Child Disability Payment decision making guide

Attention with bodily functions

Attention with bodily functions means providing personal care, prompting or motivating either in relation to:

  • bodily functions
  • assistance with communication needs (CDP regs, reg. 11(6)(b))

Bodily function means the normal action of any organ of the body or of a number of organs acting together (CDP regs, reg. 2(2)). This includes the brain.

Common examples of bodily functions that case managers may wish to consider include:

  • breathing
  • dressing and undressing
  • drinking
  • eating
  • emptying the bowels or bladder
  • hearing
  • seeing
  • speaking
  • sitting
  • moving around indoors
  • sleeping.

The list is not exhaustive.

Case managers should apply their own judgment based on the application and any supporting information available to consider:

  • whether the individual has a disability
  • what impact the individual’s disability has on their bodily functions
  • whether the person reasonably requires attention from another person in connection with those bodily functions
  • how often the attention is required and how long it takes.

Attention should:

  • involve service of a close, personal nature carried out in the presence of the individual
  • be needed for something that the individual would normally do for themselves
  • not be something which can be done by anyone in the household.

Breathing

An individual may need help with:

  • positioning themselves whilst seated or in bed
  • connecting oxygen supplies or fitting masks
  • physical therapy

because they:

  • are at risk of being unable to sit up in bed
  • have reduced manual dexterity
  • need physical therapy to maintain their airways.

Washing, bathing and personal hygiene

An individual may need help with:

  • washing
  • cleaning teeth
  • caring for their hair, nails and skin

because they either:

  • are physically not able to carrying out these activities
  • have a tendency to neglect personal hygiene due to a mental health condition.

Dressing and undressing

An individual may need help with:

  • selecting suitable clothing
  • being motivated to dress, undress and change clothing
  • fastening clothes and shoes
  • putting on clothes in the correct order

because they either:

  • are physically not able to carrying out these activities
  • have poor motivation due to a mental health condition
  • are forgetful.

Attention with dressing and undressing may be needed at the start and end of the day.

If an individual has a condition that causes them to have episodes of incontinence, they may need to change clothing more frequently.

Some individuals may have a neurological or cognitive disability that means they need prompting to either:

  • dress appropriately
  • put clothing on in the correct order.

Eating, drinking and taking nutrition

An individual may need help with:

  • cutting up food
  • seeing food on a plate
  • chewing and swallowing
  • conveying food or drink to their mouth
  • motivation to eat
  • using a tube to take nutrition

because they:

  • are physically not able to carrying out these activities
  • need help with managing a feeding tube
  • have poor motivation due to a mental health condition
  • are forgetful
  • have a visual disability.

Some disabilities can make cutting up food or feeding difficult. Case managers should take the use of special cutlery or other aids into account when assessing the amount of help needed.

Use of aids can only be considered if they remove the need for attention. An individual using aids may still need attention.

Continence and Use of Toilet

An individual may need help with:

  • getting to and from the toilet
  • managing clothing whilst there
  • getting on and off the toilet
  • managing cleanliness
  • changing incontinence pads
  • managing stoma and colostomy bags

because they:

  • are physically not able to carry out these activities
  • they do not get enough warning of the need to use the toilet
  • are forgetful or not aware of how to manage toilet needs.

Case managers should consider a need for attention with:

  • changing or washing clothing
  • cleaning or emptying commodes.

This attention should be given as part of a single period of attention in connection with the bodily function.

Case managers should take into account the use of aids or appliances, like a frame or a hoist when assessing the amount of help needed.

Use of aids can only be considered if they remove the need for attention. An individual using aids may still need attention.

Hearing

An individual may need help with:

  • learning sign language or to lip read
  • understanding speech and recognising sounds
  • having words repeated, re-phrased or explained
  • making themselves understood.

This is because the individual cannot communicate effectively in real world environments without such assistance.

An individual who is able to communicate directly with another person through a combination of sign language, hearing and lip reading does not necessarily amount to needing attention in every case. This is because the individual may or may not be able to communicate independently.

Seeing

An individual who is visually impaired may need:

  • help with reading letters
  • help with choosing appropriate clothing
  • guidance, by touch or by verbal prompting to avoid harm when walking in unfamiliar surroundings
  • places, objects and situations verbally described to them
  • verbal instructions given to them
  • encouragement, prompting or reassurance from another individual whilst they are physically present with them.

This is because the individual is unable to effectively see the world around them, this may be due to one or a combination of the following:

  • reduced clarity of vision (blurred vision)
  • reduced field of vision
  • sensitivity to light
  • reduced depth perception

The list is not exhaustive.

Where attention is provided by speaking to the individual, it should take place in the physical presence of the individual.

An individual who is visually impaired may also require help with other bodily functions such as:

  • washing and bathing as they may require help getting in and out of a bath/shower, or help differentiating types of toiletries
  • eating and drinking as they may require help cutting up food and identifying where food is on a plate to avoid spills
  • dressing as they may require extra support to ensure that they are dressed appropriately or require help using fastenings/zips for example
  • maintaining personal hygiene
  • moving around indoors to help avoid bumping into objects
  • communication and social skills as they may require help in the form of additional physical contact and/or verbal instructions to describe and reassure the individual of their social surroundings, for example an individual with a visual impairment may be unable to visually recognise a familiar person or may be unable to pick up on non-verbal cues such as smiling when engaging socially with others.

This list is not exhaustive

An individual who is visually impaired may also require additional supervision substantially in excess of the needs of another child of the same age. Additional supervision may be required depending on the age of the child, the severity of their visual impairment and on any additional disabilities they may have, as the individual may require continual supervision throughout the day to avoid substantial danger to themselves or others due to being unaware of the dangers of their surroundings

Getting in and out of bed

Individuals may need help in getting in and out of bed because of their disability. Some individuals use of aids/equipment to overcome these difficulties These should be taken into account in assessing the amount of attention that is reasonably required. An individual may still need attention even when using aids.

Turning over in bed

There are many conditions which make it difficult for the individual to turn over in bed. This may lead to significant discomfort or skin damage.

Sleeping

An individual who experiences discomfort or distress, may have difficulty sleeping without attention from another person.

Individuals with certain mental health conditions can experience disturbed sleep and/or distressing dreams. They may have to be comforted, reassured and settled back to sleep.

The individual may also have a physical condition that means they require attention from another person to become comfortable in bed. This is because of the way their condition affects or limits them. They may also require help to turn over or to sit up in bed.

Moving around indoors

An individual may need help with:

  • getting in and out of a chair
  • moving from one room to another
  • getting up and down stairs because they have:
  • reduced power or movement in their arms or legs
  • poor balance
  • poor co-ordination.

It may be unreasonable to expect the individual to remain in one room for an entire day case managers should consider:

  • the frequency of assistance needed
  • any aids or appliances that are appropriate to the individual’s needs and age.

Taking medication

An individual may need assistance from another person to take medication if they experience, for
example:

  • reduced manual dexterity
  • memory difficulties
  • periods of confusion.

Children will probably always need assistance with taking medication. A young person may also need assistance, although this may depend on their age and level of understanding.

Frequent throughout the day

“Frequent” means several times and should be given its ordinary meaning. There is no strict numerical test but it is unlikely that once or twice would amount to “frequent”. The case manager should consider all the facts of the case. The attention must be required throughout the day (CDP regs, reg. 11(1)(c)).

“Throughout” means the period from the beginning of the day to the end of the day.

Attention given first thing in the morning, again at lunch time and again in the evening, is not normally regarded as frequently throughout the day.

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