Extract from the Medical Guidelines
(DCA medical guidelines in full here)

• 5.1
  Sections 15 to 17 of the Social Welfare and Pensions Act, 2008 set out the eligibility conditions for Domiciliary Care Allowance which will apply post transfer. These conditions require that, to be eligible for payment a medical practitioner must certify that:- (i) the 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, and (ii) the disability is such that the child is likely to require full-time care and attention for at least 12 consecutive months.

  Definitions

  •  5.2 Each of the terms in the legislative requirements outline above are explained below, using clear language so that potential applicants and decision makers can understand what is required.

  •   5.3 The Group examined a number of definitions of disability that are in use in Ireland, the UK and internationally. It was agreed that Domiciliary Care Allowance is not awarded primarily on the basis of an impairment or disease, but on the resulting lack of function of body or mind necessitating a degree of extra care and attention required.

  •  5.4 There was agreement that the World Health Organisation was the closest definition of disability to what was required. This decision was based on the importance of including the word “impairment “in the definition and making sure the definition was suitable for children.

  • 5.5 The Group agreed that the definition of “impairment” used by the World Health Organisation would be used: “Any abnormality of, partial or complete loss of, or loss of the function of, a body part, organ, or system”.

  •  5.6 After some consideration, the definition of disability agreed was:- “Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a child compared to a child of the same age.”

  • 5.7 The Oxford English Dictionary descriptions of “severe” were discussed – serious, critical, extreme in an unpleasant way. These phrases could be used in the proposed guidelines to describe the nature of eligible disabilities.

  • 5.8 The provision of care and attention for Domiciliary Care Allowance must be continuous or continual. Definitions of both words were examined. These definitions would appear to allow for “brief” interruptions to the care and attention being provided.

  •  5.9 Care and attention needs would not meet the eligibility criteria if they related solely and individually to bringing a child to school or to social activities or helping with homework.

  • 5.10 The Group noted the definition of “substantial” as described in the Oxford English Dictionary as “of large size or amount”. They endorsed its use in respect of the degree care and attention that is required because of the child’s severe disability.

  • 5.11 An awareness of what type / level of care is required by children of different ages is required in order to establish what is “substantially in excess”. To assist the Medical Assessor, a guide to the normal age of attainment of certain activities, compiled as part of the Office for Population Censuses and Surveys study on Disability in Childhood in the UK, is attached at Appendix 6. In Summary

  • 5.12 All children require a certain amount of care and attention but children with severe disabilities may require substantially more care and attention.

  • 5.13 In order to qualify for Domiciliary Care Allowance a child must have a disability so severe that it requires the child needing care and attention and / or supervision substantially in excess of another child of the same age. This care and attention must be given by another person, almost all of the time, so that the child can deal with the activities of daily living. The child must be likely to require this care and attention for at least 12 months.