be considered in special circumstances.

An example of special circumstances is where a resident has a reasonable expectation of being able to return to their home following a period of recuperation in permanent aged care. Independent expert medical advice (such as from a medical practitioner) should be provided to support the application.

Cessation of Exemption of Former Home from Pension Assets Test after two Years in Care

Centrelink and DVA exclude the value of a resident’s former home from the pension assets test for two years after a resident enters permanent residential aged care. After this time, unless the person’s partner continues to reside in the home, a resident is classified as a non-homeowner, and the principal home becomes an assessable asset for pension purposes. This may result in a reduction of a resident’s pension.

However, the value of an income support recipient’s former home will continue to be exempted for pension purposes where a resident is renting out the home to assist with the payment of an accommodation charge or is paying an accommodation bond, wholly or in part, via periodic payments.

The rental income is also exempted from the pension income test and does not contribute to a resident’s income tested fee under these circumstances.

Where a reduction of pension entitlement has occurred after the two year period, hardship assistance may be considered where a person who met the criteria of a close relation, carer or dependent child as set under section 44-7 or 44-11 of the Act, continues to reside in a resident’s home at the time of reduction of the pension, continues to be in receipt of an income support payment and the resident does not have additional assets to assist them in the payment of their aged care fees. However, the payment of rates, insurance and other expenses associated with the maintenance of the property are generally not included as essential expenses in this situation. It is generally considered that these expenses should be met by the occupant of the property in lieu of a rental contribution.

Funeral Fund Expenses

Expenses associated with a resident’s funeral fund may be taken into consideration where a resident has documentary evidence of a recognised basic standard level funeral plan. Where a resident has chosen to place themselves into a difficult financial position through choosing exclusive or expensive options, it is unlikely that these expenses could be considered.

A funeral plan paid for on an ongoing basis may be considered with respect to assistance with daily fees. A lump sum payment for a funeral plan may be considered a reasonable expense in respect of assistance with an accommodation payment. Documentary evidence of these expenses must be supplied.

Payment of Standard Resident Contribution in Advance

It is common practice for approved providers to request that residents pay their standard resident contributions one month in advance.

For residents who have less than $2,000 (current) in realisable assets, financial hardship assistance may be considered in the form of a reduction to zero of the standard resident contribution for one month.

Taxation

Taxation paid by a resident or the resident’s partner is considered to be an essential expense for the purposes of determining financial hardship assistance. This is in accordance with paragraph 21.39(1)(f) of the Residential Care Subsidy Principles, which allows consideration to be given to whether a resident could reasonably be considered to have access to particular income. However, financial penalties administered by the Australian Taxation Office in respect of a resident’s, or their partner’s, taxation are generally not considered as they are most probably expenses that could have been avoided by the resident.

Debts

Residents who have accrued debts to a residential care service through no fault of their own may be approved to receive a reduction of the standard resident contribution in individual circumstances.

Assistance may be considered from the date the application was received, where the resident does not have adequate funds to pay their fees or accommodation payment. This prevents the debt to the home from escalating while steps are undertaken by a resident, or their representative, to realise assets or recoup funds.

Assistance may be backdated where the resident or their representative has exhausted all avenues to realise or recover monies. The decision to backdate assistance would be made taking into account a resident’s individual circumstances.

It is unlikely that personal debts, such as credit card and other debts will be taken into consideration as these are most probably expenses which could have been avoided by the resident.

Where it is determined that a resident or their representative, has exercised a choice to enter into a loan agreement (such as with Centrelink, a financial institution or family member) in the knowledge of their aged care fees and charges, it is unlikely that this debt would be considered.
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Discretionary Expenses

Discretionary expenses involve expenditure on items where it is a matter of a resident’s choice to incur the expense(s). Financial hardship assistance is generally not approved for discretionary expenditure, as residents retain the equivalent of 15% of the aged pension to cover these types of expenses, and are expected to tailor their expenses to allow them to live within their means. Examples of discretionary expenditure include:

• Telephone (this expense may already be subsidised by the Australian Government via the payment of the Pensioner Supplement);
• gifts;
• gambling;
• cigarettes and alcohol;
• expenses associated with pets;
• entertainment (lotto, bingo, outings);
• private health insurance (for residents with access to Medicare); and
• holidays.

