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«Updated on 28 July 2015 Foreword This document has been produced by the Department for Work and Pensions (DWP) to provide guidance for providers ...»

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(i) appropriately take medications in a domestic setting that are prescribed or recommended by a registered doctor, nurse or pharmacist;

(ii) monitor and detect changes in a health condition; and (iii) manage therapeutic activities that are carried out in a domestic setting that are prescribed or recommended by a registered doctor, nurse, pharmacist or healthcare professional regulated by the Health Professions Council.

The outcome of this activity is taking the medication or completing the recommended therapy as prescribed / recommended, without which the claimant’s health is likely to deteriorate.

Notes:

Managing medication means the ability to take prescribed medication in the correct way and at the right time.

Monitoring a health condition or recognising significant changes means the ability to detect changes in the condition and take corrective action, as advised by a healthcare professional. Note that ‘keeping an eye’ on how a person is doing does not count as monitoring, unless the person is monitoring a specific parameter under medical advice and is implementing treatment modifications to prevent deterioration. Asking someone how they are will not meet the criteria unless there is a medical reason for expecting a change, a defined sign of deterioration and an advised action plan.

This activity takes into account the administration of medication or therapy irrespective of who delivers it, and includes delivery by healthcare professionals, such as district or community psychiatric nurses. It only applies to medication/therapy delivered in the home environment i.e.

where the claimant lives (and may include care homes), that has been prescribed/recommended by a registered healthcare professional or pharmacist.

Examples of prescribed or recommended medication include tablets, inhalers, creams, suppositories and enemas. Therapies could include domiciliary dialysis, nebulisers and exercise regimes to prevent complications, such as contractures. Whilst medications and therapies do not necessarily have to be prescribed, there must be a consensus of medical opinion that supports their use in treatment of the condition, hence the necessity for it at least to be recommended by a registered healthcare professional or pharmacist.

Descriptors C – F needs supervision, prompting or assistance to be able to manage therapy apply to the duration of the supervision, prompting or assistance and not the duration of the therapy. For example if compression bandaging is worn 24 hours a day for venous insufficiency, the time spent by another person applying the bandaging is counted, not the time the bandages are worn.

For the purpose of this activity, the ‘majority of days’ test does not require the individual to actually be receiving therapy on the majority of days in a year.

However, the descriptor would still need to accurately describe the claimant’s circumstances on a majority of days – i.e. on a majority of days the statement about how much support an individual needs a week must be true. For example, if a claimant needs assistance to undergo home dialysis for three hours on Monday and Friday, they would not actually be receiving therapy on the majority of days in a year. However, the statement that they need ‘assistance to be able to manage therapy that takes more than 3.5 but no more than 7 hours a week’ would still apply, as it accurately describes the level of support needed in a week.

When considering whether a claimant requires an aid or appliance, HPs

should distinguish between:

• an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; and

• an aid or appliance that a claimant may be using or wish to use because it makes it easier to carry out the activity safely, reliably, repeatedly and in a timely manner.

Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not required in the latter.

Where a claimant chooses not to use an aid or appliance that he or she could reasonably be expected to use and would enable them to carry out the activity without assistance, they should be assessed as needing an aid or appliance rather than a higher level of support.

–  –  –

Within the assessment criteria, the ability to perform an activity ‘unaided’ means without either the use of aids or appliances;

or help from another person.

–  –  –

This descriptor captures the supervision required by the claimant taking their own medication in the home.

Supervision due to the risk of accidental or deliberate overdose is also captured here.

For example: the claimant needs physical help opening bottles or taking pills out of blister packs; help interpreting or reading blood sugar for the correct dose of medication;

supervision to ensure the medication is taken properly;

prompting to remind the claimant to take medication at the appropriate time(s).

Pill boxes, dosette boxes, blister packs, alarms and reminders only apply to descriptor B if the claimant is unable to manage their medication due to their health condition or impairment and there is evidence to explain their use; or if they are unable to read and an aid would help them to manage medication independently.





Note that needles, glucose meters and inhalers are not aids.

Needs supervision, prompting or assistance to be able to manage C therapy that takes no more than 3.5 hours a week.

‘Prompting’ means reminding, encouraging or explaining by another person. For example, a claimant needs 15 minutes of assistance with therapy each day Monday to Friday, or reminding to manage therapy.

Needs supervision, prompting or assistance to be able to manage D therapy that takes more than 3.5 but no more than 7 hours a week. 4 Needs supervision, prompting or assistance to be able to manage E therapy that takes more than 7 but no more than 14 hours a week. 6 F Needs supervision, prompting or assistance to be able to manage therapy that takes more than 14 hours a week.

