• Domiciliary Care Allowance (DCA) is a monthly payment for a child aged under 16 with a severe disability, who requires ongoing care and attention, substantially over and above the care and attention usually required by a child of the same age.

• Domiciliary Care Allowance (DCA) is not means tested.

• Domiciliary Care Allowance (DCA) is not taxable.

• The allowance amounts to €309.50 per month.

•   All children getting DCA are eligible for a full  medical card without a means test.

• If you are getting Domiciliary Care Allowance, you automatically qualify for the annual €1,700 Carer's Support Grant which will be automatically paid to you in June.

• Getting the DCA does not affect your entitlement to Child Benefit and you may also qualify for Carer's Benefit or Carer's Allowance if you meet the other conditions. People getting DCA do not need to fill out the medical form when applying for Carer's Allowance or Carer’s Benefit.

So to summarise the DCA  entitles you to:

○    €309.50 per month ( = €3,714 per year)

○    An annual grant of €1,700.

○    A full medical card for the child.

○    Medical certification automatically in place for Carer’s Allowance or Carer’s Benefit application.

For comprehensive treatment on Domiciliary Care Allowance see Citizens Information or DEASP

• Domiciliary Care Allowance is an important allowance that will be of relevance to any parent of a child diagnosed with narcolepsy. As outlined in the summary above, apart from providing financial assistance, it also provides the child with a full medical card  which is in itself an important financial help to the parent(s). Also it is effectively* NOT means tested and is NOT taxable. Furthermore, it fulfills the medical certification requirements for a Carer's Allowance application and a Carer's Benefit application which makes either of those applications considerably easier to make. (* The means test is that of the child, which in the vast majority of cases means that the means test is not relevant)

• The medical criteria which the Department's medical assessor uses to determine whether your child will qualify for DCA are very precisely defined. 

• The fact that narcolepsy is generally so poorly understood makes it possible that any third party will underestimate the severity of this disease. When filling the DCA application form care should be taken  not to exaggerate in any way the severity of your child's specific condition and how it impacts on their life. But equally important, care should be taken not to understate the severity of your child’s condition and one should not assume that the assessor will automatically understand the full implications of narcolepsy and of how disabling it almost always is.

• There is a comprehensive document prepared by the Department of Social Affairs which offers guidelines on medical eligibility for Domiciliary Care Allowance - DCA Medical Guidelines.

• We have prepared a  condensed extract from that document which can be found  here.  Note the importance placed on the exact definitions for the DCA application of such words as “disability”, “impairment”, “severe”, “substantial” and some others. If your child is severely disabled by narcolepsy then be sure that that is clearly stated on the application form using the words above, both in your own description and in the section completed by the consultant.

• The majority of the questions in the portion of the DCA form that you personally are asked to fill will require some additional comments and clarification. The space provided on the form may not be sufficient to allow you to comfortably deal with these so it is permissible to attach a supplementary letter (and attach it to the form) on which these issues can be dealt with. Make sure to reference each comment back to the relevant question and section on the form.

• MAKE SURE to put your name and PPS no on the form and on all supplementary letters / explanations / correspondence.

• In deciding on your answers you may find it useful to refer to this extract from the HSE’s own publication:   "A National Model of Care for Paediatric  Healthcare Services in Ireland. Chapter 34: Paediatric Neurology and Epilepsy"  which describes the clinical features of narcolepsy. Note their own reference to “life threatening situations”.

• We would add that it is an irrefutable fact that children who have narcolepsy with cataplexy (70% of cases) are always in danger of cataplectic collapse leading to life threatening outcomes.

It seems clear that the description above definitely describes "a severe disability requiring continual or continuous care and attention substantially in excess of the care and attention normally required by a child of the same age".

• The portion of the form to be completed by your child’s GP / Specialist / Consultant should also take account of the terminology that the  Department's assessors use. If your doctor does not consider that your child has  "a severe disability requiring continual or continuous care and attention substantially in excess of the care and attention normally required by a child of the same age" then of course they will not say that they have. But if they do believe that your child has such a disability then they should say so  using those words.

•   The final part of the form is used by the doctor to grade how your child’s condition has affected their ability levels in various categories. The grades are:  Normal, Mild, Moderate, Severe, Profound. Your doctor will almost certainly need to discuss these categories with you. While you should not in any way overstate the deterioration in your child’s ability levels, you should certainly not understate them either.

 So, to conclude and repeat:

• If your child has narcolepsy with cataplexy the reality is that your child will require full time care and monitoring for the foreseeable future. The consultant should make this clear when filling out the DCA form. The wording is critical. The words - “Severe, Disability, and Substantially more than...” etc as used below, have exact definitions in the context of the DCA. As you can see in the extract from the guidelines referred to above, the Department pays great attention to the definitions of these words as used in the 2008 Act, and those word should be used if applicable. If they are not applicable your child will not fulfill the medical criteria. So, be accurate. If the doctor / consultant feels your child meets the DCA medical criteria they should state so in an unequivocal manner,  writing as a footnote to the form (at the end) something along the lines of:

  “(Childs name) has narcolepsy with cataplexy, a severe disability.  (Childs name) requires long term, ongoing  care and attention substantially more  than another child of the same age. (Childs name)  cannot be left unmonitored / unsupervised at any time for the foreseeable future. (He / She ) will require full time care and attention for many years”.

•  Also - in filling the Medical Report on the form in relation to impairment of Ability Level, you should not overstate or understate the severity of impairments. If the impairment is profound or severe  then that is what needs to be ticked in each category where it applies.

 For comprehensive treatment on Domiciliary Care Allowance see Citizens Information or DEASP