Eligibility for the Blue Badge Scheme

Alzheimer Scotland's response to the Department of Transport consultation submitted 16 January 2006

Alzheimer Scotland is a national charity representing the interests of Scotland’s estimated 63,000 people with dementia, and their carers. We aim to be the voice of and for people with dementia and their carers, to influence the improvement of public policies and to promote and provide high quality services for people with dementia and their carers.

Dementia is the progressive decline of mental functions, such as memory and cognition. It can be caused by a range of degenerative neurological disorders, the most common of which is Alzheimer’s disease. People with dementia gradually lose their ability to carry out the activities of daily living, such as shopping, handling money, personal care and cooking. Communication skills are progressively lost. Navigational skills decline, along with the ability to recognise surroundings and people are likely to become disoriented, even in familiar places. People with dementia also become vulnerable to danger;, for example from road traffic, as their judgment is impaired, and they may need close supervision to keep them safe. Eventually even basic activities, such as dressing and going to the toilet, become impossible without help.

In the early stages of dementia, some people can continue to drive. However, because dementia affects reaction speed and decision making, many cannot and as a result rely on their carers to drive them.

Alzheimer Scotland is pleased to respond to the consultation by Transport and Travel Research Ltd. on extending eligibility to the Blue Badge scheme. However, the short time period given for responses 1 did not allow us to consult fully with our members. 8 carers, 2 members of Alzheimer Scotland’s staff and 2 carers groups contributed to this response and quotes from them are included throughout this document. In addition, we did not have the required information to answer questions 2(a) and 4.

Question 1: a) To what extent do you think that parking concessions might benefit the groups of people listed2 ?

There are many reasons why the carers of people with dementia may need to park near their destination when driving someone with dementia. These can be due to the behavioural or physical symptoms of the person with dementia.

Behavioural symptoms

• Some people with dementia may require constant supervision due to wandering. This means that it is often not possible for a carer to drop the person off at the destination whilst they park the car (additionally some people with dementia can become distressed and disorientated if separated from their carer when in unfamiliar surroundings), or for the carer to leave the person in the car whilst they; for example, go to a shop.

“Unless I can park close to venue my mother cannot attend especially if it is only the two of us as I cannot drop and leave her while I park”.

• They may be unaware of the dangers of traffic on busy streets; thus, are vulnerable as pedestrians in such situations.
• People with dementia are likely to experience short-term memory loss; thus, being able to park near familiar surroundings and landmarks, such as outside a local shop, would be helpful useful in helping them remember where they are. Additionally, unfamiliar environments can induce anxiety and aggression.
• The dimensions of a normal car park space are not big enough to allow a car door to fully open. For many people with dementia this is necessary because they have difficulties in remembering how to get in and out of a car and perceptual problems can make stepping out of a car difficult.
• Some people with dementia can experience panic, confusion and disorientation when having to walk through a large car park to reach their destination. For example, one lady would not walk past cars in a car park, as she thought they were coming towards her.

Physical symptoms

• Some people with dementia can have difficulties walking.

- Some people with dementia may have difficulty walking due to gait abnormalities, which are characterised by slowing and ataxia (a loss of the ability to coordinate muscular movement) 3. Thomas et al. (2002) 4 found that 11.8% of 900 people with Alzheimer's disease had severe gait impairment.
- Some people with dementia can be frail, which impairs mobility. This can be due to dementia, age or a combination of the two factors (of the almost 63,000 people with dementia in Scotland, 61,000 are over the age of 65).

• Due to diminished motor control or frailty, some people with dementia are prone to falling; therefore, having to walk a shorter distance could reduce the risk of this.
• Some people with dementia can be incontinent; thus, parking near facilities is vital.

b) To what extent do you think that providing them with parking concessions would contribute to tackling social exclusion in general?

Being able to park near their destination would facilitate the carer taking the person with dementia with them on outings, for both practical and leisure purposes and could increase the number of outings; thus reducing the social isolation of the person with dementia and their carer. It would also assist in the maintenance of the social and budgeting skills of the person with dementia and would reduce the stress that many carers experience making such journeys. A long term consequence could be that a Blue Badge would allow the person with dementia to be cared for in their own home for longer.

“It would be of great benefit and another breakthrough for people with dementia”.

“It would enable them to take a more active part along with their carers in these (everyday) activities”.

“It makes all the difference as the designated areas near are always for Blue Badge holders”. (Said by a carer who has a blue badge for the person with dementia they care for)

Question 2: a) To what extent do you think that extending eligibility for parking concessions might have an impact on congestion and traffic flow?

