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Exception: Review periods under 2 years
In exceptional circumstances, you can set review periods of less than 2 years. This should only be done when it is clear from the information available on the individual’s circumstances that their condition is likely to change significantly before the 2-year mark.
You should consider the available information to:
- understand the individual’s prognosis
- decide if a review period under 2 years is appropriate.
Setting a review period under 2 years could be appropriate due to one of the following having a significant impact on the individual’s needs:
- scheduled surgery planned beyond the longest possible time period for delaying a review
- scheduled, staged corrective surgery
- the individual recently starting new treatment likely to have a significant impact on their needs
- the individual soon completing treatment likely to have a significant impact on their needs once recovered
- it being difficult or impossible to anticipate how the individual’s needs will develop within the next 24 months. This could be due to a degenerative condition where the individual’s needs are expected to increase but the pace of change is unclear.
- the individual has a significant life event upcoming which is likely to have a significant impact on their needs, for example moving into adapted accommodation or a care home.
This list is not exhaustive.
Case managers must make sure that this lack of clarity is not simply due to any of the following:
- their lack of knowledge of the individual’s condition
- gaps in the application, review form or in supporting information that they have not yet explored with a Health and Social Care practitioner, the individual or the professional who provided the supporting information in question
- a lack of general confidence and experience regarding setting review periods.
If any of these bullet points apply, you must request a case discussion with a Health and Social Care practitioner to discuss what an appropriate review period would be.
Example: an individual’s award of Scottish Adult DLA will be reviewed in 18 months
Anna is 71 years old and were diagnosed with Osteoarthritis in their right hip when they were aged 58. Shortly after their diagnosis, they applied for DLA and have been in receipt of the middle rate of the care component from the point in time when they met the backwards test. They are currently on an indefinite award, which was honoured when their award transferred to Scottish Adult DLA.
Anna has reported a change of circumstance, as they received a right total hip replacement three weeks ago. Anna explains that they have started physiotherapy and will be starting occupational therapy soon. Anna states that they are already making some progress. They explain that they are expecting to note improvements in hip pain and range of motion, but that they will continue to require assistance when preparing food, with personal hygiene, dressing and undressing for about six months.
Given that Anna has not reported any night-time needs, their care needs have not changed since the surgery. Due to their recent surgery, they have mobility needs, but are highly unlikely to meet the backwards and forwards test for these, due to the anticipated recovery time. The case manager establishes that Anna’s care needs are highly likely to change in the near future, once she has recovered from the operation. Setting a longer review period therefore would not be appropriate.
To establish the point in time when Anna’s needs are likely to have changed, the case manager reviews the information provided by Anna again. Their description of the impact physiotherapy has had on their pain and mobility levels indicates that Anna is making good progress and will likely be discharged from the service in the next twelve months. The case manager expects that it will take some time afterwards for Anna’s needs to stabilise. They request a case discussion to get advice on how ong this period is expected to be. The practitioner explains that, based on Anna’s current progress it would be reasonable to expect their situation will have stabilised 6 months after they are discharged. Based on the case discussion, the case manager determines that it would be appropriate to review Anna’s award in 18 months, as it is important to see if Anna can manage these activities without assistance.
Example: An individual has their award reviewed after 16 months
Grzegorz (69 years old) has inflammatory Bowel Disease (IBD) which is well controlled and is in receipt of the middle rate of the care component of Scottish Adult Disability Living Allowance due to his daytime needs.
He recently reported a change of circumstance after he was admitted to hospital with a twisted bowel, a condition that required emergency surgery. As a result of the severity of his condition, Grzegorz underwent surgery to have a Stoma bag inserted. Due to his level of care needs related to his new condition, Grzegorz now also has night-time needs.
When his unscheduled review is carried out, he is two months into his recovery process. In his change of circumstances form, Grzegorz did not provide a lot of detail on his new level of needs. The case manager decides to request supporting information from a member of the multidisciplinary team consisting of surgeons, dietitians and stoma care nurses that are closely working with Grzegorz in his local hospital to understand
- whether he meets the criteria for night-time need
- what, if any, review period would be appropriate.
The Stoma care nurse providing supporting information explains that they and the team provide support to Grzegorz in adjusting to life with his Stoma, including both physical and emotional support. The nurse explains that Grzegorz has started to experience incontinence during the night. The statement further says that the recovery process has been challenging for Grzegorz and is expected to last around 6 months overall, during which he is going to require extensive support and medical input.
The nurse further explains that Grzegorz and his healthcare team have been discussing arranging reversal of the stoma, to be carried out around the 12-months mark after surgery. Reversal surgery would involve reconnecting his intestine and restoring normal bowel function. Due to Grzegorz’s resilience and determination, he appears to be a suitable candidate.
The case manager consults medical guidance and learns that recovery for this type of surgery is normally around 6 months.
They think that Grzegorz is likely to not have night-time needs anymore after this period. Therefore, they decide to set a review date for after the recovery of the second surgery, which is a review period of 16 months. They consult the Change of Circumstances: Change in Care Needs DMG chapter to establish when Grzegorz will have met the backwards test for his night-time needs and make a determination.
Example: An individual’s award of Scottish Adult DLA will be reviewed in 18 months
David is 74 years old and has been in receipt of an indefinite award of first DLA and now Scottish Adult DLA since the age of 50, when he lost his left arm in an accident. He has been on the lowest rate of the care component, as he is unable to prepare a cooked meal for himself and needs attention from another person in relation to his bodily functions, such as washing, toileting, as well as dressing and undressing, for a significant portion of the day.
David reports a change of circumstance, explaining that 8 months ago he had a stroke. He was admitted to hospital for 10 days where he received clot-busting medication. David has been left with right side weakness to his arm and leg.
He currently is unable to walk for more than a short distance and is using a zimmer frame. When he moves around outdoors, he requires supervision from another person, as he struggles to safely navigate curbs and uneven grounds. He is concerned that he will trip and fall if left to move around on his own. This is because his right side weakness makes it very difficult for him to use the zimmer frame effectively to stabilise his balance and prevent falls.
David has been attending physiotherapy and has been making progress with strengthening and moving his right arm and mobilising. He explains that,
- after discharge from hospital, he has been continuing to see the physiotherapist once weekly for strengthening exercises to the right arm and leg
- there has been an improvement
- his physiotherapist is expecting there to be significant improvement in the next 12 to 18 months.
The case manager considers all of the information supplied and determines that David is entitled to the middle rate of the care component. He also meets the criteria for the lower rate of the mobility component, but because he first met the criteria after he reached the relevant age, he cannot be entitled to it. The case manager determines that due to the expected improvement in David’s condition, a review in 18 months would be appropriate.