Adult Dependent Relative (ADR) visa is hard to get, but not impossible.

The rate of refusal for adult dependent relative visas is one of the highest of any way to enter the country. From 2017 to 2020, 96% of applications were turned down. This article talks about why these applications often fail and what you can do to make them work again.

This is not a plan for how to be successful. It’s meant to be a general guide to help you make the right choice for the Home Office.

What is an adult dependent relative visa?

Before, the rules about immigration were in Appendix FM. Now, they are in Appendix Adult Dependent Relative. On top of that, the Home Office puts out a guide for caseworkers.

Let’s be clear about what this visa is not before we talk about what it is. That’s not all this is—a parent visa. This isn’t just a ticket for older people. People who are old and have their own money cannot get this visa. This is not a visa for parents who depend on you financially but are fit otherwise. There is a lot more to an adult dependent cousin visa than these things.

Adult relative

It’s pretty clear what “adult” and “relative” mean. The person applying must be an adult over 18 years old and must be the sponsor’s parent, grandparent, child, or brother. Parents, grandparents, and their partner can all apply together, even if only one of them meets the standards for dependency.

UK sponsor

You can be a British citizen who has settled in the UK and has protection status, or you can be an EEA national who has already settled in the EEA and didn’t get that status because they are a joining family member (i.e. they have leave given under EU3 of Appendix EU by meeting condition 1 of EU14).

Dependency meaning

Things get tricky when you try to figure out what “dependent” means. In Appendix Adult Dependent Relative, the word “dependency” is broken down into two parts:

ADR 5.1. The applicant, or if the applicant is applying as a parent or grandparent, the applicant’s partner, must as a result of age, illness or disability require long term personal care to perform everyday tasks.

ADR 5.2. Where the application is for entry clearance, the applicant, or if the applicant is applying as a parent or grandparent, the applicant’s partner, must be unable to obtain the required level of care in the country where they are living, even with the financial help of the sponsor because either:

(a) the care is not available and there is no person in that country who can reasonably provide it: or

(b) the care is not affordable.

This first requirement is tough. This is one of many elderly relatives who will not get to meet others. Nevertheless, the second requirement makes it incredibly hard to be successful with these kinds of applications.

Long term personal care to perform everyday tasks

Showing that a person applying for an adult dependent relative visa needs long-term personal care to do everyday things is the first thing that must be done. “Long term” means longer than a short time. If I had to pick a clear answer, it was from Upper Tribunal Judge Grubb in the unreported case of Timo Nour Osman v The Entry Clearance Officer – Riyadh OA/18244/2012. It’s more than ten years old.

30. No definition of “long-term personal care to perform everyday tasks” is contained within the Immigration Rules. The reference to “personal care” is to be distinguished from “medical” or “nursing” care and would appear to mean that the care that has to be provided is “personal” rather than, for example, support provided by mechanical aids or medication. The need is for “personal” care, in other words, care provided by another person. The “personal care” must be required “long-term” rather than on a temporary or transitional basis. And, further, the provision of care must be necessary in order that an individual may perform “everyday tasks”.

Everyday jobs can include anything a person needs to get by in their daily life, like getting dressed, cooking, feeding, cleaning, shopping, working out, going outside, or even just having someone to talk to. Maybe the application doesn’t need help with all of those, but at least some of them must be done. If not, this doesn’t even begin.

Going outside and having someone to talk to are important parts of daily life that are often forgotten as personal care tasks. People need to be around other people, and being alone and lonely can make your health worse.

People who need long-term personal care must need it because of age, illness, or a disability. I have never been in a position where all three of these things were missing, so I’m not sure what would happen, but let’s say an application would be turned down.

When you talk about this part of the dependency definition, you should make sure that you take the time to explain how or why the care needs came about.

Not able to get the level of care they need in the place where they live

Once it is clear that the adult dependent relative needs long-term personal care, the next step is to show that they can’t get the level of care they need in their home country, not even with the sponsor’s money. This could be because the care isn’t available and no one in that country can reasonably provide it, or it’s too expensive.

This test is very important for adults who need a dependent cousin visa. The course of the case will depend on how you present your case in light of this rule. You should be very careful about which case you use.

Required level of care

The proof you give about the applicant’s need for long-term care must also say what type of care they need. The Home Office gives helpful advice:

The “required level of care” is a matter to be objectively assessed, with reference to the specific needs of the applicant. The level of long-term personal care must be what is required by the individual applicant to perform everyday tasks, in light of their physical needs and any emotional or psychological needs, in each case as established by evidence provided by a doctor or other health professional.

In considering whether the care is available in the country in which the applicant is living, the Entry Clearance Officer (ECO) will consider both what care is available, and whether it is realistically accessible to the applicant. As to the latter, consideration should be given both to the geographical location and the cost of such care.

Think about: what do they really need every day? What kind of care do they need to meet those needs? To answer this question, it might help to think about what a normal day is like.

