Adult dependant relative – care requirement

We have seen a number of adult dependant ILE (indefinite leave to enter) applications being refused since the much more restrictive rules came into force 09 July 2012. Prior to the change in rules, it was quite simple for an adult dependant relative of a settled person to be granted ILE. The settled person just needed to undertake a sponsorship (5 years) of their relevant adult dependent relative and provide evidence of adequate means (maintenance and accommodation) to support the relative, and they would be granted ILE. However, this all changed on 09 July 2012.

In order to try and show the ECO (Entry Clearance Officer) that your ADR (Adult Dependant Relative) satisfies the E-ECDR requirements (click) I shall create a format below that you may wish to use. I will assume that your ADR satisfies the relationship requirements, does not fall for refusal due to suitability and that you are a qualifying sponsor (settled, British or Refugee/Humanitarian protection). You must also undertake a sponsorship (click) that the ADR will be adequately maintained (click) and accommodated (click) without recourse to public funds.

Before you consider this route you need to understand that if your family member has been visiting the UK quite happily on a visit visa (or wishes to in the future) this application may make future applications for visiting very difficult or impossible. This is because ADR ILE is a settlement route and a visit visa will not be granted where the applicant intends to settle in the UK. So, considering the high refusal rate for ADR ILE and the potential adverse effect on future visits to the UK, think very carefully before continuing. You may also wish to consider the EEA route (click).

The next question is, does your ADR have a long-term health condition (either mental or physical health in nature) or is your ADR very frail due to age? If not, then there is no point continuing on the ADR ILE route. This is because the restrictions of ADR ILE are based on the ‘care requirements’ that your ADR must have. As this factor is what generates the refusals, I shall concentrate this format on the ‘care requirements’.

I have used Personal Independence Payment (PIP) [click] criteria to expand on what constitutes daily living tasks as I think that best illustrates the governments position.

Listing medical conditions and medication

A list of medical conditions should be given, how long the ADR has had those conditions and what medication/therapy they require. For example, COPD – 6 years – nebuliser, 3 times daily, salbutamol 100mcg one puff as required or diabetes – 2 years – insulin injection 3 times daily. This should be evidenced by a medical practitioner.

Long-term personal care needed

A requirement is that your ADR requires long-term personal care. Therefore, it is suggested that your ADR should have had the care requirements for at least 9 months (though it may be less particularly where there has been an accident or a sudden incident) and that the care requirements are unlikely to improve. This should be evidenced by a medical practitioner.

Personal care requirements

The care needs must be based on daily living (personal care) and the care should be in excess of that required by a person of the same age with no health conditions. The following format should help show this. Select the task(s) that apply and expand, it is suggested that at least 4 different tasks should apply (but less may be acceptable especially if they are intensive needs). For each of the tasks you should explain how often the ADR has the difficulty, the ECO will expect this to be for the majority of the time. You should also show whether it takes the ADR longer to complete each task, if so, why? And whether the ADR can complete the task safely, if not, why?

A – Preparing Food

You need to explain the difficulty that the ADR has preparing a simple one course meal for one from fresh ingredients. You should for example, explain any difficulty with peeling and chopping vegetables, opening cans and whether the ADR can safely cook or heat food using a cooker hob or microwave. You should indicate why it is not safe to cook for example, having sustained burn(s) whilst cooking due to dropping a pan of hot water as a result of wrist giving way due to arthritis.

You should explain whether the ADR uses any aids or adaptations to help prepare or cook a simple meal. For example, perching stools, lightweight pots and pans, easy grip handles on utensils, single lever arm taps and liquid level indicators.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to physically assist in preparing or cooking a simple meal, whether the ADR requires supervision to prevent danger (e.g. burns) and whether the ADR requires prompting, encouraging or reminding to prepare and/or cook a simple meal.

B – Eating and drinking

You need to explain the difficulty that the ADR has eating and drinking. You should for example, explain any difficulty remembering when to eat (e.g. Dementia), cutting food into pieces, putting food or drink in the mouth and chewing/swallowing food (e.g. thickening fluids due to dysphagia as a result of a stroke). You should indicate why it may not be safe to eat/drink an example may be the risk of chocking (aspiration) which may require supervision to keep the ADR safe when eating/drinking.

You should explain whether the ADR uses any aids or adaptations to help them eat/drink. For example, adapted cutlery and a special grip drinking beaker.

