2.2.5.60 Determining an Illness Separated Couple

Summary

A couple (whether of the same sex or a different sex) is considered to be an 'illness separated couple' (section 4(7)) where:

• they are unable to live together in their home, and
• the inability to live together:
  • is due to illness or infirmity of either or both of them, and
  • results in their living expenses being greater or are likely to be greater than otherwise, and
  • is likely to continue indefinitely.

Act reference: SSAct section 4(7) Illness separated couple

Assessment

Illness separated couples will be assessed against the single rate of payment applicable but the assessment will still take into account the combines income and assets as if they were a member of a couple.

Illness or infirmity

It is not the intention that medical evidence is required for the majority of assessments. A couple separated due to illness or infirmity will be accepted as illness separated in situations where:

• it is apparent to Centrelink that the illness or infirmity of one or both members of a couple prevents them from living together, and/or
• there is supporting evidence of illness or infirmity, for example, where the ill or infirm member of the couple:
• has current care needs that indicate that the couple cannot live together; (this could be based on information Centrelink already holds on care needs provided to assess entitlement of a carer to receive CA or CP in respect of the ill or infirm member of the couple), or
  • Example: Bill has had to move in with his daughter (Mary) as Jane (his wife) can no longer care for him. Mary has claimed CP for Bill and Jane has remained in the family home.
  • has had an ACAT assessment that indicates care is needed on an ongoing basis, or
  • permanently lives in an aged care facility that provides low (hostel) or high level (nursing home) residential care, or
  • is residing in a psychiatric facility, or
  • is a patient in a normal hospital ward and has been classified as a nursing home type patient.

Where illness or infirmity that prevents the couple living together is not apparent and no other supporting evidence is available, the claimant/recipient may be requested to provide supporting evidence from a treating doctor or relevant health professional.

It is important to note that:

• it is not necessary for a care situation (1.1.C.25) to exist for the illness separated rate to be paid, and
• an illness separated couple should not be confused with former members of a couple whose relationship has ceased as a result of ill health.

Note: To establish whether there is financial difficulty resulting from a member of a couple going into residential care, it is necessary to verify the costs incurred for the residential care. This must take into account all financial assistance available from DoHA.

The Aged Care Act 1997 has 'financial hardship' provisions for people who have difficulty in paying their residential care payments and relevant ongoing expenses. Financial hardship assistance may be available to residents who do not have the income or assets to utilise to pay their costs of care. Each case is considered on an individual basis, based on a resident's financial circumstances. Financial hardship provisions allow for financial assistance to be provided for fees and accommodation payments on application to DoHA. Residents may apply for:

• financial assistance with their basic daily fees and income tested fees, and/or
• financial assistance with an accommodation bond or accommodation charge they are being asked to pay.

Act reference: SSAct section 4(7) Illness separated couple

Health Insurance Act 1973, refer to section 3(1)

Policy reference: SS Guide 2.2.5.20 Determining Living Separately & Apart, 2.2.5.70 Determining a Respite Care Couple

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Last reviewed: 3 August 2009