Carer Payment and/or Carer Allowance – Claim Pack – · Web viewincludes use of...

Carer Payment and/or Carer AllowanceField Test

Adult

VOLUNTARY FIELD TESTWhat is this? Forms that we want to test (that WILL NOT be used to decide your claim)

Would you like to help us improve the questions we ask?

How you can have your say

Returning your forms

Your privacy

This field test is voluntary

For more information

We want to improve the way we assess eligibility for Carer Payment and Carer Allowance. We want to make the way we assess care:

simpler easier to understand shorter and quicker to complete suitable for a broad range of caring situations.

Carers and health professionals have helped us to draft new assessment questions. Now we need to test these with a larger number of people (a field test).The field test form asks for your Centrelink Reference Number (CRN), your date of birth, the date of birth of the child you care for and some other basic information. This is so we can check how well the field test questions work for people of different ages, backgrounds and caring situations.

You can have your say by completing these field test questions and writing your comments and suggestions on the feedback page provided.Ask your health professional to complete section 3 of the test form. Then return this field test form.

Return this form with Sections 1 and 2 completed by the Carer and Section 3 completed by a Health Professional. The form can then be scanned or photographed and sent to [email protected] or posted to Reply Paid 83311, Department of Social Services Carer Field Test, Canberra ACT 2601.

DSS takes privacy seriously and will only collect, hold, use and disclose personal information in accordance with the Privacy Act and the DSS Privacy Policy

This field test form will not affect the decision about your eligibility for payment.This is a voluntary field test. You can choose whether to complete this field test form.

If you have questions about this field test, please call the Carer Payments Field Test Helpline 1800 456 555 Monday to Friday, between 9.00 am and 5.00 pm, Australian Eastern Standard Time.

Note: Call charges may apply.

1 of 19

https://www.dss.gov.au/privacy-policy

https://www.oaic.gov.au/privacy-law/

mailto:[email protected]

How to complete this field test form

What happens to your field test form?

1. Complete Sections 1 and 2.2. Provide your comments and suggestions about the field test questions in the Carer

Feedback section.3. Ask your health professional to complete section 3 of this field test form4. Return your completed Field Test form to [email protected] or post

to Reply Paid 83311, Department of Social Services Carer Field Test, Canberra ACT 2601.

The field test form will be used to check how well the field test questions work for people of different ages, backgrounds and caring situations.

All forms and data collected for the purposes of the field test will be destroyed at the end of the evaluation process.

mailto:[email protected]

2 of 19

( )

3 of 19

Section 1 – About you and the person who is receiving care

About You

1 Your Centrelink Reference Number (CRN)

2 Your Date of Birth

/ /

3 Where you livePlease tick one

In a metropolitan area (i.e. within 30 kms of a capital city)

In a regional area In a remote area

4 Your gender Male

Female

5 Is English the main language you use at

home? NoYes

6 Are you an Aboriginal or Torres Strait Islander

person? NoYes

9 Is your ability to participate in leisure, community, study, or employment activities limited due to any of the following?

No YesCalls more than once a week for you to help with the person’s care at day activity, work placement or other regular programsYou have to stay while the person attends a weekly activity due to their care needsThe person you care for is unable to attend programs or organised activities due to their care needsRestriction on the hours the person can attend programs(e.g. day activity, post-school options or supported employment) due to the severity of their conditionHaving to attend appointments with the person more than once a fortnightProviding emergency care and support to the personSleep disruption for you on most nights due to the person’s night-time care needs or behaviours because of their disability or medical condition

About the person who is receiving care

10 Centrelink Reference Number (CRN) of the person who is receiving care (if known)

7 Do you consent to us contacting you about this field test? 11 Date of birth of the person who is receiving care

No Yes

Go to next questionPlease provide your phone number below

/ /

12 Gender of the person who is receiving care Male

8 Would you like information on other carer support services?

Female

13 What is your relationship to the person receiving care (e.g. parent, child, grandparent, friend)?

No Yes

Go to next questionPlease use my phone number provided aboveOR

14 I provide this care in this person’s home (i.e. in a private home that is the residence of the carer or the person receiving care)

No Yes

Carer to complete this section.

