Relevant considerations for giving an indefinite award or setting a review period
A review date should be set based on when the individual’s circumstances are likely to have changed. You should take a holistic, person-centred approach to determine when this is the case for the individual in question. This means that you should not set a review period based only on when, generally, individuals with a certain condition may experience changes. Rather, you should consider:
- the review form completed by the individual or on their behalf
- (if applicable) additional information gathered by contacting the individual with follow-up questions
- confirmation from a professional, if available
- (if applicable) any supporting information provided by the individual, or collected by Social Security Scotland (if applicable) advice from a Social Security Scotland Health & Social Care practitioner(if applicable) information received from DWP when an individual’s entitlement to Disability Living Allowance is transferred to Scottish Adult Disability Living Allowance. the factors outlined in this section
to determine when the individual’s needs will likely change in the future.
Although some conditions might suggest a longer review period (or none at all), you should make a decision based on the information available to you relating to the individual and the holistic picture you have established based on that information.
Where there is more than one condition, you should take into account the effects of all of the conditions. This should also involve considering how those conditions interact with each other and what their overall impact on the individual is.
If the information available on the individual does not provide you with this level of detail, it may be appropriate to seek a case discussion with a Health and Social Care practitioner. Read guidance on how to request a case discussion here.
The following factors are all relevant in setting an award review date:
- the age of the individual
- whether the individual might be eligible for an indefinite award whether the individual has a single condition or multiple conditions
- how long the individual has had their condition
- whether there is any ongoing, current or future treatment or surgery and how this might be expected to impact the individual’s level of needs
- the type and anticipated progress of the underlying condition
Determining the appropriate review period based on the interaction of various factors can be complex. If you are unsure, you should use decision-making tools, such as case discussion, for support in selecting the correct review period.
The following two examples illustrate how the interplay of these factors lead to vastly different review periods for two individuals with the same conditions.
Example: based on the factors relevant for setting a review period, a short review period is appropriate for an individual
John is 68 years old. He has had stage 2 COPD for 5 years and has been in receipt of the lowest rate of the Scottish Adult DLA care component and the higher rate of the mobility component for 4 years.
Due to his COPD, John experiences shortness of breath and wheezing, a persistent cough, and frequent chest infections. He has difficulty walking as a result, and needs supervision when walking outdoors. He takes COPD medication and his COPD is expected to progress gradually over time, possibly leading to increased symptoms and exacerbations in the future. John used to be a heavy smoker for 25 years.
John reports a change of circumstance as he has had a mild stroke 6 months ago. In his change of circumstances form John explains that the stroke has left him with a mild weakness to his left side, which results in problems with coordination and balance at home. His wife has to aid with washing and dressing as he can get dizzy when in the shower and does not have full use of his left side. She also has to assist with dressing due to reduced strength in his left side. His wife will cut his dinner as he is unable to manage due to poor strength in his left hand. He remains on a soft diet at present, to reduce the chances of choking due to his stroke. His memory and concentration have not fully resolved at present and he can have difficulty with short term memory. He has difficulty communicating as his speech has not fully returned and he relies on his wife to communicate for him.
John also explains that he can experience extreme tiredness as he recovers and has difficulty sleeping as is unable to get comfortable. John also needs support to get to and from the toilet during the night because he is at risk of falling when getting up during the night due to problems with his coordination and balance. Due to ongoing problems with his memory, John has become distressed during the night when trying to reach the toilet himself. This has caused John to become disorientated and leading to him moving around the house at night and risking further falls. John’s wife regularly comforts him to help John settle again after feeling distressed at night.
He is prescribed medications for stroke prevention. John provides supporting information from his wife with his change of circumstances form. His wife explains that:
- She supports him in his everyday life, both during the day and when John needs support during the night, such as when getting to and from the toilet and settling from the distress that John encounters when he is awake during the night. She also mentions that John’s left hand can get stuck when turning, requiring help from her through the night 2-3 times.
- She helps him stay on top of medical appointments and his treatment
- At present, John is still under review and monitoring from his stroke.
The case manager reviews John’s award. Based on John’s needs, they determine that he is now entitled to the highest rate of the care component of Scottish Adult DLA. This is because John requires repeated attention with his bodily functions during the day, and for another person to be awake at frequent intervals to avoid substantial danger at night.
