This article was written by Gary Vaux for the February 2014 Solicitors for the Elderly (SFE) newsletter.
Attendance allowance - the forgotten benefit?
This article is all about attendance allowance (AA) a non-means-tested benefit for people aged 65 or over with a disability or long-term health problem. In many ways, it is the forgotten element of the Government’s welfare reform programme. Benefits for working age people are facing major changes at some point before 2017, Universal Credit will replace six means-tested benefits. Disability Living Allowance (DLA) is being replaced, over a 5 year period ending in 2018, by Personal Independence Payment (PIP). Retirement pensions are being substantially altered and even the means-tested ‘top-up’ of pension credit (although remaining) will look very different once housing costs and an allowance for any dependent children are added. Yet nothing appears to be happening to attendance allowance.
With payments potentially exceeding £300 a month, it can make an enormous difference to the well-being of many older people. Yet independent research shows that only about half of eligible pensioners actually claim it.
It can even help people who are ‘self-funding’ in care homes to meet at least some of their costs, so it can be a very valuable source of additional income.
What is attendance allowance (AA)?
You may qualify for attendance allowance (AA) if you are aged 65 or over and have a mental or physical illness or disability which affects your ability to manage your personal care, or if you need someone to keep an eye on you throughout the day. For example, you may qualify if you have difficulties having a bath, getting dressed, eating, using the toilet, taking medication or moving around at home as well as problems with your sight, hearing or memory or problems with falls or seizures. AA is paid at one of two rates, depending on the level of your needs.
AA is a tax free cash payment and you can spend it however you like. It can be paid on top of other benefits and you may qualify for an increase in other benefits as a result of getting AA.
If you are under 65 and disabled (whether male or female), you should be getting DLA or PIP. If you do qualify before age 65, you can keep that benefit beyond your 65th birthday, for as long as you continue to meet the criteria for those benefits. You don’t have to switch to AA. So, if you are approaching 65, it’s worth checking your entitlement to PIP if you haven’t already claimed it (there are no new claims for DLA except for children). This is because PIP can include an extra payment for mobility needs, which isn’t available in AA.
Who can get AA?
It belongs to you, the disabled person, not your carer and you can get it even if you don’t have a carer. You can claim AA whatever your income or savings. You don’t need to have paid national insurance contributions. Many people who live alone qualify for AA.
To get AA, you must:
- be aged 65 or over (this will rise to 66 by 2020, to match the increase in pension age)
- meet residence and presence conditions, for new claims or renewals made after 8 April 2013 this includes being ‘habitually resident’ and having been present in Great Britain for at least two out of the past three years
- meet the care and/or supervision conditions
- have satisfied those conditions for at least six months
Special rules apply if you are terminally ill: you can be fast-tracked onto AA higher rate and can apply straight away, even if you haven’t needed help for six months. You also don’t need to satisfy the past presence test. To claim under the special rules, you will need to get a DS1500 certificate completed by a doctor. It is possible for someone else to make a claim for you without your knowledge.
How much AA could you get?
AA is calculated on a weekly basis and normally paid into your account every four weeks. It is paid at one of two rates.
1. Lower rate - £53.00 per week (£54.45 from April 2014)
This is paid if you:
- need frequent help with personal care throughout the day, or you need continual supervision throughout the day to avoid a substantial danger to yourself or others; or
- you need prolonged* or repeated* help with personal care during the night, or you need another person to be awake for a prolonged* period or at frequent intervals to avoid a substantial danger to yourself or others.
2. Higher rate - £79.15 per week (£81.30 from April 2014)
This is paid if you need the above help/supervision during the day and the night, or if you are terminally ill and claiming under the special rules.
* ‘Prolonged’ normally means at least 20 minutes. ‘Repeated’ means two times or more. For example, you may need someone to help you get up and use the toilet two or more times each night.
Entitlement to AA depends on whether it would be reasonable for you to have help or supervision. If you find it difficult to look after yourself, you can qualify even if you live alone or don’t get any help.
How do you claim AA?
- Telephone the DWP on 0845 712 3456 and ask for a claim form or
- Download or complete a claim form online at www.gov.uk
A carer or someone else can fill in the claim form for you, but you should still sign the form if you can.
How do you fill in the form?
The AA form asks for details about your medical condition, how you cope with personal activities, and whether you need someone to keep an eye on you.
- Take plenty of time to fill in the form and give as much information as possible. If you suffer from pain or difficulty doing something that the form asks about, describe it as fully as you can. Be realistic about how long it takes you to do things and how often you need help.
- Think about the different parts of each activity - for example, getting dressed involves selecting suitable clothes, getting them the right way round, putting them on and doing up fastenings. You may then need help later in the day to adjust clothing, remove dirty clothes or put on a coat or shoes to go out.
