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Common definitions
So severely disabled physically or mentally
To qualify for PADP, an individual must be “so severely disabled physically or mentally” that they need:
- frequent attention or continual supervision from another person throughout the day to satisfy the daytime condition (PADP regs, reg 5(2)) and/or
- prolonged or repeated attention or another person to be awake for a prolonged period or at frequent intervals to watch over them at night to satisfy the night-time condition (PADP regs, reg 5(3)).
References to “severely” do not refer to the severity of the individual’s condition. They refer to the severity of the impact of the individual’s disability. This means the severity of the needs that result from having a disability.
Case managers should consider if:
- the individual has a physical or mental disability
- the impact of that disability means that the individual meets the eligibility criteria for PADP.
Supporting information from a professional may be:
- important and useful
- not always readily available.
A lack of diagnosis does not prevent an individual from being awarded PADP. Case managers should refer to the Supporting Information chapter for more information.
Reasonably require
The attention or supervision that an individual needs must be reasonably required (PADP regs, reg 5(5)(b))
Entitlement to PADP is based on the attention or supervision that an individual reasonably requires. It is not based on the attention or supervision the individual actually receives.
Therefore, case managers should consider all the circumstances of an individual case, including:
- individual needs detailed in the application form and supporting information
- the nature of the individual’s heath condition or disability
- how often and for how long attention is required in connection with an individual’s bodily functions (PADP regs, reg 5(5))
- whether there is an aid or appliance that the individual could use to manage a bodily function independently (PADP regs, reg 5(8))
- how often and for how long supervision (PADP regs, reg 5(5)) is required during the day (PADP regs, reg 5(2)(b)) or watching over is required at night (PADP regs, reg 5(3)(b)
Reasonably required does not mean medically required (PADP regs, reg 5(5)). Medical attention, such as visits from a district nurse, should be considered as part of the individual’s wider need for attention.
Example: an individual receives attention during the day that is reasonably required and attention at night that is not reasonably required
Anne is 68 years old and was diagnosed with Stage 2A breast cancer. She started undergoing chemotherapy shortly after the diagnosis
Due to her treatment, Anne is often sick soon after eating and generally feels very tired.
Anne’s husband has to:
- help Anne get changed and clean up whenever she has been sick
- help Anne with eating and drinking as she is often too exhausted to do this herself
- help Anne with washing and dressing due to her exhaustion.
Anne’s husband is also very concerned that something might happen to Anne at night. He gets up three times every night to check on Anne to prevent her from choking in her sleep in case she is sick. Anne’s husband does this even though Anne has never been sick during the night.
Anne is entitled to the lower rate of PADP as the case manager has determined that she meets the daytime condition. This is because, using all of the information available to them, the case manager considers that she requires frequent attention with her bodily functions during the day, and this frequent attention is reasonably required. She is not entitled to the higher rate of PADP as she does not satisfy the night-time condition. This is because:
- her husband checking on her at night is not reasonably required as Anne is only sick after eating during the day, but has never been sick at night
- she does not require attention or someone to watch over her at night.
Aids and appliances
The need for attention or supervision may be reduced or removed by the use of an aid or appliance.
Aids or appliances may be available to reduce the impact of an individual’s disability. However, the case manager must decide whether it is both reasonable and practicable for the individual to obtain and use them.
In the situation where an aid or appliance does or could reduce or remove the care need a client has reported, we should avoid recommending any specific aid or appliance where we lack the legal or medical authority to advise this without the relevant or appropriate assessment
Example: an aid is not practicable for the individual to use
Johnny is 73 years old and has Parkinson’s disease. Johnny has tremors and his muscles have become stiff. Johnny is unable to stand up from a seated position independently.
To help Johnny get on and off the toilet independently, his occupational therapist has provided him with a raised toilet frame and seat. Johnny’s partner has noticed that:
- Johnny’s upper body strength has reduced
- He has difficulty pushing himself up from sitting on the frame and seat.
