Assessment and Eligibility for Service Users and Carers Policy · Assessment and Eligibility for Service Users and Carers Policy . Isle of Wight Council ASC’s Assessment and Eligibility

ADULT SOCIAL CARE AND WELLBEING

Martin Elliott, Head of Adult Social Care

_________________________________________________________________________________________________

Isle of Wight Council Adult Social Care

Assessment and Eligibility for Service Users and Carers Policy

Isle of Wight Council

ASC’s Assessment and Eligibility for Service Users and Carers Policy May 2015 – Final v0.5 Page 2 of 26

1 Document Information

Title: Assessment and Eligibility for Service Users and Carers Policy

Status: Final v0.5

Current Version: Final V0.5

Author: Catherine Smith-Ivory, Adult Social Care Policy Officer

Community Wellbeing and Social Care

[email protected]

(01983) 821000 ext. 6804

Sponsor: Debbie Morris

Commissioning Manager

[email protected]

(01983) 821000

Consultation: Legal Services, ASC Senior Managers and ASC Group Managers,

Interim Strategic Programme Manager and Programme Manager –

Systems Implementation and Transformation Programme

Approved by: Martin Elliott

Approval Date: 11th May 2015

Review Frequency:

Annually

Next Review: April 2016

Version History

Version Date Description

V0.1 January 2015 Draft v0.1

V0.2 February 2015 Amendments made by Debbie Morris, including the addition of case study Appendices

V0.3 February 2015 Amendments made by Tracy Cartmell and Vamsi Pelluri to conform to wording and guidance in the Care Act

V0.4 March 2015 Amendments made by Stephen Ward re: S117 MHA (Section 14) and related documents (Section 16)

V0.5 April 2015 Incorporated Legal comments and amendments made by Vamsi Pelluri and Catherine Smith-Ivory

mailto:[email protected]



2 Contents

Heading Number

Detail Page/s

1 Document Information 2

2 Contents 3

3 Purpose, Scope & Aims 4

4 Assessment and Eligibility Process 5

5 Eligibility Criteria for Services 6

6 What is the national eligibility threshold for adults needing care?

6

7 Interpreting the eligibility criteria (Eligibility Decision Process)

6-11 10

8 Fluctuating needs 11

9 Considering needs met by carers in eligibility determinations

11

10 What is the national eligibility threshold for carers? 11-12

11 Interpreting the carers’ eligibility criteria (Carers Eligibility Decision Process)

11-16 15

12 Capacity 16

13 Independent Advocacy 16-17

14 S117 Mental Health Act 17

15 What the IWC must do after the eligibility determination 17-18

16 The Eligibility and Assessment Process 18

17 Related Documents 19-20

Appendix 1 Eligibility Case Study 1 21

Appendix 2 Eligibility Case Study 2 22

Appendix 3 Carers Case Study 3 23

Appendix 4 Carers Case Study 4 24

Difficulty understanding – various languages 25-26



3 Purpose, Scope and Aims The Care Act, introduced in April 2015, includes new legislation and guidance around the Care and Support (Eligibility Criteria) Regulations 2014. The eligibility framework will ensure there is clarity and consistency around the Isle of Wight council (IWC) determinations on eligibility. The purpose of this policy is to explain that people are entitled to an assessment of their needs and how these improve and maintain their wellbeing and the outcomes the person wishes to achieve in their day-to-day life.



4 - Assessment and Eligibility Process (This draft Process will be phased in during 2015)

Consider at every stage

Mental Capacity

Advocacy &

Participation

Impact on the family and

carers

Safeguarding Strengths –

based Approach

Ensuring assessment

Proportionate & appropriate

Initial information gather and signposting

Urgent Need?

Meet urgent care

need by

commissioning an

interim care

package or

reablement

Initial information gather and screening: A: offer information and advice/refer to preventative services B: proceed to the next step or pause the assessment process where there is a fluctuating need

HSC HUB Individual or carer with care and/or support needs

Refer to Reablement Short

Term Services

Carers

Assessment

Range of Assessment Approaches

Joint

assessment Supported self-

assessment Face-to-face Assessment

Online or phone assessment

Combined assessment

Needs / Outcomes Impact on wellbeing

Consider if needs are likely

to fluctuate

National minimum threshold

for eligibility met?

