ADP daily living component activity 3 – managing therapy or monitoring a health condition

This chapter provides information on activity 3 of the daily living component of Adult Disability Payment (ADP).

This chapter should be read and applied in line with the ‘overview of decision making’ and the ‘daily living component introduction’.

What activity 3 covers

Daily living component activity 3 considers an individual’s ability to:

• take medication, in a domestic setting, that’s prescribed or recommended by a registered doctor, nurse, pharmacist or health professional (regulated by the Health Professions Council), which improves the individual’s symptoms or health
• detect significant changes in a health condition which are likely to lead to a deterioration in their health
• manage therapy, carried out in a domestic setting, that are prescribed or recommended by a registered doctor, nurse, pharmacist or health professional (regulated by the Health Professions Council), which improves the individual’s symptoms or health. Therapy should be carried out by the individual at home independently of the medical professional who has prescribed or recommended it.

Applies to medication and therapy done at home or in a care home

Daily living component activity 3 applies to medication taken, or therapy carried out, in a domestic setting (i.e. home environment) and can include care homes but not hospital or other health care settings.

Meaning of medication

Medication is pharmaceutical treatment which involves the use of medicinal drugs.

Drugs are substances which have a physiological effect when ingested or introduced into or onto the body.

Examples of medication

The following are examples of medication which includes but is not limited to:

• tablets
• injections
• inhaled medications
• creams
• transdermal patches

Meaning of therapy

Therapy is a non-pharmaceutical treatment which does not involve the use of medicinal drugs.

Examples of therapies

The following are examples of therapy which includes but is not limited to:

• physiotherapy
• home dialysis
• special diets where both attention to the nature and timing of food is integral in the management of the diet and where failing to adhere to the diet would result in an immediate deterioration in an individual’s condition
• psychotherapy

Registered health professional must prescribe or recommend this

There must be a consensus of medical opinion that supports the use of medication and therapy.

Hence the necessity for them to be prescribed or recommended for an individual by a registered doctor, nurse, pharmacist or health professional (regulated by the Health Professions Council).

What we do not consider therapy

Therapy does not include either of the following:

• taking or applying, or otherwise receiving or administering, medication (whether orally, topically or by any other means)
• any action which, in the individual’s case, falls within the definition of ‘monitor a health condition’

If there’s a therapeutic source for taking nutrition

An individual who requires a therapeutic source to take nutrition would not satisfy the criteria for this activity, but may be considered under daily living component activity 2.

Meaning of monitoring a health condition

Monitoring a health condition means the ability to recognise significant changes in an individual’s health condition which are likely to lead to a deterioration in the their health and taking action as advised by a:

1. registered medical practitioner
2. registered nurse
3. health professional who is registered by the Health and Care Professions Council
   without which the individuals health is likely to deteriorate.

Examples of actions to be taken may include, but are not limited to, implement of treatment plans or modifications.

Where an individual requires support otherwise from a third party by way of prompting, supervision or assistance, you should usually expect to see evidence demonstrating the role that a third party plays throughout this activity.

For example, in the case of a person with diabetes, whose blood sugar levels can change suddenly, the third party would be able to monitor for changes and take action, without which the individual’s short or long-term health would be at risk.

Daily living component activity 3 descriptors

The daily living component activity 3 descriptors describe 6 levels of functional ability to complete the activity.

1. Either/or:
   1. does not receive medication or therapy or need to monitor a health condition
   2. can manage medication or therapy or monitor a health condition unaided
2. Needs any one or more of the following:
   1. to use an aid or appliance to be able to manage medication
   2. supervision, prompting or assistance to be able to manage medication
   3. supervision, prompting or assistance to be able to monitor a health condition
3. Needs supervision, prompting or assistance to be able to manage therapy that takes no more than 3.5 hours a week
4. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week
5. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 7 but no more than 14 hours a week
6. Needs supervision, prompting or assistance to be able to manage therapy that takes more than 14 hours a week (ADP regs, Schedule 1 Part 2 -  Daily Living Activities, Activity (3)).

Consider reliability criteria

You should consider the reliability criteria when identifying the appropriate descriptor.

An individual may use an aid or aids to assist them in completing this activity and this may mean that they satisfy daily living component activity 3 descriptor B, which is covered later.

However, an individual may also satisfy daily living component activity 3 descriptor B where they do not use an aid or aids to assist them but, could reasonably be expected to do so.

Consider need for prompting, supervision, or assistance

You’ll also consider if the individual needs prompting, supervision or assistance from another person to complete the activity.

Prompting

‘Prompting’ means reminding, encouraging or explaining by another person. This does not have to be in the physical presence of the individual.

Supervision

‘Supervision’ means the continuous presence of another person for the purpose of ensuring an individual’s safety.

The supervision can be in relation to any risk to the individual’s safety, whether or not the risk directly results from carrying out the activity in question.

Assistance

‘Assistance’ means physical intervention by another person and does not include speech.

Descriptors C to F consider the length of time support is needed

For the purpose of daily living component activity 3 descriptors C to F, the need for supervision, prompting or assistance to be able to manage therapy applies to the duration of the supervision, prompting or assistance and not the duration of the therapy.

Someone may need support but not have access to it

You should also consider what supervision, prompting or assistance to be able to manage therapy an individual could reasonably need but may not actually have.

Diets are covered in activities 1 and 2

In the case of managing special diets, time spent on supervision and monitoring, cooking or eating is covered in daily living component activities 1 and 2.

Nebulisers

A nebuliser could be considered to be delivering either medication or therapy depending on the clinical indication and use.

In some cases it may be used to deliver medications such as salbutamol for asthma.

It may also be used in a therapeutic role to deliver nebulised saline water in chronic chest conditions to:

• help loosen mucous secretions and
• aid chest physiotherapy

In most cases the process of delivering nebulised liquids encompasses both medication and non-pharmaceutical treatment (therapy) so the higher descriptor may be more appropriate.

What activity 3 covers

Daily living component activity 3 considers the following:

• an individual’s ability to take medication out of packaging on the correct date and at the correct time and frequency
• an individual’s ability to carry out therapy on the correct date and at the correct time and frequency
• therapy must be received in the home environment which will include a care home
• the time taken to manage therapy is the time taken to deliver therapy rather than the duration of time for therapy to take effect

What activity 3 does not cover

Daily living component activity 3 does not consider the following:

• an individual who is not taking any medication or having any therapy
• an individual receiving therapy in a hospital or other health care setting (i.e. not a home setting, which will include a care home)
• an individual who would need supervision, prompting or assistance if they were taking medication but does not currently take medication