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Functional questions
What functional questions do
The functional questions give an individual an opportunity to tell us about how their condition or disability impacts them in their daily life.
You need to consider the information provided by the individual and use this to support appropriate descriptor choices for each of the daily living and mobility component activities.
12 functional questions
There are 12 functional questions in the Adult Disability Payment (ADP) application form:
- preparing food
- taking nutrition
- managing therapy or monitoring a health condition
- washing and bathing
- managing toilet needs or incontinence
- dressing and undressing
- communicating verbally
- reading and understanding signs, symbols and words
- engaging socially with other people face to face
- making budgeting decisions
- planning and following journeys
- moving around
For every functional question, the individual’s invited to give a detailed account of their functional ability for that activity.
Make a fair and consistent decision
To make a fair and consistent decision, you should consider the following information about an individual's functional ability:
- how are they currently completing the activity, if at all?
- do they use any aids or appliances, to complete the activity?
- do they need any assistance or support to complete the activity?
- do they need prompting to complete the activity?
- if a restriction is identified in the above what condition or symptom is related to the restriction?
In all cases, you must also consider:
- are there any effects after completing the activity, for example, fatigue or pain?
- are there any safety risks associated with completing the task?
- how long does it take to complete the task?
- if it is normal to do so, would they be able to repeat the task?
You need to decide which descriptors the client satisfies on a given day in the required period, and then apply the scoring rules to decide which descriptor they are to be scored for overall.
Example: an individual has one condition
Application form
Due to my cerebral palsy, I need help to cook.
I can get my own breakfast and lunch, as I usually have toast or cereal for breakfast and a sandwich at lunchtime.
However, I have limited movement in my left hand which makes it hard for me to hold things while chopping and trying to peel things, so I have help to do this.
Once things are chopped, I can use my right arm to do the cooking, but my carer will help me if I have to lift heavy things.
I have weakness in my legs so I will use a stool to sit while I am cooking. I cook for myself every day with the help of my carer.
I really enjoy cooking Italian food, and it usually only takes me twenty to thirty minutes to cook my main meal. Once I have cooked, I will usually have to sit down for about half an hour as my legs get very stiff and sore, even though I am using a stool.
Case manager’s decision
Using the above framework of questions, a case manager can break the individual’s answer down into the information needed to make a decision:
- the individual reports that they cook every day
- the individual reports that they use a stool due to weakness in their legs
- the individual informs us they require the help of their carer to be able to complete parts of the activity
- no prompting needs have been described
- the individual informs us that they have to sit down for half an hour after completing the activity due to fatigue
- there are no safety risks noted or suggested in the individual’s report of how they complete the activity
- the individual informs us it takes twenty to thirty minutes to complete the activity
- the individual reports that with help they are able to repeat the activity when they need to
- the restriction present is related to their condition of cerebral palsy
Example: an individual having more than one condition
Application form
I find due to my depression I do not see the point in changing my clothes, maybe once a week.
I just do not have the motivation to do it, as I am not going anywhere. When I do get changed, my partner has to help me as I had an accident six months ago and had to have my spine fused.
Due to this, I am unable to raise my arms much and cannot bend from the middle at all. When I do get changed, my partner will put my underpants and trousers on for me and then I stand, and they pull them up for me.
I can just about get my hands into a loose-fitting t-shirt but if I am wearing a jumper or a shirt with buttons, my partner has to put these over my arms for me.
I have fallen trying to dress a number of times when I tried to do it on my own, so my partner always helps me now. Even with my partner’s help, it takes me around twenty minutes to get dressed and I am left with pain in my back and shoulders for the rest of the day.
Case manager’s decision
A case manager can use the framework to understand the individual’s report of how they are able to complete the activity. They have:
- informed us they change clothes once a week, due to a lack of motivation
- identified that they are able to use loose-fitting clothes for their top half
- informed us they need their partner to dress their top and bottom half
- identified that due to their depression, they require prompting to change their clothes
- identified that when they dress it leaves them with back pain for the rest of the day
- informed us that they have fallen a number of times when dressing on their own
- informed us it takes them twenty minutes to dress
- identified their depression and spinal injury as the cause of their restriction
For this activity, the individual would only need to dress once a day
Linking functional questions
When evaluating the functional questions, you should be aware that there are links between the activities.
