Kate Sheehan explores her interpretation of the Disabled Facilities Grant (DFG)
Sometimes it is good to review your knowledge, with this in mind I enrolled on the Disabled Facilities Grant (DFG) Basics Training course run by Foundations and delivered by Rachel Russell (Foundations.uk.com). I wanted to challenge my understanding of the legislative framework, guidance and recent Ombudsman cases.
What could be described as a very dry subject, Rachel delivered it with energy and enthusiasm, and most importantly made me reflect on my interpretation of the legislation, and even more importantly made me really think about the occupational therapist’s role.
I have always used the phrase “we are advocates for our clients, not gatekeepers for our employers”, when it comes to the DFG assessment and recommendation. Is this really the case? We certainly do have a duty to our clients, our professional standards for OT practice conduct and ethics states we should provide a person-centred or personalised service, but is this the same as advocate?
On reflection, advocate is the wrong word. I need to use the word “collaboration” with our clients, and be able to have those, often difficult, conversations around what is necessary and appropriate within the context of our other standard - “to make best use of and sustain resources, including financial, human and environmental”.
I do think we should collaborate in the process of assessing and defining our client’s needs, we should not however, gatekeep services that clients have a legal right to access. We need to clinically reason our recommendations considering our professional knowledge, this process is not always easy and definitely not clear cut.
To give an example, let’s look at a case of an older person living alone in a three-bedroom property, with a ground floor bathroom and two reception rooms:
Client - the client would like to access their bedroom that they shared with their late husband during their 50-year marriage, and the spare bedroom used as her craft room.
Occupational therapist - ground floor facilities could meet her need, with minor modifications. Although access to the whole property would enable the client to continue with occupations which bring meaning and purpose to her life, which is certainly in my opinion the person-centred approach.
Landlord - the landlord stated they would not adapt the ground floor bathroom or put in a lift as they would expect her to move, she is under occupying and they have a 10-year wait for three-bedroom family homes. They have some one-bedroom wheelchair accessible properties being built down the road that would meet their tenants need.
The OT can clinically justify the necessary works to access and use a bedroom and modify the ground floor bathroom, however we need to be aware of finite resources and the strain on the housing waiting lists. Yet, our professional knowledge knows that in the Islington Judicial review Judge Mercer stated: “in my judgment it is not lawful to refuse a DFG on the ground that the claimant must move her home”.
I have no concise answer to this dilemma. What is our role? I think we need to step up and have some difficult conversations with our clients, as we hopefully have a mutually respectful relationship and rapport that will enable us to discuss their needs, the legal duties, available money/finances, limited housing stock, and what is possible to achieve.
In the end, it isn’t actually our decision, the housing department may refuse a disabled facilities grant, the landlord may refuse permission, and the client could decide to keep struggling up the stairs on their bottom and strip wash because they do not want to move, and ultimately it could end up in court in front of a judge.
So, thank you Foundations, and in particular Rachel Russell, for making me rethink my practice and allowing me to focus on a collaborative role with my clients which will include those difficult conversations. Maybe we need training on how to have those difficult conversations? Over to you Foundations.
Kate Sheehan is a well-respected occupational therapist with over 30 years experience, and is the founder and director of The OT Service. You can follow Kate on Twitter @OTKateSheehan and visit TheOTService.co.uk to find out more.