Note: If you provide your phone number, the Carer Gateway helpdesk will contact you about carer services.

( )

4 of 19

15 I n a typica

l week (7 days), how many days do you provide this care?

days

Section 2 – About the care you provide

5 of 19

Carer to complete this section.When answering these questions:Help means any physical assistance, guidance, redirection or supervision because of their disability or medical condition. Help also includes prompting the person to do daily activities (e.g. you may need to prompt the person to take medication, eat or dress themselves etc.)If the person you provide care for has a condition that changes from day to day or week to week, please indicate the level of help you provide on most days or weeks.

16 I provide help to this person with these activities because of their disability or medical condition

Mobility (e.g. moving and getting around, standing up and sitting down)

Self-care (e.g. bathing, showering, toileting, menstrual care, dressing, eating, brushing teeth, grooming hair and care provided at home because of their disability or medical condition)

Communication (e.g. understanding communication, using speech, text, signs, or symbols to communicate with others)

Tick any that apply

Learning and thinking (e.g. learning new things, understanding how things work, paying attention and concentrating, solving day to day problems, planning daily routine and activities)

Getting along with others and behaving appropriately (including behaviour towards others, behaving within limits, behaving safely and night-time behaviour)

Community participation (e.g. carer assistance required for the person to participate in community activities such as school, day care, day activities, employment, sport and leisure, family events)

6 of 19

17 Help with moving and getting aroundIf the person you provide care for has a condition that changes from day to day or week to week, please indicate the level of help you provide on most days or weeks. If someone other than you (e.g. NDIS, home care or other service provider) helps with moving and getting around, do not include this care.

Please tick one box in each row that best describes the help you provide to this person because of their disability or medical condition.

Level of help I provide

With these activities

No helpI do not have to help at allor not relevant to mycircumstances

Some helpI have to give some prompts, reminders or supervision

A lot of helpI have to give a lot of physical help or continual prompts and guidance

Complete helpI have to give total help or do this task completely for this person

Sitting down and standing upe.g. sitting and rising from a bed, chair, wheelchair, toilet etc.

Moving around inside their homee.g. walking, or moving around indoors using mobility aids, or wheelchair, or aids used to assist with vision impairmentMoving around outdoorse.g. at shopping centres, or in supermarkets, going up and down steps, using escalators or liftsApply and use daily mobility-related prosthesese.g. artificial limbs, splints, braces, pressure garments

Perform daily mobility exercises prescribed by a qualified therapisti.e. a physiotherapist or occupational therapist

Reposition in bed at night(e.g. turning, pressure area care) if the person is unable to do so

7 of 19

18 Self-care – Hygiene, dressing, eatingIf the person you provide care for has a condition that changes from day to day or week to week, please indicate the level of help you provide on most days or weeks. If someone other than you (e.g. NDIS, home care or other service provider) helps with self-care, do not include this care.








Eating meals and drinksonce food is prepared

Dressing and adjusting clothing as requirede.g. morning, night and after toilet use

Using the toiletincluding wiping, menstrual care

Managing incontinence (bladder or bowel accidents) including use of continence aids and equipment

Bathing or showeringincluding hair care, teeth brushing, shaving

8 of 19

19 Help with medical conditions and special health care needsIf the person you provide care for has a condition that changes from day to day or week to week, please indicate the level of help you provide on most days or weeks. If someone other than you (e.g. NDIS, home care or other service provider) helps with medical conditions and special health care needs, do not include this care.








Care of wounds, application of dressingse.g. for severe, extensive and long term skin conditions

Emergency medication or first aid for seizures

Stoma care(e.g. when the person has a colostomy, urostomy or other stoma).A stoma is an opening on the abdomen made by a surgeon to allow faeces or urine to pass out of the body into a bag.Management of severe eating disorder that has been diagnosed by a psychiatrist

Care at home associated with chemotherapy or radiation treatment for cancer

Preparation and administration of medication(s)

Blood or urine testing (at least daily) and the administration of insulin

Applying and operating a CPAP or BiPAP device to maintain adequate lung function during sleepA CPAP or BiPAP device helps to keep the person’s airway open by providing a flow of air at pressure, usually through a mask fitted firmly to the face.This does NOT include the use of nebulisers or inhalers.Home dialysis (for kidney failure)

9 of 19

20 CommunicationThis question does not include interpreting between English and other spoken languages. It is about the help you provide to this person for communication difficulties associated with their disability or medical condition.If the person you provide care for has a condition that changes from day to day or week to week, please indicate the level of help you provide on most days or weeks. If someone other than you (e.g. NDIS, home care or other service provider) helps with communication, do not include this care.








