Indefinite awards for individuals on maximum rate Scottish Adult DLA awards

Tommy is 60 and has been in receipt of the lowest rate of the care component of DLA and then Scottish Adult DLA for almost 40 years, as he requires attention from another person for a significant portion of the day. This is because Tommy has severe dyslexia and dyspraxia. He struggles to read or write and, due to difficulties with fine motor skills, he needs help with dressing, undressing, some aspects of personal hygiene (such as shaving), and preparing food.

14 months ago, Tommy sustained a serious spinal injury resulting from a fall. The injury led to significant paralysis in his lower body, affecting his mobility and care needs. Tommy reported a change of circumstance and was awarded Scottish Adult DLA at the higher rate of the mobility component and the highest rate of the care component and was given a 2-year review period. The case manager specified in their justification that this was because Tommy was still getting used to a new disability.

Following the fall, Tommy has now reported another change of circumstance as he underwent emergency medical care to stabilise his condition and prevent further damage to his spine. He states that he received surgical intervention to repair the injury and has been instructed to remain on bed rest for at least 12 months due to the ongoing instability. This has caused dramatic muscle wastage, which has further complicated the recovery process and will require intensive rehabilitation to rebuild muscle strength and function.

In his change of circumstances form, he explains further that his rehabilitation is going to consist of physiotherapy, occupational therapy, and adaptive equipment training to help him relearn basic activities, which his healthcare support team are hopeful can be achieved.

The case manager familiarises themselves with Tommy’s file and his change of circumstances form.

They learn that Tommy has daytime needs, as he requires

• assistance with washing and getting in and out of the bath.
• assistance with dressing, as his lack of feeling in lower limbs prevents the ability to lift easily.
• bowel and bladder care due to probable incontinence associated with lack of feeling below the waist.
• assistance with transferring from chair and mobilisation around the home.

They also learn that Tommy has night-time needs, as he requires

• 2 hourly positional changes to prevent bed sores and breakdown of skin
• Changes of bedding due to incontinence issues.

They also understand that Tommy has mobility needs, as he is unable to walk.

They determine that Tommy’s entitlement is still correct: As he has already had both day-time and night-time care needs, both of which are still present, and he is still unable to walk, Tommy continues to be entitled to the higher rate of the mobility component and the highest rate of the care component.

However, the case manager establishes that Tommy’s short review period of two years, part of which has already passed, is not appropriate.

The case manager speaks to a Health and Social Care practitioner. During the case discussion, the case manager learns that, given the severity of his spinal injury, his recovery will be a gradual process over an extended timeframe to achieve functional improvements and maximise his quality of life. The practitioner states that it is highly unlikely that Tommy will recover to an extent that would impact on his entitlement: Even though his needs will decrease overall, he will continue to have day-time and night-time care needs, as well as mobility needs.

The practitioner also advises that Tommy’s original review period of 2 years was not appropriate and should have been longer. They agree that Tommy’s needs would have most likely reduced slightly after two years. However, even without his change of circumstances, Tommy would have needed at least 5 years to recover from his accident and adapt to his disability for his needs to reduce enough for his entitlement to potentially reduce. As review periods should be set for a time where it is likely that the individual’s needs will have changed to an extent that will impact on their entitlement, 2 years was too short a review period. The case manager determines that an indefinite award is appropriate.