professional questionnaire means the questionnaire mentioned in subsection 2.1(3).
treating health professional means a person approved under section 1.5.
1.5 Treating health professional
The Secretary may approve a person as a treating health professional.
The Secretary may also approve a class of persons as treating health professionals.
Note A treating health professional is the only person who can complete the questionnaire set out in Part 2 of Schedule 1 (see subsections 2.1(3) and (4)).
1.6 Disability assessment components
Part 2 of this instrument sets out the Adult Disability Assessment Tool.
Note Under subsection 38C(1) of the Act, the Secretary may, by legislative instrument (the determination):
(a) devise a test for assessing the disability, emotional state, behaviour and special care needs of a person aged 16 or more; and
(b) provide a method for rating the person by giving him or her, on the basis of the results of the test, a score in accordance with a scale.
Under subsection 38C(3) of the Act, the part of the determination setting out the test and the rating method is the Adult Disability Assessment Tool.
Part 2—Adult Disability Assessment Tool
2.1 Questionnaires
Part 1 of Schedule 1 sets out a questionnaire (the claimant questionnaire) about disability, emotional state, behaviour and special care needs of an adult.
The claimant questionnaire may be completed only by a person (the claimant) wishing:
to claim a carer allowance or carer payment, or both, under the Act for the care of an adult; or
to continue to be qualified for receiving carer allowance or carer payment, or both, under the Act for the care of an adult.
Part 2 of Schedule 1 sets out another questionnaire (the professional questionnaire) about the disability, emotional state, behaviour and special care needs of an adult.
The professional questionnaire may only be completed by a treating health professional.
2.2 Testing method
The test for assessing a person’s disability, emotional state, behaviour and special care needs is the assessment, under this Part, of the answers given in relation to the person in the 2 questionnaires mentioned in section 2.1.
The following steps are carried out for the test:
the Secretary must be satisfied that a completed professional questionnaire is an accurate reflection of the disability, emotional state, behaviour and special care needs of the person concerned;
a score must be calculated:
1. using the rating method mentioned in section 2.3; and
2. on the basis of the answers given in the questionnaire.
If the Secretary is not satisfied that the professional questionnaire is an accurate reflection of the person’s disability, emotional state, behaviour and special care needs, the Secretary must ask for a replacement professional questionnaire to be completed by another treating health professional.
2.3 Rating method
Steps 1 to 5 in Schedule 2 set out the method for rating a person, on the basis of the answers given in each questionnaire completed in relation to the person.
The method gives the person a score:
in accordance with the scale mentioned in subsection 38C(2) of the Act; and
that determines whether the person is a care receiver to which subparagraph 197D(1)(a)(i), paragraph 198(2)(a), subparagraph 198(2)(d)(i), paragraph 954(1)(c) or paragraph 954A(1)(c) of the Act applies.
Schedule 1—Questionnaires
(section 2.1)
Part 1—Claimant questionnaire
Division A
For each question, the claimant must tick only the response code that best describes how well the person in care usually manages. Help means any physical assistance, guidance or supervision. Without help means that the person initiates and completes activities without assistance or supervision.
Does the person in care:
1
Move around the house (may use walking stick, frame, wheelchair etc)?
Response code
Without help
a
With help of one person
b
With help of two people
c
Is confined to bed
d
2
Fall over indoors or outdoors (or from wheelchair)?
Response code
Often
a
Sometimes
b
Never
c
3
Move to and from bed, chair, wheelchair and walking aids?
Response code
Without help
a
With some help
b
With a lot of help
c
Cannot do this
d
4
Have difficulty hearing others (even with hearing aids)?
Response code
Always
a
Often
b
Sometimes
c
Never
d
5
Have difficulty seeing clearly (even with glasses)?
Response code
Always
a
Often
b
Sometimes
c
Never
d
6
Need help or attention during the night?
Response code
Always
a
Often
b
Sometimes
c
Never
d
7
Have loss of bladder control or bowel control or both (incontinence)?
Response code
Always
a
Often
b
Sometimes
c
Never
d
8
Use continence aids or equipment (eg colostomy, catheter, pads)?
Response code
Without help
a
With some help
b
With a lot of help
c
Does not use aids
d
9
Use the toilet?