If needs are ELIGIBLE If needs are INELIGIBLE

Refer to Preventative

services

Offer

support

planning

function



5 Eligibility Criteria for Services The national eligibility criteria sets a minimum threshold for adult care and support needs and carer support needs which the IWC must meet. The Isle of Wight council will comply with this national threshold. The introduction of a national eligibility threshold provides more transparency on what level of need is eligible. More clarity will support authorities in deciding whether the earlier provision of information and advice or preventative services would delay a person from developing needs which meet the eligibility criteria or whether longer-term care and support might be needed. It should also help the person needing care or their carer to think more broadly about what support might be available in the local community or through their support network to meet their needs and support the outcomes they want to achieve.

6 What is the national eligibility threshold for adults needing care? The eligibility threshold for adults with care and support needs is set out in the Care and Support (Eligibility Criteria) Regulations 2014 (the ‘Eligibility Regulations’). The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. In considering whether an adult with care and support needs has eligible needs, the IWC council must consider whether: The adult’s needs arise from or are related to a physical or mental impairment or

illness. As a result of the adult’s needs the adult is unable to achieve two or more of the

specified outcomes (which are described in the guidance below). As a consequence of being unable to achieve these outcomes there is, or there is

likely to be, a significant impact on the adult’s wellbeing. An adult’s needs are only eligible where they meet all three of these conditions.

7 Interpreting the eligibility criteria

The adult’s needs arise from or are related to a physical or mental impairment or illness. The first condition that the council must be satisfied about is that the adult’s needs for care and support are due to a physical or mental impairment or illness and that they are not caused by other circumstantial factors. The council must consider at this stage if the adult has a condition as a result of either physical, mental, sensory, learning or cognitive disabilities or illnesses, substance misuse or brain injury. The council will base their judgment on the assessment of the adult and a formal diagnosis of the condition should not be required.



As a result of the adult’s needs, the adult is unable to achieve two or more of the outcomes set out in the regulations. The second condition that the IWC must consider is whether the adult is “unable” to achieve two or more of the outcomes set out in the regulations. The council are also aware that the regulations provide that “being unable” to achieve an outcome includes any of the following circumstances, where the adult:

is unable to achieve the outcome without assistance. This would include where an adult would be unable to do so even when assistance is provided. It also includes where the adult may need prompting for example, some adults may be physically able to wash but need reminding of the importance of personal hygiene;

is able to achieve the outcome without assistance but doing so causes the adult significant pain, distress or anxiety. For example, an older person with severe arthritis may be able to prepare a meal, but doing so will leave them in severe pain and unable to eat the meal;

is able to achieve the outcome without assistance, but doing so endangers or is likely to endanger the health or safety of the adult, or of others – for example, if the health or safety of another member of the family, including any child, could be endangered when an adult attempts to complete a task or an activity without relevant support;

is able to achieve the outcome without assistance but takes significantly longer than would normally be expected. For example, an adult with a physical disability is able to dress themselves in the morning, but it takes them a long time to do this, leaves them exhausted and prevents them from achieving other outcomes.

The Eligibility Regulations set out a range of outcomes. The IWC must consider whether the adult is unable to achieve two or more of these outcomes when making the eligibility determination. The following section of the policy provides examples of how local authorities should consider each outcome set out in the Eligibility Regulations (which do not constitute an exhaustive list) when determining the adult’s eligibility for care and support: (a) managing and maintaining nutrition We should consider whether the adult has access to food and drink to maintain nutrition, and that the adult is able to prepare and consume the food and drink. (b) maintaining personal hygiene We should, for example, consider the adult’s ability to wash themselves and launder their clothes. (c) managing toilet needs We should consider the adult’s ability to access and use a toilet and manage their toilet needs.



(d) being appropriately clothed We should consider the adult’s ability to dress themselves and to be appropriately dressed, for instance in relation to the weather to maintain their health. (e) being able to make use of the home safely We should consider the adult’s ability to move around the home safely, which could for example include getting up steps, using kitchen facilities or accessing the bathroom. This should also include the immediate environment around the home such as access to the property, for example steps leading up to the home.

(f) maintaining a habitable home environment We should consider whether the condition of the adult’s home is sufficiently clean and maintained to be safe. A habitable home is safe and has essential amenities. An adult may require support to sustain their occupancy of the home and to maintain amenities, such as water, electricity and gas. (g) developing and maintaining family or other personal relationships We should consider whether the adult is lonely or isolated, either because their needs prevent them from maintaining the personal relationships they have or because their needs prevent them from developing new relationships. (h) accessing and engaging in work, training, education or volunteering We should consider whether the adult has an opportunity to apply themselves and contribute to society through work, training, education or volunteering, subject to their own wishes in this regard. This includes the physical access to any facility and support with the participation in the relevant activity. (i) making use of necessary facilities or services in the local community including public transport and recreational facilities or services We should consider the adult’s ability to get around in the community safely and consider their ability to use such facilities as public transport, shops or recreational facilities when considering the impact on their wellbeing. Local authorities do not have responsibility for the provision of NHS services such as patient transport, however they should consider needs for support when the adult is attending healthcare appointments. (j) carrying out any caring responsibilities the adult has for a child We should consider any parenting or other caring responsibilities the person has. The adult may for example be a step-parent with caring responsibilities for their spouse’s children.



