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Attention with bodily functions
Attention with bodily functions means providing personal care, prompting or motivating either in relation to:
- bodily functions
- assistance with communication needs (PADP regs, reg 5(5))
Bodily function means the normal action of any organ of the body or of a number of organs acting together (PADP regs, reg 5(8)). This includes the brain.
Common examples of bodily functions that case managers may wish to consider include:
- breathing
- washing, bathing and personal hygiene
- dressing and undressing
- drinking
- eating
- emptying of the bowel or bladder
- hearing
- seeing
- speaking
- sitting
- moving around indoors
- sleeping.
This list is not exhaustive.
Case managers should apply their own judgment based on the application form and any supporting information available to consider:
- whether the individual has a disability
- what impact the individual’s disability has on their bodily functions
- whether it is reasonable or practicable for the individual to use aids or appliances
- whether the person reasonably requires attention from another person in connection with those bodily functions
- how often the attention is required and how long it takes
There is no requirement for the individual’s needs to be present for more than 50% of the time, or “most” of the time. Case managers should take a broad view and make an exercise of judgement by taking account of all of the information available to them. For more information on the criteria for PADP, reference should be made to the PADP Rates and Criteria chapter.
Attention should:
- involve service of a close, personal nature carried out in the presence of the individual
- be needed for something that the individual would normally do themselves
- not be something which can be done by anyone in the household.
Example: an individual requires attention from another person to bathe and dress
Louise is 70 years old and has chronic obstructive pulmonary disease (COPD). She can become breathless very easily from minimal activity. She needs attention from another person in relation to her bodily functions.
Louise needs help to bathe and dress herself. This is because doing so can leave her breathless. When Louise becomes breathless, it can take between 5 to 10 minutes to recover. Louise would be unable to bathe or dress herself without this attention because she would have to take multiple breaks to recover from her breathlessness.
Attention does not need to involve physical contact. It can involve the spoken word. Where attention is provided by speaking to the individual, it should take place in the physical presence of the individual (PADP regs, reg 5(4)). This could include encouraging, persuading or reassuring the individual.
Activities that normally do not involve attention with a bodily function are:
- cooking
- shopping
- domestic tasks, such as housework
There may be some situations where help with a domestic task is closely associated with a bodily function. It may be considered as attention when it forms part of an episode of attention in connection with that function.
Example: a domestic task is associated with a bodily function
Ryan is 70 years old and experiences urinary incontinence at night due to his Type 1 Diabetes. This means that Ryan experiences bed wetting. He previously managed this independently, but has recently struggled to manage his condition.
His partner has to, at least once a night:
- help him change
- remove his soiled bed clothes
- put them in the washing machine
- put new bedding on his bed.
This attention is closely associated with Ryan’s bodily function of maintaining continence. The case manager can consider this attention in determining whether Ryan meets the criteria for PADP.
The following paragraphs guide case managers on the impact some conditions might have on an individual’s ability to manage their bodily functions.
Breathing An individual may need help with:
- positioning themselves whilst seated or in bed
- connecting oxygen supplies or fitting masks
- physical therapy
because they:
- are at risk of being unable to sit up in bed
- have reduced ability to use their hands to carry out tasks
- need physical therapy to maintain their airways.
Example: an individual requires attention to their bodily function of breathing
Jocelyn is 72 years old and has a diagnosis of heart failure which causes her to be short of breath, even at rest. Her partner has to ensure that she is propped up in bed, as she cannot breathe reasonably well when lying flat. If Jocelyn slides down the bed, she can become more breathless. Her partner also has to ensure Jocelyn has her oxygen therapy available during the night when she feels more breathless.
Washing, bathing and personal hygiene
An individual may need help with:
- washing
- cleaning teeth
- caring for their hair, nails and skin
because they either
- are physically not able to carry out these activities
- have a tendency to not look after their personal hygiene due to a mental health condition.
Dressing and undressing
An individual may need help with:
- selecting suitable clothing
- being motivated to dress, undress and change clothing
- fastening clothes and shoes
- putting on clothes in the correct order
because they:
- are physically not able to carry out these activities
- have poor motivation due to a mental health condition
- are forgetful.
