UK Adult Dependent Relative Visa: Proving Care Is Not Available Abroad

The Adult Dependent Relative (ADR) visa is one of the most exacting UK family routes. The evidential threshold is high, decision-makers apply the rules strictly, and refusals commonly turn on a single proposition: that the applicant’s required level of long-term personal care can be obtained in their home country, either from family or through paid care, and that it is therefore not necessary for the applicant to come to the UK.

This article explains how the “care available abroad” issue is approached under the Immigration Rules, why applications fail, what medical and care evidence typically carries weight, and how to present a credible narrative about care needs without overstatement. The aim is not to encourage formulaic applications, but to help applicants understand what the Home Office is actually testing and how to meet that test in a disciplined, legally coherent way.

1. The legal framework: what the Adult Dependent Relative route is designed to do

An ADR application is not a general family reunification route and it is not designed to meet a preference for living near adult children in the UK. It is intended for situations of genuine dependency where, because of age, illness or disability, the applicant requires long-term personal care to perform everyday tasks and cannot obtain the required care in their country of residence, even with financial support from the UK sponsor.

In practice, this means two interlocking questions dominate most cases. First, does the applicant in fact require “long-term personal care” for everyday activities? Second, if so, is that care unavailable or unaffordable in the country where the applicant lives, and why? The Home Office’s focus on availability abroad is not incidental: it is a core element of the route and the area where evidence is most often thin, overly general, or internally inconsistent.

It is also important to understand that the Home Office assesses “availability” in a practical sense. The mere existence of care homes, agencies, nurses, or domestic helpers somewhere in the country does not answer the question. Conversely, it is rarely sufficient to say that “care is poor” or “facilities are limited” without showing why the applicant cannot realistically access appropriate care at the place they live (or could reasonably relocate to), taking into account their circumstances, safety, and the support network actually available to them.

2. Understanding the “long-term personal care” threshold: everyday tasks and functional need

Many ADR refusals begin earlier than the “care available abroad” question: decision-makers are not satisfied that the applicant’s needs reach the level of long-term personal care in the first place. The route is concerned with functional ability, not simply diagnoses.

A persuasive case therefore translates medical conditions into practical consequences. Decision-makers typically look for clear evidence of inability (or unsafe ability) to perform ordinary activities without assistance, such as washing, dressing, toileting, preparing food, taking medication reliably, mobilising safely, and managing basic domestic routines. The strongest evidence often distinguishes between what the applicant can do on a good day and what they can do consistently and safely over time. It also addresses risk: for example, falls, confusion, aspiration risk, failure to take medication, or inability to respond appropriately in emergencies.

The most effective applications present care needs as stable and long-term, supported by clinical evidence and care assessments, rather than as episodic. Where needs fluctuate, the evidence should explain the pattern and why it still amounts to long-term need (for example, progressive conditions, dementia, Parkinson’s disease, post-stroke impairment, severe arthritis with repeated falls, or significant visual impairment with poor mobility). A medical letter that lists conditions without addressing functional impact is rarely enough; equally, a submission that overstates incapacity in ways that conflict with medical notes can be fatal to credibility.

3. The core refusal ground: how the Home Office analyses “care available” in the home country

When the Home Office refuses on the basis that care is available abroad, the decision often follows a recognisable structure. The decision-maker will accept (or partially accept) that the applicant has care needs, then conclude that (a) family members in the home country can meet those needs, or (b) professional care can be purchased, or (c) the applicant can reasonably relocate within the country to access care, or (d) the evidence does not demonstrate any real attempt to obtain care.

To counter this, an application must do more than assert “care is unavailable”. It should show a realistic picture of what care is required and what has been tried, what options exist, and why each option fails in the applicant’s specific circumstances.