This may lead to apparent inconsistencies.
As such, you are advised to look at all 12 activities together to identify any inconsistencies.
For example, for functional question 12 (mobility component activity 2, moving around) the individual states that they find it difficult to stand from a seated position, due to a hip replacement. They say that standing causes them pain and stiffness in their hip joints.
For functional question 5 (daily living component activity 5, managing toilet needs) they report that they're able to sit and stand from the toilet without difficulty.
From the information provided, it seems unclear how the individual may be able to complete one activity and not the other. There could be a number of reasons why this apparent inconsistency may exist.
You should explore this further through:
- supporting information
- asking the individual further questions
- requesting a case discussion or consultation
until they are satisfied they have the information required to make a fair and informed decision.
Consider if activities are similar enough to be compared
When considering cross-activity inconsistencies, you should ensure that the activities are similar enough to be compared.
For example, cutting food for daily living component activity 1 (preparing food) and cutting food for daily living component activity 2 (taking nutrition) appear similar.
However, the level of grip and dexterity required to chop raw vegetables in activity 1 may not be comparable with the level of grip and dexterity required to cut cooked food.
Cooked food may usually be easier to cut than raw ingredients. If you are unsure of how to interpret this, further advice should be sought.
If an individual is unable or unwilling to provide sufficient information
An individual may be unable or unwilling to provide sufficient information in the functional questions for you to make a decision. Where this is linked to a person’s disability, you should gather sufficient information through:
- supporting information (which, as well as from the client or a medical professional, could include from a carer/family member if the client gives permission to do so)
- asking the individual further questions
- requesting a case discussion
- where absolutely necessary only, a consultation
Where a person simply refuses to provide further information for you to make a decision on the function questions, they should be made aware that a decision will have to be made on the basis of the available information only. This conversation should be recorded.
If you have taken all available steps to address gaps in information and have been unable to gather sufficient information to satisfy the relevant criteria, then points cannot be awarded.
However, even if information gaps exist for some functional questions, it may be that sufficient information exists for other parts of the application to make an award.
You should not automatically make an ineligible determination if information gaps remain in some areas.
Symptoms
Symptoms usually describe how an individual’s affected by their condition or disability.
They may be experienced differently by every individual.
There’s not a specific section of the application form which gathers symptoms, so you need to gather this information from any parts of the form where this is mentioned.
Symptoms may have a wide range of how they impact an individual across the same condition.
Examples of symptoms may include, but are not limited to:
- pain
- shortness of breath
- fatigue
- tremors
- paranoia
- low motivation
- hearing loss
Making assumptions about link between condition and symptoms
Decision makers may make assumptions about the probable link between a condition and its likely symptoms as long as this is based on medical information (sources of medical information may include supporting information from a healthcare professional).
For example, an individual reports that due to their heart condition they experience fatigue most days.
Medical information supports this statement, as fatigue is a likely symptom of this condition. This may be applied to the individual’s report of their functional ability when choosing an appropriate descriptor.
Inconsistencies in an individual’s condition history
Inconsistencies may be present in an individual’s condition history. For example, an individual reports that they have hearing loss linked to their condition of heart failure.
Medical information indicates that hearing loss is not usually linked to heart failure.
This apparent inconsistency would require further sources of information to support a case manager in choosing an appropriate descriptor.
Where inconsistencies appear to be present, you should explore them until they are satisfied that they can be explained. This will allow you to make fair and consistent descriptor choices.
If you do not have enough information to make an informed decision
Where you do not have sufficient information to make an informed decision, you may request a case discussion in order to inform their determination.
If you cannot get sufficient supporting information to make a determination, you can require an individual to attend a consultation with a practitioner.