Examples of typical changes in care needs
Changes in the level of the individual’s need that could lead to an unscheduled review include:
- an increase in care needs. This could be due to developing a new condition or disability, or a worsening of their condition or impact of their disability
- a decrease in care needs due to an improvement in their condition or the impact of the disability
- the individual receives medical treatment which reduces or stops the individual’s needs
This list is not exhaustive.
Once the review is complete, the case manager:
- makes a determination on the individual’s entitlement to PADP, taking into account the change in circumstances;
- decides whether or not to set a review date, and what the review date should be; and
- sends the individual the notice of this new determination.
Example: A reported increase in needs does not result in an increase in award
Mark is 75 years old. He lives with his daughter and is living with the effects of dementia. He is currently entitled to the lower rate of PADP for the frequent attention he receives during the day. Mark requires attention when taking a shower, getting dressed and when going to the toilet.
Mark’s daughter contacts Social Security Scotland and reports that because there is a slight deterioration in Mark’s condition, he now occasionally needs help to settle during the night.
This could possibly change the level of Mark’s award. Therefore, Social Security Scotland carry out an unscheduled review as a result of the change of circumstances from Mark’s daughter. As the case manager is familiar with Mark’s condition and its prognosis, they know that it is more likely than not that Mark would experience more severe symptoms of his condition over time. The case manager therefore does not require any decision-making tools, such as supporting information or a case discussion.
The case manager determines that Mark’s award will remain the same. This is because, while Mark now requires occasional help to settle during the night, his daughter has shared that Mark needs this help around once a fortnight. This would mean that although Mark does not satisfy the ‘night criterion’, he would remain entitled to the lower rate of PADP for his daytime needs. Individuals must meet both the day and night criteria to be entitled to the higher rate of PADP.
Case managers can extend the review date of an individual’s award as part of their determination if appropriate. This is true even if an individual’s needs have not changed.
A case manager should only set an award review date earlier if they receive new information that justifies doing this.
For guidance on setting an appropriate review period, reference should be made to the review periods chapter.
Example: An award rate does not change but the review period is changed
Zainab is 69 years old and has been experiencing pain and stiffness in her lower back, both hands, and her left knee for about 2 years. The stiffness and pain affect her especially badly in the mornings, meaning she struggles with washing and dressing herself and cooking breakfast. Zainab requires frequent attention throughout the day due to the impact of her condition.
Zainab was awarded the lower rate of PADP, with a review period of 2 years. Zainab’s review period was initially set at 2 years because, following a case discussion with a practitioner, it was determined that Zainab’s symptoms were relatively new and that her needs will likely change in the near future. After approximately one year she contacts Social Security Scotland to provide a letter from her GP confirming that she has been diagnosed with osteoarthritis and prescribed ibuprofen and paracetamol for pain relief.
The case manager considers the information provided and has a new case discussion with a practitioner, who helps provide more information about osteoarthritis, how it may progress, and the effects of treatment with painkillers.
The case manager determines that Zainab should remain on the lower rate of PADP but the review period should be extended to 5 years, given that her symptoms are most likely to remain stable for several years.
Example: Reported care needs change to include requiring support during the day and at night
Evelyn is 89 years old and has Alzheimer’s. She was diagnosed four years ago. She had previously been receiving frequent attention and continual supervision from her husband during the day, to ensure that she washed and dressed properly, to ensure her safety when preparing food, and due to her tendency to wander into the local area and get lost.
Evelyn’s husband contacts Social Security Scotland because for the past several months, Evelyn has now begun to wake in the night and attempt to leave the house, wandering and becoming lost overnight.
Social Security Scotland carry out an unscheduled review as a result of the change of circumstances. Evelyn’s change of circumstances form lacks some details. In order to fully understand Evelyn’s new level of need, the case manager decides that speaking to her husband would be the best option. As Evelyn’s third-party representative, he is able to provide further information as requested. They call Evelyn’s husband and ask some follow-up questions.
Because Evelyn’s change of circumstance relates to a condition the case manager is already aware of, they don’t require supporting information from a professional to broadly confirm her condition, disability or needs.
Based on the change of circumstances form and the phone call with Evelyn’s husband, the case manager determines that Evelyn now requires:
- frequent attention and continual supervision throughout the day,
- another person to be awake throughout the night to watch over her.
Therefore, Evelyn will now be awarded the higher rate of PADP. As Evelyn’s condition is unlikely to improve, the case manager decides that it is appropriate for Evelyn to receive an indefinite award.
Example: Someone’s needs increase but they already receive the higher rate of PADP
John has been awarded the higher rate of PADP and has an indefinite award. John’s appointee contacts Social Security Scotland to inform us that his care needs have increased as his condition has worsened. John’s condition would not be considered a terminal illness; therefore the Special Rules for Terminal Illness are not considered by the case manager.
The case manager is not required to review John’s award as there has not been a change of circumstances that would possibly result in a change of award. This is because John is on the highest possible rate of PADP and his award is indefinite. John’s appointee is informed that Social Security Scotland will not carry out a review for this reason.