Respite Care Expenses

The only fee payable for respite care (other than in an extra service facility) is the standard resident contribution. A resident or their representative should, in the first instance, investigate their eligibility for assistance with respite care via the Commonwealth Respite and Carelink Centres. In certain circumstances, this source of funding may reduce the resident’s standard resident contribution to zero. More information can be obtained by telephoning 1800 200 422.

All expenses that are considered for a resident of permanent aged care are also considered for a resident in respite care. In addition, expenses that the resident continues to incur in the community are generally taken into consideration as they need to maintain their principal place of residence in addition to meeting the standard resident contribution. Expenses that may be taken into consideration for respite residents include, but are not limited to: rent, mortgage, home and contents insurance, electricity, gas, property rates and water rates.

Consideration may also be given to whether Centrelink or the DVA provide rent assistance, or whether the relevant State or Territory Department of Housing has reduced the person’s rent on their principal place of residence.

Other Expenses that the Secretary or delegate may Consider

The delegate to the Secretary has discretion under subsection 21.39(2) of the Residential Care Subsidy Principles to also consider any other matters that the Secretary considers relevant.

With documentary evidence, essential care related expenses that are required on an ongoing or episodic basis, and have been prescribed by a health professional, may also receive special consideration. This may include, but is not limited to:

• dental and optical expenses;
• surgical stockings;
• orthopaedic shoes;
• transport to ongoing specialist appointments; and
• taxi fares to specialist/hospital appointments.

4.4. Financial Hardship Assistance – Accommodation Bond and Charge

The intent of the financial hardship provisions is to provide assistance where a resident is eligible to pay an accommodation payment but, for reasons beyond their control, is unable to fund all or part of their accommodation bond or charge. The Secretary may determine that a person must not be :

• charged an accommodation charge (paragraph 57A-9(1)(a));
• charged an accommodation charge of more than a specified maximum daily amount (paragraph 57A-9(1)(b));
• charged an accommodation bond (paragraph 57-14(1)(a)); or
• charged an accommodation bond of more than a specified maximum amount (paragraph 57-14(1)(b) of the Act).

Further requirements on determining cases of financial hardship assistance for the accommodation charge and accommodation bond can be found in sections 23.56 and 23.81U of the User Rights Principles.

The assets held by a resident, their ability to access those assets and the reasons for any reduction in the level of the assets over time are all relevant to these determinations.

Information about a resident’s current income and assets, as well as information from the aged care assets assessment is provided to the Department by either Centrelink or the DVA. For an entry to care prior to 1 July 2005, the statutory declaration provided to the aged care home at the time of entry provides information on a resident’s assets. Either a Centrelink/DVA or aged care provider assets assessment should be provided with any application.
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Assets

Assets include, but are not limited to, those listed in section 21.15 of the Residential Care Subsidy Principles. Types of assets include:

• accounts, including interest free accounts, with: banks, building societies, credit unions etc;
• interest bearing deposits and fixed deposits;
• bonds, debentures and shares;
• investments in: property trusts, friendly societies, equity trusts, mortgage trusts, and bond trusts etc;
• superannuation from which lump sum amounts can be withdrawn;
• real estate and businesses;
• farms;
• loans (including interest free loans);
• motor vehicles, boats and caravans;
• surrender value of life insurance policies;
• investment collections;
• household contents and personal effects; and
• complying income streams purchased after 20 September 2007 (ie income streams which comply with certain requirements of the Social Security Act 1991 and the Veterans’ Entitlements Act 1986).

Unrealisable Assets

In assessing applications consideration is given as to whether any of the assets held by the resident are unrealisable. Under sections 23.56 and 23.81U of the User Rights Principles, ‘unrealisable assets’ are defined in sub-section 11 (12) – (13) of the Social Security Act 1991, as follows:
(12) An asset of a person is an unrealisable asset if:

1. the person cannot sell or realise the asset; and
2. the person cannot use the asset as a security for borrowing.