Communicating with otherse.g. through speech, use of sign language, symbols or other methods to communicate

Understanding languagee.g. help needed to understand instructions or other information

Using equipment or technology to communicate, when the person is unable to use speech or sign language effectively

Using communication aids when the person is vision impairede.g. text to speech software, Braille readers

10 of 19

21 Learning, planning and problem solvingIf the person you provide care for has a condition that changes from day to day or week to week, please indicate the level of help you provide on most days or weeks. If someone other than you (e.g. NDIS, home care or other service provider) helps with learning, planning and problem solving, do not include this care.








Learning new skills and knowledgee.g. learning how to do things, how things work, understanding ideas and concepts

Remembering things that are important for daily livinge.g. how to do routine activities such as cook a meal, how to get to and from familiar places such as home to shops and back

Concentrating and persisting at taskse.g. being able to pay attention long enough to complete basic tasks and activities

Planning and organising daily or weekly activitiese.g. preparing a weekly shopping list, following a cooking recipe, planning outings, managing appointmentsSolving problemse.g. managing day to day problems such as what to do when an appliance breaks down; making routine day to day decisions such as what to wear, handling money

11 of 19

22 Behaviour and getting along with othersIf the person you provide care for has a condition that changes from day to day or week to week, please indicate the level of help you provide on most days or weeks. If someone other than you (e.g. NDIS, home care or other service provider) helps with behaviour and getting along with others, do not include this care.








Getting along with other peoplee.g. forming friendships, interacting with strangers and groups of people, understanding social cues and acceptable social behaviours

Night-time behavioure.g. going to bed at an appropriate time, settling to sleep, managing sleep disturbances

Personal safetye.g. managing behaviours such as deliberate self-harm, wandering or running away when the person has limited safety skills, other high risk behaviours likely to result in self-injury

Managing potential aggressive or threatening behaviourse.g. physical aggression likely to result in harm to others, deliberate damage to property or objects, verbal aggression such as shouting, screaming at or threatening othersManaging obsessive, repetitive or ritualistic behaviourse.g. rocking, or compulsive routines such as obsessive checking; using objects inappropriately and repetitively to the exclusion of social interaction

Managing symptoms and behaviours associated with severe mental health conditionse.g. hallucinations, hearing voices, delusions, paranoia, suicidal thoughts, talk or attempts, manic behavioursManaging behaviours associated with severe anxiety or depression that restricts their ability to perform daily activitiese.g. fear out of proportion to the situation, excessive worrying, avoidance of situations, avoidance of interactions with people, mood changes, inability to enjoy activitiesBehaving appropriately in social situationse.g. manage inappropriate behaviours that disrupt social and community activities such as noisy vocalisations, screaming, offensive or sexually inappropriate language or other behaviours

12 of 19

23 Community participation(attending education, training or work, joining in community activities, participating in society)If the person you provide care for has a condition that changes from day to day or week to week, please indicate the level of help you provide on most days or weeks. If someone other than you (e.g. NDIS, home care or other service provider) helps with community participation, do not include this care.








Participating in social activities in familiar environmentse.g. at own home or homes of extended family membersParticipating in activities in unfamiliar environmentse.g. community sport or recreation facilities, cinema, parks and gardens

Attending and participating in education, training or work

Using transport to attend appointments, activities or socialise outside of their homeincludes use of wheelchair, scooter, walker, bike, bus, car, taxi etc

Planning daily and weekly activities, managing schedule and appointments

24 Time away from youIn most weeks how many hours has the person you care for been away from you at any of the following activities?(If the person is away from you part of one week every fortnight include half the time.)

