CHARITIES: Major Adaptations – Understanding the DFG
by Nikki Thompson, Founder & Executive Director
In this article we aim to provide the charity community with a foundation knowledge of the Disabled Facilities Grant. We will explore what it is, how it can be used to help beneficiaries and some of the challenges the system is currently facing with its provision.
Local authorities categorise adaptations to dwellings as either minor or major works. If works are likely to cost under circa £1000 (this figure can vary from authority to authority) then the likelihood is that the authority will fund this through minor works and there would not be any means test or expected financial contribution from the beneficiary. Minor works can often be completed in timely fashion i.e. days or weeks and are small works such as simple rails, ramps, half steps. If works are going to be more than circa £1000 then they would need to go down the major works or DFG route which we will now explore in more detail.
What is a DFG?
The purpose of the DFG is to provide funds to modify the home environment of a disabled occupant to restore or enable independence, privacy, confidence, and dignity for both themselves and their families.
- A DFG is a capital grant available to beneficiaries of all ages.
- The following housing tenures (tenure means how the property is owned) can access the DFG: owner occupier, private tenants or tenants of a private registered provider i.e. a housing association.
- Eligible council tenants can apply for a DFG in the same way as any other tenant however Local authorities are not able to use the DFG to adapt their own stock i.e. council properties – there will be a different funding mechanism for this.
- The grant is up to £30,000 for adults in England.
- Central government funding for DFGs in England was set to be £573 million in 2023/24 and to remain at this level in the next financial year and On 4 April 2023, an additional £102 million was announced as a capital top up
- The grants are administered by local authorities (in England) and are aimed at enabling eligible disabled individuals to continue to live safely and independently at home through adaptations.
- The grants are to pay for or to contribute to the cost of the works and are means tested (unless the beneficiary is on certain means tested benefits in which case they will be exempt from the means test as their income threshold is assumed to be below the required limit)
- The provision of the grant is routed in legislation (Housing Grants Construction and Regeneration Act 1996) so the authorities have clear guidance on elements of its provision i.e. what it can or cannot be used for – having said that there is also elements of discretion which we will cover later.
What can a DFG be used for?
The legislation sets out clear parameters for what the DFG can be used for i.e. what works are 'eligible'. However as you will see the categories can be ambiguous, which is a positive, as it allows authorities to exercise discretion and some degree of flexibly. I have added a practical example to each category to illustrate how the legislation can be applied:
Category: Facilitating access
Description: The OT will consider the needs of the disabled occupant to both move freely around their property and access to and from it. This category includes (but not limited to) access to the bedroom, principal family room, in and out of the property.
Application example 1: Provision of a complex ramp or step lift to allow wheelchair access to the property.
Application example 2: Provision of a stair lift to allow access to a room suitable for sleeping.
Application example 3: Adding a dropped kerb outside the property to facilitate parking of the disabled occupants principal vehicle.
Category: Garden access
Description: In 2008 access to the garden was brough within the scope of the DFG to allow the disabled occupant access to their garden for drying clothes or supervising children for example, or simply to make it safe for them.
Application example: Fencing to help a disabled occupant remain within the boundaries of the garden.
Category: Making a dwelling or building safe
Description: There is a wide range of works that could be considered by the occupational therapist as appropriate to make a dwelling safe for the disabled occupant or those living with them. The aim of this category is to minimise the risk of danger.
Application example 1: for those with hearing difficulties, an enhanced alarm system to provide improved safety for the disabled occupant when cooking, or facilities to provide means of escape from fire.
Application example 2: adaptations designed to minimise the risk of danger where a disabled person has behavioural problems which cause them to act occasionally or regularly in a boisterous or violent manner damaging the house, themself and perhaps other people.
Category: Making a room usable for sleeping
Description: The occupational therapist should consider adaptations to an existing room or its access before provision of a new room is considered.
Application example 1: knocking 2 rooms into 1 to create a large enough space to accommodate the disabled occupant and their equipment i.e. wheelchair, hoist, shower chair.
Application example 2: An extension to add on a new bedroom normally on the ground floor.
