Effect on entitlement of an individual already in receipt of Pension Age Disability Payment spending time in care homes, hospitals or hospices

An individual who is already in receipt of PADP is entitled to still be paid it for the first 28 days of their stay in a care home. This is to ensure the change to payments comes into effect for longer or repeated periods in alternative accommodation.

There is no impact to the client for shorter periods of less than 28 days, where they do not link to other periods of alternative accommodation. The 28 day period may comprise of one or more separate periods, providing there are no more than 28 days between the periods (PADP regs, reg 19(3) and 20(3)). For more information on linked periods, reference should be made to the ‘Linked periods’ section of this chapter.

The individual stops being paid PADP on the 29th day of their time spent in a care home (PADP regs, reg. 19(2)). This is called ‘non-payment of assistance’.

In most cases when an individual is in alternative accommodation, the costs of their care will be paid for by the local authority or other public funds. Non payment of assistance ensures that a person does not receive support for the costs of their care twice. However, there are exceptions to these rules when an individual entirely self-funds their placement in a care home or hospital. Case managers should refer to the ‘exceptions’ section of this chapter to understand the exceptions.

The non-payment of assistance enables an individual’s entitlement to PADP to continue while they are resident in a care home.

This is because PADP helps to meet the extra costs experienced by individuals with a disability or long-term health condition.

Non-payment of assistance and linked periods also apply to hospital admissions as well. On the 29th day of a period in hospital, an individual stops being paid PADP (PADP regs, reg. 20(2)). For more information on calculating a length of stay in alternative accommodation, reference should be made to the ‘Calculating the length of stay’ section below.

For this to be the case, an individual also has to:

• be undergoing medical or other treatment as an in-patient at a hospital or similar institution
• have any of the costs of the treatment, accommodation and any other related services borne out of public funds (PADP regs, reg 20(1)).

Borne out of public funds means the cost of treatment, accommodation and any other related service is paid if the individual is undergoing medical or other treatment as an in-patient in:

• a hospital or similar institution under (PADP regs, reg. 20(4)(a))
  • the National Health Service Act 2006
  • the National Health Service (Wales) Act 2006
  • the National Health Service (Scotland) Act 1978
  • the Health and Personal Social Services (Northern Ireland) Order 1972 or the Health and Personal Social Services (Northern Ireland) Order 1991
• a hospital or similar institution maintained or administered by the Defence Council (PADP regs, reg. 20(4)(b)).

The Defence Council is the governing body of the British Armed Forces. The Armed Forces may at times provide medical treatment to some individuals through hospitals or similar institutions, which also uses public funds.

Payment continues after 28 days when the individual is in a hospice, is terminally ill and Social Security Scotland have been informed that the individual is terminally ill (PADP regs, reg. 21(1)).

The paragraph above refers only to a “hospice” as is defined earlier in this chapter. If an individual is receiving palliative care within a specialised ward or facility in a hospital or care home, the individual is considered to be in a publicly funded hospital or care home. Their award will be £0 rated on the 29th day. These rules also apply for individuals who are not terminally ill and are resident within a hospital or care home where a palliative care unit has been established.

The exceptions to these rules in this section are discussed in the Exceptions section below.

The individual who is receiving PADP has a legal duty to inform Social Security Scotland about entering and leaving alternative accommodation, or where there has been a change in how their stay in alternative accommodation is funded (SS (Scotland) Act 2018, s.56). The case manager will then make a determination without application.

They must tell Social Security Scotland about time spent in alternative accommodation as soon as is reasonably practicable.

For example, it would be unreasonable for the individual or their representative not to inform Social Security Scotland that they have entered alternative accommodation after a month of being resident. Reference should be made to the Change of Circumstances chapter for more information on what might be considered a good reason for not notifying Social Security Scotland as soon as is reasonably practicable.

An individual might not inform the case manager immediately after they have entered alternative accommodation. This might result in the case manager making a determination without application after the individual has spent 28 days in alternative accommodation. In this case, the individual would accrue an overpayment before their payment of PADP would be set to nil. This would happen in instances where the individual failed to notify the change as soon as was reasonably practical.

Reference should be made to the change of circumstances chapter for more information on when an individual should notify Social Security Scotland of a change.

There are different rules about applying for PADP when living in alternative accommodation. Please see Applications made while residing in alternative accommodation for a full explanation of this rule.