Chapter 61 -Attendance Allowance and DLA care component -Definitions - Attention with Bodily Functions
Attention with bodily functions
61101
Attention is defined as some personal service of an active nature in connection with bodily functions, including breathing, dressing, drinking, eating, eliminating waste products, getting into or out of bed, hearing, seeing, sitting, sleeping, walking and undressing. It does not in general include cooking, shopping, keeping the house clean, or other domestic tasks which are commonly done by one person for the benefit of another
61102
Where a domestic task is closely associated with a bodily function and performed as part of a continuous single episode of attention in connection with that bodily function, the domestic task may form part of that episode of attention.
Example
A disabled person with arthritis is incontinent at night. Because of the arthritis she needs help to change and wash her soiled clothing and bedding. If after helping her to change the carer rinses or puts the soiled clothing and bedding to soak, that will form part of the attention being given. The consequences of the incontinence must be dealt with on the spot to qualify.
61103
Attention must be provided in the physical presence of the disabled person and will generally involve physical or personal contact. It may also be given by means of the spoken word, only where there is physical presence.
Examples of attention by means of the spoken word include
guiding a blind person in unfamiliar surroundings will involve giving oral directions,
reading personal correspondence to a person with a visual impairment
encouraging a person with a mental disability to eat, wash, dress or get out of bed where he would not otherwise do so.
This list is not exhaustive.
Also, DMs must not overlook the need to check the usual requirements of mental/physical disablement and whether that is so severe that the person reasonably requires attention in connection with one or more specific "bodily function", and what precisely the relevant impairment of function is.
61104
The DM should look at the evidence and consider the following questions
1. does the person have a disability?
2. if so, what bodily functions does it impair?
3. does the person reasonably require attention in connection with those functions?
4. how often is the attention required and how long does it take?
61105
To satisfy the conditions of entitlement, attention has to be reasonably required, not medically required1. It is the amount of attention required that is the determining factor, not the amount of attention received.
Example
Someone may provide more attention than is actually needed. They may check if the person needs to go to the toilet during the night when there is no evidence of incontinence.
61106
The amount of attention required to satisfy the conditions of entitlement is not defined in legislation.
This should be decided from
1. the frequency and pattern of the person’s need for attention
and
2. the evidence of the person’s requirements over a period of time.
Note Someone may manage without attention even though it is reasonably required.
61107
Attention required to enable a person to carry out a reasonable level of social or leisure activity is reasonably required1. The DM should consider whether it is reasonable for a person with the claimant’s disability to want to undertake a particular activity. It may be that there are activities in which the disabled person cannot take part, whatever attention is given. Such attention is not reasonably required.
61108
Examples of bodily functions for which attention may be required are in 61120-61136. The list is not exhaustive, and DMs should use their own judgement in each case. Some functions considered on their own may need relatively little help but combined with others may bring a person within the scope of AA or DLA (care). Further guidance is available in the Handbook.
Breathing
61120
A disabled person may need a considerable amount of help with breathing from somebody else
Example
People with severe respiratory problems may only be able to breathe reasonably well when propped up in bed. If they slide down the bed they may become very breathless. If they are unable to pull themselves back upright, they are likely to need repeated propping up in bed.
Cleanliness and skin protection
61121
Help with washing, cleaning teeth, and caring for the hair, nails and skin may be needed, because a person is
1. physically incapable of carrying out these tasks
or
2. so disturbed mentally as to neglect personal hygiene.
Dressing and undressing
61122
Dressing and undressing are usually only needed at the beginning and end of the day. But it may be a long slow process for those who are disabled physically or mentally. (For example a person with severe arthritis may not have enough function in the hands to do up buttons).
61123
There may be a reasonable need for attention even though a person is able to perform this function. For example, a person with dementia may not even recognize the need to dress and may need to be reminded repeatedly to do so
Eating and drinking
61124
Severe disability can lead to difficulty with cutting up food or with feeding. If a person has special cutlery or other aids this should be taken into account when assessing the amount of help that is needed.
Getting into or out of bed
61125
A person may need help in getting in and out of bed. But the possession of suitable aids should be considered when assessing the need for attention.
Going to the toilet (elimination of waste products)
61126
Incontinence is a feature of many disabilities. A disabled person may be physically incapable of getting to the toilet in time because
1. of general infirmity
or
2. the person does not get enough warning of the need to go to the toilet.
61127
Incontinence may also occur when a mentally disabled person is unaware of the need to go to the toilet.
61128
Other needs connected with incontinence, such as help with clothing, changing bedding and emptying commodes, should also be taken into account
61129
Help with going to the toilet is not limited to people who are incontinent. It can include help
1. to get there
or
2. with clothes whilst there
or
3. on and off the toilet
or
4. with wiping.
Hearing
61130
Where a person with a hearing defect needs a third party to interpret in order to communicate with someone else, the interpreter is providing attention. In a two-way conversation where the parties are signing rather than speaking to communicate, that will not usually amount to attention. Someone who has to speak more loudly or slowly, or listen more carefully is not providing attention. Only if there is an element of service involved is the other party to a two-way conversation providing attention; for example, when helping a deaf person to learn sign language.
Seeing
61132
A visually impaired person may need
1. help with reading letters
or
2. help with choosing appropriate clothing
or
3. guidance to avoid injury when walking in unfamiliar surroundings.
The guidance may be given by touch or by the spoken word
Sitting
61133
Attention may be needed if a person cannot get up from a chair. The use of any suitable furniture or special aids a person has should be considered when assessing care needs.
Sleeping
61134
The inability to sleep does not in general, give rise to additional needs for adults. But assistance to a person who, through discomfort or distress, is unable to sleep without relief (for example someone who is completely unable to move in bed), should be taken into account.
Taking medication
61135
A person with impaired manual dexterity may not be able to administer their own medication. A person who is confused may need attention to ensure the correct dose of medication is taken at the right time.
Turning over in bed
61136
Many disabilities make it difficult to turn over in bed. This may lead to skin damage, for example to a person who has lost skin sensation as in paraplegia or some other neurological disorder. There is a great risk of the skin breaking down and pressure sores forming if the person is not regularly turned each night. Such a person also needs regular attention to the skin.