As a consequence there is, or there is likely to be, a significant impact on the adult’s wellbeing The third condition that must be met is that the IWC must consider whether the adult’s needs and their inability to achieve the outcomes above cause or risk causing a significant impact on their wellbeing. The definition of “wellbeing” is set out in detail in Section 1 of the Care Act as follows:- “Wellbeing” is a broad concept, and it is described as relating to the following areas in particular:- personal dignity (including treatment of the individual with respect); physical and mental health and emotional wellbeing; protection from abuse and neglect; control by the individual over day-to-day life (including over care and support

provided and the way it is provided); participation in work, education, training or recreation; social and economic wellbeing; domestic, family and personal; suitability of living accommodation; the individual’s contribution to society. The council must determine how the adult’s inability to achieve the outcomes above impacts on their wellbeing. Where the adult is unable to achieve more than one of the outcomes, the council does not need to consider the impact of each individually, but should consider whether the cumulative effect of being unable to achieve those outcomes is one of a “significant impact on wellbeing”. In doing so, the council should also consider whether: the adult’s inability to achieve the outcomes above impacts on at least one of the

areas of wellbeing in a significant way (as described in the 9 wellbeing descriptions above) ; or,

the effect of the impact on a number of the areas of wellbeing mean that there is a significant impact on the adult’s overall wellbeing.

The IWC will have to consider whether the adult’s needs and their consequent inability to achieve the relevant outcomes will have an important, consequential effect on their daily lives, their independence and their wellbeing. In making this judgment, the council should look to understand the adult’s needs in the context of what is important to him or her. Needs may affect different people differently, because what is important to the individual’s wellbeing may not be the same in all cases. Circumstances which create a significant impact on the wellbeing of one individual may not have the same effect on another. The next table illustrates the interplay of the three conditions above, the outcomes listed in the eligibility regulations and the wellbeing principle, which is broken down into areas of wellbeing as above.



Eligibility decision process

1. Needs 2. Outcomes 3. Wellbeing The adult’s needs arise from or are related to a physical or mental impairment or illness.

As a result of the needs, the adult is unable to achieve two or more of the following: a) managing and maintaining nutrition; b) maintaining personal hygiene; c) managing toilet needs; d) being appropriately clothed; e) maintaining a habitable home environment; f) being able to make use of the home safely; g) developing and maintaining family or other personal relationships; h) accessing and engaging in work, training, education or volunteering; i) making use of necessary facilities or services in the local community including public transport and recreational facilities or services; j) carrying out any caring responsibilities the adult has for a child

As a consequence, there is or is likely to be a significant impact on the adult’s wellbeing, including the following: a) personal dignity (including treatment of the individual with respect); b) physical and mental health and emotional wellbeing; c) protection from abuse and neglect; d) control by the individual over day-to-day life (including over care and support provided and the way it is provided); e) participation in work, education, training or recreation; f) social and economic wellbeing; g) domestic, family and personal relationships; h) suitability of living accommodation; i) the individual’s contribution to society.



The eligibility case studies that are attached as Appendices 1 & 2 demonstrate examples of how eligibility determinations may be made. The purpose of these case studies is to illustrate eligibility on the basis of significant impact on wellbeing where the person has needs caused by a physical or mental impairment or illness which mean they are unable to achieve two or more outcomes specified in the Eligibility Regulations. Significant impact on wellbeing is personal, so although two people are in similar circumstances, the impact on their wellbeing is different.

8 Fluctuating needs

Individuals with fluctuating needs may have needs which are not apparent at the time of the assessment, but may have arisen in the past and are likely to arise again in the future. Therefore the council must consider an individual’s need over an appropriate period of time to ensure that all of their needs have been accounted for when the eligibility is being determined. Where fluctuating needs are apparent, this should also be factored into the care plan, detailing the steps we will take to meet needs in circumstances where these fluctuate. For example, a carer could be caring for an adult with a mental illness, which has been managed in the past 8 months, but which could deteriorate, if circumstances in the adult’s life change. In such situations, the IWC must consider what the nature of the cared for person’s needs have been over the past year to get a complete picture of the carer’s level of need. The level of a carer’s need can also fluctuate irrespective of whether the needs of the adult for whom thy care, fluctuate. For example, if the carer is a parent of school children, they may not have the same level of need for support during term time as during school holidays.