Attention with dressing and undressing may be needed at the start and end of the day. If an individual has a condition that causes them to have episodes of incontinence, they may need to change clothing more frequently, including during the night. Some individuals may have a neurological or cognitive disability that means they need prompting to either:
- dress appropriately
- put clothing on in the correct order.
Eating, drinking and taking nutrition
An individual may need help with:
- cutting up food
- seeing food on a plate
- chewing and swallowing
- using cutlery and crockery
- motivation to eat
- using a tube to take nutrition
because they:
- are physically not able to carry out these activities
- have a visual disability
- are forgetful
- have poor motivation due to a mental health condition
- need help with managing a feeding tube.
Some disabilities can make cutting up food or feeding difficult. Case managers should take the use of special cutlery or other aids into account when determining the amount of help that is reasonably required.
Use of aids can only be considered if they reduce or remove the need for attention. An individual using aids may still need attention. The case manager must also decide whether it is both reasonable and practicable for the individual to obtain and use aids.
Example: aids which remove an individual’s need for attention with the bodily functions of eating
Charlotte is 70 years old and has rheumatoid arthritis. The joints in her hands and wrists make it difficult for her to use cutlery. This is because she isn’t able to grip them comfortably. Charlotte invests in some specially adapted cutlery. This cutlery is more comfortable for Charlotte to use. This means she is able to eat without needing attention from another person.
Continence and use of toilet An individual may need help with:
- getting to and from the toilet
- managing clothing while using the toilet
- getting on and off the toilet
- managing cleanliness
- changing incontinence pads
- managing stoma and colostomy bags
because they:
- are physically not able to carry out these activities
- they do not get enough warning of the need to use the toilet
- are forgetful or not aware of how to manage toilet needs.
Case managers should consider a need for attention with:
- changing or washing clothes
- cleaning or emptying commodes.
This attention should be given as part of a single period of attention in connection with the bodily function.
Case managers should take into account the use of aids or appliances, like a frame or a hoist when assessing the amount of help that is reasonably required.
Use of aids can only be considered if they reduce or remove the need for attention. An individual using aids may still need attention. The case manager must also decide whether it is both reasonable and practicable for the individual to obtain and use aids.
Hearing
An individual may need help with:
- learning sign language or lip reading
- understanding speech and recognising sounds
- having words repeated, re-phased or explained
- making themselves understood
This is because the individual cannot communicate effectively in real world environments without such assistance.
An individual who is able to communicate directly with another person through a combination of sign language, hearing and lip reading does not necessarily amount to needing attention in every instance. This is because the individual may or may not be able to communicate independently.
Example: an individual is entitled to the lower rate of PADP because they require attention to communicate effectively
Claire is 75 years old and is moderately to severely deaf due to hearing loss in childhood. She uses hearing aids. The hearing aids only make sounds louder and clearer, they do not restore Claire’s hearing back to normal. Claire has developed age related problems with her vision which means she now has to wear glasses and finds lip reading more difficult.
Claire now lives with her son who spends a lot of time repeating words and explaining things to her. In quiet environments where she is one on one with another person, Claire can communicate face to face without assistance.
Claire’s application notes that her hearing loss may be a contributing factor to issues with her cognitive abilities, as Claire has reduced memory retention and concentration. The case manager requests a case discussion with a practitioner to discuss links between hearing loss and cognitive abilities. The practitioner shares that some research suggests that there may be a link between hearing loss and cognitive abilities and alertness. On the balance of probabilities, the case manager takes this into consideration when making a determination.
However, Claire requires support to communicate in busy environments, such as the supermarket. Claire’s son now cares for her. Claire’s hearing loss has caused her to reduce social engagements, which has had a significant impact on her mental health, as well as difficulty remembering new and important information.
The case manager determines that Claire is entitled to the lower rate of PADP. This is because Claire needs attention with her communication needs and has satisfied the daytime condition. This attention takes place during multiple episodes across the day, when she communicates with others and when she is trying to concentrate on everyday tasks.
If a person or carer has to either:
- speak loudly
- speak slowly
- listen more carefully
in order to communicate with an individual, this can sometimes be seen as providing attention. Whether these efforts amount to attention is dependent upon the nature and complexity of the information being communicated, as well as the person’s ability to use sign language or to lip read independently.