We have no knowledge about this; therefore, cannot answer this question.

b) Do you have any information as to the number people who would become eligible

There are currently around 63,000 people with dementia in Scotland, 60% of whom live in the community (37,800). Around 30% of these people (11,340) have mild dementia; 42% have moderate dementia (15,876) and 20% have severe dementia (7560) 5 .

The symptoms that can be experienced in each of the stages are detailed below.

• Mild dementia – manifest impairment of attention and memory; forgetful of recent information; occasional confusion or disorientation; some help or guidance needed with any activities outside the daily routine.
• Moderate dementia – amnesia for recent events; some disorientation for time and place; severe impairment of reasoning and ability to understand events, resulting in dependency on others in personal care and routine daily tasks.
• Severe dementia – incoherent speech; disorientation for time, place and person; failure to recognise close relatives; incontinence of urine and faeces; complete dependence on others for basic personal care.

It is most likely that it would be people with moderate and severe dementia who would require a Blue Badge. This is a group of 23,436 people; however, clearly, not all would apply.

Question 3: To what extent do you think that extending eligibility for parking concessions might have an impact on public acceptance of the Blue Badge Scheme?

If the scheme is extended to people with dementia and others, the new inclusions should be well advertised to inform potential new users of the scheme and also to educate the public as to why people with dementia, who may not have a physical disability, require parking concessions.

“The public are becoming more aware of the problems dementia presents…the media gives it more coverage these days. I think therefore, it would enhance the public’s perception of the scheme”.

“I think the public are very sympathetic. That has been my feedback.” (Said by a carer who has a Blue Badge for the person with dementia they care for).

“It is possible that public acceptance of the scheme is influenced by the perception that there is widespread abuse of parking concessions. If the scheme is abused then that should be addressed, but the scheme should not be limited because some people may abuse it”.

“It definitely would help people to become more aware of the need to assist vulnerable members of society”.

“I would hope the public would become more aware”.

“The problem for a person with dementia is the getting in and out of vehicles – not necessarily because of physical problems, but because of memory problems – they forget how to move their bodies to achieve the task. The majority of people would be able to see the difficulties and be aware that the person has a difficulty”.

Question 4: To what extent do you think that extending eligibility might have an impact on the practicality and cost of administering parking concessions for disabled people?

No comment

Question 5: To what extent do you think that extending eligibility criteria might have an impact on abuse of the provision of on-street, or off-street, parking facilities for disabled people?

Potential abuse of the scheme is a separate issue to whether people with dementia need blue badgeBlue Badges and should be dealt with as such. It is not a reason to decide against what may be of real benefit to many people. One group of carers felt that visible enforcement of the scheme would be essential for its success. They also suggested having badges fixed to the license plate where a person with dementia relies on one vehicle.

“…it will be up to the council to monitor such abuse and for Blue Badge holders to be clear on the guidelines”.

“I think there needs to be more enforcement of only those eligible using the spaces so that people who need the spaces can find one”.

Question 6: On balance, do you think that eligibility for parking concessions should be extended to some groups of people? If so, to whom should eligibility be extended? What type of parking concession do you think would be most appropriate?

Alzheimer Scotland is of the position that eligibility for parking concessions should be available to people with dementia. Current eligibility criteria fail to recognise how an illness such as dementia can impact upon mobility in ways other than walking. At present, issuing Blue Badges to people with dementia is at the local authority’s discretion and there is no right to an appeal if the badge is refused. This route has potential for inconsistent decision making.

The majority of respondents throughtthought that the scheme should be extended to people with dementia; however, one respondent did not agree as he thought it would “devalue the public acceptance of the scheme” and would “lead to more abuse, leave the scheme for those with physical problems”.

Alzheimer Scotland's position is that the eligibility criteria should cover people who require supervision due to personal safety when left unattended; for example, who may wander and become lost, behavioural issues or a combination of physical and psychological impairment that require supervision and walking assistance.

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1. We received the consultation on 9th December 2005 and received an extension to 16th January 2006. The initial deadline we were given was before Christmas.
2. We are solely concerned with people with dementia.
3. Waite, L.M., Broe, G.A., Grayson, D.A. & Creasey, H. (2000) Motor function and disability in the dementias. International Journal of Geriatric Psychiatry, 15 (10), 897-903.
4. Thomas, V.S., Vandenberg, E.V. & Potter, J.F. (2002) Non-neurological factors are implicated in impairments in gait and mobility among patients in a clinical dementia referral population. International Journal of Geriatric Psychiatry, 17 (2), 128-133.
5. Alzheimer Scotland can provide estimated numbers of the people in each of the stages of dementia in each local authority area in Scotland on request.