(13) For the purposes of the application of this Act to a social security pension (other than a pension PP (single)), an asset of a person is also an unrealisable asset if:

1. the person could not reasonably be expected to sell or realise the asset; and
2. the person could not reasonably be expected to use the asset as a security for borrowing.

Unrealisable Homes

It would generally need to be demonstrated that the property has been actively marketed for 6 or more months at a price that is in accordance with that shown on the resident’s assets assessment before it could be considered unrealisable. This valuation would generally need to be provided by the Australian Valuation Office (AVO) as Centrelink and DVA utilise the AVO for assets assessment property valuations unless a recent valuation has been conducted.

Documentary evidence of the sale price, the length of time a property has been marketed, and at least one reduction in the asking price over a six month period should be provided to substantiate unrealisability of a property. If satisfactory evidence is supplied, the Secretary or delegate may backdate assistance. Where assistance is backdated to date of entry, it would generally need to be demonstrated that the property was put on the market in a timely manner following a resident’s entry to care.

Where there is variance as to the value of the property between the AVO and a licensed Real Estate Agent, the AVO valuation would normally take precedence.

Where a person is the sole owner of a property, and prefers to rent rather than sell the property, financial hardship assistance is not approved. It is considered that the resident could have made the decision to sell the property to alleviate their financial difficulty.

Where a jointly owned property is rented and the other owner does not wish to sell, financial hardship assistance may be appropriate. The Secretary or delegate may take into consideration the rental income of the property.
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Gifting

As a basic principle, financial hardship assistance is not provided where a resident has chosen to gift assets which could have assisted with his or her care-related expenses.

For residents who enter residential aged care or moved to another aged care home from
1 January 2007, any amount given away from 10 May 2006 over $10,000 in a single financial year, or $30,000 in a five year financial period, will be included in the assets assessment undertaken by Centrelink or the DVA.

It should be noted that while gifted amounts under the above thresholds will not affect pension entitlements or be recorded on a Centrelink or DVA assets assessment, they may still be taken into account when assessing applications for financial hardship assistance. Gifting is considered to be a discretionary decision and hardship assistance is generally not available where a resident chooses to place themselves in a position of financial difficulty.

Gifting includes when a resident (or their partner) gifts or disposes of assets, including transferring assets or selling assets for less than their market value, or the resident does not receive adequate consideration for the gift or transfer in the form of money, goods or services.

Examples of gifts include:

• where an asset is sold to a family member for less than market value;
• where a loan is forgiven;
• where a family member’s business loan is repaid by a resident as they were a guarantor; or
• money is put into a family trust that is not controlled by the resident or their partner.

Special Disability Trusts may be exempt from the aged care assets assessment if they comply with the same conditions required for pension exemption purposes. Complying contributions are usually not considered to be gifting for financial hardship purposes.

If a resident gifts more than the allowable limit the asset will be treated as a deprived asset, and income will be deemed on the amount in excess of the allowable limit for a five year period. This assessment may change if a gifted asset is returned.

Consideration may also be given to a resident’s mental health at the time of gifting.

Protected Home

Under section 44-10(2) of the Act, the value of the home is not counted as an asset if, at the time of the assets assessment or the date of entry to care (whichever is earlier), the home is occupied by the person’s:

• partner or dependant child; or
• carer, who is eligible to receive a means tested Australian Government income support payment and has lived in the home for the past two years; or
• close relation, who is eligible to receive a means tested Australian Government income support payment, and has lived in the home for the past five years.

Where a property has been protected from inclusion in the resident’s aged care assets assessment, it will also be excluded for the purposes of assessing the resident’s entitlement to assistance in respect of an accommodation bond or accommodation charge.

Granny Flat Provisions

A granny flat interest is established when a resident or their partner exchanges assets or money for a right to reside in someone else’s property for as long as they live.

Centrelink applies a reasonableness test in certain situations (such as where a person transfers assets in excess of the cost of building a granny flat onto another person’s property). As a result, a person may be assessed as having deprived themselves of assets, and penalties may apply under the gifting rules.