Due to John’s age, he is not eligible to increase the rate of the mobility component which he receives. The case manager considers that he still requires supervision when walking outdoors, due to both his COPD and the risk of falls associated with his stroke, and therefore maintains his award of the lower rate of the mobility component.
The case manager moves on to determine whether, and when, a scheduled review would be appropriate. From the information John has provided, as well as the statement of support, they gather that John will be receiving continued treatment. They also understand that John is planning to manage his conditions and is embracing the rehabilitation to regain his independence. They consult medical guidance to read up on the symptoms of John’s conditions, as well as the treatment and prognosis. They request a case discussion with a Health and Social Care practitioner to better understand both
- the interplay of John’s conditions
- how lifestyle changes he is making impact on his level of needs.
The case manager decides that a review after 2 years is appropriate, as John is likely to have experienced a reduction in his level of needs by the end of that period, as he continues to recover from his stroke, and has noted lifestyle changes that may assist with this, such as his retirement and giving up smoking. The case manager anticipates that John’s entitlement might reduce to a lower-level Scottish Adult DLA award for his stage 2 COPD.
Example: based on the factors relevant for setting a review period, an indefinite award is appropriate for an individual
Viktor is 80. He has stage 3 COPD and is in receipt of the middle rate of the care component. He lives with his wife who helps him daily.
Due to his COPD, he experiences breathlessness when moving around his home which is worsened by the increased effort due to reduced coordination and balance. Viktor requires daily medication for COPD. Viktor sleeps in a recliner chair which is better for his breathing, as he gets increasingly breathless when lying flat.
Viktor reports a change of circumstance, as he has had a stroke. Although he has a shower chair that was supplied by an Occupational Therapist before his stroke, his neighbour has to help with washing due to the right-side weakness following his stroke. His wife finds this too difficult to manage, and the aid does not allow Viktor to manage this task independently anymore.
Viktor is unable to dress as he cannot manage buttons or zips and wears loose clothing. His neighbour will make and bring meals that Viktor’s wife has to cut up to make it easier to chew or swallow, as he can still have issues with eating and is at risk of choking. He has issues with incontinence, however this is due to the reduced pace and being unable to make the toilet on time.
In his change of circumstances form, Viktor explains how he relies on his wife and neighbours and which adjustments have been made in the recent past to accommodate his needs.
Viktor’s wife used to help him out of the bed in the mornings, and into bed at night. The neighbour had arranged for Viktor to have urinal bottles at the side of his bed, as he was finding it difficult to get up for the toilet. Using the bottles was supposed to prevent his wife trying to help him get up and having falls. However, due to Viktor’s right-side weakness, he would often spill these and be unable to get up to change the bedding, so his wife now helps him to get to and from the toilet at night, otherwise Viktor is likely to wet the bed. This takes a significant amount of time due to Viktor’s reduced balance and coordination.
Viktor regularly tries to walk to the toilet during the night, which has resulted in multiple falls. He calls on his wife when he has to get up and to help get him comfortable when lying down again.
Viktor is prescribed medication for stroke prevention as well as physiotherapy for stroke rehabilitation.
The case manager reviews Viktor’s award. They use their knowledge of his conditions as well as guidance on aids and appliances in the Definitions DMG chapter, as they do not consider those noted in Viktor’s form to be reasonable or practicable for him to use following his stroke. The case manager also considers the potential impact of other relevant factors outlined in this chapter on his level of need to establish whether setting a review period would be appropriate.
From the information Viktor has provided they gather that Viktor faces a challenging prognosis with a mild stroke and a longer history of COPD. The case manager determines that, given Viktor’s age, it is more likely than not that he will not fully recover from the stroke. Furthermore, given that COPD is a degenerative disease, Viktor’s breathlessness and treatment needs are likely to increase over time.
The case manager therefore decides that an indefinite award for the highest rate of the care component of Scottish Adult DLA is appropriate. Due to the age at which the change of circumstances occurred, and the fact that Viktor was not in receipt of the mobility component prior to reaching the relevant age, the case manager is not able to award Viktor the mobility component