You should explain if the ADR uses a feeding tube or PEG (Percutaneous Endoscopic Gastroscopy) system to eat/drink. For example, a feeding tube with a rate limiting device as a delivery system or feed pump or a person in a semi-conscious state who is fed intra-abdominally is using a PEG feeding system.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to physically assist in eating, e.g. cutting food into pieces or putting food in their mouth, supervision to reduce the risk of chocking, promoting, encouraging or reminding the ADR to eat, helping to manage a feeding tube or PEG system.

C – Managing medication/treatment

You should explain any difficulties with monitoring health conditions, for example, monitoring blood sugar levels (glucometer) due to diabetes, any changes in mental state and levels of pain. You should indicate whether the ADR is receiving any treatments for example, physiotherapy, acupuncture or dialysis. You should have indicated (as above) what medication is taken, the dosage and frequency.

You should explain whether you use any aid, for example, a Dosette box to assist with taking medication, you should also explain whether this is not possible for example, with Warfarin (after a Stroke, Pulmonary Embolism, DVT or with Atrial Fibrillation) the dosage may change frequently as a result of INR blood test results. A safety supervision issue with Warfarin may be the risk of overdose and major bleeding.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to physically assist in taking medication, therapy or managing treatment? Whether the ADR requires supervision to prevent danger (e.g overdose)? Whether the ADR requires prompting, encouraging or reminding to take medication/therapy or manage treatment? Whether the ADR required assistance from another person to interpret their mental state or pain levels e.g. facial expressions to express a need for increased pain relief (analgesics).

D – Washing and bathing

You need to explain the difficulty that the ADR has keeping their body clean. You should for example, explain any difficulty with washing their body, limbs, face, underarms and hair and whether they can use a normal bath/shower. You should indicate why it is not safe to wash/bath for example, having sustained falls whilst washing due to leg giving way as a result of spondylosis.

You should explain whether the ADR uses any aids or adaptations to help with washing and bathing. For example, bath/shower seat, grab rails, bath mats, wet rooms and walk in showers.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to physically assist in washing and bathing, whether the ADR requires supervision to prevent danger (e.g. falls) and whether the ADR requires prompting, encouraging or reminding to wash and bathe.

E – Managing toilet needs

You need to explain the difficulty that the ADR has going to the toilet and managing incontinence. You should for example, explain any difficulty with getting on/off a normal toilet or cleaning up after going to the toilet. You should indicate why it is not safe to use the toilet for example, having sustained falls whilst going to the toilet as a result of motor neurone disease. You should explain whether the ADR has any difficulty emptying their bowel and/or bladder, for example diarrhoea due to colon cancer or difficulty urinating due to constriction of the urethra.

You should also indicate whether the ADR uses a collecting device, for example, a bottle, bucket, catheter (indwelling or supra-pubic) or colostomy bag and whether they need any assistance with such devices. You should also indicate whether the ADR requires help with cleaning up after using the toilet or dealing with incontinence.

You should explain whether the ADR uses any aids or adaptations to help with managing toilet needs. For example, commodes, raised toilet seats, bottom wipers, bidets, incontinence pads or collective devices such as bottles, buckets, catheters or colostomy bags.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to physically assist in managing toilet needs or cleaning up, whether the ADR requires supervision to prevent danger (e.g. falls) and whether the ADR requires prompting, encouraging or reminding to go to the toilet or how to do so.

F – Dressing and undressing

You need to explain the difficulty that the ADR has dressing and undressing. You should for example, explain any difficulty with putting on and taking off appropriate clothes, including shoes and socks and whether they know when to put on or take off clothes and whether they can select clothes that are appropriate. You should indicate why it is not safe to dress and undress, for example, having sustained falls whilst dressing due to leg giving way as a result of arthritis.

You should explain whether the ADR uses any aids or adaptations to help with dressing and undressing. For example, modified buttons, zips, front fastening bras, Velcro fastening and shoe aids.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to physically assist in dressing and undressing, whether the ADR requires supervision to prevent danger (e.g. falls) and whether the ADR requires prompting, encouraging or reminding to dress, undress, when to change and what clothes to choose?

G – Communicating

You need to explain the difficulty that the ADR has communicating in their native vocal language. You should for example, explain any difficulty in speaking, hearing and understanding what people are saying. You should indicate why it is not safe, for example, not being able to communicate that the ADR is in pain and suffering as a result.