The value of a granny flat, as determined by Centrelink or the DVA, is not be included in the resident’s assets assessment for entry to residential aged care (except where the amount provided for the granny flat exceeds the Centrelink or the DVA reasonableness test amount). If this were the case, it would be unlikely that the deprived asset would receive favourable consideration under the financial hardship provisions.

Significant Financial Interest

If a person residing in a resident’s home can demonstrate a significant financial contribution to the property, the value of the resident’s home may be excluded from the assets test for accommodation payment purposes under the hardship provisions.

A significant financial interest can be demonstrated if the person residing in the home has, for example, made significant mortgage repayments or paid for substantial renovations to or extension of the property, while the resident was residing there. Evidence of expenditure must be provided.

The payment of property rates and utilities for the duration of a person’s residence in a property alone does not constitute a significant financial interest for financial hardship assistance purposes.
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Jointly Owned Property

Where a property is jointly owned by the resident and another person, and the other person does not agree to sell or rent the property, the property may be considered to be unrealisable for the purposes of assessing the resident’s eligibility for financial hardship assistance. See Unrealisable Assets above.

Farming Properties

The value of a resident’s farming property is automatically included in assets assessments conducted by Centrelink and the DVA. Even in situations where a home is exempt from the assets test, curtilage (the land surrounding the home) in excess of two hectares on the same title as a resident’s former home may be assessable, as is any land on a separate title.

Where it can be demonstrated that another person (other than the resident) was and continues to be reliant on a farming property for his or her principal source of income, a farming property may be considered unrealisable under the financial hardship provisions.

Where a person has been required to accept other employment because of circumstances associated with a reduction in the income generated by a farming property, such as drought, the assessment may take into consideration that in normal circumstances the person is reliant on the property for the generation of their principal source of income. Any approval of financial hardship assistance in this circumstance would be time limited taking into consideration the period of the drought declaration.

Frozen Assets

The 2008 Global Financial Crisis has contributed to increased demand for redemptions from mortgage funds. Some of these funds made a decision to freeze redemptions and income from the funds may not be generated or distributed.

In October 2008, the Australian Securities and Investments Commission (ASIC) announced special measures that allow fund operators to approve early redemptions for members where there is hardship. These measures include recognition of difficulties such as a need to meet living expenses or medical costs.

Residents with assets in frozen funds can apply to their fund for relief under the hardship measures announced by ASIC. Residents may be able to access a portion of the funds held. It would be expected that residents with frozen assets should have applied for redemption of their funds under the fund’s hardship provisions. Documentary evidence of the outcome of this process should be supplied before financial hardship assistance can be considered.

Short term financial hardship assistance may be provided based on the amount of assets the resident is able to access.

Private Trusts and Private Companies

If a resident is involved in a private trust or company, the asset may be included in the Assets Assessment for the purposes of calculating an accommodation payment.

Where a resident has a loan to a private trust or company, income may be deemed on the outstanding loan amount irrespective of whether they are a controller or non-controller. In the situation where a resident has relinquished control of a private trust or company, they may be considered to have gifted all assets held by the trust or company, and a five-year deprivation period may apply.

Compensation Payments

Lump sum compensation payments may be included in the assessment of a person’s assets conducted by Centrelink or DVA for the purposes of aged care accommodation payments. A compensation payment that has been paid to a resident’s partner who is still in the community may also be considered.

Any other Matters that the Secretary or Delegate Considers Relevant

The delegate to the Secretary has discretion under sections 23.56 and 23.81U of the User Rights Principles to have regard to any other matter that the Secretary considers relevant when making a determination of financial hardship for an accommodation bond or accommodation charge.

4.5. Assessment of a Reduction of the Accommodation Bond or Charge

The intention of the hardship provisions pertaining to accommodation payments is to leave a resident with assets up to the minimum asset level applicable at the resident’s date of entry to care.

The Secretary may determine that a person must not be charged an accommodation bond or charge, or that a person must not be charged an accommodation bond or charge of more than a specified maximum amount. The matters that are considered to constitute financial hardship in relation to accommodation bonds or charges are set out under sections 23.56 and 23.81U of the User Rights Principles, respectively.

