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Care needs questions
The care needs questions give individuals an opportunity to tell Social Security Scotland about how their disability, health condition or symptoms impact them in their daily life.
A case manager needs to consider the information provided by the individual and use this to determine whether an individual satisfies the eligibility criteria for PADP.
There are 11 care needs questions in the PADP application form:
- getting in and out of bed
- washing and bathing
- toilet needs and managing incontinence
- moving around indoors
- dressing and undressing
- communicating with others
- eating and drinking
- staying safe during the day
- activities and interests
- support taking medication, monitoring a condition and with therapy
- night-time care needs
For every care needs question, the individual is invited to give a detailed account of the support they need for that task.
To ensure a fair determination is made in line with the eligibility criteria, case managers should consider the following information from the application form:
- how are they currently completing the task, if at all?
- do they use any aids or appliances to complete the task?
- do they need any assistance, support or supervision to complete the task?
- do they need prompting to complete the task?
- do they have a need for the support outlined above, but do not have a support network that can provide this?
If there is a restriction identified in the above, case managers should consider what condition or symptom is related to the restriction.
In all instances, case managers must also consider:
- are there any effects after completing the task, for example, fatigue or pain?
- are there any safety risks associated with completing the task?
- how long does it take to complete the task?
- If it is expected that a task would be repeated, would the individual be able to repeat it?
The case manager needs to determine if the individual has satisfied the backwards test and make a determination on whether the individual has satisfied the daytime condition or the night-time condition.
Example: an individual has completed the application form on behalf of their parent and detailed one condition
“Due to my dad’s Alzheimer’s disease, he needs support with his personal hygiene. I support my dad with his this every day for around 20 to 30 minutes. He would not consider washing or bathing himself without encouragement. We have not identified any aids that could assist with washing time. We also have tried prompting him to do this independently, but we now have to assist with washing as he becomes distressed if left to do this himself. My dad has difficulty understanding what is happening around him, so washing can be stressful as I often need to comfort and reassure him throughout, and for a while after washing.”
Using the above framework of questions, the case manager is able to break down the individual’s answer into the information needed to make a determination:
- the individual notes that assistance is required everyday with washing and bathing
- due to the distress it would cause, the individual cannot wash or bathe independently
- the application notes that for a while afterwards, comforting is required
- there are no available aids that would be reasonable or practicable to use
- they note that it takes between 20 to 30 minutes to assist with this task
- the needs identified are related to their condition of Alzheimer’s disease
Example: an individual has more than one condition noted in their application form
“I find due to my depression I don’t see the point in changing my clothes, maybe once a week. I just don’t have the motivation to do it, as I am not going anywhere. When I do get changed, my partner has to help me as I had an accident six months ago and had to have my spine fused.
Due to this, I am unable to raise my arms much and cannot bend from the middle at all. When I do get changed, my partner will put my underwear and trousers on for me and then I stand, and they pull them up for me. I can just about get my hands into a loose-fitting t-shirt but if I am wearing a jumper or a shirt with buttons, my partner has to put these over my arms for me. I have fallen trying to dress myself a number of times, so my partner always helps me now. Even with my partner’s help, it takes me around 20 minutes to get dressed and I am left with pain in my back and shoulders for the rest of the day.”
Using the above framework of questions, the case manager is able to break down the individual’s answer into the information needed to make a determination:
- the individual changes clothes once a week, due to a lack of motivation
- they are able to use loose-fitting clothes for their top half
- they need their partner to dress their top and bottom halves
- due to their depression, they require prompting to change their clothes
- when they get dressed, it leaves them with back pain for the rest of the day
- they have fallen a number of times when dressing independently
- it takes around 20 minutes to dress with support
- the needs are related to their conditions of depression and spinal injury.
Linking care needs questions
When reviewing the care needs questions, case managers should be aware that there are links between different tasks. This may lead to apparent inconsistencies.
Case managers should explore any apparent inconsistencies further through referring to the understanding and interpreting information chapter.
