3.6.7.47 Qualification for CA - verifying care provided by non co-resident carers
Summary
This topic covers verifying where possible whether the personal care and attention provided by a non co-resident carer addresses special care needs that the care receiver is assessed under the ADAT as having AND whether the amount of time undertaking that caring is reasonable.
Verifying care provided against the ADAT
To verify that the care described by the carer in his or her CA claim correlates with the personal care required as assessed by the ADAT, the type of care provided as indicated by the carer in their CA claim form (SA381) must be matched to the personal care described as being needed under the ADAT. The table below identifies how each answer may be verified.
If the care provided cannot be verified through the table below further investigation will be required - as described in 'Where the personal care provided does not match the care needs indicated in the ADAT' later in this topic.
Note: DO NOT REJECT OR CANCEL BASED ON THIS TABLE ALONE.
| Where hours are indicated in the CA claim form (SA381) | Cross check against this section of the ADAT (which correlates with the THP professional questionnaire (SA332A)) |
|---|---|
| Mobility (Question 14) | |
| Helping the person you care for to be able to move about.
Example: Helping the care receiver getting in and out of chairs or bed, around house, up or down stairs. |
ADAT - Part 2 - Division A THP form Question 10, Parts 6, 7 and 9 |
| Personal hygiene (Question 15) | |
| Helping the person you care for to bathe or shower, cleaning their teeth, grooming and dressing themselves, using the toilet, using continence aids, clipping their nails etc. | ADAT - Part 2 - Division A THP form Question 10, Parts 1, 2, 3, 4, 8 and 10 |
| Eating and drinking (Question 16) | |
| Helping the person you care for to eat their meals and take liquids.
Explanation: This does not include cooking meals, but includes cutting, mashing or juicing food so that they can eat it, feeding it to them and/or supervising them to ensure that they do eat and drink. |
ADAT - Part 2 - Division A THP form Question 10, Part 5 |
| Communication (Question 17) | |
| Helping the person you care for to communicate (including listening, signing, using equipment and interpreting). | This criteria is not directly related to any specific questions in the THP questionnaire. However, responses in Sections B or C could indicate that the care receiver MAY have communication needs. Consideration should be given to the care receiver's other care needs and medical condition together with relevant information in the claim (as communication needs could be present for a wide variety of reasons). Generally the carer's response should be accepted in this area. |
| Treatment (Question 18) | |
| Helping the person cared for to take medication, do therapy or have treatment (including massaging limbs, changing dressings, doing physiotherapy and operating and monitoring medical apparatus). | This criteria is not directly related to any specific questions in the THP questionnaire. Consideration should be given to the care receiver's care needs and medical condition together with relevant information in the claim as treatment needs could be present for a wide variety of reasons. Generally the carer's response should be accepted in this area. |
| Behaviour management (Question 19) | |
| Supervising the person cared for to ensure their safety and/or to prevent inappropriate behaviour.
Example: Not letting the care receiver wander, removing them from dangerous situations, preventing them from damaging property or injuring themselves or others. |
ADAT - Part 2 - Division C THP form Questions 11 and 12 Consideration should be given to the care receiver's other care needs, medical condition, and any relevant questions from Division B as behaviour management needs could be present for a wide variety of reasons. |
If care provided matches the care needs indicated in the ADAT, the care is verified.
Where the personal care provided does not match the care needs indicated in the ADAT
If there are care needs that do not match the ADAT, these care needs will need to be verified before they can be counted towards the 20-hour per week total. If some of the care needs match the ADAT and care is being provided to address these needs for a total of 20 or more hours per week, then there is no need for further verification.
To verify care needs that do not match the person's current ADAT, consideration should be given to the length of time since the last ADAT and whether the care receiver's medical condition supports the level of care stated.
Explanation: The care receiver's condition may have deteriorated since their last ADAT and is the type of condition that would be expected to require more care over time.
Where the care receiver's medical condition does not support the level of care stated, the care needs may be able to be verified through discussions with the carer and/or through current medical evidence that the carer may have. This could include information from a third party such as a physiotherapist, specialist, community care service etc. Failing this, the carer may be asked to supply a new THP assessment.
If it cannot be verified that the care provided is required, the carer does not qualify for CA.
Verifying that the personal care provided is reasonable
To verify that the time spent providing care is reasonable, it should be compared to the table of task times below.
Note: If the personal care provided falls outside the average times listed on this table further investigation will be required before the claim is finalised.
| Category | Tasks - These tasks are examples only - they are not an exhaustive list | Average time
(See Note A below) |
|---|---|---|
| Mobility |
|
Up to one hour per day in the home. Allow an additional one hour for assisting with medical appointments (Average of 2 per month). Note: This does not include driving time, or waiting time. |
| Personal hygiene |
|
Up to 2 hours most days (daily bathing, plus other personal hygiene activities). Bathing time may increase SIGNIFICANTLY with incontinent care receivers. Supervision and prompting of people with mental illness may increase times. |
| Eating and drinking |
|
Up to one hour per day (total) for all meals. Note: This does not include meal preparation. Time may increase if setting up and monitoring feed pumps/gastro feeding equipment, supervising people with swallowing disorders or mental illness. |
| Communication |
|
Up to 30 minutes per day in the home. Allow additional time for activities outside the home that relate to personal care activities. Example: Medical appointments, treatment. |
| Treatment |
|
Up to one hour per day for all activities excluding monitoring medical equipment and performing physiotherapy. Where monitoring of medical equipment is required to sustain life, the time may equal the period that the carer is responsible for the person. Physiotherapy may take 2 or 3 hours a day. |
| Behaviour management |
|
Times may vary. The person will generally require supervision for the period that the carer is responsible for the person. |
Note A: Times quoted are averages NOT limits - if the carer says they do more than the average it must be discussed with the carer to determine if in that particular case the extra time is reasonable.
Where the care provided falls outside the average ranges listed in the above table
If the carer claims to spend more time undertaking tasks than the average ranges listed in the above table, additional information may need to be sought from the carer. However, if the categories of care that exceed the specified ranges were reduced to the maximum levels and the total care provided is at least 20 hours per week, then there is no need to further verify that the care provided is reasonable.
To verify that the care provided is reasonable, consideration should be given to whether the care receiver's medical condition supports the level of care stated.
Where the care receiver's medical condition does not support the amount of time spent caring, the amount of time spent caring may be able to be verified through discussions with the carer and/or through current medical evidence that the carer may have. This could include information from a third party such as a physiotherapist, specialist, community care service etc.
If it cannot be verified that the carer is providing personal care and attention that address special care needs for at least 20 hours per week, the carer does not qualify for CA.