Response code
Without help
a
With some help
b
With a lot of help
c
Cannot use a toilet
d
<br>
10
Eat their food (does not include meal preparation)?
Response code
Without help
a
With some help
b
With a lot of help
c
Cannot feed themselves
d
11
Shower or bathe themselves?
Response code
Without help
a
With some help
b
With a lot of help
c
Cannot do this
d
12
Dress themselves? (eg buttons, zips, etc)
Response code
Without help
a
With some help
b
With a lot of help
c
Cannot do this
d
13
Look after their grooming (eg shaving, caring for hair, and teeth)?
Response code
Without help
a
With some help
b
With a lot of help
c
Cannot do this
d
14
Take care of their own medication (eg takes the right tablet at the right time)?
Response code
Without help
a
With some help
b
With a lot of help
c
Cannot do this
d
Does not take medication
e
<br>
15
Take care of their own treatment (eg oxygen, wound care, gastric feeding)?
Response code
Without help
a
With some help
b
With a lot of help
c
Cannot do this
d
Does not have treatment
e
Division B
For each question, the claimant must tick only the response code that best describes how well the person in care usually manages.
Does the person in care:
1
Understand what you, the carer, say?
Response code
Always
a
Usually
b
Sometimes
c
Never
d
2
Understand what other people say?
Response code
Always
a
Usually
b
Sometimes
c
Never
d
3
Let others know how they feel and what they want (eg by speaking, using sign, or a communication aid)?
Response code
Always
a
Usually
b
Sometimes
c
Never
d
<br> <br>
4
Know where they are?
Response code
Always
a
Usually
b
Sometimes
c
Never
d
5
Know whether it is morning, afternoon, or night?
Response code
Always
a
Usually
b
Sometimes
c
Never
d
6
Remember things that happened today?
Response code
Always
a
Usually
b
Sometimes
c
Never
d
Division C
For each question, the claimant must tick only the box that best describes how the person in care usually behaves.
Does the person in care:
1
Wander away or ‘run away’ from home?
Response code
Never
a
Sometimes
b
Often
c
2
Shout, scream at or threaten other people?
Response code
Never
a
Sometimes
b
Often
c
3
Physically harm other people?
Response code
Never
a
Sometimes
b
Often
c
4
Damage furniture, possessions or objects?
Response code
Never
a
Sometimes
b
Often
c
5
Laugh or cry without apparent reason?
Response code
Never
a
Sometimes
b
Often
c
6
Withdraw from contact with other people, or appear depressed, worried or fearful?
Response code
Never
a
Sometimes
b
Often
c
7
Deliberately harm themselves (e.g. by biting, scratching skin, hitting or banging their head)?
Response code
Never
a
Sometimes
b
Often
c
8
Have unusual, inappropriate, or repetitive behaviours (eg uncontrolled eating, spinning objects, hand flapping, rocking, calling out or saying the same thing over and over again)?
Response code
Never
a
Sometimes
b
Often
c
Part 2—Professional questionnaire
Division A
This is an assessment of personal activities of daily living. For each function, the treating health professional must tick only the box that best describes the person receiving care.
The information under each function should be used as a record of what a person does, not as a record of what a person could do.
The main aim is to establish degree of independence from any help, physical or verbal, however minor and for whatever reason.
The need for supervision renders the person not independent.
A person’s performance should be established using the best available evidence. Asking the person, friends or relatives or both, and nurses will be the usual source, but direct observation and common sense are also important. However, direct testing is not needed.
Usually the performance over the preceding 24-48 hours is important, but occasionally longer periods will be relevant.
Middle categories imply that the person supplies more than 50% of the effort.
Use of aids to be independent is allowed.
1
Bowels - Assess preceding week. If needs enema, then ‘incontinent’.
Response code
Incontinent (or needs to be given enema)
a
Occasional accident (once a week)
b
Continent
c
2
Bladder - Assess preceding week. Occasional = less than once a day. A catheterised person who can completely manage the catheter alone is registered as ‘continent’.
Response code
Incontinent or catheterised and unable to manage
a
Occasional accident (once a week)
b
Continent
c
3
Grooming - Assess preceding 24-48 hours. Refers to personal hygiene including cleaning teeth, fitting false teeth, doing hair, shaving, washing face. Implements can be provided by helper.
