Part 1—Preliminary
1 Name of principles
These principles are the Approval of Care Recipients Principles 2014.
3 Authority
These principles are made under the Aged Care Act 1997.
4 Definitions
In these principles:
Act means the Aged Care Act 1997.
Commonwealth home care package means a package of care and services in respect of which home care subsidy is payable.
episode of short‑term restorative care has the meaning given by section 4 of the Subsidy Principles 2014.
episode of transition care has the meaning given by section 4 of the Subsidy Principles 2014.
hospital episode has the meaning given by section 4 of the Subsidy Principles 2014.
multi‑purpose service has the meaning given by section 4 of the Subsidy Principles 2014.
short‑term restorative care has the meaning given by section 4 of the Subsidy Principles 2014.
transition care has the meaning given by section 4 of the Subsidy Principles 2014.
Note: A number of expressions used in these principles are defined in the Act, including the following:
(a) flexible care;
(b) home care;
(c) respite care.
Part 2—Eligibility to receive care
5 Purpose of this Part
For sections 21‑2, 21‑3 and 21‑4 of the Act, this Part specifies additional criteria that a person must meet to be eligible to receive residential care, home care or flexible care.
6 Residential care
(1) For paragraph 21‑2(c) of the Act, a person is eligible to receive residential care only if:
(a) the person is assessed as:
(i) having a condition of frailty or disability requiring continuing personal care; and
(ii) being incapable of living in the community without support; and
(b) for a person who is not an aged person—there are no other care facilities or care services more appropriate to meet the person’s needs.
(2) In deciding if a person meets the criteria mentioned in subsection (1), the Secretary must consider the person’s medical, physical, psychological and social circumstances, including (if relevant) the following:
(a) evidence of a medical condition, as decided by a suitably qualified medical practitioner;
(b) evidence of absence or loss of physical functions, as established by assessment of capacity to perform daily living tasks;
(c) evidence of absence or loss of cognitive functioning, as established by:
(i) a medical diagnosis of dementia or other condition; or
(ii) assessment of capacity to perform daily living tasks; or
(iii) evidence of behavioural dysfunction;
(d) evidence of absence or loss of social functioning, as established by:
(i) information provided by the person, a carer, family, friends or others; or
(ii) assessment of capacity to perform daily living tasks;
(e) evidence that the person’s life or health would be at significant risk if the person did not receive residential care.
7 Home care
Home care—level 1
(1) For paragraph 21‑3(c) of the Act, a person is eligible to be approved as a recipient of home care at level 1 only if:
(a) the person is assessed as having needs that can only be met by a coordinated package of care services; and
(b) the person is assessed as requiring a basic level of home care; and
(c) the person prefers to remain living at home; and
(d) the person is assessed as being able to live at home with the support of home care at level 1; and
(e) for a person who is not an aged person—there are no other care facilities or care services more appropriate to meet the person’s needs.
Home care—level 2
(2) For paragraph 21‑3(c) of the Act, a person is eligible to be approved as a recipient of home care at level 2 only if:
(a) the person is assessed as having needs that can only be met by a coordinated package of care services; and
(b) the person is assessed as requiring a low level of home care; and
(c) the person prefers to remain living at home; and
(d) the person is assessed as being able to live at home with the support of home care at level 2; and
(e) for a person who is not an aged person—there are no other care facilities or care services more appropriate to meet the person’s needs.
Home care—level 3
(3) For paragraph 21‑3(c) of the Act, a person is eligible to be approved as a recipient of home care at level 3 only if:
(a) the person is assessed as having needs that can only be met by a coordinated package of care services; and
(b) the person is assessed as requiring an intermediate level of home care; and
(c) the person prefers to remain living at home; and
(d) the person is assessed as being able to live at home with the support of home care at level 3; and
(e) for a person who is not an aged person—there are no other care facilities or care services more appropriate to meet the person’s needs.