Where a resident has unrealisable assets and his or her realisable assets are in excess of the minimum permissible asset level, the Secretary may determine that the person must not be charged an accommodation bond or charge of more than a specified maximum amount under paragraphs 57-14(1)(b) and 57A-9(1)(b) of the Act may be considered. This has only been possible from 1 January 2009, when new legislation to enable the partial reduction of accommodation bonds was enacted.

If a resident is subsequently able to access previously unrealisable assets, the financial hardship determination ceases, and the resident becomes eligible to pay the accommodation bond or charge as per the accommodation agreement.
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5. Financial Hardship Assistance – Administrative Processes

A decision in relation to financial hardship assistance is a reviewable decision.

5.1. Reviews

Under subsection 85-5(1), a person whose interests are affected by a reviewable decision may request the Secretary to reconsider the decision.

The decisions that can be reviewed with respect to financial hardship assistance are detailed in the Act and listed as follows:

Item 44 – Decision - To refuse to make a determination that the daily income tested reduction is zero. The provision under which the decision is made is subsection 44-22(2).

Item 45 – Decision - To specify a period at the end of which a determination that the daily income tested reduction is zero ceases to be in force. The provision under which the decision is made is subsection 44-22(3).

Item 48 – Decision - To refuse to make a determination that a resident is eligible for a hardship supplement (in respect of standard resident contributions). The provision under which the decision is made is subsection 44-31(1).

Item 49 – Decision - To specify a period or event at the end of which, or on the occurrence of which, a determination under section 44-31 will cease to be in force. The provision under which the decision is made is subsection 44-31(3).

Item 51 – Decision - To refuse to make a determination that paying an accommodation bond would cause financial hardship. The provision under which the decision is made is paragraph 57-14(1)(1)(a).

Item 51A – Decision - To refuse to make a determination that paying an accommodation bond of more than a specified maximum amount would cause financial hardship, or to specify a particular maximum amount under such a determination. The provision under which the decision is made is paragraph 57-14(1)(b).

Item 52 – Decision - To specify a period or event at the end of which, or on the occurrence of which, a determination under subsection 57-14(1) ceases to be in force. The provision under which the decision is made is subsection 57-14(3).

Item 53 – Decision - To revoke a determination that paying an accommodation bond would cause financial hardship. The provision under which the decision is made is subsection
57- 15(1).

Item 53A – Decision - To refuse to make a determination that paying an accommodation charge would cause financial hardship. The provision under which the decision is made is paragraph 57A-9(1)(a).

Item 53AA – Decision - To refuse to make a determination that paying an accommodation charge of more than a specified maximum daily amount would cause financial hardship, or to specify a particular maximum daily amount under such a determination. The provision under which the decision is made is paragraph 57A-9(1)(b).

Item 53B – Decision - To specify a period or event at the end of which, or on the occurrence of which, a determination under subsection 57A-9(1) ceases to be in force. The provision under which the decision is made is subsection 57A-9(3).

Item 53C – Decision - To revoke a determination that paying an accommodation charge would cause financial hardship. The provision under which the decision is made is subsection 57A-10(1).

The appeals process occurs in two phases, the:

• Reconsideration by the Secretary (also known as ‘internal review’); and
• Administrative Appeals Tribunal review.

5.2. Reconsideration by the Secretary

The applicant, or their nominated representative, may request the Secretary to reconsider the original decision to reject an application for financial hardship assistance within 28 days of the applicant’s receipt of the original decision. The Secretary may allow a longer period for requesting a reconsideration. In the request for review, the applicant must state the reasons for making the request.

5.3. Applications to the Administrative Appeals Tribunal

If the applicant is not satisfied with the Secretary’s reconsideration of the original decision, he or she may apply to the Administrative Appeals Tribunal (AAT) for review of the decision. The application should be made within 28 days of receiving the internal review decision, stating the reasons for making the application and why they believe the original decision was incorrect. However, the AAT may allow a longer period for requesting a reconsideration.

