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Condition
Considering an individual’s conditions and understanding how they are likely to impact the individual over time is one of the important factors to consider during this decision-making process.
It is important to remember that the typical features of a health condition might not apply to every individual. Some conditions will potentially involve a future change in the individual’s level of care needs, but for some individuals with this condition, this may not be the case. The presence or absence of these features may still be relevant to the award review date, as you should set the review date when needs are likely to change in a way that would impact entitlement. If the individual’s needs are highly unlikely to change in a way that would impact entitlement, you should consider giving an indefinite award.
If it is unclear what the natural progress of a health condition may be, and how the typical progression of a condition applies to the individual in question, you should
- consider medical guidance A to Z list of common illnesses and conditions | NHS inform ; Health A to Z - NHS (www.nhs.uk) ; Scottish health information you can trust | NHS inform
- request a case discussion with a practitioner.
Conditions can be categorised according to their likely progression over time. Considering this is important when making a decision on whether or not setting a review period might be appropriate. You should bear in mind that the severity of some conditions may change over time.
Individuals may have a number of conditions that fall into different categories. You will have to consider how the individual’s overall needs will develop over time. It is possible that an individual’s level of need is highly unlikely to change in a way that would impact their entitlement, despite them having a number of conditions that change over time.
The individual’s condition, and how that condition can be categorized, is only one factor when establishing whether an indefinite award or a review period would be appropriate. You should also consider the other factors set out in this chapter.
This means that, even if an individual has a condition that might change over time, you may become aware of additional factors, that when taken together, suggest a review would be inappropriate. In that case you should consider making an indefinite award.
Example: an individual is eligible for an indefinite award due to the combined impact of their conditions on their life
Blair is 68 and has been struggling with Osteoarthritis for the past 20 years. Additionally he has been diagnosed with stage 3 Chronic Obstructive Pulmonary Disease (COPD) which has been worsening progressively over time. These comorbidities significantly impact his care needs and overall quality of life. After choosing not to apply for disability benefits for a long time, Blair decides to submit an application for Pension Age Disability Payment.
In his application form, Blair mentions that he is prescribed high dose pain medications, including co-codamol 30/500mg (4x daily) and Naproxen 50mmg (2x daily). Despite this he continues to experience chronic pain and limitations to his ability to move around in his home making it challenging to manage daily life and activities.
During the day, Blair experiences pain, breathlessness and fatigue, which cause difficulty with washing. When he has a bath, he requires assistance to get in and out of the tub. He has a raised toilet seat at home, and handrails in the bathroom to help with toileting, however it still takes Blair a lot of time to use the toilet, and he needs to take around 20 minutes to recover from breathlessness each time.
Additionally Blair is currently prescribed triple inhaler therapy (3 different inhalers) to help alleviate his breathlessness. Despite this Blair often experiences frequent exacerbations of COPD leading to hospitalisation (last admission 6 weeks ago for 5 days).
His osteoarthritis mainly affects upper (hands and shoulders) and lower joints (hips and knees). Blair therefore finds bending, for example to wash his lower half and when getting dressed, to be difficult. He requires assistance, also due to his breathlessness when attempting to perform these tasks independently.
He needs assistance when getting in and out of bed and to get settled, as he is unable to lift his legs into bed. He has to sleep sitting up as he experiences increased breathlessness lying down. He also requires use of his inhaler 1-2 times per night.
Blair’s pillow will slip during the night and his family have to get him comfortable in bed and fix his pillows to ensure he remains upright. Due to his Osteoarthritis he is unable to manage this himself.
He also struggles with removing medications from their packets due to osteoarthritis in his fingers, and his family manage this using a Dossett box.
Blair gets breathless walking around the home and holds on to furniture when walking within the home. Due to the pain, he will shuffle when walking around the home and has had instances of trips and falls.
Blair did not provide any supporting information with his application.
- The case manager doesn’t think that supporting information is needed to make a robust decision They apply good cause because Blair’s account of his conditions and needs is consistent with what can be expected from his conditions and circumstances, and
- the information he has provided is detailed enough to make a determination about his entitlement.
The case manager determines that Blair is entitled to a higher award of PADP.