Home care—level 4
(4) For paragraph 21‑3(c) of the Act, a person is eligible to be approved as a recipient of home care at level 4 only if:
(a) the person is assessed as having needs that can only be met by a coordinated package of care services; and
(b) the person is assessed as requiring a high level of home care; and
(c) the person prefers to remain living at home; and
(d) the person is assessed as being able to live at home with the support of home care at level 4; and
(e) for a person who is not an aged person—there are no other care facilities or care services more appropriate to meet the person’s needs.
8 Flexible care—transition care
For paragraph 21‑4(c) of the Act, a person is eligible to receive flexible care in the form of transition care only if the person:
(a) is assessed as satisfying all of the following requirements:
(i) the person is in the concluding stage of a hospital episode;
(ii) the person is medically stable;
(iii) the person has the potential to benefit from transition care; and
(b) is, at the time the assessment is undertaken, admitted to a hospital; and
(c) would be assessed as eligible to receive residential care if the person applied for residential care.
8A Flexible care—short‑term restorative care
For paragraph 21‑4(c) of the Act, a person is eligible to receive flexible care in the form of a single episode of short‑term restorative care (the proposed episode) only if:
(a) the person is assessed as experiencing functional decline that is likely to be reversed or slowed through short‑term restorative care; and
(b) the person is at risk of losing independence to such a degree that, without short‑term restorative care, it is likely that the person will require home care, residential care or flexible care provided through a multi‑purpose service; and
(c) the person is not receiving residential care, home care through a Commonwealth home care package, or is not in an episode of transition care; and
(d) the person is not on leave from a residential care service or a flexible care service through which the person is receiving flexible care in the form of transition care; and
(e) the person would not be assessed as eligible to receive flexible care in the form of transition care if the person applied for flexible care in the form of transition care; and
(f) the person has not, at any time during the 6 months before the date of assessment, been in an episode of transition care; and
(g) the person has not, at any time during the 3 months before the date of assessment, been hospitalised for a condition related to the functional decline mentioned in paragraph (a); and
(h) the person is not receiving end of life care; and
(i) in receiving the proposed episode, the person will not have received more than 2 episodes of short‑term restorative care in any 12 month period.
Part 3—Limitation of approvals
9 Purpose of this Part
For section 22‑2 of the Act, this Part specifies matters and circumstances to which approval of a person as a care recipient of one or more types of aged care may be limited.
10 Residential care provided as respite care
Approval of a person as a recipient of residential care may be limited to respite care if respite care is appropriate to the needs of the person, the person’s carer or both.
11 Home care
(1) Approval of a person as a recipient of home care may be limited to one of the following levels of home care:
(a) level 1;
(b) level 2;
(c) level 3;
(d) level 4;
where level 4 is the highest level of home care and level 1 is the lowest.
(2) However, if a person is approved as a recipient of a particular level of home care, the limitation of approval to that level does not prevent the person receiving home care at a lower level.
Part 3A—Applications for approval
11A Applications in relation to residential care for certain younger persons
(1) This section applies if a person applies under section 22‑3 of the Act to be approved as a recipient of residential care, and the person is not:
(a) a person who is at least 65 years of age; or
(b) a person from an Aboriginal or Torres Strait Islander community who is at least 50 years of age; or
(c) a person who is homeless or at risk of becoming homeless and is at least 50 years of age.
(2) The application must be accompanied by one of the following:
(a) an Exploration of Home & Living Supports for NDIS Participants Form completed for the person by the National Disability Insurance Agency;
(b) a Summary Report: Younger People at Risk of Entering Residential Aged Care completed for the person by Ability First Australia.
(3) However, the documentation mentioned in subsection (2) is not required if the application is:
(a) in relation to the provision of respite care; and
(b) made on the basis that the person urgently needed the care when it started and it was not practicable to apply for approval beforehand.
Part 4—Date of effect of approval
12 Purpose of this Part
For paragraph 22‑5(2)(b) of the Act, this Part sets out the circumstances in which the Secretary may be satisfied that a person who was provided with care before being approved as a recipient of that type of care urgently needed the care when it started.
13 Care provided in emergency circumstances
The Secretary may be satisfied that the person urgently needed the care when the care started if the Secretary is satisfied that an emergency existed when the care started.