Response code
Needs help with personal care: face, hair, teeth
a
Independent (implements provided)
b
4 Toilet use - Should be able to reach toilet or commode, undress sufficiently, clean self, dress and leave. With help = can wipe self, and could do some of the above. Response code
Dependent a
Need some help but can do some things alone b
Independent (on and off, wiping, dressing) c
5 Feeding - Able to eat any normal food (not only soft food). Food cooked and served by others, but not cut up. Help = food cut up, person feeds self. Response code
Unable a
Needs help in cutting, spreading butter etc b
Independent (food provided within reach) c
6 Transfer - From bed to chair and back. Unable = no sitting balance (unable to sit), 2 people to lift. Major help = 1 strong or skilled or 2 normal people. Can sit up. Minor help = 1 person easily, or needs any supervision for safety. Response code
Unable - no sitting balance a
Major help (physical, 1 or 2 people), can sit b
Minor help (verbal or physical) c
Independent d
7 Mobility - Refers to mobility about house or indoors. May use aid. If in wheelchair, must negotiate corners or doors or both unaided. Help = by 1 untrained person, including supervision, moral support. Response code
Immobile a
Wheelchair independent, including corners etc (i.e. uses wheelchair without assistance) b
Walks with help of 1 person (verbal or physical) c
Independent d
8 Dressing - Should be able to select and put on all clothes which may be adapted. Half = requires help with buttons, zips etc but can put on some garments alone. Response code
Dependent a
Needs help but can do about half unaided b
Independent (including buttons, zips, laces etc) c
9 Stairs - To be independent must be able to carry any walking aid used. Response code
Unable a
Needs help (verbal, physical, carrying aid) b
Independent up and down c
10 Bathing - Usually the most difficult activity. Bath: Independent = must get in and out unsupervised, and wash self. Shower: Independent = unsupervised or unaided or both. Response code
Dependent a
Independent b
Division B
1 In your opinion is the person cognitively impaired? Response code
No, please go to Division C a
Yes, please answer question 2 b
2 Cognitive Function Response code
This is an assessment of cognitive function. Ask the person receiving care for the following information. Tick box () to indicate if the person’s answers were right or wrong.
Right Wrong
Time (to nearest hour) a
Memory Phrase: Repeat this phrase after me and remember it for later - 42 West Street
Name of institution or suburb where the person lives b
Recognition of 2 persons in the room (doctor, nurse, carer etc) c
Date of birth (day, month and year) d
Name of present Prime Minister of Australia e
Count backwards from 20 to 1 f
Repeat the memory phrase g
3 Unable to administer Abbreviated Mental Test because: Response code
Person unable to communicate a
Person refuses to participate b
Division C
For each question tick () the response code that best describes the person’s usual state.
Does the person:
1
Show signs of depression?
Response code
Never
a
Sometimes
b
Most of the time
c
2
Shows signs of memory loss?
Response code
Never
a
Sometimes
b
Most of the time
c
3
Withdraw from social contact?
Response code
Never
a
Sometimes
b
Most of the time
c
4
Display aggression towards self or others?
Response code
Never
a
Sometimes
b
Often
c
<br>
5
Display disinhibited behaviour?
Response code
Never
a
Sometimes
b
Often
c
Schedule 2—Rating method
(section 2.3)
STEP 1
If a medical practitioner has certified that the care receiver is in the terminal phase of a terminal illness and is not expected to live for more than 3 months, add a value of 30 to the professional questionnaire component of the total final score.
No further steps are relevant where the relevant qualification provisions of the Act state that the final total score to qualify for carer payment or carer allowance is 30 or less.
STEP 2
(1) Calculate a score for each question in the claimant questionnaire of the Adult Disability Assessment Tool set out in Part 2 of this instrument. If a claimant has marked more than 1 answer to any question in division A, B or C, accept only the answer which gives the highest score.
(2) Calculate the total score for each division by adding the score for each answer in that division.
(3) Calculate the total claimant questionnaire score by adding the total score from each division of the Adult Disability Assessment Tool.
