Internal Guidelines used in processing claims
Table of contents:
1. Description of scheme
2. Information Leaflet
5. Qualifying Conditions
6. Medical Conditions
7. Habitual Residency Condition
8. Rates of payment
9. Method of payment
10. Duration of payment
11. Half rate payment
12. Hospital stays
13. Absences from state
14. Respite payment
15. How to apply
16. Late claims
17. Where to apply
18. The Application Process
19. Decisions/Review and the right of appeal
1. Description of Scheme:
Domiciliary Care Allowance (DCA) is a monthly payment for a child, aged under 16 with a severe* disability who requires ongoing (continual or continuous) care and attention, substantially* over and above the care and attention usually required (in excess of that required) by a child of the same age. The child is likely to require full-time care and attention for at least 12 months. There are no PRSI conditions and it is not means tested.
*The definitions used for terms such as severe or substantial in this qualifying condition are detailed in the DCA Medical Guidelines used by the Department in assessing applications for DCA. These can be found on www.welfare.ie
2. Information Leaflet:
Domiciliary Care Allowance - SW127 available from Intreo Centres, Citizens Information Centres, on www.welfare.ie or from DCA Section Sligo.
The DCA scheme is a statutory scheme with the primary legislation provided for in the Social Welfare and Pensions Act 2008. The medical criteria as set out in the Act require that "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". The Department uses a set of consistent and objective guidelines** in determining the medical eligibility of children for the scheme. These guidelines were drawn up by a Group chaired by the Department’s Chief Medical Advisor comprised of senior medical personnel from the HSE as well as eminent professionals in the areas of physical disabilities which affect children, and child psychiatry/psychology. All claims are assessed by designated Departmental Medical Assessors who have received special training in Human Disability Evaluation.
**These guidelines were originally published in 2009, reviewed and revised in May 2013 and operational in their revised format from date of publication.
The scheme is administered from the Social Welfare Services Office, College Road, Sligo.
5. Qualifying Conditions:
You may qualify to receive the allowance for a child under 16 with a disability if:
- you are providing for the care of the child,
- the child meets the medical criteria,
- the level of care is likely to be required for at least 12 months,
- Both you and the child are ordinarily resident in the State. This means that you both live in the Republic of Ireland and only leave Ireland for holidays,
- the child normally lives at home with you for at least 5 or more days a week, and
- the child is not detained in a children's detention school, in residential care or other placement.
- Payment is not made for a child who lives full time in residential care or in other placements. However, a half rate payment can be made for a child in residential care, who goes home for two or more days a week. For example, a child who attends residential services from Monday to Friday and goes home at weekends.
6. Medical Criteria
In order to qualify for DCA 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 level of care and attention for at least 12 months.
Eligibility for DCA is not based primarily on the medical or psychological condition, but on the resulting lack of function of body or mind necessitating the degree of extra care and attention required. As such it is not possible to say if a particular child or any particular condition/disability will qualify for a payment under the scheme. Each application is assessed on an individual basis taking account of the evidence submitted.
The Department's Medical Assessor will take the following into account before giving his/her opinion on whether the child meets the medical criteria:
- Review the history of the case
- Consider all medical reports received
- Have regard to the description of the care and attention required by the child given by the parent/guardian.
7. Habitual Residency Condition
In addition, the person claiming the allowance for the child must provide for the care of the child and also be habitually resident in the State. The term "habitually resident" is not defined in either Irish or EC law, but it is intended to convey a degree of permanence evidenced by a regular physical presence enduring for some time, beginning at a date usually in the past and intended to continue for a period into the foreseeable future. It implies a close association between the applicant and the country from which payment is claimed and relies heavily on fact.
The following are the five factors taken into consideration in relation to Habitual Residency:
- Length and Continuity of residence in Ireland or in any other particular country
- Length and purpose of any absence from Ireland
- Nature and pattern of employment
- Applicant's main centre of interest
- Future intentions of applicant as they appear from all the circumstances.
8. Rates of payment:
The DCA rate is €309.50 per month (2010). There is no restriction on the number of children in respect of whom DCA can be claimed.
9. Method of Payment:
Payment is made on the third Tuesday of every month for the current month. Payment maybe made through a Post Office of the applicant’s choice by Social Welfare swipe card (E.I.T.), alternatively, the allowance may be paid by electronic fund transfer (E.F.T.) into his/her account in a financial institution. Any arrears of payment due may be included in the normal method of payment or paid by cheque.
10. Duration of Payment
DCA and increases for qualified child/ren are payable as long as all the qualifying conditions are satisfied and the person is not disqualified from receipt of the Allowance e.g. ceases to provide full-time care and attention, the child reached age 16, or leaves the State.
11. Half rate payment
Children who are being cared for on a full time basis in residential homes or other institutions are not eligible for the allowance. However, children in residential care who go home may receive a half rate payment if they are at home for 2 days or more a week, for example, a child who attends residential services from Monday to Friday and goes home at weekends.
12. Hospital stays
Payment may continue for up to 13 weeks if the child is getting medical or other treatment in hospital.
13 Absences from the state:
The allowance is not payable in respect of any perios that the child is living outside the state.
14. Respite Payment
You will also qualify for a Respite Care Grant; this is an annual payment to persons who provide full-time care and attention to others and is paid in June of each year. You do not have to apply for this grant but will receive it automatically if in receipt of DCA in June. This grant is paid at a fixed amount per eligible child.