Example: an individual is not entitled to PADP because they do not require attention to communicate effectively
Charles in 67 years old and has full hearing in his right ear. However, following an injury to his ear drum, he has mild to moderate hearing loss in his left year. Charles is able to hear conversations at home and when carrying out everyday activities. He will turn his head to help if someone is talking quietly.
Charles doesn’t find this impacts him at all most of the time, however at times he will use public transport when coming home from the shops with his partner which can be very noisy. Charles finds it hard to hear his partner talking to him when sat on his left, so he will always sit with his partner on his right so that he can hear them over the noise.
The case manager determines that Charles does not meet the criteria for PADP as his hearing loss does not mean he requires extra attention to communicate independently, and he does not have any night-time needs. Charles does not have needs at this time that meet the threshold for any award, however his needs in relation to his ear drum injury may change in future.
Seeing
An individual who is visually impaired may need:
- help with reading letters
- help with choosing appropriate clothing
- guidance, by touch or by verbal prompting to avoid harm when walking in unfamiliar surroundings
- places, objects and situations verbally described to them
- verbal instructions given to them
- encouragement, prompting or reassurance from another individual whilst they are physically present with them.
This is because the individual is unable to effectively see the world around them, this may be due to one or a combination of the following:
- reduced clarity of vision (blurred vision)
- reduced field of vision
- sensitivity to light
- reduced depth perception.
This list is not exhaustive.
Where attention is provided by speaking to the individual, it should take place in the physical presence of the individual.
An individual who is visually impaired may also require help with other bodily functions, such as:
- washing and bathing as they may require help getting in and out of a bath/shower, or help differentiating types of toiletries
- eating and drinking as they may require help cutting up food and identifying where food is on a plate to avoid spills
- dressing as they may require extra support to ensure that they are dressed appropriately or require help, for example, with using fastenings or zips
- maintaining personal hygiene
- moving around indoors to help avoid bumping into objects or managing stairs
- communication and social skills as they may require help in the form of additional physical contact and/or verbal instructions to describe and reassure the individual of their social surrounds, for example, an individual with a visual impairment may be unable to visually recognise a familiar person or may be unable to pick up on non-verbal cues such as smiling when engaging socially with others.
This list is not exhaustive.
Example: an individual is entitled to the higher rate of PADP because they require frequent attention throughout the day and repeated attention during the night in connection with their bodily functions
Annie is 68 years old and has sight loss and chronic musculoskeletal problems, largely on her left side, following a road traffic accident. Annie’s ability to carry out everyday activities is greatly affected due to their long-term health conditions.
Annie’s husband has detailed that he needs to help Annie with all areas of her daily needs due to her restricted movement on her left hand side. Her husband will assist with washing and bathing as she requires support while sitting in the bath. He also assists Annie with toileting and dressing, as her restricted movement and sight loss prevents her from managing these tasks independently. Annie’s husband will also cut all of her food, as she is unable to do this on her own.
At night, Annie’s sleeping can be a major challenge due to the pain and movement issues she experiences. Her husband gets up regularly during the night to comfort Annie due to the pain she experiences, as well as turning her regularly to prevent bed sores.
Annie’s vision problems complicate her condition. She has been provided with specialist support from a physiotherapist who has provided input to help Annie manage her physical condition. Her husband helps Annie with carrying out exercises provided by the physiotherapist each day, however Annie struggles to follow the instructions due to her sight loss.
The case manager requests a case discussion with a practitioner to discuss the combined impact of Annie’s conditions. The practitioner reviews all of the information with the case manager and explains the impact that Annie’s physical condition has on her needs, and details the added challenge of her sight loss which adds further difficulty to her day to day life.
The case manager reviews all of the information available to them and awards Annie the higher rate of PADP, having taken into consideration Annie’s care needs during the daytime and night-time.
Example: an individual is entitled to the lower rate of PADP as they require frequent attention throughout the day in connection with their bodily functions
Aisha is 85 years old and has type two diabetes. Aisha has struggled to manage her diabetes independently, which has led to the development of advanced diabetic retinopathy. This is a complication of diabetes which can result in loss of vision. Aisha has satisfied the backwards test, and is awaiting treatment for her condition.
