Deciding whether more detail is needed to establish the new level of need

When carrying out a review to establish an individual’s new level of need, you will only have to establish the following:

1. Have the individual’s needs decreased so significantly that they do not satisfy the day-time and/or night-time condition anymore?
2. Has the individual developed either:
   1. Night-time needs in addition to their existing daytime needs?
   2. Daytime needs in addition to their existing night-time needs?

Whether or not the individual’s needs, that their existing entitlement to the daytime or nighttime condition is based on, have either

• increased
• decreased slightly, but the individual continues to satisfy the daytime or night time condition

is not relevant for determining their new entitlement.

There are special rules for when an individual receives PADP for renal dialysis and their needs change. Refer to the Rules for Renal Dialysis chapter to find out how their entitlement is impacted by changes to their needs.

The individual’s entitlement might also end for other reasons reported as a change of circumstance, for example because they move away from Scotland or go into a care home. Refer to the Unscheduled Reviews chapter for more information.

Individuals might not be aware of their increased needs or might not feel that (some of) the changes they have experienced are relevant to their review. This can be because the changes might be attributed to frailty, rather than their existing conditions or disability.

Frailty is a medical condition. You should therefore consider any frailty-related needs when establishing the individual’s new level of entitlement. You should remember that individuals do not require a formal diagnosis for their needs to be relevant for PADP. Frailty can be used to describe the individual’s overall resilience in terms of how they recover from health conditions and illness or manage their disability. Individuals with frailty may have long-term conditions or a disability of which frailty is a progression or consequence. Frailty can also be present as a new and unrelated health condition. The impact of frailty should be considered as to how this affects the individual’s overall health and wellbeing and how this may increase the individual’s care needs. Frailty is not an inevitable or sole consequence of age.

You should use decision-making tools, such as case discussion, if

• you think an individual might have underreported their needs.
• you are unsure how frailty might affect an individual’s needs.