9 Considering needs met by carers in eligibility determinations

The eligibility determination must be made based on the adult’s needs and how these impact on their wellbeing. The council must only take consideration of whether the adult has a carer, or what needs may be met by a carer after the eligibility determination when a care and support plan is prepared. The determination must be based solely on the adult’s needs and if an adult does have a carer, the care they are providing will be taken into account when considering whether the needs must be met. The council are not required to meet any eligible needs which are being met by a carer, but those needs should be recognised and recorded as eligible during the assessment process. This is to ensure that should there be a breakdown in the caring relationship, the needs are already identified as eligible, and therefore the IWC must take steps to meet them without further assessment.

10 What is the national eligibility threshold for carers?

Carers can be eligible for support in their own right. The national eligibility threshold for carers is also set out in the Care and Support (Eligibility Criteria) Regulations 2014. The threshold is based on the impact a carer’s needs for support has on their wellbeing.



In considering whether a carer has eligible needs, the IWC must consider whether: the needs arise as a consequence of providing necessary care for an adult; the effect of the carer’s needs is that any of the circumstances specified in the

Eligibility Regulations apply to the carer; and as a consequence of that fact there is, or there is likely to be, a significant

impact on the carer’s wellbeing.

A carer’s needs are only eligible where they meet all three of these conditions.

11 Interpreting the carers’ eligibility criteria

The needs arise as a consequence of providing necessary care for an adult The IWC must consider whether the carer’s need for support arises because they are providing care to an adult. Carers can be eligible for support whether or not the adult for whom they care has eligible needs. The eligibility determination must be made based on the carer’s needs and how these impact on their wellbeing. The determination should be made without consideration of whether or not the adult the carer cares for, has eligible needs. The carer must also be providing “necessary” care. If the carer is providing care and support for needs which the adult is capable of meeting themselves, the carer may not be providing necessary support. In such cases, local authorities should provide information and advice to the adult and carer about how the adult can use their own strengths or services available in the community to meet their needs. The effect of the carer’s needs is that any of the circumstances specified in the Eligibility Regulations apply to the carer The second condition that the council must consider is whether the carer’s physical or mental health is either deteriorating or is at risk of doing so, or whether the carer is unable to achieve any of a list of other outcomes which may apply.

The IWC must be aware that the regulations provide that ‘being unable’ to achieve outcomes, includes circumstances where the carer: Is unable to achieve the outcome without assistance. This includes where the

carer would be unable to achieve an outcome even if assistance were provided. A carer might, for example, be unable to fulfil their parental responsibilities unless they receive support in their caring role.

Is able to achieve the outcome without assistance, but doing so causes or is likely

to cause significant pain, distress or anxiety or endangers. A carer might for example be able to care for the adult and undertake fulltime employment, but if doing both, this causes the carer significant distress, the carer should not be considered able to engage in employment.



Is able to achieve the outcome without assistance but doing so is likely to

endanger the health or safety of the carer or any adults or children for whom the carer provides care. A carer might for example be able to provide care for their family and deliver necessary care for the adult, but, where this endangers the adult with care and support needs, for example, because the adult receiving care would have to be left alone while other responsibilities are met, the carer should not be considered able to meet the outcome of caring for their family.

The eligibility Regulations set out a range of outcomes. The IWC must consider whether the carer is able to achieve these outcomes or if due to nature of their needs they are unable to achieve any of the outcomes. The carer will have eligible needs met if they are unable to achieve any of these outcomes and as a result there is, or there is likely to be, a significant impact on their wellbeing.

The following section of the guidance provides examples of how we should consider the outcomes set out in the Eligibility Regulations when they determine whether a carer meets the eligibility criteria. To be eligible, a carer must be unable to achieve any of the following outcomes: (i) carrying out any caring responsibilities the carer has for a child We should consider any parenting or other caring responsibilities the carer has for a child in addition to their caring role for the adult. For example, the carer might be a grandparent with caring responsibilities for their grandchildren while the grandchildren’s parents are at work. (ii) providing care to other persons for whom the carer provides care We should consider any additional caring responsibilities the carer may have for other adults. For example, a carer may also have caring responsibilities for a parent in addition to caring for the adult with care and support needs. (iii) maintaining a habitable home environment We should consider whether the condition of the carer’s home is safe and an appropriate environment to live in and whether it presents a significant risk to the carer’s wellbeing. A habitable home should be safe and have essential amenities such as water, electricity and gas.