Aisha’s daughter is now her carer. Her daughter regularly checks Aisha’s blood sugar levels and administers insulin when required. Due to her loss of vision, Aisha requires her daughter to assist with bathing and washing as well as getting dressed. Aisha also requires support to move around her house, including getting to the toilet and getting in and out of bed. Aisha requires support with eating and drinking, as her vision prevents her from eating independently, and due to struggling to manage her diabetes, Aisha’s daughter prepares her meals to ensure appropriate nutrition.
The case manager determines that Aisha meets the criteria for the lower rate of PADP as she requires frequent attention throughout the day in connection with her bodily functions. She is not entitled to the higher rate as she does not require any support at night. As it is noted in her application that Aisha is on a waiting list for treatment, the case manager sets a two year review period to ensure Aisha continues to receive the appropriate rate of PADP following any treatment and recovery time
Getting in and out of bed
Individuals may need help getting in and out of bed because of their disability or health condition. Some individuals use aids or equipment to overcome these difficulties.
These should be taken into account when determining the amount of attention that is reasonably required. An individual may still need attention even when using aids. The case manager must also decide whether it is both reasonable and practicable for the individual to obtain and use aids.
Example: an individual requires attention when getting in and out of bed
Sandra is 73 years old and has Parkinson’s disease. Sandra lives in her own home and has been provided with a hoist to lift her between her bed and wheelchair. Sandra’s carer needs to help her, as she cannot use the hoist independently. Sandra’s carer operates the hoist to help her into bed, and to help her get out of bed in the morning.
The case manager determines that Sandra needs attention when getting both in and out of bed.
Turning over in bed
There are many conditions which make it difficult for the individual to turn over in bed. This may lead to significant discomfort or skin damage.
Example: an individual requires attention regarding turning over in bed
Gabriel is 85 years old and has paralysis. Gabriel is unable to move all of his body parts and has a loss of skin sensation when lying in bed.
If he is not regularly turned at night, there is a significant risk of both:
- his skin breaking down
- pressure sores forming.
Gabriel has a special mattress that reduces this risk. However, he still needs to be turned a few times at night. The case manager determines that Gabriel needs attention in connection with his bodily functions at night.
Sleeping
An individual who experiences discomfort or distress may have difficulty sleeping without attention from another person.
Individuals with certain mental health conditions can experience disturbed sleep and/or distressing dreams. They may have to be comforted, reassured and settled back to sleep.
The individual may also have a physical condition that means they require attention from another person to become comfortable in bed. This is because of the way their condition affects them. They may also require help to turn over or to sit up in bed.
Moving around indoors
An individual may need help with:
- getting in and out of a chair
- moving from one room to another
- getting up and down stairs
because they have:
- reduced power of movement in their arms or legs
- poor balance
- poor co-ordination.
It may be unreasonable to expect the individual to remain in one room for an entire day. Case managers should consider:
- the frequency of assistance needed
- any aids or appliance that are appropriate to the individual’s needs.
Taking medication
An individual may need assistance from another person to take medication. This may be because they have:
- reduced ability to use their hands to carry out tasks
- memory difficulties
- periods of confusion.
This list is not exhaustive.
Individuals may use aids or appliances to help with taking medication, such as a pill box to regulate taking medication, or a pill crusher/splitter to make their medication more manageable or to measure doses. The case manager must also decide whether it is both reasonable and practicable for the individual to obtain and use aids or appliances.
Frequent throughout the day
‘Frequent’ means several times and should be given its ordinary meaning. There is no strict numerical test, but it is unlikely that once or twice would amount to ‘frequent’. The case manager should consider all the facts of an individual’s application. The attention must be required throughout the day (PADP regs, reg 5(2)(a))
‘Throughout’ means the period from the beginning of the day to the end of the day (PADP regs, reg 2 and 5(8))
Attention given first thing in the morning, again at lunch time and again in the evening, is not normally regarded as frequently throughout the day.
Example: an individual does not require frequent attention throughout the day
Fiona is 68 years old and has reduced grip and a decrease in her ability to use her hands to carry out tasks due to rheumatoid arthritis. She needs attention to use cutlery at each mealtime, including breakfast, lunch and dinner. She does not require any other attention throughout the day. The case manager determines that Fiona does not need frequent attention throughout the day.