Chapter 61 - Attendance Allowance and Disability Living Allowance Contents General rules on entitlement Introduction AA.................................................................................................................61001 DLA ..............................................................................................................61008 Primary qualifying conditions .......................................................................61012 Age ...............................................................................................................61013 The residence and presence and competency conditions ..........................61015 Day for payment of AA and DLA AA............................................................................................................61016 DLA .........................................................................................................61017 Provision of NINO.........................................................................................61020 Medical advice Customer Case Management Adult and Childrens Medical Guidance .......61021 Referrals to Medical Services .....................................................................61024 Examination and report ................................................................................61028 Failure to attend for examination ............................................................61030 AA and DLA care component AA and DLA care component - the disability conditions .........................................................................61051 The day condition....................................................................................61053 The night condition..................................................................................61054 Rates of AA Higher rate ..............................................................................................61055 Lower rate ...............................................................................................61056 Vol 10 Amendment 34 June 2012 Rates of DLA care component Highest rate.............................................................................................61061 Middle rate ..............................................................................................61062 Lowest rate..............................................................................................61063 Change of rate ........................................................................................61064 Special provisions ...................................................................................61065 AA and DLA care component - definitions Preparation of the cooked main meal ..........................................................61081 Attention with bodily functions......................................................................61101 Breathing.................................................................................................61120 Cleanliness and skin protection ..............................................................61121 Dressing and undressing ........................................................................61122 Eating and drinking .................................................................................61124 Getting into or out of bed ........................................................................61125 Going to the toilet (elimination of waste products)..................................61126 Hearing....................................................................................................61130 Seeing .....................................................................................................61133 Sitting ......................................................................................................61134 Sleeping ..................................................................................................61135 Taking medication...................................................................................61136 Turning over in bed .................................................................................61137 Frequent or repeated ..................................................................................61138 Alternatives to attention or supervision ........................................................61141 Continual supervision...................................................................................61150 Watching over .............................................................................................61161 Frequent intervals ........................................................................................61164 Prolonged .....................................................................................................61165 Substantial danger .......................................................................................61171 Falling......................................................................................................61179 Night and day ...............................................................................................61200 Renal dialysis ..........................................................................................61201 Day and night needs ....................................................................................61202 Vol 10 Amendment 34 June 2012 Period throughout which ………………………………………………………..61204 Significant portion.........................................................................................61206 So severely disabled physically or mentally ...........................................61207 Renal dialysis .............................................................................................61220 Exceptions...............................................................................................61224 DLA mobility component DLA mobility component - conditions of entitlement Introduction...................................................................................................61251 Higher rate ...................................................................................................61255 Lower rate ....................................................................................................61256 DLA mobility component - definitions Unable or virtually unable to walk ................................................................61276 Physical or mental disability....................................................................61280 Refusal or reluctance to walk..................................................................61290 Severe discomfort ...................................................................................61300 Relevance of stops and severe discomfort.............................................61309 Walking with support ...............................................................................61312 Artificial limbs and appliances.................................................................61313 Swinging through ....................................................................................61315 Virtually unable to walk ...........................................................................61319 Danger to life or serious deterioration in health ......................................61327 Virtually unable to walk flow