Alzheimer's Society

If a person is confused or has dementia and needs support, their local authority social services department should carry out a community care assessment. If this assessment shows that the person needs certain services, the local authority has a duty to ensure that these services are provided.

Under the NHS and Community Care Act 1990, local authority social services departments are responsible for assessing the needs of people who may need care services to enable them to carry on living at home. Services can also include care in a care home if that seems to be the best option. The social services department must arrange any services that the assessment concludes are needed.

It is not necessary to wait for a diagnosis of dementia before requesting a community care assessment. What matters is that the person needs certain types of care or support.

The assessment

The community care assessment enables social services to find out what the person's care needs are and to decide which services could help to meet these needs. The social services department will work closely with other services, such as health services and voluntary organisations, when assessing the person's needs.

The local authority cannot arrange services unless an assessment has taken place. An assessment may involve:

• talking to the person concerned and their carer, where appropriate, to find out what their needs and views are
• assessing the person's health and disabilities and considering what they can and cannot do
• considering the person's present living arrangements and arrangements for care.

A community care assessment may also be referred to as a 'care assessment' or a 'needs assessment'.

What kinds of services can be offered?

Local authorities vary in the way services are organised and the kinds of services that they offer.

However, services often include:

• equipment and adaptations
• meals on wheels
• home care
• respite care
• day care
• care in a care home.

Services may be provided directly by social services or arranged through other agencies, such as health or housing departments, or voluntary or private organisations.

Some services, such as community nursing, are arranged through the GP, either directly or after discussion with social services.

How is an assessment arranged?

• A GP, a consultant or another professional can refer the person to social services for assessment.
• The person concerned can contact social services directly and ask for an assessment or another person, such as a friend or relative, can do so on their behalf.
• If the person is in hospital, they can ask the hospital social worker to contact social services on their behalf.

Problems with arranging an assessment

Each local authority has its own criteria for deciding who is eligible for assessment. Local authorities can take their own resources into account when setting their eligibility criteria. People may be refused an assessment if the local authority does not believe that they meet their criteria.

However, the local authority may be basing its decision on inadequate information. A carer or relative should write to explain the circumstances in more detail, or they can ask a professional or advice agency to write on their behalf. If they are still unsuccessful, they can make a complaint (see Making a complaint below).

Even if an assessment has been agreed, there may be a wait. There are no guidelines on how long people should expect to wait for an assessment but if the wait seems to be unreasonable, they can complain to the social services department.

The local authority cannot refuse to assess a person on the grounds that they have a high enough income or sufficient savings to pay for their own care services.

Who carries out the assessment?

Usually, at least one of the people carrying out the assessment is from social services. The assessment may be completed in one visit, or spread over several weeks if there are more complex needs.

The social services department is responsible for co-ordinating the assessment, but other professionals, such as doctors, nurses or representatives from other agencies or organisations, may also provide information or take part.

Where will the assessment take place?

The assessment is often carried out in the person's home as this gives a clearer picture of how they are coping and what support they need.

If the assessment is arranged elsewhere it should be somewhere that is convenient for the person being assessed and for their carer.

If the person being assessed is in hospital, social services may also arrange for someone to visit their home to get a better idea of their situation before they are discharged.

Will the views of the person being assessed and their carer be taken into account?

The assessors should listen very carefully to the views of the person being assessed and their carer, if appropriate, in order to find out as much as possible about their situation and their needs.

• The person being assessed and the carer should each explain any worries and explain their own point of view, even if their opinions differ.
• The person being assessed and/or their carer should make clear what types of service they would like and how services could be most conveniently provided.

It may help to write down any important points before the assessment.

How long do services take to arrange?

In some cases, a service may be provided straight away. In other cases, more time may be needed to consider the situation. Assessors may want to discuss the matter with other people, such as the home care organiser or day centre manager, or they may want other people to visit to get a fuller picture. However, once it has been agreed that services are needed, the social services department must ensure that these are provided, although there may still be a wait.

The single assessment procedure

The single assessment procedure for older people means that people's needs for community care services, health care and other services, if appropriate, will be assessed using just one procedure, although it may be spread over several visits. This should lessen the need for repeat assessments and for the same questions to be asked by different agencies. It should also enable professionals from different backgrounds to get a fuller picture of the person and to work closely together to ensure that the person receives the best possible care.

Paying for community care services

The local authority can charge for the services it arranges. However, only the person receiving the services will be financially assessed. Questions will be asked about the person's financial circumstances to see how much, if anything, they can contribute towards the cost of services.

The procedures for charging and the amounts charged may vary among local authorities but charges should always be 'reasonable'.

If the person with dementia needs to move into a care home, the local authority will assess the person's income and savings according to national rules. For further details, see the Society's information sheet Paying care home fees.

Charges

If the person with dementia or their carer thinks that the charge for community care services is unreasonable, or if the person with dementia is unable or unwilling to pay, ask the social services department whether it will reduce or waive the charge. A service cannot be discontinued because a person is unable to pay.

What are direct payments?

If a person with dementia or a carer has been assessed as needing community care services, their local authority may agree to give them money so that they can arrange and pay for their own services, if this is what they prefer. These payments are called direct payments. The local authority must be clear that the person is able to manage a direct payment, either alone or with assistance.