- Don’t be embarrassed to describe problems with things like using the toilet - it’s important to give a full picture of the difficulties you have.
- If someone has to remind or encourage you to do things, put that on the form. Spoken help can be just as important as physical help.
- If someone does household jobs for you like cleaning, laundry or shopping, that can’t normally be taken into account. However, if someone helps you to do these activities for yourself it may count, for example, if you need someone to accompany you to the shops to help you to choose things. Someone doing your laundry for you at your home may also be taken into account, especially if it’s part of a bigger package of help, such as helping you change dirty bedding or clothing.
- It doesn’t matter if you are not actually getting any help or supervision; it’s the need that matters. For example, if you used to have a bath every day but you can’t have baths any more because you live alone and it wouldn’t be safe, you can write on the form that you need help with having a bath every day.
- It may help if you (or your carer) can keep a diary for a few days before completing the form, to remind yourself of the difficulties you have. You could send a copy of the diary along with your claim form.
- If you have a carer, go through the questions with them - they can add information on the form or in a separate letter. There is a section on the form to be completed by someone who knows about your difficulties. This could be your carer, a relative or a professional person such as a GP, occupational therapist or social worker.
What happens next?
Decisions are mostly based on the information that is in the claim form. The DWP may write to your doctor or arrange for a health professional to visit you if they need more information. They may also write or phone you for further information. They will write to tell you their decision. AA can be awarded for a fixed period or for an indefinite period.
AA claims are handled by Blackpool Benefits Centre, Warbreck House, Warbreck Hill, Blackpool, Lancs., FY2 0YE. Tel: 0845 712 3456.
How does AA affect other benefits?
Getting AA can help you to qualify for other benefits. For example:
- It could help you to either get - or get more - pension credit, housing benefit or council tax support. This is especially true if you live alone and no-one gets carer’s allowance for looking after you. Tell the office that pays you these other benefits if you get AA.
- If you have a carer, they may become entitled to carer’s allowance or extra means tested benefits if you get AA. However, it is important to get advice about this because if your carer gets carer’s allowance that could reduce the amount of some of the benefits that you get.
What happens if you go into hospital or a care home?
If you apply for AA while in a NHS hospital it will not be paid until you leave. If you already get AA when you go into a NHS hospital or council-funded care home, it stops after 28 days. AA does not stop if you are a private patient or if you are in a hospice. In Scotland, if you receive a Personal Care Contribution, entitlement to Attendance Allowance ceases.
If you go into a care home, AA stops after 28 days if your local council or the NHS pays some or all of the fees for your accommodation. If you pay the fees yourself, or have agreed you will repay the council when, for example, you sell your house, AA does not stop.
If you are in residential care that includes nursing care, and it is funded by the NHS, you are normally treated as though you are in hospital and AA stops after 28 days. However, there was a ‘test case’ in 2012 which established that just being funded by the NHS doesn’t automatically mean that you are getting nursing care. The DWP were told that they should look at the type and extent of the care provided, if it was ‘domestic and personal’ rather than nursing then AA could continue even if the NHS were paying for the accommodation. Unfortunately for many residents, this path to getting AA was closed in April 2013 by amendment regulations. But there may be some residents who were refused AA prior to that date who should actually have qualified. Ask your adviser to check CDLA/3638/2008, which was later reported as Secretary of State for Work and Pensions v Slavin.
Separate stays in hospital or residential care that are less than 28 days apart get added together when working out the 28 days before AA is suspended.
If your AA stops because you are in hospital or a care home, it should start again when you return home, even if only temporarily, as long as you tell Blackpool Benefits Centre. You should also tell the offices that pay your other benefits if your AA has stopped or restarted, because loss of AA can affect how much you get from other benefits.
In some cases, you may be getting what is called ‘continuing care at home’ i.e. NHS-funded nursing care whilst still living at home. This has no impact on your right to claim or retain AA.
What to do if you are unhappy with a decision about AA
Before you decide whether to dispute a decision, make sure you understand the rules for AA as described above. If you think an award, or a higher award, should have been granted you can challenge the decision by asking for a mandatory revision. Since October 2013, you must ask for a revision first before you can put in an appeal.
If you are refused AA, or if you are unhappy with the rate awarded or the length of time it has been awarded for, you can challenge the decision. You must do this within one calendar month of the date on the decision letter if possible, although the time limit can be extended in some circumstances (seek advice).
If you already get lower rate AA but then start needing help or supervision during the night as well as during the daytime, you may be able to get the higher rate. You can ask for your claim to be looked at again. Write to the Blackpool Disability Centre or phone them on 0845 712 3456.
