Conditions that suggest a review is inappropriate (Pathway 1)

Some conditions will generally not involve a change in the individual’s level of need. These conditions will usually be permanent or progressive.

If the individual has one of the following conditions, case managers should consider whether setting a review date is inappropriate:

Whilst the individual may have a condition that is listed, the supporting information may indicate that they are undergoing treatment or therapy that may change their level of need. In these circumstances, the case manager should still consider the likelihood of a change based on the available supporting information before deciding whether or not to set a review period.

Example: a lifelong condition that may have changing levels of need

Kellie has a diagnosis of schizophrenia. This condition was first diagnosed age 22. Kellie is 24 years old and lives with her family who support her on a daily basis. Schizophrenia is a mental health condition that can lead to lifelong impacts for many people, however successful treatment and support can reduce the impact on daily life. On Kellie’s application form, she notes she requires prompting, support and assistance for activities 1, 2, 3, 4, 6, 9, and 10. The following points were awarded:

1(e): 4 points

2(d): 4 points

3(b): 1 point

4(c): 2 points

6(c): 2 points

9(c): 4 points

10(b): 2 points

For the mobility activities Kellie reports that she is able to go out on her own. The supporting information indicates that on the majority of days she needs to be accompanied as she would not be able to safely undertake journey’s alone due to acting out on pervasive thoughts that attract hostile attention. She reported no difficulty with walking. The following points were awarded

1(f): 12 points

The case manager seeks the input of a practitioner. The practitioner advises that schizophrenia is a lifelong condition with low probability of full remission. However there is indication of Kellie responding to treatment, so there is a possibility that she will experience a change in her overall level of need.

As Kellie has been undergoing treatment for only two years and is responding well to treatment, the case manager decides that an indefinite award is not appropriate. The case manager decides that a five year review is appropriate, as treatment may improve Kellie’s condition within the medium term