(iv) managing and maintaining nutrition We should consider whether the carer has the time to do essential shopping and to prepare meals for themselves and their family.



(v) developing and maintaining family or other significant personal relationships We should consider whether the carer is in a position where their caring role prevents them from maintaining key relationships with family and friends or from developing new relationships where the carer does not already have other personal relationships.

(vi) engaging in work, training, education or volunteering We should consider whether the carer can continue in their job, and contribute to society, apply themselves in education, volunteer to support civil society or have the opportunity to get a job, if they are not in employment.

(vii) making use of necessary facilities or services in the local community We should consider whether the carer has an opportunity to make use of the local community’s services and facilities and for example consider whether the carer has time to use recreational facilities such as gyms or swimming pools.

(viii) engaging in recreational activities We should consider whether the carer has leisure time, which might for example be some free time to read or engage in a hobby.

As a consequence of that fact there is, or there is likely to be, a significant impact on the carer’s wellbeing

The third condition that must be met is that the IWC must consider whether the carer’s needs and their inability to achieve the outcomes above present a significant impact on the carer’s wellbeing. In doing so, the council should consider whether:

The carer’s needs and inability to achieve the outcomes impact on an area of the carer’s wellbeing in a significant way; or

The impact on a number of the areas of wellbeing is such that they have a significant impact on an adult’s overall wellbeing.

The IWC will have to consider whether the carer’s needs and their inability to achieve the outcomes will have an important, consequential effect on their daily lives, their independence and their own wellbeing.

In making this judgement, the council should look to understand the carer’s needs in the context of what is important to them. The impact of needs may affect different carers differently, because what is important to the individual’s wellbeing may not be the same in all cases. Circumstances which create a significant impact on the wellbeing of one individual may not have the same effect on another.

When considering the type of needs a carer may have, the IWC should note that there is no hierarchy of needs or of the areas of wellbeing as described in chapter 1 of the guidance.

The table overleaf illustrates the interplay of the outcomes listed in the eligibility regulations and the wellbeing principle.



Carers’ eligibility decision process

1. Needs 2. Outcomes 3. Wellbeing The needs arise as a consequence of providing necessary care to an adult, and the carer is ‘unable’ to achieve the following:

As a result of the carer’s needs, either: a) the carer’s physical; or mental health is, or is at risk of, deteriorating, or b) the carer is unable to achieve any of the following outcomes: i. carrying out any caring responsibilities the carer has for a child; ii. providing care to other persons for whom the carer provides care; iii. maintaining a habitable home environment; iv. managing and maintaining nutrition; v. developing and maintaining family or other significant personal relationships; vi. accessing and engaging in work, training, education or volunteering; vii. accessing and engaging in work, training, education or volunteering; viii. making use of necessary facilities or services in the local community including recreational facilities or services; ix engaging in recreational activities.

As a consequence, there is or is likely to be a significant impact on the carer’s wellbeing, including: a) personal dignity (including treatment of the individual with respect); b) physical and mental health and emotional wellbeing; c) protection from abuse and neglect; d) personal dignity (including treatment of the individual with respect); e) physical and mental health and emotional wellbeing; f) protection from abuse and neglect; g) control by the individual over day-to-day life (including over care and support provided and the way it is provided); h) participation in work, education, training or recreation; i) social and economic wellbeing; j) domestic, family and personal relationships; k) suitability of living accommodation; l) the individual’s contribution to society.



The carers case studies that are attached as Appendices 3 & 4 demonstrate examples of how eligibility determinations may be made. The purpose of these case studies is to illustrate eligibility on the basis of significant impact on wellbeing where the carer has needs caused by providing necessary care. Significant impact on wellbeing is personal, so although two people are in similar circumstances, the impact on their wellbeing is different.

12 Capacity

An individual may be unable to request an assessment or may struggle to express their needs. The local authority must in these situations carry out supported decision making, helping the person to be as involved as possible in the assessment, and must carry out a capacity assessment, where appropriate. The requirements of the Mental Capacity Act and access to an Independent Mental Capacity Advocate apply for all those who may lack capacity. Where there is concern about a person’s capacity to make a specific decision, for example as a result of a mental impairment such as dementia, acquired brain injury or learning disabilities, then a decision specific capacity assessment should be carried out under the Mental Capacity Act (MCA). Those who may lack capacity will need extra support to identify and communicate their needs and make subsequent decisions, and may need an Independent Mental Capacity Advocate. The more serious the needs, the more support people may need to identify their impact and the consequences. Professional qualified staff, such as social workers, can advise and support assessors when they are carrying out an assessment with a person who may lack capacity.