The quote above really hits home for me when it talks about emotional or mental needs. This is where we can go beyond the physical tasks that a paid nurse might do. We can think about how much the applicant needs to talk to the supporting family member just to get through the day. This advice comes from paragraph 59 of Britcits v SSHD [2017] EWCA Civ 368, which explained that “care” could include emotional and mental needs as long as they were backed up by medical proof.

A few of the sponsors I’ve worked with spend several hours a day on WhatsApp or Skype calls with their parent living abroad. The calls kept me happy and kept me from feeling lonely, sad, or depressed. But for many sponsors, this kind of arrangement can’t last in the long run. A lot of sponsors spend time every day planning different parts of their parent’s care with nearby friends, family, or carers, in addition to making direct calls.

This huge amount of time investment is a real and necessary part of the level of care that is needed. By only showing the physical parts, it’s easy for the Home Office to say that those are just boring jobs that can be done by anyone willing to be paid to do them. The emotional parts are a lot more interesting, and they need to be part of a full evaluation of the amount of care that is needed.

Ideally, someone from the medical field, the mental health field, or even the social work field will talk about the case. Not often will it be enough for a sponsor to just say all of this. At least one expert should really connect the story with an unbiased evaluation and explanation of the amount of care that is needed to be given.

There is no one in that country who can properly give that care.

As soon as the amount of care needed is known, the next question is whether there is someone else in that country who can reasonably give it. That word “reasonably” is very important, and the idea of fairness can help a lot in this case. There may be people or places in the country that can help with care, but is that kind of care reasonable?

The advice tells the entry clearance officer what to look for when deciding if something is reasonable:

The ECO should consider whether there is anyone in the country where the applicant is living who can reasonably provide the required level of care. This might be a close family member: son, daughter, brother, sister, parent, grandchild, grandparent, a wider family member, friend or neighbour, or another person who can reasonably provide the care required, for example a home-help, housekeeper, nurse, carer or care or nursing home.

If an applicant has more than one close family member in the country where they are living, those family members may be able to pool resources to provide the required care.

The concept of whether another person can “reasonably” provide care may require consideration of such matters as the location of that person, their own circumstances and other commitments, and their willingness to provide such care. The fact that a person or organisation has been providing care for a period may suggest that they can continue to do so, however, if evidence is provided as to the temporary nature of such care, or as to a change in circumstances, this must be carefully considered.

The provision of the care in the applicant’s home country must be reasonable both from the perspective of the provider of the care and the perspective of the applicant.

Cases tend to be different when it comes to the question of what is fair. Everybody’s family is different. The applicant has to explain and show everything they say in a clear way. Do you have family in the same country who can’t help? Give proof and an explanation of why. Is there a partner or lover who has died? Show it. Does any country have a good health care system that offers paid care that is still not enough? Give proof and an explanation of why.

There is a key part of the dependency rules where you might be able to make the case that the sponsor is the only one who can realistically provide the level of care called for. Such as, you could say that while the applicant’s physical needs might be met by a carer, the applicant’s mental support needs are so high that a paid carer can’t act as a family member.

Using dementia or Alzheimer’s disease as an example again, there is strong proof that people with these diseases can get upset or scared around strangers, which means that “stranger care” won’t meet their needs. This can be discussed in a lot of different ways, and in the end, you will have to show proof for all of your claims.

Take a look at these questions in order:

  1. How will you take care of the application in the long term?
  2. What amount of care does the applicant need?
  3. Is there someone in the applicant’s home country who could offer the level of care that is needed? For instance, by relying on family or friends in the area, paid home care, moving into a residential care home, or a mix of these? Why not, if not? You will need to talk about how the application has been getting by so far and why they need to do something different to move to the UK. At this point, you can usually make a good case for saying that family care from a certain person is the only kind of care that is right.
  4. If free or low-cost care in the area can meet the needs, then access should be taken into account. Is there care available?Why not, if not? What steps have been taken to make this clear? What proof do you have?
  5. If paid care is available and fits your needs, can you afford it? If not, give estimates and proof.

If the situation lets you concentrate and win your case at point 3, you don’t have to worry about points 4 and 5.

Adult dependent relative visa applications often get held up by arguments about how many care homes or paid workers are available and how much they cost in the home country. If you argue with the Home Office about these things, you have already given up important ground and put yourself in a tough spot.

You are indirectly agreeing with the premise that paid care can meet the applicant’s care needs by arguing about it. There is a talk going on at the Home Office about this because they mostly win. Eventually, you might win this kind of argument, but the key is usually to show that no amount of care in the home country will ever be enough, and that the sponsoring family member is the only one who can fairly meet that level of care.

You can avoid those tricky arguments about care availability and cost if you can show that, even with the best hospitals and nursing homes in the world, the applicant can only be cared for by the sponsoring family member.

Supporting Evidence

Most of the time, the person applying for immigration has to show their case. The person making the choice is not going to go on their own evidence-gathering trip. They will decide what to do after looking at the papers you give them.

One problem with this is that the Home Office’s automatically created document checklist doesn’t help at all. Here is a common document check list:

Isn’t that very helpful? It gives me a thought about why the refusal rate might be so high.