Part 5—Lapsing of approval
14 Purpose of this Part
For section 23‑3 of the Act, this Part specifies:
(a) the entry period for flexible care in the form of transition care and flexible care in the form of short‑term restorative care; and
(b) circumstances in which a person’s approval as a recipient of flexible care in the form of transition care, or flexible care in the form of short‑term restorative care, lapses.
15 Entry period
(1) For paragraph 23‑3(1)(a) of the Act, the entry period for a person who is approved as a recipient of flexible care in the form of transition care is 4 weeks beginning on the day after the approval is given under subsection 22‑1(2) of the Act.
(2) For paragraph 23‑3(1)(a) of the Act, the entry period for a person who is approved as a recipient of flexible care in the form of an episode of short‑term restorative care is 6 months beginning on the day after the approval is given under subsection 22‑1(2) of the Act.
16 Circumstances in which approval lapses
(1) For subsection 23‑3(3) of the Act, the approval of a person as a recipient of flexible care in the form of transition care lapses if the person is not provided or is not taken to be provided for the purposes of subparagraph 50‑1(1)(b)(iii) of the Act, for a period of at least 1 day after the entry period for the person’s approval ends, with the care in respect of which the person is approved.
Note: Section 102B of the Subsidy Principles 2014 sets out when an approved provider is taken to provide transition care to a care recipient for the purposes of subparagraph 50‑1(1)(b)(iii) of the Act.
(2) For subsection 23‑3(3) of the Act, the approval of a person as a recipient of flexible care in the form of an episode of short‑term restorative care lapses if:
(a) the episode of short‑term restorative care ends; or
(b) both of the following apply:
(i) for a period (the non‑care period) of at least 1 day after the entry period for the person’s approval ends, the person is not provided with the care in respect of which the person is approved;
(ii) the provision of care to the person was not suspended in accordance with subsections 111C(3) to (5) of the Subsidy Principles 2014 for each day in the non‑care period.
(3) In this section:
entry period, for a person’s approval, means:
(a) if the person is approved as a recipient of flexible care in the form of transition care—the entry period specified in subsection 15(1); or
(b) if the person is approved as a recipient of flexible care in the form of short‑term restorative care—the entry period specified in subsection 15(2).
Part 6—Transitional provisions
18 Transitional provisions relating to the Aged Care Legislation Amendment (Increasing Consumer Choice) Principles 2016
(1) If:
(a) immediately before the commencement of this section, a person met the criteria in paragraphs 7(1)(b) and (d) of the old principles; and
(b) the person did so as a result of an assessment of the person made at any time before the commencement of this section;
on and after the commencement of this section the person is taken, for the purposes of paragraphs 7(2)(b) and (d) of the new principles, to have been assessed as a result of that assessment as:
(c) requiring a low level of home care; and
(d) being able to live at home with the support of home care at level 2.
(2) If:
(a) immediately before the commencement of this section, a person met the criteria in paragraphs 7(2)(b) and (d) of the old principles; and
(b) the person did so as a result of an assessment of the person made at any time before the commencement of this section;
on and after the commencement of this section the person is taken, for the purposes of paragraphs (7)(4)(b) and (d) of the new principles, to have been assessed as a result of that assessment as:
(c) requiring a high level of home care; and
(d) being able to live at home with the support of home care at level 4.
(3) In this section:
new principles means these principles as in force on the day this section commences.
old principles means these principles as in force immediately before the day this section commences.
19 Transitional provisions relating to amendments made by Schedule 3 to the Aged Care Legislation Amendment (Residential Aged Care Funding) Instrument 2022
(1) Section 10, as amended by Schedule 3 to the Aged Care Legislation Amendment (Residential Aged Care Funding) Instrument 2022, applies in relation to an approval given on or after 1 October 2022.
(2) If:
(a) an approval was given before 1 October 2022; and
(b) immediately before that day, both of the following applied in relation to the approval:
(i) the approval was limited to a matter referred to in subsection 10(2);
(ii) the approval was in effect;
the approval is taken, on and after 1 October 2022, to no longer be limited to that matter.