Division A
Question
Answer
Value
Score
1
a
0
b
3
c
6
d
9
2
a
2
b
1
c
0
3
a
0
b
3
c
6
d
9
4
a
3
b
2
c
1
d
0
5
a
3
b
2
c
1
d
0
6
a
9
b
6
c
3
d
0
7
a
3
b
2
c
1
d
0
8
a
0
b
1.5
c
3
d
0
9
a
0
b
1.5
c
3
d
4.5
10
a
0
b
2.5
c
5
d
7.5
11
a
0
b
1.25
c
2.5
d
3.75
12
a
0
b
1.25
c
2.5
d
3.75
13
a
0
b
2
c
4
d
6
14
a
0
b
1
c
2
d
3
e
0
15
a
0
b
1
c
2
d
3
e
0
Total A =
Division B
Question
Answer
Value
Score
1
a
0
b
0.5
c
1
d
1.5
2
a
0
b
0.5
c
1
d
1.5
3
a
0
b
1
c
2
d
3
4
a
0
b
1.5
c
3
d
4.5
5
a
0
b
1.5
c
3
d
4.5
6
a
0
b
1.5
c
3
d
4.5
Total B =
Division C
Question
Answer
Value
Score
1
a
0
b
3
c
6
2
a
0
b
3
c
6
3
a
0
b
3
c
6
4
a
0
b
2
c
4
5
a
0
b
2
c
4
6
a
0
b
2
c
4
7
a
0
b
3
c
6
8
a
0
b
2
c
4
Total C =
Total A +
Total B +
Total C __________
Total claimant questionnaire score
STEP 3
(1) Calculate a score for each question in the professional questionnaire of the Adult Disability Assessment Tool. If a treating health professional has marked more than 1 answer to any question in division A or C, accept only the answer which gives the highest score. In division B, question 2, no score is given for a right answer; each wrong answer by the care receiver is allocated the score indicated. Where all answers to question 2 are left blank because the care receiver is unable to communicate, no points should be awarded for the question but points should be allocated in accordance with question 3.
(2) Calculate the total score for each division by adding the score for each answer in that division.
(3) Calculate the total professional questionnaire score by adding the total score from each division of the Adult Disability Assessment Tool.
Division A
Question
Answer
Value
Score
1
a
3
b
1.5
c
0
2
a
3
b
1.5
c
0
3
a
2
b
0
4
a
3
b
1.5
c
0
5
a
5
b
2.5
c
0
6
a
9
b
6
c
3
d
0
7
a
9
b
4.5
c
4.5
d
0
8
a
5
b
2.5
c
0
9
a
4
b
2
c
0
10
a
2.5
b
0
Total A =
Division B
Question
Answer
Value
Score
1
a
Nil
b
Nil
2
a
1.5
Maximum
b
1.5
score for
c
1.5
question
d
1.5
2 is 10.5
e
1.5
f
1.5
g
1.5
3*
a
8.5
b
8.5
Total B =
* If question 3 is answered, ignore any points awarded in question 2 of this division.
Division C
Question
Answer
Value
Score
1
a
0
b
2
c
4
2
a
0
b
1.5
c
3
3
a
0
b
2
c
4
4
a
0
b
3
c
6
5
a
0
b
2
c
4
Total C =
Total A +
Total B +
Total C _________
Total professional questionnaire score
STEP 4
Add the claimant questionnaire total score (from step 2) and the professional questionnaire total score (from step 3) to achieve a final total score.
Total claimant questionnaire score +
Total professional questionnaire score _________
Total final score
STEP 5
The minimum professional questionnaire score that must be achieved if an individual is to qualify for payments is as follows:
a professional questionnaire score of 8 for carer payment under subparagraph 197D(1)(a)(i) of the Act;
a professional questionnaire score of 10 for carer payment under subparagraph 198(2)(a)(i) of the Act;
a professional questionnaire score of 32 where an individual care recipient is qualified to have more than one carer for carer payment under subparagraph 198(2)(a)(ii) of the Act;
a professional questionnaire score of 8 for carer payment where the care is provided to an adult and that adult’s dependent child under subparagraph 198(2)(d)(i) of the Act;
a professional questionnaire score of 12 for carer allowance (adult) under paragraph 954(1)(c) of the Act;
a professional questionnaire score of 12 for carer allowance under paragraph 954A(1)(c) of the Act.
Note: Satisfying the minimum professional questionnaire score does not automatically qualify a person for the relevant payment. Both the minimum professional questionnaire score and the minimum total final score must be satisfied to qualify for the relevant payment.