“Availability” is not just about theoretical services. The Home Office will often expect evidence on whether appropriate care exists locally, whether it is accessible given the applicant’s mobility and health, whether it is reliable, and whether it meets the level required (for example, whether the need is for daily personal care, overnight supervision, or skilled nursing). If the applicant needs dementia supervision and medication management, it is usually unhelpful to provide only generic information about domestic helpers or care homes without addressing whether those services provide safe supervision, training, safeguarding, and continuity.

Affordability is also tested carefully. The Immigration Rules (and the way they are applied) typically contemplate that the UK sponsor can fund care abroad if that would meet the need. As a result, “we cannot afford it” often fails where the sponsor can afford to pay. Successful cases are commonly those where the evidence shows either that appropriate care cannot be obtained at all, or that it cannot be obtained even with the sponsor’s financial help because of factors such as local unavailability, lack of suitable providers, or barriers related to the applicant’s circumstances.

If family support is relied on by the Home Office, the question becomes: is there in fact someone who can provide the required level of care, and is it reasonable to expect them to do so? It is not enough to state that relatives are “busy” or “have their own lives”; however, it can be highly relevant if the only available relatives are themselves elderly, unwell, live far away, have childcare responsibilities that make hands-on care unrealistic, or have a relationship breakdown or safeguarding concerns. The point is to evidence limitations without denigrating family members or offering exaggerated claims.

4. What evidence carries weight: medical, functional and care-market evidence that answers the test

A frequent reason for refusal is that the evidence is “too medical” (diagnoses without care implications) or “too general” (country-level statements without showing the applicant’s lived reality). Strong applications tend to combine three strands: clinical evidence, functional/care assessment evidence, and evidence about care options in the relevant location.

Clinical evidence is best when it is recent, from a treating clinician, and explains prognosis and functional impact. It should identify what care is needed and why. For example, “requires assistance with bathing and dressing due to pain and limited range of motion; unsafe to mobilise without supervision due to recurrent falls” is more persuasive than “has osteoarthritis”.

Functional evidence often makes the difference. Where available, an occupational therapy assessment, a geriatric assessment, a neurologist’s functional evaluation, or a formal care needs assessment can be powerful because it focuses on what the applicant can and cannot do. These assessments should be specific about frequency and duration of care (daily, multiple times per day, overnight), whether assistance must be from a trained person, and whether the applicant requires supervision rather than only physical help.

Evidence about care options abroad should be anchored in the applicant’s actual locality. Decision-makers are sceptical of generic internet printouts. More persuasive evidence might include written responses from local care agencies or nursing providers confirming what services they can offer, at what level, and whether they can accommodate the applicant’s needs (for example, dementia supervision, catheter care, insulin management). If care homes are relied on, evidence should address admission criteria, availability, and suitability, not merely that care homes exist. Where there is an absence of services locally, evidence should show that too, and then address whether relocation is realistic given the applicant’s health, support network, language, and safety.

Where the argument is that family cannot provide care, evidence should be careful and proportionate: statements from family members explaining their circumstances, medical issues, employment constraints, caring responsibilities, distance, and practical limitations can be helpful if consistent and not overstated. The goal is to show that there is no realistic, sustainable arrangement that meets the identified care needs.

Two points deserve emphasis. First, consistency is critical: if the application says the applicant cannot be left alone at all, but medical evidence suggests the applicant lives independently with occasional support, credibility will suffer. Second, the evidence should not appear “reverse engineered” to the rule: it should read as a genuine attempt to assess needs and explore care options.

5. Building a persuasive care-needs narrative: specificity, credibility and causation

Because ADR decisions are heavily evidence-driven, the narrative should act as a disciplined bridge between the documents and the legal tests. A useful approach is to present the story as a sequence of problems and attempted solutions.

Start with the baseline: where the applicant lives, what their day-to-day routine looks like, and what they can do unaided. Then set out how the medical conditions translate into specific care needs, using the same language and concepts as the care assessment (for example, assistance with toileting, medication prompting, supervision to prevent harm). The narrative should then explain the existing care arrangement, if any, and why it is insufficient. If the applicant currently relies on ad hoc help, explain why ad hoc help cannot meet a long-term need.

