Click to edit SEO parameters
Length of time the individual has had the condition
Individuals who only recently acquired a new condition might still be adjusting to their disability. For example, they might still be learning how to use aids enabling them to manage their bodily functions. This might impact the likelihood of their needs changing in the future.
You must not set a review period solely based on the duration the individual has had their condition. Instead, you should consider all other factors discussed in this section and how they apply to the individual in question when setting a review period.
There is no requirement that an individual must have had a condition for a certain period of time before they may be eligible for an indefinite award. An individual can receive an indefinite award at any point when a determination without application is made at the end of a scheduled or unscheduled review.
The length of time an individual has had a condition is not the same as the recency of a diagnosis of a condition or of starting treatment. An individual may have had their condition for a long period of time and may have learned to adapt (e.g. by self-medicating, avoiding certain environments or movements, relying on support from others, or using aids) before they got diagnosed. The individual may be unaware that, and to what degree, they’ve adapted their way of doing things to their needs. However, a recent diagnosis can lead to new and potentially more appropriate treatment or support becoming available, which the individual then will need time to adapt to. This is likely to impact on their level of needs.
Example: An individual is still adapting to a recently acquired condition
Minnie, aged 63, has bilateral cataracts, which significantly impacts her vision, and is in receipt of the lowest rate of the care component and the lower rate of the mobility component for Scottish Adult DLA. She has recently been diagnosed with Type 1 diabetes after being hospitalised for losing consciousness due to significantly low blood sugars. Minnie reports a change of circumstances.
In her change of circumstances form, Minnie explains that managing her blood sugar levels and administering insulin has become a crucial part of her daily routine, especially since she struggles to see well enough. She relies on her daughter for support, including checking blood sugars and administering insulin. She has been unable to learn how to use glucose monitors and understand the variability in her sugar levels, due to her reducing eye sight all while dealing with physical weakness, fatigue, and vulnerability following her recent hospital discharge. This leads to her daughter regularly monitoring Minnie to ensure her treatment can be delivered effectively.
Minnie has struggled to adapt to a regulated diet since her diagnosis and treatment started. Her daughter has to ensure Minnie eats a proper diet, at least 4 times per day.
Her ongoing struggles and regular hypoglycaemic events, cause dizziness and blackouts, in which she has had numerous falls due to the instability of her condition. This dizziness has caused Minnie to need support with washing and bathing, as she is at risk of falling when carrying out this task. She used to attend numerous social clubs with friends, however is currently unable to due to the ongoing support she is requiring within the home. Minnie requires consistent monitoring and intervention. She remains under the supervision of her diabetic consultant 3-monthly and is reviewed by the diabetic nurse monthly due to her instability.
Minnie does not require support during the night. Occasionally, Minnie’s daughter will check in on her to make sure she is okay, but this is only on an ad-hoc basis, and unrelated to her condition.
The case manager establishes that Minnie has satisfied the backwards test, as her needs related to her diabetes have now been ongoing for more than 26 weeks. They determine that Minnie is entitled to the middle rate of the care component, and that her entitlement to the mobility component has not changed. The case manager makes this determination as Minnie has satisfied the daytime condition due to requiring frequent attention with her bodily functions in relation to eating, taking medication as well as washing and bathing.
Due to the new diagnosis and variability of the condition, they set a 2 year review period as Minnie may have learned to adapt to her condition by then, potentially leading to her Scottish Adult DLA entitlement to the care component reducing, with her entitlement to the mobility component remaining the same.
Six months after her determination, Minnie reports another change of circumstance. She informs Social Security Scotland that she will be undergoing surgery on her eyes to treat her cataracts. The first operation is scheduled for in two weeks. The case manager consults medical guidance and learns that the second operation will most likely be scheduled three months after the first. Minnie can be expected to recover from the second surgery after three months. Given that her difficulties with managing her diabetes as well as with her mobility are strongly linked to her eye sight, the case managers establishes that it is more likely than not that she will learn to adapt to her diabetes within these three months and will become able to navigate routes independently and safely outside, given that her eye sight will have improved significantly. Given that Minnie will have had more time to adjust to her condition by then, her need for assistance regarding her diet might have decreased or ceased by then as well.