Be aware that by asking for a revision, appeal or supersession, you are opening up the whole claim again. It is possible that the DWP could remove what you have already got, rather than increase it, although that is relatively rare. Get advice before asking for an increase in AA.
To ask for a revision, phone or write to the DWP office that made the decision, using the address or phone number on the decision letter they sent you. Ask them to revise your claim. Send in any additional evidence that will support your claim. Someone else in the DWP will look at the claim again and see if the decision should be changed.
You have one month from the date on the decision letter to ask for it to be looked at again. (This time limit can be extended in some circumstances, seek advice.)
It is worth writing a letter telling them again about the difficulties you are having. Bear in mind the criteria for AA outlined above. It’s unlikely that the decision will be changed unless you can provide some new or additional information or evidence. You may be able to get a friend, relative, carer, doctor, social care worker, or somebody else that knows about your situation, to write a letter confirming your problems and supporting your claim. If you think it will take you some time to gather this together, make this clear when you ask for the revision so that a new decision isn’t made whilst you are getting the information.
What if benefit is still refused or not awarded at the right level?
If you ask for a revision and the decision still isn’t favourable, you can appeal to an independent tribunal. You have one month from the latest decision letter to appeal. (This time limit can be extended in some circumstances, seek advice). You should appeal using form GL24, which is available from the DWP or from advice services or online at www.gov.uk
Appeals made since October 2013 should be sent directly to the Courts and Tribunals Service. Their address will be on the revision decision letter.
Try to gather evidence about your condition and how it affects you. Letters from doctors, consultants, or other professionals involved in your case carry a lot of weight with tribunals. It may also help if you or your carer can keep a diary for a week or so, showing the sort of help you need, so that you don’t forget anything.
If the appeal goes to tribunal, you will be sent a copy of all the papers related to your claim, including your claim form and any medical or other evidence that has been used by the DWP to make their decision. At the same time, you will be sent an enquiry form to complete and return within 14 days. If you miss the deadline, your appeal will lapse. The enquiry form asks you whether you wish to continue with your appeal, whether you would like an oral or paper hearing and if there are any dates you are not available.
A paper hearing is where the tribunal just look at information that has been received about your claim. An oral hearing is where you attend a hearing and a tribunal ask you questions about the difficulties you have. Please try to attend the hearing as this is your opportunity to discuss your case and the tribunal can learn more about your case than can be gathered from papers alone. Oral hearings are more likely to succeed than paper hearings.
What happens at the appeal hearing?
The tribunal panel is made up of three people: a judge, a doctor and someone, usually from a local organisation such as Red Cross, MENCAP, etc who understands disability issues. They are independent and decide cases purely on merit. Although it is a tribunal, it’s not a court-room and you are not on trial! Most tribunals are held at ordinary offices and the members will do their best to put you at ease.
The appeal will normally be heard at the tribunal venue nearest your home. If this is not the most convenient place for you, notify the Tribunal Service and it may be possible for a different venue to be arranged. You can bring a relative or friend to the hearing if you wish.
At the hearing, everyone sits around a large table. Each member of the panel will take it in turn to ask you questions. When answering their questions, try and draw a link between your illness or disability and the assistance you need. Give plenty of detail and examples of how you have difficulty with different activities, and emphasise how often you need help. Make sure you understand the basic criteria to qualify for the benefit and be aware of these when answering questions.
You will then be asked to leave the room while the tribunal make their decision. You will probably be invited back into the room to be told the decision, or alternatively they may send you a written decision. The tribunal will give or send you a decision notice and they will also send a copy to the benefit office that made the original decision.
The benefit office will then carry out the instructions of the tribunal. If your appeal is successful you will be paid benefit from the date the original claim would have been paid from. If your appeal is unsuccessful, seek further advice as you may be able to request another appeal to the Upper Tribunal, but strict rules and time limits apply.
Further help and advice
CAB - Online information: www.adviceguide.org.uk
GOV.UK - Government website with information on benefits and public services: www.gov.uk
DWP - Blackpool Benefits Centre. Warbreck House, Warbreck Hill, Blackpool, FY2 0YE. Tel: 0845 7123456
Carer’s Allowance Unit - Palatine House, Lancaster Road, Preston, Lancs. PR1 1HB. Tel: 0845 608 4321
Carers UK - Adviceline 0808 808 7777. www.carersuk.org
Turn2us - on-line benefits calculator, benefits advice, grant-finder. www.turn2us.org.uk/benefits or 0808 802 2000
Age UK - Information on benefits, care homes, tax and many other issues. www.ageuk.org.uk or 0800 169 6565
Independent Age - Full range of guides and factsheets. www.independentage.org/ or 0800 319 6789.