Leigh Day: Impact of SCI when your vocation is inside the home

A few weeks ago I met a client who had suffered a spinal cord injury following a fall. After months of rehabilitation she was finally home and physically making progress. She was out of a wheelchair, managing a few steps.

I met her with her husband and daughter. They were clearly thrilled to have her home, relieved that she was alive and physically getting better.

When I asked about how her injuries affected her I was told about her problems walking, how she couldn't stand and how she couldn't get upstairs. They talked about how she didn't leave the house and how they had to look after her, cook and clean for her and do the school run she used to do for her grandchildren.

Nothing was said about how she was feeling mentally, or about the effect of all these changes to her life were having on her psychologically.

Yet as they talked I could see what a huge role she had played in the family. Prior to her injury she'd been a wife, housewife, mother to adult children and hands-on grandmother. She had been the centre of the family. Although not employed she had numerous roles; carer, nurturer, babysitter, cook, cleaner, chauffeur, which with her physical injury had all, for now at least, been taken for her. Instead, she required others to do all of those things for her.

She had suffered a loss, in fact a number of losses.  She had lost her mobility, but also her independence and her role in the family, in the home and in the world in general. Her vocation had been looking after her family and she could no longer fulfil that role.

It made me think about the effect that must have been having on her, and what support could I suggest that might help her to come to cope with this change in role.

Psychiatrists talk of a period of adjustment following spinal cord injury (SCI). Statistics suggest 20% who suffer such an injury experience anxiety, 30-40% depression and 10-40% Post Traumatic Stress Disorder.  Those are significant numbers and make clear (if we were in any doubt) that attention needs to be paid to the mental, as well as the physical, health of those who have suffered a SCI.

Studies show that families can sabotage an injured person’s progress without meaning to. Sometimes by helping or taking over they take away even more of the injured person’s independence. Of course, it is hard for them too; to manage and to know what is for the best.

We all know that the help and support that can be expected from overstretched poorly funded statutory mental health services is limited, if not non-existent.

That’s why SIA’s peer support is so important. It is run by those who have a spinal cord injury for those who have also suffered such an injury. It offers one to one support, practical information and advice on life after injury to the person injured, as well as helping families adjust and find support.

This is exactly what this lady and her family need and referring them to SIA made me feel I was offering something that could really help.

It also brought home to me, that whilst the difficulties of returning to work after a SCI are well recognised (and SIA offers vocational support) we should not forget those whose vocation was within the home, the loss of role they have suffered and the support they will need in dealing with that. 

Nicola Wainwright, Partner - Leigh Day 

nwainwright@leighday.co.uk  

020 7650 1262

Leigh Day: Buying houses for clients with spinal cord injuries

It is frequently the case that clients who have sustained a spinal cord injury cannot return to their home following injury because it is no longer suitable.

Instead, often clients need accommodation on one level, suitable for wheelchair use and with extra space for their equipment and therapy needs. Some clients need carers and space needs to be provided to preserve family life and privacy.

Invariably, the new home will cost more because of the need for more space and most homes require adaptation to make them suitable for wheelchair use which could include increasing door width, adapting kitchens and bathrooms and sometimes building extensions for therapy areas and making outside space accessible.

In practice, most houses require substantial adaptation works to make their new home suitable.  Many clients are surprised to learn that whilst the law allows them to claim the full cost of adapting their new home only a proportion of the extra purchase costs are recoverable in their compensation claim.

The legal principles that govern additional accommodation costs are set out in the 1988 case of Roberts v Johnstone.  In a nutshell, only the cost of borrowing the additional money needed to buy the larger house (calculated at the measly rate of 2.5% per year) for the remainder of the Claimant’s life is recoverable.  Not only can’t you borrow money at 2.5%  but life expectancy is based on actuarial tables rather than the actual number of years.  For older clients, or any client with a shortened life expectancy or where clients live in areas where property prices are high, the way this part of their claim is calculated results in a significant shortfall in the amount of funds that are needed to buy the new house.

A key part of our job is to find a solution to this problem.  Ways of getting round this issue are to use other parts of the Claimant’s compensation to meet the accommodation shortfall, for example by using the pain and suffering damages to plug the gap or part of the Claimant’s loss of earnings.

There are also alternatives to the conventional Roberts v Johnstone calculation which can put the Claimant in a far better financial position.  These include renting but only if you can find a landlord willing to allow the necessary adaptations, or an interest only mortgage.  Both of these options can potentially be funded by index linked annual payments for life (periodical payments) from the defendant to cover the expense involved.  Another option is an interest free loan from the defendant who in exchange are given a charge over the new home which is not realisable until after the Claimant has died.  However, many Claimants are not attracted to the idea of renting or living in a home that someone else owns. Where the Claimant has a family to provide for this solution can be unattractive.

