Government Response - Report on the inquiry into better support for carers 46-50
Recommendations 46 - 50
That the Minister for Health and Ageing direct the Department of Health and Ageing to provide a preventative health care program targeted at carers. This could be achieved by extending the Enhanced Primary Care Program to include carers who receive Carer Payment and/or Carer Allowance as an at risk population group requiring intervention under this program.
The Enhanced Primary Care Program provides preventative care for older Australians and improved coordination of care for people with chronic conditions and complex care needs. Under the Enhanced Primary Health Care Program Medical Benefits Scheme health assessments have been developed. These health assessments provide a structured way of identifying health issues and conditions that are potentially preventable or amenable to interventions in order to improve health. These assessments mainly target specific critical life stages or medical conditions.
Many carers who receive Carer Payment and/or Carer Allowance may already be eligible for these health assessments under the Enhanced primary Carer Program. These include:
- the 45 to 49 Year Old Health Check: carers aged 45 to 49 inclusive who are at risk of developing a chronic disease may be eligible for a health check under this initiative. The decision that a patient is at risk of developing a chronic disease is a clinical judgement made by their General Practitioner.
- the Medicare Health Checks for Aboriginal and Torres Strait Islander Australians3: Aboriginal or Torres Strait Islander carers may be eligible for health checks under this initiative.
- the Adult Health Check is a two-yearly service for Aboriginal and Torres Strait Islander people aged between 15 and 54 years (inclusive).
- the Older Person’s Health Check is an annual health check for Aboriginal and Torres Strait Islander people who are at least 55 years of age.
- the Older Person’s Health Assessment: older carers, aged 75 years and older, may be eligible for health checks under this initiative. These health assessments are annual, voluntary health assessments for older Australians that provide an opportunity for General Practitioners to undertake an in-depth assessment of the patient's health.
Preventative health is a priority of the Commonwealth Government. On 1 September 2009 the National Preventative Health Taskforce’s National Preventative Health Strategy was released. The recommendations in the Strategy will be considered on their merit within the broader health reform process. The Government is consulting widely before putting a position to states and territories on health reform later in the year.
A recommendation of both the Taskforce and the Health and Hospital Reform Commission is the establishment of an Australian National Preventive Health Agency. The Australian National Preventive Health Agency Bill 2009, which establishes the Agency, was introduced into the House of Representatives by the Minister for Health and Ageing on 10 September 2009.
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That the Minister for Families, Housing, Community Services and Indigenous Affairs direct the Department of Families, Housing, Community Services and Indigenous Affairs to review the temporary cessation of care requirements for Carer Payment and Carer Allowance recipients, particularly in relation to:
- the adequacy of the 63 days of respite per year particularly in comparison to minimum conditions of paid employment; and
- the requirement of carers to use all or part of the allowable period of time to cover periods of time, when as a result of illness, they are unable to provide care.
AGREE TO FURTHER CONSIDER
The Commonwealth Government agrees to consider further a formal review of the adequacy and appropriateness of the current temporary cessation of care requirements for Carer Payment and Carer Allowance recipients.
The Commonwealth Government notes that any changes to the temporary cessation of care provisions would have significant legislative and financial implications.
Currently carers may temporarily cease to provide care for up to 63 days per calendar year. Relevant parts of the Guide to Social Security Law, the Commonwealth Government’s policy guide for social security legislation and its application, were revised in March 2009 to provide further clarity on the temporary cessation of care provisions. The guide now explains that a temporary cessation of care day is calculated from midnight to midnight. For example, a break in care from 8:00 am on Friday to 6:00 pm on Sunday only equates to one day of temporary cessation of care. This is because only the period between midnight Friday and midnight Saturday meets the definition of a temporary cessation of care day under the guide.
Short periods of care (of less than 24 hours) provided by an organisation or person other than the carer, will not necessarily preclude someone from qualifying for payment or count as temporary cessation of care, even if this occurs regularly.
Additionally, the 63 days may be extended in special circumstances. A delegate of the Secretary has discretion to extend the period of temporary cessation of care for any special reason. Delegates must exercise discretion in determining what constitutes a special reason. Generally, such reasons would be events outside the carer’s control and consistent with their role as a carer, where the care situation would be expected to resume after a definite period. Special reasons may include illness or other caring responsibilities.