13 Independent Advocates

At the point of first contact, request or referral (including self-referral), local authorities must seek to ascertain whether an individual is able to be involved in their assessment and local authorities must therefore consider whether the individual has substantial difficulty in doing so. Local authorities must consider whether the adult would experience substantial and communicating the person’s views, wishes or feelings. Where a person has substantial difficulty in any of these four areas, then they need assistance.

If a person does have substantial difficulty, the local authority must find someone appropriate and independent to support and represent the person, for the purpose of facilitating their involvement. This should be done as early as possible in the assessment process so that the individual’s involvement can be supported throughout all stages of the process. Individuals may require help to understand information provided, assistance in weighing up the information, and support in communicating their wishes and preferences.



Where there is a family member or friend who is willing and able to facilitate the person’s involvement effectively, and who is acceptable to the individual and judged appropriate by the local authority, they may be asked to support the individual in the assessment process. Where there is no one thought to be appropriate for this role – either because there is no family member or friend willing and available, or if the individual does not want them to be a part of the assessment – the local authority must appoint an independent advocate.

14 Section 117 Mental Health Act

There is a duty on the IWC to provide services to service users who are entitled to after-care under Section 117. This is a free-standing duty and is not subject to eligibility criteria. Therefore no eligibility assessment is required in relation to services provided under Section 117.

15 What the IWC must do after the eligibility determination?

When the eligibility determination has been made, the IWC must provide the person to whom the determination relates (whether that is an adult with care and support needs, or a carer with support needs) with a copy of their decision. Where the person is found to have no eligible needs, the council must provide information and advice on what can be done to meet or reduce the needs (for example what support might be available in the community to help the adult or carer) and what can be done to prevent or delay the development of needs in the future. We should consider how this package of information can be tailored to the needs which the person does have, with the aim of delaying deterioration and preventing future needs, and reflect the availability of local support (see also chapter 2 of the Care Act on preventative services and chapter 3 on information and advice). If the adult has some eligible needs, the IWC must: Agree with the adult which of their needs they would like us to meet. The person

may not wish to have support in relation to all their needs – they may, for example, intend to arrange alternative services themselves to meet some needs. Others may not wish for the council to meet any of their needs, but approach the authority only for the purposes of determining eligible needs.

Consider how IWC may meet those needs. This does not replace or pre-empt the care and support planning process (see chapters 10–13 of the Care Act), but is an early consideration of the potential support options, in order to determine whether some of those may be services for which the council makes a charge. Where that is the case, the council must carry out a financial assessment (see chapter 8 of the Care Act).



Establish whether the person meets the ordinary residence requirement. This applies differently for adults with care and support needs and for carers. In the case of the adult, they must be ordinarily resident in the Isle of Wight area. In the case of the carer, the person for whom they care must be ordinarily resident in the authority’s area. This is because carers’ needs are met by local authorities where the adult with the needs for care and support lives, not the authority where the carer lives. Determining ordinary residence at this stage should not lead to a delay in meeting eligible needs – more guidance on ordinary residence can be found in chapter 19 of the Care Act.

16 The Eligibility and Assessment Process

To assess your needs and decide whether we can support you to improve and maintain your wellbeing, the following process will take place. 1. Initial assessment

The purpose of the initial assessment is to identify how you can improve and maintain your health and wellbeing and what support is available from the voluntary sector, circle of support. The initial assessment will identify if you will benefit from a short period of support to regain your independence and the requirement for a more detailed assessment. 2. Detailed assessment

An Adult Social Care member of staff will have a detailed discussion with you, and anyone else you would like at your assessment, about your needs and improve and maintain your wellbeing. When this has been completed, we will be able to make a further decision and tell you whether you have eligible care needs. 3. Support planning After we have worked out what how much will be your allocated indicative budget and what support you may require to regain your independence, we will agree a support plan with you for your eligible unresolved needs and suggest ways your other needs can be met. 4. Review We will regularly review the services you are getting from us to ensure that your outcomes are being met and the care you are receiving is appropriate. We will also review your needs to decide whether they still meet our Eligibility Criteria. However, if there are any significant changes to your needs we will carry out a full reassessment and explain the process to you.



