Exception: Review periods under 2 years

Anna is 71 years old and were diagnosed with Osteoarthritis in their right hip when they were aged 68. Shortly after their diagnosis, they applied for PADP and have been in receipt of the lower rate of the benefit from the point in time when they met the backwards test.

Anna has reported a change of circumstance, as they received a right total hip replacement three weeks ago. Anna explains that they have started physiotherapy and will be starting occupational therapy soon. Anna states that they are already making some progress. They explain that they are expecting to note improvements in hip pain and range of motion, but that they will continue to require assistance when preparing food, with personal hygiene, dressing and undressing for about six months.

Anna did not submit any supporting information with their change of circumstances form. Based on the information available, as well as the “Relevant considerations when making a determination as part of an award review” DMG chapter, the case manager decides that confirmation from a professional is not needed (good cause), They go on to establish Anna’s needs and review period.

Given that Anna has not reported any night-time needs, their needs have not changed since the surgery. However, the case manager establishes that Anna’s needs are highly likely to change in the near future, once she has recovered from the operation. Setting a longer review period therefore would not be appropriate.

To establish the point in time when Anna’s needs are likely to have changed, the case manager reviews the information provided by Anna again. The supporting information provided on their physiotherapy indicates Anna is making good progress and will likely be discharged from the service in the next twelve months. The case manager expects that it will take some time afterwards for Anna’s needs to stabilise. They request a case discussion to get advice on how long this period is expected to be. The practitioner explains that, based on Anna’s current progress it would be reasonable to expect their situation will have stabilised 6 months after they are discharged. Based on the case discussion, the case manager determines that it would be appropriate to review Anna’s award in 18 months, as it is important to see if Anna can manage these activities without assistance.

Grzegorz (69 years old) has inflammatory Bowel Disease (IBD) which is well controlled and is in receipt of the lower rate of Pension Age Disability Payment due to his daytime needs.

He recently reported a change of circumstance after he was admitted to hospital with a twisted bowel, a condition that required emergency surgery. As a result of the severity of his condition, Grzegorz underwent surgery to have a Stoma bag inserted. Due to his level of care needs related to his new condition, Grzegorz now also has night-time needs.

When his unscheduled review is carried out, he is two months into his recovery process. In his change of circumstances form, Grzegorz did not provide a lot of detail on his new level of needs. The case manager decides to request supporting information from a member of the multidisciplinary team consisting of surgeons, dietitians and stoma care nurses that are closely working with Grzegorz in his local hospital to understand

• whether he meets the criteria for night-time needs
• what, if any, review period would be appropriate.

The Stoma care nurse providing supporting information explains that they and the team provide support to Grzegorz in adjusting to life with his Stoma, including both physical and emotional support. The nurse explains that Grzegorz has started to experience incontinence during the night. The statement further says that the recovery process has been challenging for Grzegorz and is expected to last around 6 months overall, during which he is going to require extensive support and medical input.

The nurse further explains that Grzegorz and his healthcare team have been discussing arranging reversal of the stoma, to be carried out around the 12-months mark after surgery. Reversal surgery would involve reconnecting his intestine and restoring normal bowel function. Due to Grzegorz’s resilience and determination, he appears to be a suitable candidate.

The case manager consults medical guidance and learns that recovery for this type of surgery is normally around 6 months.

They think that Grzegorz is likely to not have night-time needs anymore after this period. Therefore, they decide to set a review date for after the recovery of the second surgery, which is a review period of 16 months. They consult the Change of Circumstances: Change in Care Needs DMG chapter to establish when Grzegorz will have met the backwards test for his night-time needs and make a determination.

David is 74 years old and 8 months ago he had a stroke. He was admitted to hospital for 10 days where he received clot-busting medication. David has been left with right side weakness to his arm and leg.

David has been attending physiotherapy and has been making progress with strengthening and moving his right arm and mobilising. In his application for PADP, he explains that,

• after discharge from hospital, he has been continuing to see the physiotherapist once weekly for strengthening exercises to the right arm and leg
• there has been an improvement.

The case manager considers all of the information supplied and determines that David is entitled to lower rate PADP. In the short statement his consultant provided in David’s application as confirmation from a professional, they have advised that with the progress David is making in physiotherapy, there should be significant improvement in the next 12 to 18 months. The case manager determines that due to the expected improvement in David’s condition, a review in 18 months would be appropriate.

Nancy is 71 years old and experienced a significant impact to her health when she suffered a heart attack, resulting in severe complications, including infection following a stent, which further complicated her recovery process. Nancy applies for PADP four months after her heart attack.

In her application form, she states that she currently receives treatment of Intra venous antibiotics, which will last for a total of 6 months. Once the infection has cleared she might be a candidate for valve replacement, as the infection damaged her heart valve. She has an appointment with a cardiologist specialist monthly.

Due to her cardiac issues Nancy experiences low blood pressure, which causes nausea and dizziness. She requires assistance when standing and to balance when she has to get up from the chair as this makes it worse. She is exhausted with the slightest tasks, and requires assistance with getting washed and dressed. She has to nap following this due to the exertion.

She experiences insomnia, which adds to her severe fatigue, and cannot sleep at night as her bones ache. She has leg cramps every night and her husband has to massage her legs for at least 30 minutes before bed and then again through the night.

Her diet is restricted to prevent overloading on fluids and she has to follow a dietary fluid restriction, as she has developed kidney problems associated.

A statement of support sets out that, according to her doctors, Nancy’s recovery from the heart attack is expected to be longer than conventional recovery and requiring close monitoring.

The case manager determines that, once she has met the backwards test, Nancy will be entitled to a higher award of PADP, as she satisfies the daytime and the night-time condition.

In order to set an appropriate review period, the case manager requests a case discussion to find out more about Nancy’s likely recovery time. The Health & Social Care practitioner explains that it is expected that stabilisation of Nancy’s heart is to be achieved by 6-9 months. Nancy will then require cardiac rehabilitation to regain strength and function with the hope of a successful recovery over the next 12-18 months.

The case manager decides that a review period of 21 months, starting when her entitlement starts, is appropriate. If Nancy’s needs decrease before her scheduled review, she would have to report a change of circumstance.