Next, explain what has been tried in the home country. Decision-makers often look for evidence of attempts to obtain care: enquiries made, providers contacted, services offered, costs, and practical barriers. Even where the applicant lives in a country with nominal care services, the question is whether suitable care is actually obtainable for this person, in this place, at this time. The narrative should therefore be grounded: naming towns or regions, describing travel barriers, and demonstrating why arrangements break down in reality.

Avoiding exaggeration is not simply an ethical point; it is tactical. Overstatement invites the Home Office to test plausibility. If the applicant is said to be entirely immobile, the decision-maker may ask how they attend appointments, how they live at home, or why there is no hospital involvement. If the applicant is said to have “no family support”, but there are relatives nearby, that invites a refusal. A more credible narrative acknowledges what support exists and explains why it does not meet the required level of care.

It is also wise to deal proactively with anticipated Home Office reasoning. If the sponsor is financially able, the application should not rely principally on affordability. Instead, it should emphasise suitability and availability: for example, the lack of regulated providers, inability to secure consistent carers, safeguarding risks, or the need for supervision that cannot reliably be delivered. If the applicant could theoretically relocate, the narrative should address why relocation is unreasonable given their medical needs, dependence on a familiar environment, and the absence of a support network elsewhere.

6. Common pitfalls that trigger refusals on “care available abroad”

Refusals often arise from predictable weaknesses in evidence and presentation. One recurring problem is relying on a single brief GP letter stating that the applicant “needs care” without explaining the nature, level and duration of the care required. Another is providing a “country conditions” report that describes general healthcare shortcomings but does not address whether personal care for daily living can be arranged for the applicant.

A further pitfall is failing to explain family dynamics with care. Where the Home Office sees adult relatives abroad, it will often assume they can help unless the application provides a clear, evidenced explanation. Vague references to relatives being “too busy” are rarely persuasive; a refusal can often be avoided by explaining the practical reality in a measured way, supported by statements and, where appropriate, medical evidence about the relatives’ own limitations.

Applications also fail when they ignore the sponsor’s ability to fund care abroad. If the sponsor can fund care, the narrative must make clear why funding does not solve the problem. That might be because the only services available do not provide the necessary level of care, because there is no reliable workforce, or because the applicant requires a type of supervision or safeguarding that cannot be assured.

Finally, credibility issues can arise when the application presents the situation as suddenly impossible, without documentary history. Progressive conditions typically generate a paper trail: appointments, prescriptions, hospital letters, therapy referrals, fall reports, or care assessments. Where the paper trail is thin, it is important to explain why, rather than hoping the Home Office will infer severity from assertion.

Conclusion: meeting the test by evidencing need, then evidencing the failure of overseas solutions

An ADR application that is likely to succeed usually does two things well. It proves, through specific and consistent evidence, that the applicant requires long-term personal care for everyday tasks. It then proves, with equal specificity, that this care cannot be obtained in the applicant’s country of residence, even with the UK sponsor’s financial support, because suitable care is not realistically available or accessible for this individual.

The “care available abroad” issue is rarely won with general statements. It is won by careful alignment between medical evidence, functional assessments, and real-world evidence of care options and failed attempts. The narrative should be candid and measured, acknowledging complexities and existing support, and explaining why those arrangements do not meet the required standard of long-term personal care. In a route where decision-makers expect precision, credibility is often the decisive asset.

Contact Our Immigration Lawyers in Switzerland

If you are considering a UK Adult Dependent Relative visa application, or you have received a refusal on the basis that care is available overseas, our immigration barristers can advise on the relevant legal tests, the evidence needed, and how best to present your circumstances. To arrange an initial consultation, please telephone Richmond Chambers Switzerland on +41 21 588 07 70 or complete our enquiry form to request an appointment.