17 Related Documents

Corporate Plan 2014-17 http://wightnet.iow.gov.uk/documentlibrary/view/corporate-plan

Care Act 2014 http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted/data.htm

Social Care Institute for Excellence (SCIE) – Assessment and Eligibility

http://www.scie.org.uk/care-act-2014/assessment-and-eligibility/

ADASS, DOH, LGA Developing Care and Support Planning

http://www.adass.org.uk/home/

Section 4 and 8 of the Disabled Persons (services, representation and consultation) Act 1986 for a person with a disability

http://www.legislation.gov.uk/ukpga/1986/33

Section 1 of the Carers (Recognition and Services) Act 1995

http://www.legislation.gov.uk/ukpga/1995/12/contents

Carers and Disabled Children Act 2000


Carers (Equal Opportunities) Act 2004 for a person who is a carer


Human Rights Act 1998 http://www.legislation.gov.uk/ukpga/1998/42/contents

Mental Health Act 1983 http://www.legislation.gov.uk/ukpga/1983/20/contents

Health Services and Public Health Act 1968


National Health Service Act 2006


IWC Appointing Independent Advocates Policy

Appointing Independent Advocates Policy

IWC Self-funders Fees (Non-Residential Policy)

As of March 2015 in draft form

Equality Impact Assessment (EIA)

EIA

Officer Decision Record (ODR)

Filed with Council Adult Social Care ICT system

Data Protection Act 1998 https://www.gov.uk/data-protection/the-data-protection-act

Data Protection Policy http://wightnet.iow.gov.uk/documentlibrary/view/dataquality-

strategy-and-action-plan

http://www.adass.org.uk/home/

http://wightnet.iow.gov.uk/documentlibrary/view/appointing-independent-advocates-policy

http://wightnet.iow.gov.uk/documentlibrary/view/eia-assessment-and-eligibility-for-service-users-and-carers-policy1



Equality Policy Statement Practice Guidelines

http://wightnet.iow.gov.uk/documentlibrary/view/equality-policy-statement-practice-guidelines

SHIP’s Multi-Agency Safeguarding Adults Policy, Procedure & Guidance, July 2013

http://wightnet.iow.gov.uk/documentlibrary/view/safeguarding-adults-multi-agency-policy-procedure-guidance





APPENDIX 1

Eligibility Case Study 1: John Taylor (Eligible) John is 32 and has been referred by his mother for an assessment, who is concerned for John and his future. John is unemployed and lives with his mother and she is getting to an age where she realises that she might not be able to provide the same level of care and support for her son as she has done so far. John is able to manage his own personal care, but his mother does all the housework for both of them. John feels increasingly isolated and will not leave the house without his mother. It is important to John that he is intellectually stimulated and there is a chess club nearby which he would like to join, but John does not feel confident about this due to his anxiety in social situations.

Needs Outcomes Impact on wellbeing Decision: Eligible

Adult on the autistic spectrum.

John has severe difficulties socialising and co-operating with other people. He only has transactional exchanges and cannot maintain eye contact. John knows that others feel uneasy around him, and spends a lot of his time alone. As a result, John is unable to achieve the following outcomes: Developing and maintaining family or other personal relationships and making use of necessary facilities and services in the community.

John is too anxious to initiate developing friendships on his own although he would like to and he feels lonely and depressed most of the time. His nervousness also affects his ability to take advantage of facilities in the community, which could help him feel less lonely. Feeling anxious and lonely has a significant impact on his wellbeing.

Next Actions: John’s local authority thinks John’s needs are eligible. Both John and the local authority agree that the most effective way of meeting John’s needs is to develop his confidence to join the chess club. John uses his personal budget to pay for a support worker to accompany him to an autism social skills group, and to the chess club and to travel with him on the bus to get there. John’s local authority notes that John’s mother could need support too and offers her a carer’s assessment.



APPENDIX 2

Eligibility Case Study 2: Dave Brown (Not Eligible) Dave is 32 and has been referred by his mother for an assessment, who is concerned for Dave and his future. Dave lives with his mother and she is getting to an age where she realises that she might not be able to provide the same level of care and support for her son as she has done so far. Dave is able to manage his own personal care, but his mother does all the housework for both of them. Dave also works, but would like to get a job that is a better match for his intellectual abilities as his current job does not make the most of his numerical skills. Dave’s social contact is mainly online because he feels more comfortable communicating this way and he spends a lot of time in his room on his computer.

Category Needs Impact on wellbeing Decision: Not Eligible

Adult on the autistic spectrum.