chart...........................................................61331 DLA mobility component - people without both legs....................................61332 DLA mobility component - severely visually impaired..................................61334 Evidence of visual acuity/visual field.......................................................61337 Supersession of existing awards ............................................................61339 DLA mobility component - deaf and blind ....................................................61340 Assessment of the degree of deafness ..................................................61344 Severely mentally impaired with severe behavioural problems...................61350 Vol 10 Amendment 31 July 2011 Severely mentally impaired Arrested development or incomplete physical development of the brain............................................................................................61351 Arrested development or incomplete physical development of the brain and schizophrenia .............................................................61356 Arrested development or incomplete physical development of the brain and attention deficit hyperactivity disorder ........................61359 Severe impairment of intelligence...........................................................61366 Severe impairment of social functioning .................................................61369 Severe behavioural problems .................................................................61376 Evidence of severe mental impairment or severe behavioural problems....61381 Severely mentally impaired with severe behavioural problems flow chart ..61382 Lower rate DLA mobility component The need for guidance or supervision ....................................................61391 Guidance.................................................................................................61394 Supervision .............................................................................................61397 Fear or anxiety ........................................................................................61400 Guidance or supervision .........................................................................61404 Special hospitals .....................................................................................61411 Benefiting from enhanced facilities for locomotion ......................................61413 DLA mobility component - invalid carriage users....................................61421 Invalid Vehicle Scheme beneficiary over 65 ...........................................61423 Qualifying period Attendance allowance ...............................................................................61451 Extension to the qualifying period ................................................................61452 Period for which AA is payable ....................................................................61454 Disability living allowance DLA care component ...................................................................................61461 DLA mobility component ..............................................................................61466 The qualifying period and prospective test on or around age 16.................61468 Modifications ................................................................................................61469 Vol 10 Amendment 31 July 2011 Special cases Terminally ill (special rules cases) Conditions of entitlement..............................................................................61491 Qualifying period AA and DLA care component .................................................................61501 DLA mobility component .........................................................................61502 Period of award .......................................................................................61503 Claim on behalf of a terminally ill person made by a third party ..................61511 Disability Living Allowance - under 16s Claim received for a child under 16 .............................................................61520 DLA care component ...................................................................................61521 Renal dialysis ...............................................................................................61522 DLA mobility component ..............................................................................61523 Points for consideration................................................................................61524 Assessment of care needs...........................................................................61529 Care substantially in excess.........................................................................61530 Attention or supervision at school ....................................................... …….61535 Nocturnal Encopresis and Enuresis…………………………………………….61537 Assessment of mobility needs......................................................................61541 Quality and quantity of supervision and guidance . ………………………….61543 Disability Living Allowance - people 65 years old or over New claims ...................................................................................................61551 Renewal claims ............................................................................................61557 Revisions or Supersessions.........................................................................61565 DLA care component Highest and middle rate ..........................................................................61568 Lowest rate..............................................................................................61569 Effect of these conditions........................................................................61570 DLA mobility component Higher rate .............................................................................................61581 Lower rate ..............................................................................................61583 Vol 10 Amendment 44 October 2016 DLA mobility component - award of DLA care component.....................61584 Determination of claims and awards Claims and awards .....................................................................................61601 DLA claims with evidence of one component only ......................................61603 Advance claims and awards ........................................................................61607 Interchange of claims ..................................................................................61611 Movement between rates.............................................................................61612 Period of award AA and DLA ............................................................................................61613 DLA only..................................................................................................61618 Hospitals, Similar institutions and Care Homes General rule on payability for hospitals and similar institutions ...................61651 Exception to the general rule - first 28 days.................................................61653 Claimants who enter a hospital or similar institution under the age of 18 ...61654 The Motability Scheme – Exceptions to the general rule.............................61655 Meaning of “current term of