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That the Minister for Health and Ageing expand the National Carers Counselling Program to better meet the demand for counselling services by carers.
AGREE TO FURTHER CONSIDER
The National Carers Counselling Program provides an important supplementary service to a range of other counselling programs and supports available to carers. Counselling in the National Carers Counselling Program is provided through qualified counsellors on issues that are specific to carers’ needs such as depression, stress-related conditions, grief and loss, and coping skills. Counselling is provided by several other Commonwealth Government funded programs, including the Home and Community Care Program, Family Relationship Services for Carers, the Dementia Education and Support Program and the Veterans and Veterans Families Counselling Service.
The Department of Health and Ageing has been working closely with Carers Australia to improve current data collection in the National Carers Counselling Program. Limited data capability makes an assessment of demand for National Carers Counselling Program services difficult to quantify. The Commonwealth Government supports a continued focus on program consolidation, including through improved data collection, enhanced relationship building with other carer-focused service providers and national consistency underpinned by a common approach to assessment, as critical to any future decision making about program expansion.
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That the Minister for Health and Ageing direct the Department of Health and Ageing to raise awareness among General Practitioners of the high incidence of mental health problems among carers and their families and of the options available for support.
The Commonwealth Government recognises the important role of general practitioners in attending to the emotional health and wellbeing of patients as part of holistic general practice and in the detection of mental health issues.
To this end, the Commonwealth Government has implemented a range of measures that support awareness raising and education and training of general practitioners, and foster better teamwork between general practitioners and specialist mental health professionals.
The Commonwealth Government, through the Department of Health and Ageing, funds the Better Access to Psychiatrists, Psychologists and General Practitioners initiative through the Medicare Benefits Schedule. The Better Access initiative provides improved access for people with an assessed mental disorder, to mental health care by general practitioners, psychiatrists, psychologists and appropriately trained social workers and occupational therapists. Eligible people may access up to 12 individual and/or 12 group allied mental health services in a calendar year and up to 18 individual sessions in exceptional circumstances.
To be eligible to access Medicare rebates for mental health services with a psychologist, social worker or occupational therapist, the person must be referred by a general practitioner (who is managing that person under a General Practitioner’s Mental Health Treatment Plan), or a psychiatrist or paediatrician in private practice.
Under the Better Access initiative, funding is available for education and training activities to help ensure the primary care and specialist mental health workforces are equipped to recognise and treat mental illness.
The Department of Health and Ageing continues to work with these professions and other key stakeholders to develop appropriate education and training options. Awareness of the mental health needs of carers and their families will be included in this context.
Mechanisms also exist within current programs to raise awareness among general practitioners of support programs available for carers of people with a mental illness. For instance, an important role of Commonwealth Respite and Carelink Centres funded under the Mental Health Respite Program is to promote the program, including raising general practitioner awareness of the program.
The Commonwealth Government also notes that this program is currently being evaluated and the effectiveness of awareness raising activities with general practitioners will be considered in this review.
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That the Minister for Social Inclusion nominate carers as an early priority for social inclusion on the social inclusion agenda and with the Australian Social Inclusion Board.
AGREE IN PART
The priorities of the Commonwealth Government’s Social Inclusion Agenda encompass the most disadvantaged Australians, including the most disadvantaged carers.
The Minister for Social Inclusion will seek to ensure that, when developing policies and programs to support social inclusion priority groups, the needs of carers within those groups are considered.
Many carers will benefit from the Commonwealth Government’s Social Inclusion Agenda:
- young carers will benefit from the Commonwealth Government’s efforts to deliver effective support to children at greatest risk of disadvantage
- some unemployed carers will be encompassed by the ‘jobless families with children’ priority group
- carers living in areas of concentrated disadvantage may also benefit from the Social Inclusion Agenda’s focus on providing programs and services to locations in greatest need.
Carers will also benefit from the Social Inclusion Agenda’s focus on employment for people with disability. This includes the development of the National Disability Strategy, which will address the social, economic and cultural barriers faced by people with disability and their families and carers, and promote social inclusion.
- For the purpose of the health checks, a person is an Aboriginal or Torres Strait Islander person if they, or their parent or carer, identify them as being of Aboriginal or Torres Strait Islander descent.
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