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For the purposes of CA (child), substantially more care and attention means more care and attention than another child of the same age without a disability (1.1.D.160). This is assessed by using the 14 hours rule for HCC only CA (child) (1.1.F.170), but children who do not qualify when measured in this way may still qualify if the child is otherwise considered to require substantially more care and attention. If, in making decisions about qualification, the level of care is an issue, delegates can be guided by the findings of the AAT in the cases mentioned below.
Assessment of the level of care is complex and needs to cover the following issues:
Each issue is explained in more detail below.
A THP must certify by signing the medical report that extra care and attention is required as a result of a disability or a medical condition.
Note: If the THP is a close relative (parent, child, sibling or grandparent) of the carer or care receiver, there may be a conflict of interest because a relative may benefit financially from the THP assessment. Discretion should be exercised in determining whether the Secretary's delegate accepts that the assessment is an accurate reflection of the child's functional ability.
Explanation: AAT decision Bosworth (1989) provides the definition of care and attention which is 'needed' because of a child's disability.
A concerned parent (section 5(1)) or guardian (1.1.G.80) may be providing substantial care, but that care is not necessarily required to manage the disability.
Example: A mother states that she does shopping and daily food preparation for her child's special diet due to food sensitivities. The need for such a diet would need to be established through a qualified professional opinion such as an endocrinologist or formal food sensitivity tests. If not, this care cannot be taken into account when assessing whether the child requires substantially more care and attention.
Explanation: AAT decision Carter (1994) indicates that the care needed does not always equate with the care and attention which a devoted or anxious parent may provide. Sachs (1984) provides an explanation regarding an objective assessment of need.
SSAct section 954 does not say that the carer must be providing all of the additional care and attention required by the disability. It is possible for the carer to delegate some of the additional care and attention to other non-professional carers.
Example: Some care and attention may be delegated to a special school or therapist.
Explanation: AAT decision Maclean (1993) provides an interpretation of section 954 of the Social Security Act 1991.
Act reference: SSAct section 5(1) Family relationships definitions-children
To be considered substantial, the care and attention must be:
Explanation: AAT decision Bosworth (1989) provides a definition of 'substantially more'.
A child who has a medical condition that they can manage by themselves is not a disabled child (1.1.D.160) for the purposes of CA qualification.
It is accepted that many children with disabilities will become more independent in the management of their disability as they mature, requiring less parental care and attention. A child who is assessed as having a disability when young, and who becomes better able to cope with their impairment when older, may subsequently be assessed as 'not having a disability' without there being a change in the impairment, as the care and attention requirements have diminished.
Act reference: SSAct section 1061ZK(2) Qualification for health care card, section 1061ZK(3) This section applies to a disabled child...
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Last reviewed: 1 July 2010
