Chapter 5: Carer Payment (child) Eligibility
The Taskforce compared the circumstances of carers of children under the age of 16 years with severe illness or disability who currently qualify for the payment with those who have not qualified, and drew on Carer Payment (child) and Carer Allowance (child) application, eligibility and recipient data and case studies.
Current eligibility criteria
Chapter 3 of this report outlines details of the eligibility criteria and assessment processes. The evidence available from the review established that there are many children who, because of severe disability or medical conditions, by any reasonable standard clearly require a level of extra attention and supervision such that the carer is precluded from substantial participation in the workforce but is not eligible for the payment.
As discussed above, currently the eligibility criteria for Carer Payment (child) are prescribed by reference to the consequences of, or treatment for, a limited number of circumstances that are used as a surrogate for determining the actual care needs of the child. This contrasts with the comparable Carer Payment (adult), which is determined by reference to the directly assessed care needs of the care receiver.
The difference between the methods of assessment for Carer Payment (child) and Carer Payment (adult) is apparently related to a view about the general, and particularly the agerelated, care responsibility inherent in parenthood. The evidence available to the Taskforce, however, indicates that the additional care necessarily involved in caring for a child who has a severe disability or is suffering from a severe medical condition compared with the care required by a child of similar age who is not suffering from such a disability or condition can be identified in the majority of cases and becomes increasingly demonstrable with older children. Under the current regime the issue, then, is the impact of those additional care needs as related to workforce participation.
There is increasing pressure from interested stakeholder groups for recognition of a range of specific conditions as automatically meeting the qualifying requirement, similar to the Lists of Recognised Disabilities for Carer Allowance (child). While there are some conditions which by their very nature and without exception are so severe that they will always meet any qualifying medical requirement, many conditions present a range of impacts across care receivers. Some are unique, such as chromosomal disorders, with limited diagnostic information and unclear intervention plans and no clear prognosis.
Even within a single condition, the impacts are not uniform but can range from extremely severe to mild. For the purposes of assessing eligibility for Carer Payment (child), the Taskforce is of the view that the test should not be the condition as such but should be the level of care needed by the care receiver as a result of the condition and the provision of that care by the carer. This issue is discussed further in Chapter 6.
Not surprisingly, the major issue identified by the Taskforce through the review process related to the perceived inequity of the current eligibility requirements, particularly the need to meet arbitrary and, in the view of many, irrelevant specific care-related criteria.44
The specificity of the criteria means that many carers whose caring responsibilities are at least as necessary and as great as those of carers who qualify for the payment are precluded from receiving the payment, even when they meet the other criteria.
Ongoing advances in medicine and in medically applied technology combine to make the prescription of specific conditions and their attendant care needs even more inappropriate, inefficient and inequitable.
Given its appreciation of the underlying purpose of Carer Payment (child), the overwhelming conclusion of the Taskforce is that the current eligibility criteria are too restrictive and consequently the payment is not effectively achieving its intended purpose.
Recommendation 18
The Taskforce recommends that the eligibility criteria for Carer Payment (child) be amended to recognise the level of care required by and provided to children with severe disability or medical conditions.
Ineligible carers
An analysis of the number of applications for Carer Payment (child) that are granted compared with the number that are rejected provides a stark illustration of the restrictive nature of the current eligibility process.
In 2005–06, around 12 per cent of applications for Carer Payment (child) resulted in payment being granted. This is by far the lowest grant-to-application ratio of all income support payments.
Table 2 provides the relevant data.
| Carer Payment (child) claims | |||
|---|---|---|---|
| Financial year | Granted | Rejected | Total claims |
| 2004–05 | 502 11.7% | 3,791 88.3% | 4,293 |
| 2005–06 | 591 12.1% | 4,299 87.9% | 4,890 |
Note: It is possible for customers to have more than one claim record—for example, a rejected claim can be followed by a granted claim.
Source: Standing Committee on Finance and Public Administration, Answers to Questions on Notice, Department of Human Services
and Agencies, Supplementary Budget Estimates, 2006–07.
Centrelink advised the Taskforce that its claim streaming processes also significantly reduce the number of people who lodge a claim for Carer Payment (child), as carers who enquire about the payment are informed by Customer Service Advisers about the stringent medical, care and means test requirements.
While appreciating the need for accurate advice, the Taskforce has some concerns that this approach may be discouraging potentially eligible carers from applying. The Taskforce acknowledges, however, that anyone may choose to apply, regardless of their circumstances.
The Taskforce notes that the current assessment process also does not cater for children with mental health conditions. While the behavioural criteria may cover some of the circumstances these children experience, the Taskforce is not convinced that the caring load associated with many of these conditions is sufficiently allowed for in the current arrangements.
This was also evident in the submissions, with those caring for children with mental health conditions noting that their circumstances did not fit into any of the current eligibility criteria.