The case manager establishes that it is more likely than not that Minnie’s needs will not change in a way that would impact her entitlement between now and her having fully recovered from the second operation. They therefore make a determination that Minnie remains entitled to the lower rate of the mobility component and the middle rate of the care component.
As Minnie might no longer satisfy neither the criteria for the mobility component nor the day-time condition once she has fully recovered from her surgery and adapted to her condition, the case manager sets the review date for Minnie’s award for three months after her second surgery. They request Minnie to report a change of circumstances, should her care needs significantly reduce before her review, as it is the responsibility of the individual to report changes in their circumstances. This is to avoid Minnie incurring an overpayment.
In some cases, the condition itself is likely to be so severe and enduring that it is appropriate to make an indefinite award shortly after the onset of the individual’s condition or disability. However, the individual must satisfy the backward test.
Example: An individual has a new progressive condition
Frank is 51 years old and has been in receipt of an indefinite award of the lowest rate of the DLA care component for 20 years. Shortly after transferring to Scottish Adult DLA, his family reports a change of circumstances on Frank’s behalf.
Frank’s family explain that Frank has been diagnosed with early-onset dementia after 2 years of significant changes in his life and personality, as well as challenges for his family.
Following a series of cognitive assessments and medical review, Frank got his diagnosis only 3 months ago, indicating a progressive decline in cognitive function.
Frank’s family indicate he appears weaker and fatigued and shows a lot more vulnerability to stresses in life. He is unable to perform a number of activities independently, leading to an increased reliance on family. He has had a number of falls, and with his poor appetite he appears malnourished, which is worrying for the family. His change of circumstances form indicates that he now needs support during the day as well as the night.
It states that Frank requires assistance with washing. He has no understanding why someone would be present or why people would be trying to undress him which causes significant resistance. His family try to stick to as much of a routine around this as possible. However, Frank is not always compliant and to de-escalate the situation his family will let him go some days without washing at all.
He requires assistance with dressing, as due to his cognitive decline, he can choose inappropriate clothes for the weather. He can put clothes on in the wrong order and he requires assistance from his family daily to manage dressing.
Franks family deal with all his medications, as he will forget to take them at all, or forget he has already taken them leading to a higher dose of medication taken.
Bedtime can be challenging for the family as Frank only sleeps around 3 hours per night. He gets up and wanders and they have had to fit the doors with alarms, so they know when Frank is up and about, to usher him back to bed.
He attends an Adult Day centre 2 times per week, where he is cared for and the caregivers are trained in handling different aspects of the condition.
Frank now also requires guidance and supervision from his family or staff at the day centre when moving around outdoors. This is because he is unsteady on his feet, and at heightened risk of falling. Frank often gets confused when being outside. He often is unable to remember where he is, where he is going and why. Frank does not understand why he needs to be supervised, which can lead to him becoming scared, frustrated, or overwhelmed. Frank can lash out in these situations, shouting at his caregivers for following him and frequently refusing to walk at all. Frank can suddenly walk into traffic when he is feeling like this as he seems to lose awareness of the potential dangers around him.
The case manager establishes that Frank has satisfied the backwards test as his care and mobility needs relating to this condition have been ongoing for 2 years.
They conclude that Frank’s diagnosis of dementia presents complex challenges that are also influenced by his age and frailty. They determine that Frank is entitled to the
- highest rate of the care component as he has satisfied both the daytime and night-time conditions.
- higher rate of the mobility component, as he is virtually unable to walk.
The case manager decides to give him an indefinite award. Not setting a review period is appropriate as dementia is a long term progressive condition and Frank is highly unlikely to experience a reduction in needs.