hire” ............................................................61672 Hospices Definition of hospice.....................................................................................61690 Rules on payability for hospices ..................................................................61692 Care homes other than hospitals and hospices from 6.10.03 Definition of a care home .............................................................................61700 Rules on payability for care homes..............................................................61715 Qualifying Services .................................................................................61717 Direct payments ......................................................................................61735 Self funders .............................................................................................61749 People with homes to sell or who await other release of funds...................61750 Background information ...............................................................................61752 War pensioners and civilians in relevant accommodation...........................61801 Vol 10 Amendment 44 October 2016 Whether the claimant is in a similar institution to a hospital or a care home..............................................................................................61820 Care homes funded by NHS ........................................................................61821 Care home payability flow chart ...............................................................61822 Payment during periods in hospital or a care home Calculation of the period ..............................................................................61851 Days of admission and discharge Hospitals .................................................................................................61852 Care homes.............................................................................................61854 Days of transfer.......................................................................................61856 Entitlement begins during period in hospital or a care home..................61857 Entitlement begins before admission - payability on readmission..........61860 Payment at daily rate....................................................................................61880 Conditions for payment at daily rate .......................................................61881 Period payable at daily rate ....................................................................61882 Absence more than 28 days ...................................................................61883 Application of daily rate provisions..........................................................61884 Discharge before 28 day period ends.....................................................61886 Discharge after 28 day period ends........................................................61887 Other restrictions on payability and exclusions.....................................61890 Imprisonment................................................................................................61891 Vol 10 Amendment 44 October 2016 Overlapping benefits AA or DLA (care).....................................................................................61892 DLA mobility component .........................................................................61893 Adjustment of benefit ..............................................................................61894 Split payments of DLA.............................................................................61896 Acts relating to people with disabilities and Acts relating to young people, education or training ........................................................... Appendix 1 Assessment of the % degree of disablement..................................... Appendix 2 Rates of benefit (AA).......................................................................... Appendix 3 Rates of benefit (DLA)........................................................................ Appendix 4 Application of the general rule for people in hospital on or before 31.7.96............................................................................................. Appendix 5 Motability agreements before 8.4.13.................................................. Appendix 6 List of local authorities for the purpose of DMG 61738...................... Appendix 7 Vol 10 Amendment 44 October 2016 Chapter 61 - Attendance Allowance and Disability Living Allowance General rules on entitlement Introduction AA 61001 AA is a benefit designed to help severely disabled people who need 1. attention from another person or 2. supervision from another person or 3. another person to watch over them. 61002 There is only one AA component made with two rates which are 1. the higher rate and 2. the lower rate. Severely disabled people may be entitled to either of these rates. The rate depends 1 on the level of attention, supervision or watching over a person needs . 1 SS CB Act 92, s 64 61003 - 61007 DLA 61008 DLA is a benefit that depends on a person’s need for care and help with mobility 1 arising from a disability . It is the functional deficiency, physical or mental and whether 1. care needs or 2. mobility needs or 3. both care and mobility needs 2 which result from the functional disability satisfy any of the entitlement conditions . 1 R(DLA) 3/06; 2 SS CB Act 92, s 72(1)(a) to (c) & 73(1)(d) Example Amy, aged nine, has behavioural problems and learning difficulties. Medical evidence indicates mental health problems but there is no diagnosis as to the disabilities which Amy suffers. The DM accepted that, despite no diagnosis, Amy Vol 10 Amendment 41 October 2015 was unable to control her behaviour and was at risk of substantial danger requiring continual supervision throughout the day. The DM accepted that the supervision Amy required was substantially in excess of a nine year old who does not have Amy’s disability. 61009 DLA is made up of two components. These are 1. the care component and 2. the mobility component. A disabled person may be entitled to one or both components. See guidance in DMG 61603 for claims with evidence of one component only. 61010 There is a range of disability conditions relating to care and mobility needs. Satisfying any one of the conditions gives entitlement. 61011 There are three rates of the DLA care component and two rates of the DLA mobility component. The rate of benefit payable depends on which of the disability conditions are satisfied. Primary qualifying conditions 61012 The three primary qualifying conditions which apply to AA and DLA are 1. age and 2. residence, presence and competency and 3. disability. Although there is no formal order of consideration of these conditions, if either of the first two are not satisfied, then the third need not be considered. Age 61013 To be entitled to AA a person must be 1. aged 65 or over and 1 2. not entitled to DLA or PIP . 2 Note: From 6.12.18 the age condition will be that a person has reached 3 pensionable age . See DMG Chapter 75 for guidance on the meaning of pensionable age. 1 SS CB Act 92, s 64(1); SS (DLA) Regs, Sch 1, para 7; WRA 12, s 83, SS (PIP) Regs, reg 25-27; 2 Pensions Act 07, s 13(3); 3 SS CB Act 92, s 64(1) 61014 To be entitled to DLA a person must be 1. under 65 years of age and Vol 10 Amendment 41 October 2015