Activity 4 – Washing and bathing This activity considers a claimant’s ability to wash and bathe.

‘Washing’ means cleaning ones whole body, including removing dirt and sweat.

‘Bathing’ means getting into and out of either a standard bath or shower. Shower includes shower attachments for a bath.

For the purposes of this activity, wet-rooms are not a consideration either in the context of a standard bathroom or as an aid or appliance.

When considering whether a claimant requires an aid or appliance, HPs should

distinguish between:

• an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; and

• an aid or appliance that a claimant may be using or wish to use because it makes it easier to carry out the activity safely, reliably, repeatedly and in a timely manner.

Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not required in the latter.

Where a claimant chooses not to use an aid or appliance that he or she could reasonably be expected to use and would enable them to carry out the activity without assistance, they should be assessed as needing an aid or appliance rather than a higher level of support.

A Can wash and bathe unaided.

Applies to claimants who can wash and bath unaided, including getting in to and out of a standard bath or shower.

To avoid doubt, a claimant does not have to be able to access both a bath and a shower for this descriptor to apply. If they are able to wash unaided using either a standard bath or a standard shower, that is all that is required. Note: shower attachments for a bath are included.

Within the assessment criteria, the ability to perform an activity ‘unaided’ means without either the use of aids or appliances; or help from another person.

B Needs to use an aid or appliance to be able to wash or bathe.

For example: a long-handled sponge, shower seat or bath rail. If a claimant uses a shower attachment on a bath, this should be considered as a standard bath or shower. A wet-room is not considered an aid for this activity.

C Needs supervision or prompting to be able to wash or bathe.

‘Prompting’ means reminding, encouraging or explaining by another person. For example: may apply to claimants who lack motivation or need to be reminded to wash, or require supervision for safety reasons. When considering safety, the HP should assess the likelihood of a risk to the claimant occurring. If the claimant can wash or bathe the majority of the time without risk of injury, for example because their health condition is under control through medication, then this descriptor would not apply.

Needs assistance to be able to wash either their hair, or body below the D waist.

For example: may apply to claimants who are unable to make use of aids and who cannot reach their lower limbs, or their hair.

E Needs assistance to be able to get in or out of a bath or shower.

This descriptor relates to physical assistance by another person and should be applied to the use of a standard bath or shower.

Needs assistance to be able to wash their body between the shoulders F and waist.

Torso refers to any part of the body between the shoulders and waist; front and back.

–  –  –

Activity 5 – Managing toilet needs or incontinence This activity considers a claimant’s ability to get on and off the toilet, to clean afterwards and to manage evacuation of the bladder and/or bowel, including the use of collecting devices.

This activity does not consider the ability to manage clothing, climb stairs or mobilise to the toilet.

Notes:

Managing incontinence means the ability to manage involuntary evacuation of the bladder and/or bowel including self catheterisation, incontinence pads, using collecting devices and cleaning oneself afterwards.

Claimants with indwelling (permanent) catheters or stoma are considered incontinent for the purposes of this activity.

If the urinary tract is normal there will be little risk of incontinence no matter how long it takes to mobilise to the toilet. If there is, however, a bladder problem and the claimant will be incontinent before they reach the toilet, then a commode could be considered as an aid for the bladder condition (toilet needs) not the mobility problem (mobility needs). Urinary tract conditions that cause urgency of micturition will be relevant, other urinary tract conditions may not be relevant.

When considering whether a claimant requires an aid or appliance, HPs should

distinguish between:

• an aid or appliance that a claimant must use or could reasonably be expected to use, in order to carry out the activity safely, reliably, repeatedly and in a timely manner; and

–  –  –

Descriptor advice in favour of an aid or appliance should only be given in the former case. An aid or appliance is not required in the latter.

Where a claimant chooses not to use an aid or appliance that he or she could reasonably be expected to use and would enable them to carry out the activity without assistance, they should be assessed as needing an aid or appliance rather than a higher level of support.

–  –  –

Within the assessment criteria, the ability to perform an activity ‘unaided’ means without either the use of aids or appliances; or help from another person.

Descriptor A may be appropriate for claimants who use a commode due to limited mobility (to the toilet) but can manage their toilet needs or incontinence. If the urinary tract is normal there will be little risk of incontinence no matter how long it takes to mobilise to the toilet. If there is, for example, a bladder problem and the claimant will be incontinent before they reach the toilet, then the commode is being used as aid for the bladder condition (toilet needs) not the mobility problem (mobility needs). Urinary tract conditions that cause urgency of micturition will be relevant, other urinary tract conditions may not be relevant.



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