Effect on entitlement of an individual in receipt of Scottish Adult DLA spending time in alternative accommodation

An individual who is already in receipt of Scottish Adult DLA is entitled to still be paid it for the first 28 days of their stay in a care home, hospital or legal detention. 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, if 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 for hospital and care home stays (Scottish Adult DLA regs, reg. 22(3) and 23(3)), or one year between the periods where the periods are in legal detention (Scottish Adult DLA regs, reg. 25(4)). For more information on this please see the section on linked periods.

The non-payment of Scottish Adult DLA enables an individual’s entitlement to Scottish Adult DLA to continue while they are resident in alternative accommodation. 22. This is because Scottish Adult DLA helps to meet the extra costs experienced by individuals with a disability or long-term health condition.

In most cases when they are in alternative accommodation, the costs of their care will be paid for by the local authority or other public funds. Non-payment of Scottish Adult DLA 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 individual stops being paid the care component of Scottish Adult DLA on the 29th day of their time spent in a care home (Scottish Adult DLA regs, reg. 22(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 .

For payment of care component to stop when in a care home, it must also be the case that the cost of any qualifying services are publicly funded (whether in whole or in part) (Scottish Adult DLA regs, reg.22(4)). If the full costs are paid by an individual or a charity (or a combination of both), payment of care component can continue as long as the person is eligible.

On the 29th day of a period in hospital (Scottish Adult DLA regs, reg. 23(2)), or in legal detention (Scottish Adult DLA regs, reg. 25(3)), an individual stops being paid both components of Scottish Adult DLA. For more information on calculating a length of stay in alternative accommodation, reference should be made to the ‘Calculating the Length of Stay’ section.

For payment to stop when in hospital, it must also be the case that the individual:

• is undergoing medical or other treatment as an in-patient at a hospital or similar institution
• has any of the costs of the treatment, accommodation and any other related services borne out of public funds (Scottish Adult DLA regs, reg 23(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 (Scottish Adult DLA regs, reg. 23(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. (Scottish Adult DLA regs, reg.23(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.

When an individual enters, or is released from, legal detention, the Scottish Prison Service will inform Social Security Scotland. For more information on this process please follow operational guidance: Change of circumstance reported by a third party representative.

An individual stops being paid both components of Scottish Adult DLA on the 29th day in legal detention. For more information on calculating a length of stay in alternative accommodation, reference should be made to the ‘Calculating the Length of Stay’ section.

A review will need to be carried out at the earliest opportunity if the scheduled review date passes while the individual is in legal detention.

An individual entering or leaving legal detention is regarded as a change of circumstances if it will likely lead to a change in entitlement. A case manager must complete a determination without application in these circumstances (Scottish Adult DLA regs, reg. 43(a))

Individuals may be overpaid Scottish Adult DLA if Social Security Scotland is not notified of a change (SS Act 2018, s. 56). For more information on what to do if there has been an overpayment, see the Overpayments section of the Rates and Payments chapter.

Payment continues after 28 days when the individual is in a hospice, is terminally ill (Scottish Adult DLA regs, reg. 24(1)) and Social Security Scotland have been informed that the individual is terminally ill.

Payment after 28 days in a hospice refers only to a “hospice” as defined in the regulations (Scottish Adult DLA regs, reg.24(2)). That is, a palliative care institution that isn’t publicly funded and whose main function is to provide palliative end of life care for people suffering from a progressive disease at the final stages. 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. This means that their care component will be £nil rated on the 29th day in a care home, or both components will be £nil rated on the 29th day in hospital. 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.

The individual who is receiving Scottish Adult DLA 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 Scottish Adult DLA would be set to nil. This would happen in instances where the individual failed to notify the change as soon as was reasonably practicable. For more information on when an individual should notify Social Security Scotland of a change of circumstances, please see the change of circumstances chapter.