You should explain whether the ADR uses any aids or adaptations to help with communicating. For example, hearing and voice aids, picture symbols and assistive computer technology.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to communicate, whether the ADR requires someone to interpret speech into sign language, tell the ADR what is being said, what something means or speaking on behalf of the ADR. The ADR may require prompting, motivating or encouraging to communicate with others due to for example, autism or a learning disability.

H – Reading

You need to explain the difficulty that the ADR has reading in their native written language. You should for example, explain any difficulty in reading signs, symbols and words written or printed in their native written language and doesn't include Braille. You should indicate why it is not safe, for example, not being able to read the result of a glucose test and this result in a diabetic emergency due to incorrect medication dosage.

You should explain whether the ADR uses any aids or adaptations to help with reading. For example, magnifiers.
You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to read for them or perhaps they require help to understand the meaning of signs, symbols or words.

I – Mixing with other people

You need to explain the difficulty that the ADR has mixing with other people, either strangers or people they know well. You should for example, explain any difficulty in interacting, for example, whether they behave appropriately towards other people, e.g. do they display sexual disinhibition or do they become aggressive to the extent where they cannot interact with others? You should indicate why it is not safe, for example, they may injure themselves or others.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to mix with other people, whether the ADR requires someone support or reassure them or understanding/explain their behaviour and prevent danger to themselves or others. The ADR may require prompting, motivating or encouraging to mix with others.

J – Making decision about money – budgeting

You need to explain the difficulty that the ADR has with making decisions about money/budgeting. You should for example, explain any difficulty understanding how much things cost when they buy them or how much change they should be receiving. You should indicate whether they require any assistance with purchasing their everyday household essential items due to difficulty with understanding how much the items cost and/or what change they should receive.

You should explain what help is required from another person (whether they get that care or not), this is perhaps the most important aspect. For example, does the ADR require help from someone to manage household budgets, pay bills or plan for future purchases?

Is the care available or affordable in Home Country?

Once you have shown personal care needs as above you then need to show that the care the ADR requires is not available or affordable where they are living.

If they live with other family members then the ECO will expect that they will carry out the personal care tasks. However, if for example, the family members cannot care for the ADR or they are not willing to, this should be enough to show that the care is not available. This should be evidenced with a letter from the family member(s) stating that they have other commitments and are unable to care for the ADR or that they are not willing to care for the ADR.

In order to show that the care is not affordable (if it is not) you should show the income level for which the ADR has (income and savings) and the cost for the care in their home Country. For example, it may be necessary to attain 2 or 3 different quotations for nursing or residential care and accommodation. If the ADR requires 24 hour care, then it may be necessary to attain 2 or 3 different quotations to show the cost of providing 24/7 domiciliary care in their home. This should take in to account whether basic carer’s are adequate or whether more specialised nursing teams are required.

Next you need to complete and income (ADR’s income and savings tariff [savings divided by £250 gives a weekly tariff income figure]) minus expenditure (Electricity, Gas, Food etc.) form to show what remaining disposable income is left to pay for care. You should use average figures for the Country, do not exaggerate figures. Remember to include the cost of prescriptions and medical treatment (but not care) as this can be expensive. If the cost of care exceeds the ADR’s disposable income with the addition of the sponsor’s disposable income (again complete income minus expenses form to show the sponsor’s disposable income) then the care should be deemed unaffordable.

Note; if the ADR has other relatives, then the ECO may expect those people to contribute towards the cost of care, thus making it affordable. In order to rebut this, a letter from any applicable relatives indicating they are unable or unwilling to contribute (if they are) due to their own commitments should aid. Banks statements and proof of income and savings will be required for both the ADR and the sponsor.

You should then set out how the care is to be facilitated in the UK, as you have suggested that the care is unaffordable in their home Country, it (should) may not be possible to pay for UK professional carers. You should explain who will provide the care in the UK, which could be you and/or your partner and/or children and/or other family members in the UK. You should set out a care diary showing how the same level of care you had quotations for will be provided in the UK and statements from each person to say that they are willing to carry out the care in the UK only for free.

In order to try and succeed with an ADR ILE application it is imperative that you format the application very well and supply evidence from professionals.

This is by no means a guarantee to getting ILE as this application is perhaps the most difficult to achieve. However, this format should help a strong case.

See also, the guidance (click).

New Appendix Adult Dependent Relative immigration rules

Appendix Adult Dependent Relative.