Category: Facilitating preparation and cooking of food
Description: The disabled occupant is entitled to have access to facilities to cook and prepare meals for themselves and any dependents. It’s worth noting here that even where the main meal preparation is completed by another resident kitchen adaptations can still be made to allow the disabled occupant to prepare a snack or drink.
Application example: Rearrangement of kitchen units to allow accessible work tops and cupboards for a wheelchair user.
Category: Heating, lighting and power
Description: This would be considered where the disabled person cannot operate the controls for power, light or heating in their home. The OT could also recommend works under this category if the disabled occupant had limited mobility and remained in one room for long periods leading them to feel the cold.
Application example 1: The raising of power points so the disabled occupant did not have to reach down to access them.
Application example 2: the installation of an additional radiator to the disabled occupants principal room.
Application example 3: Air conditioning units could also be considered where heat exposure could cause or heighten symptoms. A good example of this is multiple sclerosis where it is known that the heat can exacerbate symptoms which may include fatigue, muscle weakness, blurred vision.
Category: Dependent residents
Description: This is to allow adaptations to the property to allow for the disabled occupant better access to move around the property to care for another person normally residing with them.
Application example: An example of this could be where a wheelchair user needs to care for their child and although their bedroom and bathroom facilities are on the ground floor the child sleeps upstairs. The OT could in these circumstances recommend a through-floor lift so that the parent could access both floors of the property to care for their child. Note that in these circumstances the occupational therapist would need to take multiple factors into account, such as how the parent would facilitate the child’s exit from the property in the event of a fire.
Category: Bathrooms
(Although this also falls under access, bathroom works are so prevalent within DFG applications that we have separated it out into its own category.)
Description: A disabled occupant should have access to a w/c, washbasin, bath and / or shower.
Application example 1: Removal of the bath and installation of a level access shower to enable independence with personal care.
Application example 2: Removal of a wall in-between a bathroom and separate w/c to create more space around the w/c for the disabled occupant.
Criteria for a DFG
In order for works to be eligible for a DFG, the legislation dictates that the works must be ‘reasonable and practicable’ and ‘necessary and appropriate’. We will explore what these mean in practice in more detail.
Necessary and appropriate
This is determined through the OT assessment. The OT will need to clinically justify, as appropriate why their recommendations would for example:
- meet the identified needs of the beneficiary and what alternative (more cost effective) solutions they have considered and discounted.
- enable a care plan to be implemented which would facilitate them remaining at home and enhance their level of independence
- are based on an assessed and justified clinical need and not solely on the ‘wants’ of the beneficiary.
The occupational therapist will also give (and demonstrate in their report) consideration to:
- the needs of any other members of the household
- how the works will maximise and enable the beneficiaries independence and ability to remain at home.
- That their recommendations are proportionate, for example they have not recommended a bathroom be adapted when there is an alternative accessible bathroom that would meet the beneficiaries needs.
Whilst the recommendations need to be ‘person centred’ the OT also needs to demonstrate that they have paid consideration to the best use of public funds. In order for works to be considered and approved by the housing team, the OT will need to evidence this approach to their recommendation in their assessment report.
Reasonable & practicable
This is determined by the housing department within the local authority. When deciding if proposed works are reasonable and practical the authority will have to consider the age of the property, conservation considerations, structural characteristics, the impact on any other residents and the balance of these needs for example in communal properties or where there is restricted access. The authorly has the right to look at rehousing an individual where it is appropriate if this is a more cost-effective solution.
Why are charities commissioning private occupational therapy assessments?
Go back 5 years and certainly pre covid, the number of referrals we received from charities where the request was for a major adaptation was relatively small. However today approximately 35% of referrals from our charity customers are for an OT assessment in relation to a major adaptation to a beneficiary’s home.