Away from you at Hours per weekEducation

Day program/activity

Work

Respite

Cared for by someone else

Other Information25 Are there any other types of care you provide to this person that have not been covered in this field test form?

No Go to next question

Yes Give details below

Carer’s Declaration26 In the final version of this form there would be a declaration for you to sign that the information you have provided is true and

correct.

13 of 19

Thank you for completing this field test form.In the final process, carers may not have to complete all questions if the person they provide care for has a permanent and severe disability/medical condition.Your comments and suggestions will be very helpful.

14 of 19

Carer Feedback about this Questionnaire

Please consider each of the following questions and tick the box that best describes your opinion.You may also provide comments in the boxes under each question.

1 Compared to the Official Carer Questionnaire, I found the time to complete this field test form was: Slower

About the sameQuicker

Comments:

2 Compared to the Official Carer Questionnaire, I found the questions were: Harder to understand

About the same Easier to understand

Comments:

3 Compared to the Official Carer Questionnaire, I found the number of questions were: Too few

About right Too many

Comments:

4 Compared to the Official Carer Questionnaire, this field test form is: Less appropriate to my carer activities

About the same More appropriate to my carer activities

Comments:

5 Were there any questions, words or terms that were difficult to

understand? No Go to next question


15 of 19

6 Do you have any other comments about this draft

questionnaire? No Go to 7


7 Now take this form to the health professional who is completing the medical report for your official claim form. Ask the health professional to complete Section 3 of this Field Test form.

Section 3 – Field Test – Health Professionals Report

16 of 19

5 Please list any other conditions that contribute to this person’s disability.

About the person who is receiving care

1 Date of birth of the person who is receiving care

/ /

6 What type(s) of disability does this person have?Tick any that apply

Physical disability Intellectual disability Psychiatric disability

2 Does this person have a medical condition(s) resulting in disability?

Other Give details below

No Yes

3 Is this condition(s) permanent? No

Yes

4 What is the primary medical condition that results in this person’s disability?

i.e. the condition that contributes most to the person’s disability.

Print in BLOCK LETTERS

7 For how long will this person’s condition(s) result in additional care being needed at home?

i.e. how long will this person require help from the carer applying for this payment to perform self-care tasks?

Less than 3 months 3 months to 5 months

6 months to 11 months12 months to 2

years More than 2 years

8 Does this person have a terminal condition?

i.e. the average life expectancy for a person with the same or similar condition is not substantially longer than 24 months and because of the condition, the person will need constant care for the remainder of his or her life.

No Go to 12

Yes Go to next question

9 Name of this condition or illness

About this Field TestThe Australian Government is working to improve the assessment process for Carer Payment and Carer Allowance. We would greatly appreciate your input.Following consultations with carers and health professionals, we are now field testing a draft new assessment tool which includes a Health Professionals Report (Section 3 below).We need to test how appropriate and relevant the questions are and how they compare to those in the current medical/ treating health professional reports.Privacy and other provisions are explained on the front page of this Field Test form.Please complete the field test questions below.

Health Professional to complete this section.

i.e. a medical diagnosis, including mental illness or developmental delay, associated with impairment of a body structure or function that results in difficulty performing tasks or activities.

Physical disability or impairment requiring

Go to 20

17 of 19

Ventilator dependent

Regular suctioning of airways

10 What is the expected survival prognosis for a person at this stage of this terminal condition?

Less than 3 months 3 months

to 2 years More than 2 years

11 If this terminal illness is not within your professional scope of practice, please state the name, qualifications and contact details of the health professional who made this diagnosis

High Level Care Needs12 Is the person receiving care aged under 3

years? No Go to next questionYes Go to 15

13 Does the person need complete physical assistance with all self-care tasks (feeding, dressing, bathing, transfers, toileting/ continence care)?

e.g. the person’s physical impairments are so severe that they cannot perform any of these basic self-care tasks

No Yes

Other Care Needs

17 Is the person receiving care a child aged under 2

years? No Go to 19

Yes Go to next question

18 Has this young child’s medical condition/disability resulted in any of the following:

No YesDevelopmental delay requiring additional care at homei.e. the person needs more care than is usual for a child of the same age without a medical condition, disability or illnessSpecial health care that needs to be provided by a carer at homei.e. the person needs health-related procedures to be performed by the carer which require specific training and knowledge – these procedures are above and beyond the usual home health care needs expected for a child without a medical condition, disability or illness

additional care at home

14 Does the person need constant supervision (i.e. 24 hours per day) to manage potential aggressive, life threatening, dangerous, self-harming or suicidal behaviours?

