Case Studies » Domiciliary Care Allowance » Domiciliary Care Allowance - Case from 2015 Annual Report (ref: 2015/02)

Question at issue: Whether the eligibility criteria are met

Background: The appellant’s daughter (aged 6 years) underwent surgery when she was 2 years old.  However, she reacted adversely and sustained cardiac damage.  She has been diagnosed as suffering from Heart Block, Plaque (Guttate) Psoriasis, and has had a pacemaker surgically implanted.  In her appeal, the appellant stated that both the cardiac problem and the Psoriasis are life-long conditions which require constant monitoring and frequent attention both during the day and at night. 

Oral hearing: The appellant attended, accompanied by a relative.  The Appeals Officer asked if she had been advised as to the cause of the conditions which her daughter now suffers and she responded that she had never received a satisfactory explanation.  She said that the child had been monitored and examined extensively prior to heart surgery in 2013, having had a heart monitor fitted regularly from 2011 up to the time of the operation in 2013.  She had attended a number of consultants, and had been admitted to hospital for tests and observation in the week prior to the operation.  She had not been on medication before the pacemaker was fitted.

The Appeals Officer asked the appellant to outline the additional care and attention that her daughter now requires.  She advised that she cannot be allowed near generators or microwave cookers, that she cannot use mobile phones or tablets, and must avoid loud beat music as all these situations have the potential to interfere with the pacemaker.  She recalled an incident where the pacemaker had activated a security alarm as she was leaving a shop, and said that it had been very embarrassing.  She is required to attend an outpatients’ clinic for treatment of Psoriasis and she finds this very distressing and cries every time she has to travel for the appointments.

The appellant stated that her daughter is additionally very restricted in the activities she can engage in and is not allowed, for example, to attend the circus, or go to a disco, or take part in sports.  She said that she is very isolated from other children.  Her food is also restricted; she can eat meat and vegetables but cannot be allowed white bread, pasta or cheese, as she must avoid wheat and dairy products.  She can dress herself adequately other than the problems that arise from the cream that is applied for the Psoriasis.  The appellant said that the medication prescribed is normally restricted to adult use.  Her sleeping pattern is regularly disturbed and interrupted due to her skin problem, as she may scratch in her sleep and aggravate the condition, causing a flare-up which wakes her.  This can require a full application of cream to assist in bringing the flare-up under control.  On a daily basis, she must be washed and have three applications of cream.

The appellant stated that her daughter is not on any medication other than the topical application of cream for Psoriasis and that she attends outpatient appointments on a quarterly basis.  She attends her local primary school, where there is a defibrillator on site in the event that she should require it.

The appellant submitted that heating and electricity bills for the family are usually very high as her daughter must be bathed frequently.  She referred also the travelling costs for attending appointments in Dublin, and advised that her daughter’s clothing must be replaced regularly because of the difficulty in washing clothes that have been in contact with the cream applied for Psoriasis.

Conclusion: The Appeals Officer noted that there were two specific medical conditions referred to, and that the appellant’s daughter required specific care for each.  He noted that medical evidence, in the form of the ability/disability profile, indicated that she was affected to a mild degree in one area only as a result of these conditions – that of reaching/lifting/carrying.  In all other areas, she had been assessed as having a normal ability level.  Having considered all the medical evidence and the evidence adduced at oral hearing, he concluded that it had not been established that the appellant’s daughter requires additional care and attention which is substantially in excess of that required by a child of the same age without the conditions diagnosed, as set out in social welfare legislation for the purposes of Domiciliary Care Allowance.

Outcome: Appeal disallowed.