Example: an apparent inconsistency
An individual notes in the ‘getting in and out of bed’ section that they can get out of bed easily and without support, but in the ‘toilet needs and managing incontinence’ section they set out that they find it difficult to stand from a seated position.
The case manager considers that there is an apparent inconsistency from the information provided, as it would seem unclear how the individual may be able to complete one task and not the other. The case manager decides to explore this inconsistency, as they are currently unable to make a determination in a way that is fair and informed.
The case manager phones the individual to discuss this. They decided that a phone call was the most appropriate tool to clarify the apparent inconsistency, as this was noted as their main communication preference, and was the most efficient way to clarify details of the application form.
The individual shares that they had forgotten to add to their application that they have a bed rail that they use to get out of bed without support. They also tell the case manager that their occupational therapist had arranged grab rails for standing up from the toilet, but they have been unable to use this aid as the toilet grab rails require more strength to use than their bed rails.
The case manager discusses the use of the bed rail and toilet grab rails with the individual so that they can fairly apply the eligibility criteria. The case manager is now satisfied that they have enough information to make a determination of entitlement.
This is because the case manager determines that the use of a bed rail is a reasonable and practicable aid for this task, and that in the individual’s circumstances, the use of grab rails for standing up from the toilet would not be reasonable or practicable for the individual to use.
When considering apparent inconsistencies across different tasks, case managers should ensure that the tasks are similar enough to be compared.
For example, an individual may have reduced ability to use their hands to carry out tasks. Case managers should consider that the level of grip and ability to use their hands under the ‘eating and drinking’ section may not be comparable with the level of ability needed under the ‘support taking medication’ section. If a case manager is unsure how to compare different tasks in a specific application, a case discussion with a practitioner should be requested.
An individual may be unable or unwilling to provide sufficient information in the care needs questions for the case manager to make a determination. Where this is linked to a person’s disability, the case manager should gather sufficient information through:
- asking the individual further questions
- requesting a case discussion
- requesting supporting information.
Supporting information can be requested from a professional or an individual’s carer or family member, where the individual has given permission to do so. More information on when and how to request supporting information can be found in the gathering supporting information chapter.
Where an individual is unable to provide further information on the care needs questions to allow the case manager to make a fair and informed determination, the individual should be made aware that a determination will be made on the basis of the available information only. Operational Guidance should be followed to log this conversation.
If the case manager has taken all available steps to address gaps in information and has been unable to gather necessary information to decide that an individual satisfies the criteria, a determination should be made that the individual does not satisfy the criteria.
However, even if information gaps exist for some care needs questions, it may be that the case manager can make a determination as the individual has already satisfied the criteria through answer to other questions. Case managers should refer to the understanding and interpreting information chapter where an individual has a gap in information but there is enough information to make a determination.
Case managers should not automatically make an ineligible determination if they can make an award of PADP, even if information gaps remain in some areas.
Symptoms
Symptoms usually describe how an individual is affected by their condition or disability.
An individual might describe their symptoms throughout the application form, so case managers need to gather this information from any parts of the form where this is mentioned.
Symptoms may have a wide range of how they impact an individual across the same condition. Examples of symptoms include:
- pain
- shortness of breath
- fatigue
- tremors
- confusion
- paranoia
- low motivation
- hearing loss.
This list is not exhaustive.
Case managers may make assumptions about the probable link between a condition and its likely symptoms, so long as this is based on medical information. For example, medical information may include approved medical guidance or supporting information from a professional where this has been supplied.
It is important that case managers do not make assumptions in other instances about an individual or their symptoms or condition. Reference should be made to the principles of decision-making chapter for more information on assumptions and unconscious bias.
Inconsistencies may be present in an individual’s condition history. For example, an individual reports that they have hearing loss linked to their condition of heart failure. This apparent inconsistency would require further sources of information to support a case manager in applying the eligibility criteria.
Where inconsistencies appear to be present, a case manager should consider if they need exploring. Where they do, they should explore them until they are satisfied that they can be explained. This will allow them to make fair and informed determinations. Case managers should refer to the understanding and interpreting information chapter throughout this process.