From reading medical guidance to find out more about COPD and osteoarthritis, as well as from prior training run by practitioners, the case manager understands that the combination of osteoarthritis and stage 3 COPD is highly likely to significantly impact Blair’s daily living. Despite receiving treatments and interventions, his conditions are unlikely to substantially improve over time and may continue to deteriorate.
The case manager awards an indefinite award due to the long-term and challenging nature of his conditions.
Where it is unclear from the information available how the individual’s condition and needs might develop over time, and how other factors might impact the likelihood of changes occurring, you should use medical guidance or request a case discussion.
Fluctuating conditions
You should allow for short-term periods of change in the level of need, if the individual has a fluctuating condition. If the individual’s needs are highly unlikely to fluctuate beyond what can be expected based on their condition you should consider giving an indefinite award.
Progressive condition
A progressive condition is a disease or health condition that gets worse over time, resulting in a general decline in health or function. A progressive condition is different from a relapsing and remitting condition (see below). Depending on the condition, a progressive condition may progress quickly or very slowly. Examples of progressive conditions are dementia, frailty, and Parkinson’s disease.
If the individual is entitled to the higher rate of PADP, you should consider whether an indefinite award would be appropriate. If the individual is entitled to the lower rate of PADP, a progressive condition can change their level of entitlement over time, if the individual is likely to develop night-time needs in addition to existing daytime needs or vice versa. Therefore, setting a review period to a point in time when their entitlement will have changed is likely to be appropriate.
Relapsing and remitting conditions
In a relapsing and remitting condition, there is often a period when the condition is stable for a while or is in remission. As an example, an older adult with Multiple Sclerosis (MS) may experience symptoms, both existing or new, that arise or worsen for a period of time, followed by recovery.
In contrast, a progressive condition does not have these breaks. It is also possible for relapsing and remitting conditions to become progressive over time as symptoms may remain to some extent during the recovery period.
Permanent
A permanent condition is a condition that will not change and for which there is no treatment or cure. Examples are blindness, severe spinal injury, or severe brain injury.
If the needs resulting from a permanent condition are either
- highly unlikely to change in the long term (for lower and higher PADP awards);
- only likely to increase (for higher PADP awards),
an indefinite award (PADP Regs., reg 29(3)(a)) is likely to be appropriate for the individual. You should also consider the other factors outlined in this chapter to determine whether that’s the case.
Example: a lifelong condition that may have changing levels of need
Kellie has a diagnosis of Parkinson's disease (PD). This condition was first diagnosed age 66. Kellie is 69 years old and lives with her family who support her on a daily basis.
Parkinson’s disease is a progressive neurological condition which affects movement, however successful management of symptoms and support can reduce the impact on daily life. On Kellie’s application form, she notes she requires assistance with a number of bodily functions during the day, including preparing food and eating, dressing and undressing, and taking medication.
Kellie did not report any difficulties with managing toilet needs. However, the supporting information she has provided indicates that Kellie has a urinary catheter and on the majority of days she requires assistance to empty this.
The case manager determines that this inconsistency does not need to be explored further, as Kellie’s other needs mean that she already satisfies the day-time condition.
Based on Kellie’s application form, the case manager establishes that Kellie currently does not have night-time needs.
The case manager knows that PD is a progressive disease and that Kellie’s needs are highly unlikely to improve. An indefinite award might be appropriate. However, as she is entitled to the lower rate of PADP, the case manager wants to understand whether her needs are also unlikely to increase in a way that would impact on her entitlement. This is to avoid Kellie missing out on payments she might be entitled to if she fails to report a change of circumstances after starting to have night-time needs.
The case manager seeks the input of a practitioner. The practitioner confirms that Parkinson's disease is a progressive condition. However, they advise that there is indication of Kellie responding to treatment. Therefore, it is likely that the treatment will
- improve Kellie’s ability to manage her condition within the medium term.
- slow the deterioration of Kellie’s condition.
However, as Kellie’s condition is progressive, it is more likely than not that the treatment will not reverse the overall effects PD has on her needs.
The case manager decides against awarding an indefinite award and sets a review period of 5 years. This is because: Kellie’s needs will
- remain significant enough for her to continue to satisfy the daytime condition
- will increase slowly which makes it likely that she will meet the night-time condition in the future