15. How to apply
To apply, fill in a Dom Care 1 form which can be downloaded from www.welfare.ie or text "FORM DCA" followed by your name and address to 51909 (from the Republic of Ireland only). Standard text rates apply. Application forms are available in Intreo Centres or Citizens Information Centres. You should complete Parts 1 to 5 of the application form and have your child’s G.P./Specialist complete parts 6 and 7 (the medical section). Please ensure that you attach any reports or assessments relevant to your child’s disability and the impact it has on their care needs.
If your child has a pervasive development disorder (PDD) (see below), you are advised to have the medical professional/specialist dealing with your child complete an additional medical form Dom Care 3 available on www.welfare.ie. The completed form will detail your child’s conditions, any specific care needs your child might have as a result of their disability and will assist the Department’s medical assessor in forming an opinion on eligibility.
Pervasive Development disorder (PDD) refers to a group of disorders characterized by delays in the development of socialization and communication skills. Autism, Asperger’s Syndrome, Childhood Disintegrative Disorder and Rett’s Syndrome are generally referred to under this category.
16. Late Claims
- You should apply as soon as you consider that you and your child satisfy the qualifying conditions Office.
If you delay in applying, you will, subject to satisfying the qualifying conditions for the scheme, usually get Domiciliary Care Allowance from the month after we get your application. If some circumstances the payment can be back-dated for 6 month if good cause for the delay in applying can be shown.
17. Where to apply
Application forms and supporting documentation should be sent to:
Domiciliary Care Allowance
Department of Social Protection
18. The Application Process
- Departments Website, www.welfare.ie, any SWLO, Citizens Information Centre, DCA Section in Sligo or by texting 51909.
- Complete the application form Dom Care 1, and have your GP/Specialist fill in the medical section of the form, include medical reports or other supporting documentation that you think helps explain your child’s care needs.
- Please note that as your child will not be physically examined by the medical assessor (MA) (they assess your child’s care needs based on the medical and other information you provide), it is IMPORTANT that you detail your child’s care needs in a comprehensive but concise manner. This will ensure the MA will have all the necessary information available to them.
- If you child has a pervasive developmental disorder (PDD), e.g. Autism Spectrum Disorder, you are advised to complete an additional medical form, Dom Care 3, which is available on www.welfare.ie or from DCA Section Sligo. This form should to be completed by a medical professional/specialist dealing with your child. It will detail the child’s condition(s) and any specific care needs the child might have as a result of their disability and will assist the Department’s MA in forming their opinion.
- If you give us a mobile phone number, we will send you a text message to confirm receipt of your application by the Department.
- Your application, including any additional information you provide, will then be examined by one of the Department’s medical assessors, who will provide an opinion to the deciding officer as to whether your child meets the medical criteria for the scheme.
- If the additional form “Dom Care 3” is not received and is considered desirable/necessary by the MA, a decision will not be made until we contact you to see if you want to submit this form. If a completed form has not been provided in a reasonable time frame the MA will proceed to make a decision.
- The deciding officer having received the opinion of the medical assessor will consider the application in its entirety and make a decision on whether you qualify for DCA or not. You will receive notification of the Deciding Officer’s decision in writing. (We will write to inform you of the decision.)
- In the notification you receive, you will be advised of the Deciding Officer’s decision. If the application is allowed you will be advised when and how payment will be made and when your entitlement may be reviewed. If the decision is to disallow your application, you will be told the reason for the disallowance and given the right to have the decision reviewed and/or you can appeal the decision directly to the Social Welfare Appeals Office (SWAO).
- In the case of PDDs - Where the decision of the deciding officer is that you do not qualify for DCA, a detailed assessment form can be provided to document the areas that were considered by the MA in forming their opinion.
- Should you request a review of or appeal a disallow decision, your application will be sent for a review opinion by another medical assessor, together with any new or additional medical or other information received.
- When the medical assessor’s opinion is known, a revised decision will be considered by the deciding officer if necessary.
- If you appeal the case, the appeals officer in reaching their decision will provide a reason for their decision in each case, for your information and that of the deciding officer.
19. Decisions/Reviews and the right to Appeal
Claims are decided by Deciding Officers appointed by the Minister under Section 299 of the Social Welfare (Consolidation) Act 2005. They are independent in the exercise of their function in deciding on entitlement to DCA.
A written notification of the decision is issued to the claimant. Claimants are also advised of their right of appeal against a Deciding Officer's decision.
Any decision of a Deciding Officer may be subsequently revised by a Deciding Officer in the light of new information or evidence. This could arise where new information is made available as part of an appeal by the claimant. In such circumstances, a Deciding Officer may revise a decision on entitlement, if it is to the advantage of the claimant. There is also a right of appeal against a revised decision.
In the case of an application which is refused on medical grounds, the applicant may submit additional information and/or ask for the case to be reviewed by a different Medical Assessor specially designated for this task. Where a person is not satisfied with the decision of a Deciding Officer they may appeal the decision to the Social Welfare Appeals Office. The appeal should be made by writing to the Chief Appeals Officer, Social Welfare Appeals Office, D'Olier House, D’Olier Street, Dublin 2, within 21 days of notification of the Deciding Officer's decision, stating the grounds of appeal. The Appeals Officer can decide the matter summarily or may deal with the case by way of an oral hearing.
A statement is prepared on the facts relied on by the Deciding Officer in the making of a decision on entitlement to DCA and on the extent to which the facts and contentions advanced by the appellant are admitted or disputed. This statement is put before the Chief Appeals Officer.