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"Needs Must?" more like "Some Needs May"

Local Authority Care Assessments

With this feature we start to consider the way the state provides for adults with care needs.

Most people wait a long timebefore asking an 'outsider' for help. Often when they do it's because they are at 'breaking point'. If you (or your family) are finding it hard to get by it's important to understand the support you are entitled to.

Now, hard as it seems you MUST ask for help sooner rather than later. At the very least it will mean you can access experts who should be able to suggest and explain services and adaptations that will make life easier for you. That will be the case even if you do not, at that point, qualify for support from the state.

Who you should go to for help will depend on the nature and severity of your care needs. If your needs arise from serious health problems then you may qualify for support from the NHS. I will cover that eventuality in a later feature, here I will focus on support that can be provided by the Local Authority.

The process should start with you calling your local Adult Social Care team. In Somerset you can reach them on 0845 345 9133. You should ask them to perform a 'Care Assessment'. If there are friends or family members involved in your care, and they are finding that responsibility challenging, you should also ask for them to receive a 'Carer's Assessment'.

The Care Assessment is free and will take the form of a discussion between you, your existing carers, family and a Social Worker or another suitably qualified and experienced person. The assessment will consider how you would like to lead your life and the types of care and support that could assist you in meeting those objectives. As a result of that process the Adult Social Care team will be able to develop a 'Care Plan' for you.

Once your needs have been identified they are evaluated by the Local Authority as being either 'Low', 'Moderate', 'Substantial' or 'Critical'. Local Authorities are currently free to decide what level needs they will support and Somerset (like most authorities) only consider needs rated as 'Substantial' or 'Critical' to be 'Eligible'.

At the end of the assessment you should be presented with a document recording the assessment, the care plan and the needs which have been identified as 'Eligible'. If you are not happy with the assessment you should be given the opportunity to raise your concerns and, if necessary, to appeal against it.

The question of whether a need is 'Eligible' is important. The Local Authority will only consider funding action to meet needs that are 'Eligible'.

If you do have 'Eligible' needs it doesn't necessarily mean that your care and support will be funded by the Local Authority. That question will be decided by a 'means test'. I will be covering the financial assessment process in the next feature, but the basic rule is if you have more than £14,250 in savings you will have to pay some of your care costs and if you have more than £23,250 you will have to meet the whole cost.

So that's the process - nice and simple. You contact the Local Authority, they work with you and your carers/family to perform the assessment and agree an appropriate care plan. The plan records your eligible needs and if your savings are below a certain level the Local Authority will fund the actions required to meet those needs.

And yet I am seeing increasing numbers of clients where that simple process is proving a bit more complex. So here are my top tips�

1) The question of money should not be raised at all until after your assessment has been completed. I have clients whose experience was that because they had savings of more than £23,250 a 'Care Assessment' was not performed at all. That is wrong.

Whether you are a pauper or a prince you are entitled to benefit from the experience and advice the Adult Social Care Team can give you to understand your needs and how they might be met.

You can quite justifiably refuse to talk to the Local Authority about your income and savings until they have identified your 'eligible' needs. Indeed, I would recommend you take that approach.

2) Local Authorities are obliged to follow guidance issued by the Department of Health. Somerset have come up with their own definitions of what constitute 'Critical' and 'Substantial' needs.

Somerset's definitions are more limited than those in the Guidance. For example it seems Somerset might not consider a lone-parent being unable to care for their child as being a 'Critical Need' but any sensible reading of the Guidance means that they should.

You should perform your own evaluation of the needs the Local Authority have not rated as 'eligible'. If you think your needs fall within the Department of Health's Guidance for 'Critical' or 'Substantial' but have been rated as ineligible you should challenge the decision. We have set out the definitions below to assist you in that evaluation. We have also included the definition of 'Eligibility' that would have been suggested by the Care Act 2014 and will come into force in April 2015 replacing the existing definitions.

Category of Need Department of Health Guidance Somerset Description Care Act 2014
Critical

� Life is, or will be, threatened; and/or

� Significant health problems have developed or will develop; and/or

� There is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or

� Serious abuse or neglect has occurred or will occur; and/or

� There is or will be, an inability to carry out vital personal care or domestic routines; and/or

� Vital involvement in work, education or learning cannot or will not be sustained; and/or

� Vital social support systems and relationships cannot or will not be sustained; and/or

� Vital family and other social roles and responsibilities cannot or will not be undertaken.

 

If these needs were not met, there would be an almost immediate (within 72 hours) risk to your personal safety, health and well-being.

1) The needs are caused by a physical or mental impairment or illness
2) The needs result in the adult being unable to achieve one of the following outcomes:
a. Carry out some or all basic care activities meaning:

i. Eating & drinking
ii. Maintaining personal hygiene
iii. Toileting
iv. Getting up and dressed
v. Getting around one's home
vi. Preparing meals
vii. Cleaning and maintenance of one's home

b. Maintaining family or other significant personal relationships

c. Accessing and engaging ion work, training, education or volunteering

d. Accessing necessary facilities or services in the local community including medical services, public transport, educational facilities, and recreational facilities or services;

e. Carrying out any caring responsibilities the adult has for a child.

3) As a result there is, or is likely to be a significant impact on the adult's well-being.

'Unable to achieve' means:

� Unable to achieve without assistance
� Able to achieve but doing so causes significant pain, distress or anxiety,
� Able to achieve but doing so endangers health and safety of self or others
� Able to achieve but takes significantly longer than would be expected.

Substantial

 

� There is, or will be, only partial choice and control over the immediate environment; and/or

� Abuse or neglect has occurred or will occur; and/or

� There is, or will be, an inability to carry out the majority of personal care or domestic routines; and/or

� Involvement in many aspects of work, education or learning cannot or will not be sustained; and/or

� The majority of social support systems and relationships cannot or will not be sustained; and/or

� The majority of family and other social roles and responsibilities cannot or will not be sustained.

 

If these needs were not met, there would be a very quick (within six weeks) rise in risk to your personal safety, independence, health and well-being.

Moderate

 

� There is or will be an inability to carry out several personal care or domestic routines; and/or

� Involvement in several aspects of work, education or learning cannot or will not be sustained; and/or

� Several social systems and relationships cannot or will not be sustained; and/or

� Several family and other social roles and responsibilities cannot or will not be undertaken.

 

If these needs were not met, there is a risk of your health and well-being getting worse so that, in the longer term (between six weeks and six months) your needs could become substantial.

 
Low

 

� There is or will be, an inability to carry out one or two personal care or domestic routines; and/or

� Involvement in one or two aspects of work, education or learning cannot or will not be sustained; and/or

� One or two social support systems and relationships cannot or will not be sustained; and/or

� One or two family and other social roles and responsibilities cannot or will not be undertaken.

 

If these needs were not met, you are likely to experience a poorer quality of life and your long term health and well-being.

 

3) The Care Act will place a cap on the amount you have to pay towards your own care. Initially this will be £70,000-£75,000. However, only payments towards care for 'eligible' needs count towards that cap not the amount you actually spend on care.

I will return to the 'Care Cap' in a later feature, but if you pay for your own care and you haven't had an assessment to determine your eligible needs, there is a serious danger that the money you are spending now will not count towards the cap.

If you do encounter problems accessing assessments or care, please make sure you are aware of your rights and don't just take what you are told at face value�and of course if you do need assistance feel free to get in touch.