At Leigh Day we have extensive experience of dealing with this issue and a track record of successfully obtaining large interim payments to enable clients to buy and adapt a new home during the course of their claims.  The advantages of doing so are that the Claimant is then moved before a case is settled and the actual costs of buying and adapting a home are known and can be claimed as part of the case.  It also enables the care and therapy regimes to be fully established and costed and equipment trialled and bought.  This means that the Claimant’s damages claim reflects the actual rather than anticipated costs which is invariably preferable.

One of the most satisfying parts of our job is seeing our clients and their families move into a new home which has been adapted to maximise their independence.  It can make a huge difference to a client’s life and often provides the platform from which they can build their future.

Sally Moore, Partner & Head of Personal Injury Team & Lorna Bidston, Solicitor - Leigh Day

Hodge Jones & Allen: Motor Biking for the Disabled

Nick Mclean suffered undiagnosed cord compression for over 2 years before he was operated upon to relieve the situation.  Having run his own successful business for many years as well as living an active sporting life enjoying diving, swimming and motor bike riding, it seemed during the initial years after his operation any active life would not be possible.  Despite severe disabilities Nick has had a new lease of life through Ride’til We Rot Society.  For any motorbike enthusiast this is a must – do check this out.  The charity is based nationally and internationally promoting biking for anyone with any type of disability whether physical or mental health to get back into the saddle and onto the road.  Like Nick, those with disabilities, use adapted bikes and join in rides when they can in addition to social events.

Julie Say of Hodge Jones & Allen says “This is a an amazing charity that enables people to continue doing what they love despite extreme adversity”

Nick McLean says “Ride’til We Rot has given me a new lease of life enabling me to participate in a pass time that I thought would never be possible.  I have made many friends and the organisation has helped to infuse fun into my life which now feels more worthwhile.”

For more details there is a Facebook page https://www.facebook.com/pages/Ride-til-we-rot-president-uk/559640390751854

Julie Say is a Partner and Head of Clinical Negligence at Hodge Jones & Allen
jsay@hja.net

Hodge Jones & Allen: Claiming VAT Relief for Disability Adaptations

Clients often describe the stress and anxiety that is involved when a property is being adapted for wheelchair use.  Hodge Jones & Allen work with professional architects who keep us updated with developments and this blog below by Steve Woodley at Wyvern Architects discusses one very important (and costly) point that can be overlooked when a property is being adapted.
Carrying out works to make a property suitable for a disabled person can be a costly experience.
Building costs, Architects/Surveyors fees and VAT all need to be carefully considered prior to work beginning on site.
It is important that you discuss the cost of the adaptation works with your chosen builder as soon as possible, as you may be able to claim VAT relief on part, if not all, of the proposed alterations.
HM Customs & Excise has produced a very helpful booklet entitled "VAT Reliefs for disabled people - notice 701/7 August 2002". Within this booklet the works which can be zero rated for VAT purposes are identified.
Although not exhaustive these works include the following:-

• Constructing ramps.
• Widening doorways or hallway/passage and the restoration of the immediate decor.
• Constructing, extending or adapting a bathroom, washroom or lavatory provided the work is   necessary to suit the condition of a disabled person.

Where economy and feasibility dictate resulting in occupying the space which was previously part of another room then you may also claim VAT relief for restoring that room elsewhere in the building to its original size. For example, if you convert a bedroom into an especially adapted/equipped bathroom then you may also zero rate the supply of constructing a replacement bedroom as long as it is the same size as it was previously.
It must be appreciated that the VAT assessment is ultimately the responsibility of the building contractor and therefore discussions ought to be held before commencement of any works to agree the likely VAT liability. A VAT Eligibility Declaration will need to be signed and handed to the building contractor who will need to attach this with his VAT return. 

Steven Woodley
Director
Wyvern Architects - Devizes Ltd
www.wyvernarchitects.co.uk

Simon O’Loughlin is a Partner and Solicitor at Hodge Jones & Allen
soloughlin@hja.net

Hodge Jones & Allen: 'Batting About'

Clients often describe the huge difference that new technology can make to their lives, especially when that technology improves mobility and can increase independence.  Hodge Jones & Allen work with Occupational Therapists who keep us updated with developments and the blog below by Bush & Company discusses the Batec - a powered attachment for wheelchairs.

Working as an OT in the field of posture and seating, I consider myself fortunate to meet individuals with SCI, who pretty much defy what the textbooks says about their level of injury or (dis)ability.

This refreshing way of looking at function and functional ability, echoes Davis’ sentiments regarding The International Classification of Function, Disability and Health (ICF). ‘ICF as a framework for rehabilitation ensures that the focus of rehabilitation is not only on the level of impairment and disability. It needs to focus on the individual’s participation in the environment and in society’. Davis 2006.