Why is this? The answer is multifaceted and has had much mainstream media airtime over recent years. Traditionally, a DFG would be accessed through an OT assessment completed by the local authority. However, as our population ages, we are seeing an increase in demand for public sector services across the board at a time when resources and staffing levels particularly for OT’s are significantly stretched. In May 2023 The Royal College of Occupational Therapists released their ‘Occupational Therapy Under pressure Workforce Survey’ findings for 2022 / 2023. This has found that 78% of respondents stated that they did not believe their teams were large enough to meet demand and 86% reported an increase in demand for OT services within the last 12 months. This combination of circumstances is leading to a backlog of beneficiaries sat on local authority waiting lists.
The risk here is that beneficiaries are left at home struggling with basic activities of daily living such as bathing or using the stairs. This not only has a significant impact on the quality of their day-to-day life and independence, but also places them at a great risk of falls resulting in hospital stays, increased care needs and potentially losing the choice as to whether they are able to remain in their own homes.
Charities are therefore stepping in to commission and fund these OT assessments through The OT Practice to reduce the time their beneficiaries are having to wait. This practice is generally received well by the local authority as long as the occupational therapist’s recommendations are in line with DFG legislation and best practice.
Managing expectations
It is essential that the OT makes it clear to the beneficiary that the recommendations they discuss with them at the time of the assessment are only that, recommendations. They must make it clear there is no guarantee that the works they have discussed will be carried out. There are several reasons for this including:
- It is ascertained that the beneficiary is not eligible for the grant when the local authority complete their means test. Whilst the grant is up to £30,000 in England, the actual amount that an individual receives will be dependent on their income and savings of both themselves and their partner (no other household members are assessed). An initial portion of savings is ignored (the sum is variable depending on the authority) but anything after that savings are considered. Remember that recommended works under a DFG can range from a ramp costing a few thousand through to an extension which could exceed the £30,000 threshold. Once the results of the means test have been established the beneficiary may not be eligible for any or only partial funding and so they may decide not to proceed with the works.
- Once the OT has made their recommendations that they deem necessary and appropriate, the local authority housing team need to ensure the works are reasonable and practical. They will need to consider multiple factors as explained above and may decide that the works are not able to proceed based on one or more of those factors. Whilst alternatives will be offered and discussed if possible, it is important to recognise that these will be different from those originally discussed with the OT.
Additionally, waiting lists for works can be long so even once the OT assessment has been completed, the beneficiary will still need to wait for the works to be approved, scheduled and completed. Whilst charities can influence the wait time for the OT assessment by funding it themselves, there will still be downstream processes within the local authority for the approval and implementation of the recommendations, that may still take time if a DFG is being used to fund the works.
If the OT is not explicitly clear on this and the works either do not proceed or do not proceed in the way the OT and beneficiary discussed, or they haven’t set expectations over the wait time, the beneficiary is likely to feel frustrated or disappointed. This can lead to complaints and challenges for all so we ensure our therapists are clear about the importance of managing the beneficiary’s expectations around the works.
Hopefully this article has provided an informal and practical 'whistle stop tour' of DFG’s in England (there are slight variations across the 4 nations of the UK which for simplicity we have not covered in this article). The DFG is a fantastic opportunity to ensure beneficiaries are able to remain in their own homes as safely and independently as possible. The OT Practice works collaboratively with local authorities and charities on DFG assessments to facilitate timely occupational therapy assessments.
We are proud to support charities both large and small and would be delighted to discuss in more detail if you provide grants for health and well-being to your beneficiaries. Call us on 0330 024 9910 or email enquiries@theotpractice.com.
Disclaimer
Please note that this article has been created for information purposes only. Whilst the legislative frameworks will be consistent there are regional variations to the approach to DFG’s which each local authority will be able to advise on.
References and further reading
Disabled Facilities Grant Delivery: A Guide for local authorities in England
Department of Health and Social Care
Department for levelling up, housing and communities.
Foundations
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1065574/DFG_Guidance.pdf
Occupational Therapy Under pressure Workforce Survey: The Royal College of Occupational Therapists https://www.rcot.co.uk/practice-resources/workforce-survey-report-2023
Disabled Facilities Grants for Home Adaptations Housing of Commons Library https://researchbriefings.files.parliament.uk/documents/SN03011/SN03011.pdf