The case manager decides that although it is a reasonable aid to use, it is not practicable for Johnny to use it.
Example: an aid is reasonable and practicable for the individual to use
Geraldine is 70 years old and has had a stroke. She has a weakness in her left arm and leg. This means she has had difficulty dressing without the use of aids. Geraldine notes that she uses aids to assist her with dressing.
Geraldine uses:
- a sock and stocking aid to put on socks
- a button hook to fasten buttons with one hand
- a dressing and reaching stick to adjust and help remove clothing.
Geraldine can now get dressed and undressed independently through the use of aids. The case manager decides that:
- it is reasonable and practicable for Geraldine to use the appliances
- Geraldine does not need help with dressing and undressing.
The case manager continues to review the rest of Geraldine’s application to determine if she meets the eligibility criteria for PADP for her other needs that she may require help and support with.
Case managers should consider:
- the consequences of using any suggested aid or appliance
- if it is safe for the individual to use a particular aid or appliance
- asking for advice from a practitioner if it is not clear that an item is reasonable or practicable.
Daytime and night-time routine
Whether an individual requires attention or supervision by day (PADP regs, reg 5(8)) or by night (PADP regs, reg 2) should be considered in relation to the ordinary domestic routine of the household where they live.
There may be considerable variation between households. Case managers should take a broad view of when the household as a whole closes down for the night.
For example, where appropriate, case managers should give consideration to when an individual’s caregiver goes to bed when determining whether the individual’s needs fall within the daytime or night-time condition.
The individual’s application form may have described their daytime and night time routines. Case managers should consider contacting the applicant in line with their communication preferences if there is any doubt about the household routine.
Example: the daytime condition is satisfied
Jenny is 90 years old and lives with Type 2 Diabetes and Alzheimer’s disease. Jenny requires frequent attention throughout the day. She needs support with eating and drinking, as the impact of Alzheimer’s disease causes Jenny to forget what she has eaten and when, which can have a significant impact on her blood sugars.
Jenny’s son supports her with managing personal hygiene. Jenny can feel tired and has blurred vision, meaning she needs assistance with washing and toileting as she can often become disorientated. Jenny’s son regularly monitors her blood sugars and will administer insulin when required.
Jenny’s son assists her with dressing as she can become confused with the order that clothes should be put on and selecting appropriate clothing. The case manager determines that the use of aids would not be appropriate given the combined impact both of Jenny’s health conditions have.
Jenny’s diabetes leads to incidents of incontinence at night. Jenny’s son has established the following bedtime routine to help manage this:
- 8pm: Jenny goes to bed
- 10pm: Jenny’s son takes her to use the toilet
- 11pm: Jenny’s son goes to bed
As Jenny’s son assists her to use the toilet before he goes to bed, this attention is not considered to be night-time needs due to the domestic routine of the household. Therefore, Jenny does not satisfy the night-time condition as the case manager considers the attention with toileting needs to fall into the daytime condition.
Therefore, the case manager determines that Jenny satisfies the daytime condition as she requires frequent attention in relation to her bodily functions and is entitled to the lower rate of PADP.
Example: the night-time condition is satisfied
Alex is 67 years old and has Schizophrenia. Alex finds it difficult to get to sleep. This is because he has hallucinations and muddled thoughts which causes him distress.
Once Alex is in bed, he is often distressed and anxious. Alex’s wife checks on him regularly to soothe him and provide reassurance. Hearing his wife helps Alex to feel settled. It normally takes Alex around three hours to fall into a deep and prolonged sleep. In order to manage Alex’s needs, his wife has pushed back her regular bedtime.
Before Alex started to need support to fall asleep, his wife normally went to bed around 10pm. However, the household now follows this bedtime routine:
- 9pm: Alex goes to bed
- midnight: Alex’s wife goes to bed, as Alex will have fallen asleep by then.
The attention provided from 10pm is relevant to the night-time, rather than the daytime condition.