Domain 5 of 12

Mobility

Independent movement, transfers, posture, and falls risk.

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What this domain measures

The Mobility domain captures independent movement, transfers, posture, and falls risk. It interacts strongly with Cognition (cognitively impaired falls, exit-seeking), Skin (immobility-related pressure damage), and Continence (toileting transfers). The Mobility descriptors turn on the level of assistance required for transfers, falls risk evidence, and the presence of involuntary spasms or contractures.

How it's scored (Annex C wording)

DST scoring levels for the Mobility domain, with verbatim Annex C descriptors.
Level	DST descriptor
No needs	Independently mobile
Low	Able to weight bear but needs some assistance and/or requires mobility equipment for daily living.
Moderate	Not able to consistently weight bear. OR Completely unable to weight bear but is able to assist or cooperate with transfers and/or repositioning. OR In one position (bed or chair) for the majority of time but is able to cooperate and assist carers or care workers. OR At moderate risk of falls (as evidenced in a falls history or risk assessment)
High	Completely unable to weight bear and is unable to assist or cooperate with transfers and/or repositioning. OR Due to risk of physical harm or loss of muscle tone or pain on movement needs careful positioning and is unable to cooperate OR At a high risk of falls (as evidenced in a falls history and risk assessment). OR Involuntary spasms or contractures placing the individual or others at risk.
Severe	Completely immobile and/or clinical condition such that, in either case, on movement or transfer there is a high risk of serious physical harm and where the positioning is critical.

Evidence that moves the score up

Moving & handling risk assessment with current transfer method and number of carers required
Falls log with dates, location, mechanism, injuries, and ambulance/A&E involvement
Physiotherapy assessments and any rehabilitation goals or plateau notes
Equipment inventory — hoist, profiling bed, specialist wheelchair, pressure-relieving cushion, contracture splints
Occupational therapy reports including seating assessment
Care plan section describing positioning regime and posture management
Photographs or measurements of contractures or pressure-area risk where consented
Hospital admissions for falls-related injury (hip fractures, head injury)

How ICBs commonly under-score this domain

Pattern: Assessor scored Moderate because the person 'transfers safely' with two carers and a hoist, AND cooperates with the transfer.

Rebuttal: Moderate IS the correct descriptor where the person cannot weight-bear but cooperates with transfers. The score elevates to High only when the person is unable to assist or cooperate — or where there is high falls risk, careful positioning needs that the person cannot cooperate with, or involuntary spasms/contractures placing them or others at risk. Argue High only with evidence of one of those.

Source: DST Annex C Mobility Moderate and High descriptors

Pattern: Assessor scored High instead of Severe because the person 'tolerates' specialist seating and the positioning is established.

Rebuttal: The Severe descriptor turns on complete immobility OR a clinical condition where movement or transfer carries high risk of serious physical harm AND positioning is critical. If specialist seating exists because positioning is critical to prevent serious physical harm on transfer, Severe is the correct level — tolerance of the seating is not a downgrade.

Source: DST Annex C Mobility Severe descriptor

Pattern: Assessor scored Low because the person 'has had no falls in the last 3 months'.

Rebuttal: Absence of falls in a recent window is evidence the falls-prevention regime is working (1:1 supervision, sensor mat, low bed, hourly toileting). The Moderate descriptor explicitly recognises 'moderate risk of falls as evidenced in a falls history or risk assessment'. Per paras 162–166, score the present-day risk if the falls-prevention regime were withdrawn.

Source: para 162-166 + DST Annex C Mobility Moderate descriptor

4-line rebuttal template

I disagree with the [LEVEL] score for Mobility. The evidence shows [SPECIFIC PATTERN — inability to cooperate with transfers / high falls risk / careful positioning needed / involuntary spasms or contractures] which meets the [HIGHER LEVEL] descriptor. On [DATE/PERIOD], the mobility profile was [DESCRIBE: transfer method, ability to cooperate, falls history, equipment, postural management, contracture/spasm risk]. Per the well-managed needs principle (National Framework paras 162–166), the [hoist / 1:1 supervision / specialist seating] is the intervention, not the absence of need. If [SUPPORT] were withdrawn, the present-day risk would be [DESCRIBE: falls injury, contracture progression, pressure damage]. I therefore request the Mobility domain be re-scored to [HIGHER LEVEL] with reference to the [SPECIFIC EVIDENCE: M&H risk assessment, falls log, physio notes, OT seating assessment].

Mobility rarely secures eligibility on its own

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