Analysis of appeals
A brief analysis was done of 35 cases where unsuccessful applicants had appealed the unfavourable decision to the Social Security Appeals Tribunal and/or the Administrative Appeals Tribunal, or had used other mechanisms such as the Scheme for Compensation for Detriment caused by Defective Administration.
Of the 35 cases analysed, 29 related to Carer Payment, five related to Carer Allowance and one related to both. Eight of the 35 cases involved act of grace decisions; and 19 of the Carer Payment cases involved Carer Payment (child).
The reason most often given for rejecting a claim for Carer Payment was a failure to meet the‘profoundly disabled child’ criteria, expressed as, for example, ‘the child’s condition satisfies sections 197(2)(a) and (b), but not section 197(2)(c) of the Act in that her/his condition includes only one and not three circumstances set out in the sub-section’ or ‘Carer payment rejected on basis that there were only two ticks’.
Case studies
The Taskforce has included the following case studies to illustrate in a practical way the kinds of difficulties carers of children with severe disability or medical conditions experience when applying for Carer Payment (child).
Case Study 1
The child, aged 10, has a very severe peripheral neuropathy which is the cause of major disability. It is a variant of Charcot-Marie-Tooth syndrome (peripheral neuropathy) and is not fatal. The condition involves progressive deterioration of the muscles of the feet, lower leg, hand and forearm. The child is confined to a wheelchair for many activities of daily living and is reliant on her parents for dressing, washing and help with feeding. She has extremely poor hand strength and is unable to do anything that requires very fine motor control. She needs assistance at school and has a special teachers aide during recess and lunch times. Her parent is not eligible for Carer Payment (child).
Case Study 2
A Carer Payment (child) application was considered ineligible as it failed to meet the medical criteria. The child is six years of age and has Costello syndrome (lifelong illness). The child requires full-time care as he is mentally and physically disabled, dependent on a walking frame, and incontinent. He also requires full-time assistance at school. The mother initially took maternity leave but has not been able to work for seven years.
Case Study 3
A child who is blind, deaf and unable to speak, who cannot walk and cannot use his hands was deemed not to be eligible for Carer Payment (child) because he didn’t meet three of the seven ticks on the medical report. However, a full day’s work is required by his carer each day to support him, making it impossible for the carer to gain paid employment.
Case Study 4
A Carer Payment (child) application was considered ineligible as it failed to meet the medical criteria. The child is one year of age and has congenital nephrotic syndrome– Finnish type (lifelong illness). It is associated with chronic renal failure. The child requires full-time care and the mother is unable to return to work. Treatment has included extended long stays in hospital, daily hospital attendance for albumin infusions which take between five and nine hours, a permanent central line, special formula and daily medications. The child may require a kidney transplant in a few years or peritoneal dialysis.
Case Study 5
A Carer Payment (child) claim was rejected as the child was assessed as having only one of the three conditions necessary to fulfil the medical criteria. The child is two years old and has been diagnosed with skeletal dysplasia with global development delay and hypothyroidism (likely to be lifelong). The child is unable to sit or walk without support, unable to feed by themselves and suffering from hearing loss. The child requires periodic hospital stays. The medical report diagnoses the child as having severe multiple disability and requiring continuous personal care.
Case Study 6
A child, aged 11, has Rett syndrome, a neurodevelopment disorder that is a common cause of profound mental impairment in girls. The condition often involves loss of purposeful use of the hands and serious disability for life, with reduced muscle tone and seizures. The onset of symptoms in this case was gradual. At 17 to 18 months she lost her word skills and effective use of her hands, and only began walking at five years of age. She is unable to feed herself and move around due to visual problems. She has no speech, is not toilet trained and has intellectual problems which are increasing. She attends a mainstream preschool for four days per week and receives assistance from a teacher’s aide.
The child does not meet the criteria for a ‘profoundly disabled child’ as she does not have three of seven circumstances and also does not meet the criteria for dangerous, aggressive or sexually deviant behaviour.
44 In particular, satisfying three of the following seven conditions:
- the child receives all food and fluids by nasogastric or percutaneous enterogastric tube
- the child has a tracheostomy
- the child must use a ventilator for at least 8 hours a day
- the child:
- is 3 or over and has faecal incontinence day and night; or
- is under 3 and is expected to have faecal incontinence day and night at the age of 3
- the child:
- is 2 or over and cannot stand without support; or
- is under 2 and is expected to be unable to stand without support at the age of 2
- a medical practitioner has certified that the child has a terminal condition for which palliative care has replaced active care
- the child:
- is at least 6 months old and requires personal care on two or more occasions between 10 pm and 6 am each day; or
- is under 6 months but is expected to require personal care on two or more occasions between 10 pm and 6 am each day at the age of 6 months.