We all have goals we would like to achieve, and for individuals with SCI this is no different; to regaining function, to be independent, to return to work or to do an activity which you are passionate about and just get on with living life. It’s exciting when you come across people and equipment that can actually focus on making this happen.

Insert: Dave Hawkins (T11), Cyclone Mobility, BATEC user. 
Picture taken at Silverstone Race Track.

Ok, so what is this new craze which seems to be sweeping the nation…?
‘Batting’ as it’s become known on the street. Hearing terms used like ‘Batting up and down the road’ can only create interest and intrigue, right?

So what is this ‘Batting’ all about? Well we have Pau Bach, a C5 quadriplegic from Barcelona to thank for this.  Pau following his injury was forced into career changing decisions.

Pau retrained in computing from his former career plan of industrial design, due to limited vocational options available at the time for a spinally injured person. 

As an independent young man Pau did not wish to use a powered wheelchair so he set about re-inventing the world of mobility from a lightweight wheelchair. In 2001 Pau created a manually powered handcycle that attached to his everyday wheelchair and with this increased his mobility. In 2003 Pau improved the design by adding a battery and motor…. and the Batec was born.

The range includes an electric, manual, and hybrid versions. The Batec can be fitted to a rigid-frame or a folding-frame manual wheelchair in only 3 seconds! And Yes – it comes in many colour options and you guessed it – it even has a dock for your iPhone.

So from a getting out and about point of view it ticks all my OT boxes in promoting individuals with SCI (and other mobility related issues) to be able to achieve Independence, Function and Participation…now to sort the rainy weather.

Lee Ann Hoffman Occupational Therapist at Bush & Co www.bushco.co.uk
Julie Say Partner and Head of Hodge Jones & Allen’s Clinical Negligence Team
jsay@hja.net

Hodge Jones & Allen: Whizzy Bug Loan Scheme

Obtaining funding for a powered wheelchair can be difficult at any age, but even more difficult for pre-school age children who can grow out of a wheelchair by the time funding has been provided and a wheelchair delivered.  Hodge Jones & Allen are aware of a valuable scheme that has addressed this issue with their Wizzybug Loan Scheme.  Occupational Therapists at Bush & Co www.bush.co.uk direct clients to Wizzybug Loan Scheme when they can. 

Wizzybug Loan Scheme

The Wizzybug is a fun first experience of powered mobility for children aged 18 months to five years

to learn to move independently. It is well researched that at this young age, self-produced mobility impacts on all aspects of development.  To ensure that this window of opportunity is not missed, the national charity, Designability is loaning out Wizzybugs free of charge to children in mainland UK who could benefit from them.

Wizzybug can be easily adjusted to meet a child’s individual postural needs and can be driven using a joystick or switches.  It can be used indoors at home and in nursery and outdoors in accessible areas such as level gardens, playgrounds and parks.  It also dismantles so that it can be transported in a small family car to take to the park, nursery, shops or grandparents’ home.

Through the loan scheme, families receive a Wizzybug to use for as long as the child can benefit.  Parents are asked to pay a security deposit of £200.00, which is refunded when their Wizzybug is returned in an acceptable condition at the end of the loan period.

Application forms need to be completed by the child’s therapist and are available from Designability on 01225 824103 or from anneharris@designability.org.uk

For more information please visit www.designability.org.uk
Julie Say is a Partner and Head of Clinical Negligence at Hodge Jones & Allen
jsay@hja.net

Hodge Jones & Allen: Why is it important to make a living will?

Living Wills, also known as Advance Directives, are a written record of your wishes about the medical treatment and care you would want to receive if you were incapacitated and were unable to make decisions or communicate your wishes.

In September 2011, the Court of Protection ruled in the case of 'M' that withdrawing life support treatment from a person in a minimally conscious state was not in that person's best interests.

'M' had sustained brain damage in early 2003 following an illness and had been entirely dependent on others for her care since then. There was no prospect of any recovery. She appeared to be unconscious.  It was thought that she was in a persistent vegetative state but doctors later concluded that she was in a minimally conscious state.  

After all attempts to bring about a recovery had failed over a period of 8 years, her family had applied for life sustaining treatment to be withdrawn on the grounds that 'M' had no quality of life.

The Judge indicated that if 'M' had left a Living Will or Advance Directive stating that she did not wish to receive life sustaining treatment then the Court would have agreed to the request from 'M's family for treatment to be withdrawn.  However, as there was no written record of 'M's wishes, the treatment must continue.

Such tragic cases serve as a reminder of the need to draw up Living Wills.  An alternative procedure is to appoint a friend or relative to act as your Attorney under a Lasting Power of Attorney for health and welfare.

Philippa Barton

Hodge Jones & Allen

020 7874 8300

pbarton@hja.net