Dave struggles severely in social situations leading to difficulties accessing work and cooperating with other people. He only has transactional exchanges with others and cannot maintain eye contact. Dave knows that others feel uneasy around him and spends a lot of his time alone.

Dave is not in ideal employment, but has access to and is engaged in work. This has some impact on his wellbeing but not to a significant extent. Dave prefers to socialise with people online. It emerges from conversations with Dave that he has access to those personal relationships that he considers essential. Dave is contributing to society, has contact with others, is in employment and is able to look after himself.

Dave has difficulties doing some of the things that many other people would think should be a natural part of daily living and he is unable to participate in recreational activities in a conventional sense. Those aspects of his wellbeing that are affected by the needs caused by his autism are not so significantly affected that Dave’s overall wellbeing is at risk. The local authority decides that Dave’s needs are not eligible, because they do not have a significant effect on his wellbeing despite his mother’s concerns. Next Actions: The local authority records Dave’s assessment and sends him a copy. They include information about a local autism support group. Dave’s local authority notes that Dave’s mother could well need support and offers her a carer’s assessment.



APPENDIX 3

Carers Case Study 3: Deirdre (Not Eligible) Deirdre is 58 and has been caring for her neighbour for the past six years. Deirdre has been coping with her caring responsibilities, which include checking in on her neighbour, doing her shopping and cleaning and helping her with the cooking every other day. Deirdre works 20 hours a week at the local school, and she is also helping her daughter by picking up her grandchild after school. Deirdre’s son is concerned that she is taking on too much and notices that she is tired. Deirdre’s son persuades her to ask the local authority for a carer’s assessment.

Caring responsibilities

Outcomes Impact on wellbeing

Decision: Not Eligible

Neighbour with COPD.

Deirdre enjoys the variety that her working life and caring role provide. She would like to be able to spend more time with her grandchild in the afternoons, but recognises that there is a balance between doing this and caring for her neighbour. Deirdre’s needs impact on the following outcomes:

Carrying out caring responsibilities the carer has for a child.

Engaging in recreational activities.

Deirdre’s needs are impacting on a few outcomes. Deirdre enjoys her caring responsibility for her grandchild and would like more free time. On the other hand, her caring roles are fulfilling so although Deirdre is tired at the end of the day, her local authority does not think her wellbeing is significantly affected.

The local authority decides that Deirdre is not eligible because her wellbeing is not significantly affected. Next actions: The local authority recognises that Deirdre could do with some advice to help her manage her day so that she can find some time for herself and so she does not get tired. They advise on how she may reduce some of her tasks such as sitting down with her neighbour to order their food shopping online rather than carrying them home. They make contact with a local carers’ organisation and the local authority makes sure Deirdre is able to access it. The organisation is able to provide additional advice.



APPENDIX 4

Carers Case Study 4: Sam (Eligible) Sam is 38 and cares for his mother who has early-stage dementia. Sam’s mother has telecare, but he still checks in on her daily, and does her shopping, cooking and laundry. Sam is a divorced father of two children, who live with him every other week. Sam works fulltime in an IT company and has come forward for an assessment as he is starting to feel unable to cope with his various responsibilities in the weeks when he looks after his children. Sam has made an arrangement with his employer that he can work longer hours on the weeks when the children are with their mother and fewer when he has the children.

Caring responsibilities

Outcomes Impact on wellbeing Decision: Eligible

Mother with early stage dementia.

Sam wants to spend more time with his children and for instance be able to free up an hour in the afternoon to help them with their homework, so it doesn’t have to be done in the evening when the children are tired. Sam’s needs impact on the following Outcomes:

Carrying out caring responsibilities the carer has for a child.

Engaging in recreational activities.

Sam’s responsibilities impact on a few important outcomes. Sam is starting to feel like he is failing as a parent and it affects the relationship he has with his children, his ex-wife, and his mother. He also worries that his ability to stay in work would be in jeopardy unless he receives support. Sam seems quite stressed and anxious.

The local authority decides that Sam’s fluctuating needs are eligible for support, because it perceives that they have a significant impact on his wellbeing. If the local authority supports Sam to maintain his current role, everyone is better off, because Sam can stay in employment, sustain his family relationships and provide security for his mother. Next actions: The local authority gives Sam a direct payment which he uses to pay for a care worker to come in for three days every other week to check on his mother and make her a meal. This gives Sam more time to spend with his children, doing homework with them and spending some more relaxed time with them. The local authority directs Sam to a carers’ organisation which provides Sam with information about his rights at work and how to speak to his employers.



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