An application fee is payable unless the AAT registrar waives the fee on the grounds that payment would impose financial hardship on the applicant. Pensioners are exempt from payment and the fee may be waived for other applicants upon request. The application fee is refunded if the Tribunal certifies that the application has been determined in a way that is favourable to the applicant.

The AAT Process

Information regarding how the AAT manages most applications can be found at the Administrative Appeals Tribunal 'The application process' webpage.

5.4. Other Mechanisms of Complaint

Commonwealth Ombudsman

The Commonwealth Ombudsman considers and investigates complaints about Australian Government departments and agencies. This means that the Commonwealth Ombudsman has powers to investigate complaints regarding the financial hardship assistance program. If a person thinks they have been unfairly treated by an Australian Government agency, they may make a complaint to the Ombudsman. If the complaint raises a matter that the Ombudsman can and should investigate, the Ombudsman does so as quickly as possible, with a remit to act fairly, independently and impartially.

The Ombudsman’s services are free of charge to the complainant. If the Ombudsman finds that a complaint against an agency is justified, the Ombudsman may recommend that an agency should reconsider or change its action or decision; that a law, rule or procedure should be changed; and/or that the agency should take any other action that is appropriate in the circumstances.

A person may lodge an application with the Administrative Appeals Tribunal if he or she is not satisfied with the response from the Commonwealth Ombudsman.

Further information regarding the Commonwealth Ombudsman can be found at http://www.ombudsman.gov.au
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6. Appendices

6.1. Appendix A - Legislation relevant to financial hardship assistance

The following legislative provisions relate to assessments of applications for financial hardship assistance:

The Aged Care Act 1997
Section 44-7(3) Relates to those concessional residents who cannot be asked to pay an accommodation bond or charge.

Section 44-10 Shows how the value of a person’s assets is to be calculated.

Section 44-11 Provides definitions for the terms used in relation to supported, concessional and assisted residents.

Section 44-22 Allows the delegate to determine that the daily income tested reduction from the residential care subsidy is to be taken to be zero.

Section 44-27(c) Lists the hardship supplement as an ‘other supplement’, as opposed to a ‘primary supplement’, or ‘additional primary supplement’.

Section 44-30 Provides the basis for which the hardship supplement is payable, including whether the resident is receiving residential aged care and meets the eligibility for a hardship supplement as defined in the Act and Principles. This Section also states that the hardship supplement is not payable to residents receiving care on an extra service basis.

Section 44-31 Provides the legislative basis for determining a lower standard resident contribution, as well as setting an end date for payment of the supplement. Additionally, this Section sets the statutory timeframe of 28 days to either complete a hardship determination or request additional information.

Paragraph 57-14(1)(a) Enables the delegate to determine that payment of an accommodation bond would cause a resident to experience financial hardship.

Paragraph 57-14(1)(b) Enables the delegate to determine that the payment of more than a specified maximum amount of accommodation bond would cause a resident to experience financial hardship.

Paragraph 57-14(1)(a) Enables the delegate to determine that payment of an accommodation bond would cause a resident to experience financial hardship.

Section 57-15 Enables the delegate to revoke a determination made under Section 57-14.

Paragraph 57A-9(1)(a) Enables the delegate to determine that payment of an accommodation charge would cause a resident to experience financial hardship.

Paragraph 57A-9(1)(b) Enables the delegate to determine that payment of more than a specified maximum daily amount of accommodation charge would cause a resident to experience financial hardship.

Section 57A-10 Enables the delegate to revoke a determination made under Section 57A-9.

Section 85-1 Lists all decisions which are reviewable decisions under the Act.

Section 85-5 Allows the Secretary or delegate to reconsider reviewable decision following a request from a person whose interests are affected.

The Aged Care Principles

Residential Care Subsidy Principles 1997Section 21.29 – 21.30 Sets out the classes of people whose daily income tested reduction
from the residential care subsidy is to be taken to be zero.

Section 21.37 Specifies classes of residents eligible for hardship supplement.

Section 21.39 Specifies matters for consideration when determining eligibility for a hardship supplement and in determining a lesser amount of resident fees.
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User Rights Principles 1997
Section 23.30 Specifies that an accommodation bond agreement must still be made where the resident has applied for financial hardship assistance in respect of the accommodation bond.