No Yes

15 Does the person require any of the following complex respiratory care at home day and night to sustain life:

No Yes

i.e. the person requires mechanical ventilation to maintain adequate respiratory ventilation during the day and at night.Note: This does not include the use of a nebuliser, CPAP or BiPAP used at

night only.i.e. the person requires suctioning to maintain a clear airway during the day and at night

16 Did you answer ‘Yes’ to any items in questions 13, 14 or

15? No Go to next question

18 of 19

Yes Go to 20

19 of 19

19 Please complete the following table, based on your assessment of the person receiving care and your knowledge of their condition(s), the prognosis and impairments likely to result from the condition(s).For children (aged 2–16 years) receiving care, please indicate assistance above that usually required for a child of the same age without a disability, illness or injury.Based on your clinical assessment and available medical evidence, is the person receiving care likely to require the following assistance from another person at home:

Please tick one box in each row.

Level of assistance required from carer

Daily Living Activitiesas appropriate for the care receiver’s age

No assistancecan do tasks independently as expected for a person of the same age

Minor assistanceneeds some prompting, supervision or minor physical help above that expected for a person of this age

Major assistanceneeds a lot of help above that expected for a person of this age

Complete assistanceneeds complete help withtasks usually performed without help by a person of thisage

Unable to determinenot able to observe or assess, or insufficient clinical evidence

Mobilityi.e. standing up, sitting down, walking or moving around, transfers, even when using any mobility aids they haveSelf-carei.e. feeding, bathing, showering, dressing, toileting and health care at home

Communicationi.e. understanding and using speech, text, signs, symbols or devices to communicate

Learning and applying knowledgei.e. cognitive activities such as understanding, learning, remembering, attention and concentration, problem solving and planning

Interpersonal interactions, relationships and behaviouri.e. social behaviour, interacting with others, behaving within acceptable limits, managing emotions, mental health

Community participationcarer assistance required for the person to participate in community activities such as education, work, recreation

20 of 19

Health Professional’s Declaration

20 Your full name (voluntary for this field test)

21 Your professional qualifications and professional registration

22 Your contact details or practice stamp (voluntary for this field test)

23 How long have you or your practice/organisation been treating or providing services to the person receiving care?First consultation

Weeks Months

Years

24 DeclarationI declare that the information I have provided is a true and accurate record based on my professional assessment and/or treatment of this person and their condition(s).

Signature (voluntary for this field test)

Date

Thank you for completing this field test form. Your comments and suggestions will be helpful.Please provide any feedback you have in the section on the next page.

/ /

21 of 19

Health Professional Feedback

Please consider each of the following questions and tick the box that best describes your opinion. You may also provide comments in the boxes under each question.

1 Compared to the Official Medical/Treating Health Professional Report, I found the time to complete this field test form was Slower

About the sameQuicker

Comments:

2 Compared to the Official Medical/Treating Health Professional Report, I found the questions were: Harder to complete

About the same Easier to complete

Comments:

3 Compared to the Official Medical/Treating Health Professional Report, I found the number of questions were: Too few

About right Too many

Comments:

4 Compared to the Official Medical/Treating Health Professional Report, this field test form is: Less appropriateAbout the same

More appropriate

Comments:

5 Were there any questions, words or terms that were difficult to interpret, or not consistent with contemporary medical/allied health terminology and practice?

No Go to next question


22 of 19

6 Do you have any other comments about this field test Health Professionals

Report? No Go to 7


7 Now, give this Field Test form to the carer, who will return this form.

Carer Payment and/or Carer Allowance – Claim Pack – · Web viewincludes use of...

Documents

Transcript of Carer Payment and/or Carer Allowance – Claim Pack – · Web viewincludes use of...