Community care assessment

If a person is confused or has dementia and needs support, their local authority social services department should carry out a community care 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 those needs.

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.

It has long been considered good practice for individuals and their carers to be fully involved in their own assessments and care planning. The Community Care Assessment Directions 2004 LAC (2004) 24 introduced directions that placed good practice guidelines within a legal framework, meaning that local authorities are required to comply with them by law.

If a person with dementia is assessed as being in need of certain services, social services have a duty to provide the services that fall within their eligibility criteria (locally set rules about what type of needs the local authority will meet).

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.

What is a community care assessment?

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.

The social services department will work closely with other services, such as health services and voluntary organisations, when assessing the person's needs.

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

Why request an assessment?

What kinds of services can local authorities offer?

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

However, services often include:

• equipment and adaptations
• meals on wheels
• home care
• short break services (respite)
• 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.

What is a carer's assessment?

Carers over the age of 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 Carers (Equal Opportunities) Act 2004 came into force in April 2005. It extended the legislation on the right to a carer's assessment, so that the assessments must now include a consideration of whether the carer participates, or wishes to participate, in any work, education, training or leisure activity. This recognises that carers should be able to access opportunities that those without caring responsibilities take for granted.

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 'What are direct payments?', below).

Potential 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. Someone may be refused an assessment if the local authority does not believe that they meet its criteria. However, the local authority may be basing its decision on inadequate information.

If this happens, 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.

What will the assessment involve? 

The assessment involves:

• assessing the person's needs and circumstances
• identifying which of the person's needs the local authority should meet under its eligibility criteria (locally set rules on what type of needs the local authority will meet − see 'Eligibility criteria for services', below)
• assessing the person's finances.

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
• 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.

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.

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, if there are more complex needs, spread over several weeks.

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.

How is an assessment arranged?

The assessment can be arranged in a number of ways:

• 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.

The single assessment procedure

The single assessment procedure ensures that older people's needs for community care services, health care and any other services 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 together closely to ensure that the person receives the best possible care.

What happens next?

Producing 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 should 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?

People's circumstances change, so the services they receive should be reviewed from time to time. Local authorities do this through 'reviews' − meetings to see whether people's needs 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 their situation.

If there is a change in the situation of the person with dementia or their carer 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.

How long do services take to arrange?

In some cases, the local authority may provide a service straight away. In other cases, assessors may need more time to consider the situation. They 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.

Eligibility criteria for services

The local authority decides if a person is entitled to receive services by comparing the person's needs with the eligibility criteria that it has set. Each local authority sets its own criteria, so they vary from area to area, although they are required to follow a government guidance document called Fair access to care services. This guidance highlights four separate bands that reflect the severity of risk to a person's independence if these needs are not met − critical, substantial, moderate and low.

Each local authority publishes its criteria in its Better care, higher standards charter. Once it has set its criteria, it cannot change its mind, and cannot refuse services or offer less suitable services simply because it is short of resources. However, local authorities do review their criteria each financial year, and changes may mean that some people are no longer entitled to the same services that they received before. If its criteria do change, the local authority must carry out a new assessment and once again compare the person's needs with their new criteria.

Will I be charged?

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. The assessors will ask questions 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 Factsheet 468, Paying care home fees.

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, they should ask the social services department whether it will reduce or waive the charge. A service cannot be discontinued simply 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. This system is called 'direct payments'. The local authority must be clear that the person is able to manage a direct payment, either alone or with assistance (see Factsheet 473, Direct payments.)

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.

If a person has a registered lasting power of attorney (LPA), their attorney cannot give consent to receive direct payments on the individual's behalf, unless the person with dementia has given consent previously.  To ensure that the person with dementia continues to have the option of direct payments, their LPA should include a direction stating that they would like to have this option.

Note that lasting powers of attorney (LPAs) were created by the Mental Capacity Act 2005, and replace enduring powers of attorney (EPAs). From 1 October 2007 it has not been possible to execute an EPA, although existing EPAs created prior to this date will continue to operate. For more information, see Factsheet 472, Enduring power of attorney and lasting powers of attorney.

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 is not successful, 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. For example, you can contact the Local Government Ombudsman Advice Team (see 'Useful organisations' below).

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, phone or call in to your 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 Alzheimer's Society Northern Ireland helpline on 028 9066 4100.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue.

Useful organisations

Age Concern Cymru

Ty John Pathy
13-14 Neptune Court
Vanguard Way
Cardiff CF24 5PJ
T 02920 413 555
E enquiries@accymru.org.uk
http://www.accymru.org.uk/

Provides advice and information for older people in Wales.

Age Concern England

Freepost SWB 30375
Ashburton
Devon TQ13 7ZZ
T 0800 00 99 66 (free helpline every day 8am-7pm)
E use the enquiry form on the website (see below)
W http://www.ace.org.uk/

Provides advice and information for older people in England.

Alzheimer's Society

Devon House
58 St Katharine's Way
London E1W 1JX
T 020 7423 3500
E info@alzheimers.org.uk
W alzheimers.org.uk

The UK's leading care and research charity for people with dementia, their families and carers.

Carers UK

20 Great Dover Street
London SE1 4LX
T 0808 808 7777 (free carers' line, Wednesday and Thursday 10am-12pm and 2pm-4pm)
E info@ukcarers.org
W http://www.carersuk.org/

Provides information and advice to carers about their rights, and how to access support.

Citizens Advice Bureau (CAB)

Various locations

W http://www.citizensadvice.org.uk/

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, ask at your local library or look on the citizens advice website (above). Opening times vary.

Counsel and Care

Twyman House
16 Bonny Street
London NW1 9PG
T 0845 300 7585 (advice line, weekdays 10am-4pm except Wednesdays 10am-1pm)
E  advice@counselandcare.org.uk
W http://www.counselandcare.org.uk/

Provides advice, information and financial support for older people, their families and carers.

Help the Aged (England)

207-221 Pentonville Road
London N1 9UZ
T 020 7278 1114
   0808 800 6565 (seniorline freephone, weekdays 9am-4pm)
E info@helptheaged.org.uk
W http://www.helptheaged.org.uk/

Help the Aged (Wales)

12 Cathedral Road
Cardiff CF11 9LJ
T 02920 346 550
E infocymru@helptheaged.org.uk
W http://www.helptheaged.org.uk/

Local Government Ombudsman Advice team

T 0845 602 1983
E advice@lgo.org.uk

Princess Royal Trust for Carers

142 Minories
London EC3N 1LB
T 020 7480 7788
E help@carers.org
W http://www.carers.org/

Provides information, advice and support services to carers of all ages.

Factsheet 418

Last updated: July 2008
Last reviewed: July 2008

Reviewed by: Louise Lakey, Policy Officer, Alzheimer's Society