If a person has an enduring power of attorney (EPA) that has been registered, it is unclear whether their attorney can receive direct payments on their behalf, as the person with dementia is not considered to have given consent. To ensure that the person with dementia continues to have the option of direct payments, their EPA should include a direction stating that they would like to have this option. For more information, see the Society's information sheet Enduring power of attorney and receivership. Lasting power of attorney will be introduced in October 2007.

Direct payments may sometimes offer more choice and flexibility but they can be complicated to handle and rules vary from area to area. Seek advice if necessary.

What is a care plan?

The social services department will work closely with other local agencies, such as health and housing, as well as local voluntary organisations, to ensure that services are organised in the best way for the person with dementia and their carer.

After the assessment has been completed, the person carrying out the assessment should write a 'care plan'. This describes which services are to be provided, when and by whom.

The person with dementia or their carer should be given a copy of the care plan. If they are not, they can ask for one. They should also be given the name of the person responsible for ensuring that the care plan is carried out. That person is often known as a care manager.

The care manager can be contacted if there are any difficulties or anything that the person with dementia or their carer wants to discuss.

The social services department cannot reduce or withdraw services from a person with dementia or a carer without carrying out a reassessment of their needs.

What are reviews?

Reviews are meetings to reassess people's needs and see whether they have changed. The person with dementia or carer should be told whether social services will hold regular reviews or whether it is up to them to get in touch when they want to discuss the situation.

If there is a change in either person's situation and they feel that they need more help or different kinds of services, they should contact social services, whether or not there is a regular review.

What is a carer's assessment?

Carers who are over 16 are entitled to an assessment of their own needs if they are providing, or intending to provide, a substantial amount of care on a regular basis to help a friend, neighbour or relative remain at home. This is based on two pieces of legislation:

• The Carers (Recognition and Support Services) Act 1995 enables carers to request an assessment of their own needs at the same time as the person they are caring for is being assessed.
• The Carers and Disabled Children Act 2000 extends carers' rights so that they can request an assessment of their own needs irrespective of whether the person they are caring for is being assessed. It also enables local authorities to provide carers with services in their own right, in addition to any services they may be providing for the person being cared for.

The full involvement of individuals and their carers in both assessment and care planning has long been acknowledged as good practice. The Community Care Assessment Directions 2004 LAC (2004) 24 introduced directions that placed good practice guidelines within a legal framework, that is to say local authorities are now required to comply with them by law.

Local authorities cannot take a carer's ability to pay into account before deciding whether or not to provide a service. However, they can charge carers for services after means testing them to assess how much they can afford.

Instead of receiving such a service, carers can ask for a direct payment (see above).

Making a complaint

If the person with dementia or the carer has a complaint, it is advisable to try to sort it out on a personal level first. There may simply have been a failure in communication or a misunderstanding that can be easily rectified.

However, if this does not have a successful result, there is a local authority complaints procedure. The local authority will explain how to use this. The complaints procedure might be useful if:

• There are problems arranging an assessment.
• There is an unreasonably long wait for an assessment.
• The services needed are not provided or are unsatisfactory.

If the local authority complaints procedure does not resolve the issue either, there are other avenues of complaint. You can telephone the local government ombudsmen advice line on 0845 6021983 (Monday to Friday 9am-4pm).

Finding out more

Each local authority has its own assessment procedure. The local social services department will publish information on:

• who is eligible for assessment and how to apply
• what kinds of services might be arranged
• how to make representations and complaints.

Write, call in to or phone the local social services department to ask for the appropriate leaflets. The address will be in the phone book under the name of the local authority. Leaflets should also be available at local libraries. For details of assessments in Northern Ireland please call the Northern Ireland helpline on 028 9066 4100.

Helpful organisations

Age Concern England

Astral House
1268 London Road
London
SW16 4ER

Freephone information line: 0800 00 99 66 (every day 8am-7pm) Website: http://www.ace.org.uk/

Provides useful advice and information.

Carers UK

20-25 Glasshouse Yard
London
EC1A 4JT

Free Carers Line: 0808 808 7777 (Wednesday and Thursday 10am-12pm and 2pm-4pm)
Email: info@ukcarers.org
Website: http://www.carersuk.org/

Citizens Advice Bureau (CAB)

Your local CAB can provide information and advice in confidence or point you in the right direction. To find your nearest CAB look in the phone book or ask at your local library. Opening times vary.

Counsel and Care

Twyman House
16 Bonny Street
London
NW1 9PG

Advice line: 0845 300 7585 (weekdays 10am-12.30pm and 2pm-4pm except Wednesday afternoons)
Email: advice@counselandcare.org.uk
Website: http://www.counselandcare.org.uk/

Help the Aged

207-221 Pentonville Road
London
N1 9UZ

Telephone: 020 7278 1114
Seniorline freephone: 0808 800 6565 (weekdays 9am-4pm)
Email: info@helptheaged.org.uk
Website: http://www.helptheaged.org.uk/

Princess Royal Trust for Carers

142 Minories
London
EC3N 1LB

Telephone: 020 7480 7788
Email: help@carers.org 
Website: http://www.carers.org/

Further reading

We can provide a list of further reading on request. Please contact the librarian at the Alzheimer's Society national office on  email library@alzheimers.org.uk.

Information sheet 418

Last updated: March 2007
Last reviewed: March 2007