Section 23.48 Specifies that an accommodation bond agreement must still be made where the resident has applied for financial hardship assistance in respect of the accommodation bond, where the application has not been decided or where the approved provider intends to charge an accommodation bond if the application is refused or later ceases to be in effect.

Section 23.54 Specifies that the Secretary may make a financial hardship determination in respect of an accommodation bond only if the care recipient’s income has been assessed under the Social Security Act 1991 or Veterans’ Entitlements Act 1986.

Section 23.55 Provides that a financial hardship determination in respect of an accommodation bond may take effect from a date before it is made.

Section 23.56 Sets out the matters that the delegate must consider when determining applications for financial hardship assistance in respect of the accommodation bond. These sections refer to unrealisable assets as defined under the Social Security Act 1991.

Section 23.58 Provides the delegate with the circumstances in which a hardship determination can be revoked in relation to financial hardship assistance in respect of an accommodation bond.

Section 23.67A Specifies that an approved aged care provider must not retain any income derived from the investment of a resident’s bond if that resident has been granted financial hardship assistance under paragraph 57-14(1)(a) of the Act.

Section 23.75A Specifies that an approved aged care provider must not deduct any retention amounts from a resident’s bond balance if that resident has been granted financial hardship assistance under paragraph 57-14(1)(a) and 57-14(1)(b) of the Act.

Section 23.81E Specifies that an accommodation charge agreement must still be made where the resident has applied for financial hardship assistance in respect of the accommodation charge, where the application has not been decided or where the approved provider intends to charge an accommodation charge if the application is refused or later ceases to be in effect.

Section 23.81K Specifies that if a determination is in effect in respect of paragraph 57A-9(1)(a) or 57A-9(1)(b) of the Act the approved provider cannot charge an accommodation charge or cannot charge an accommodation charge of greater than a specified maximum daily amount (whichever is applicable).

Section 23.81M Specifies that an approved aged care provider must set out the amount of accommodation charge payable in a resident agreement, for those residents applying to the Department for financial hardship assistance in respect of an accommodation charge. Specifies that an accommodation charge agreement must set out the amount of the accommodation charge payable where the resident has applied for financial hardship assistance in respect of the accommodation charge but the application has not been decided or the approved provider intends to charge an accommodation charge if the application is refused or later ceases to be in effect.

Section 23.81S Specifies that the Secretary may make a financial hardship determination in respect of an accommodation charge only if the care recipient’s income has been assess under the Social Security Act 1991 or Veterans’ Entitlements Act 1986.

Section 23.81T Provides that a financial hardship determination in respect of an accommodation charge may take effect from a date before it is made.

Section 23.81U Sets out the matters that the delegate must consider when determining applications for financial hardship assistance in respect of accommodation charge and the circumstances that constitute financial hardship.

Section 23.81W Specifies that the Secretary may revoke a determination made under paragraph 57A-9(1)(a) or 57A-9(1)(b) of the Act.

6.2. Appendix B - Additional Resources

Before lodging an application for financial hardship assistance it may be beneficial for a resident or their representative to contact the following:

Aged Care Advocacy Services

The National Aged Care Advocacy Program (NACAP) is a national program funded by the Australian Government under the Aged Care Act 1997. The NACAP aims to promote the rights of people receiving Australian Government funded aged care services.

Under the NACAP, the Department of Health and Ageing funds aged care advocacy services in each State and Territory. These services are community based organisations which can give advice about resident rights, and help residents to exercise their rights. Aged care advocacy services also work with the aged care industry to encourage policies and practices which protect consumers. The NACAP can be contacted by calling 1800 700 600.

Advocacy services are free, confidential and independent.

Centrelink Financial Information Service

It is recommended that people entering residential aged care seek financial advice in relation to the payment of accommodation costs. The Financial Information Service, which is available through Centrelink, provides comprehensive information about the rules regarding aged care fees and charges and their interaction with the pension or superannuation. General information may also be provided regarding taxation and senior Australians. This service is free and available to anyone. Appointments can be made by calling Centrelink on 13 23 00.
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