Independent medical proof is a must when proving the need for long-term care. If you don’t have or can’t show medical proof, your application will fail right away. The advice from the Home Office says you need to give:

Medical proof that the applicant needs long-term personal care because they can’t do daily things like cooking, bathing, and dressing themselves because of their physical or mental condition. This must come from a doctor or other health care worker.

Under paragraphs 36 to 39 of the Immigration Rules, the person in charge of clearing people to enter the country can send the applicant for medical examination and make sure it is done by a doctor or another health worker on a list approved by the British Embassy or High Commission.

Let’s not talk about the Alvi problem of a hard rule in guidance. It’s clear that the Home Office wants to see independent medical evidence to show why care is needed. It’s not enough to explain the case in a letter, on the application form, or in a statement. You must definitely show something else, and it must not come straight from the applicant or the sponsor.

A strong medical record is essential for any adult dependent relative visa application. If you can get more than one medical report from different doctors, that’s even better. If more than one health worker is involved in different parts of care, you may need more than one report. Someone applying might need reports from a family doctor, a physiotherapist, an expert consultant, a psychologist, a psychiatrist, or even a social worker.

Medical proof should ideally list, either in a single report or a number of reports:

  • Professional credentials and knowledge of the author.
  • How much the author knows about the application, including any tests that were given for the purpose of the report.
  • Any health problems the applicant has been identified with, along with any treatments or medications they are currently taking.
  • current care needs of the applicant, including a clear list of the specific daily jobs they need help with and why.
  • The prognosis: Will the care needs be short-term so that the person can fully heal, or will they last a long time?
  • How much care or help does the applicant need at the very least? Where does this come from at the moment? If it’s not good enough, why?
  • Is it reasonable for paid home care to meet the applicant’s care needs? What about a nursing home? Give an example.
  • If you are fighting about the availability (or lack of) care, what is the availability of care in your area and across the country?

This is by no means a complete list. Every case has its own special facts and circumstances. You should use your own judgement to figure out what factors are important when writing letters of instruction to medical experts.

I often see forms of proof that don’t help: copies of hospital records, x-rays, scans, lists of drugs and doses, or just a list of diagnoses. Think about what a normal person would do if they saw this proof. Will what you show them make sense to them?

The person making the choice probably won’t be able to understand the documents you want them to look at or come to any useful conclusions that will help your cause unless they are a medical expert. These kinds of proof can still be useful if they are paired with a clear English report from a doctor that puts them in context. But by themselves, I never find them useful, and I don’t think the Home Office does either.

Don’t expect too much from the person making the choice. Help them understand the case by giving them proof they can trust to help them come to a decision. If you don’t tell them what they’re looking at, they won’t do any study on their own to try to figure it out.

You can ask if you can add objective proof about a condition that an applicant has if you think that a medical professional hasn’t been able to give you enough. The NHS website can be helpful because it uses plain English to explain a lot of different medical problems in a way that makes sense.

As a final note on medical proof, keep in mind that sponsors usually know a lot more about their relative’s illness or disability than you or a civil servant. What seems clear to them might not be clear to you or a civil servant. Never assume that the person making the choice knows what they’re talking about; it’s up to you to make a strong case. A detailed statement from the sponsor is still a big part of most of the cases I work on. It gives all the context and background that cold medical proof probably won’t have.

Adequate maintenance and accommodation

ADR 6.1 to 6.5 is the amount of money that is needed. The sponsor must be able to offer the applicant enough food, shelter, and medical care in the UK without using public funds. ADR 6.2 spells out the proof that is needed based on whether income or savings are being used as proof.

I’m not going to go into this in great depth, but do not lose sight of the money needed in the midst of all the arguments about dependence. You wouldn’t want to win an argument about dependence only to forget the money proof at the end.

Tuberculosis tests

Finally, it’s important to remember that people applying from the countries listed in Appendix T: tuberculosis screening will need to show proof that they have had a good tuberculosis test at an approved clinic.

Article 8 human rights

Article 8 of the European Convention on Human Rights should not be forgotten if everything else fails. The rules for article 8 are written into ADR 7.1–7.2. Before refusing, the person making the decision has to think about whether the choice would have unfairly bad effects on the applicant or their family. It’s possible to make a strong Article 8 case even if you can’t quite fit a case under the dependency thresholds. This is because of other unusual situations.

Final thoughts

The point of this article is to stress that applications for adult dependent relative visas can be approved. You should treat your first applications like an appeal, since you might end up in one. Carefully lay out the case and go through each part of the dependence test. Describe how you connect with each part. Show everything you say. If you can, get proof from outside experts. Pay close attention to whether you can make the case that only a family member can reasonably provide the amount of care that is needed.

Instruct me

If you want to instruct me, my name is Atty Lindoven Magsino, BSc, MBA, GDL, LLM, DBA (candidate), a qualified Solicitor in the UK. Mobile: 07446 888 377. Email: don@mbmsolicitors.com or attydonmagsino@gmail.com 

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