Community care assessment
Please note that this factsheet will soon be updated to reflect changes resulting from the Care Act 2014.
A person with dementia may need help to live well with the condition. This help may include community care. This is personal care, services or support provided by a local authority or council. Community care could be provided at home, for example by a home care worker or personal assistant, or in a care home.
Local authorities have a duty to assess the needs of a person with dementia who may require community care. They also have a duty to provide services directly or - more often - make arrangements to meet any needs for which someone is eligible.
The process of assessing what someone's needs are is called a community care assessment. This factsheet looks in more detail at what a community care assessment is, what it will involve, how services and support will be arranged, and how they will be paid for.
Please note that this information will only be valid until April 2015, when the factsheet will be updated to reflect changes the government is making to the rules around community care assessments.
What is a community care assessment?
The community care assessment, also referred to as a needs assessment, enables social services to find out what an individual's care needs are, and to decide which services could help to meet those needs. This could be care in the person's own home, such as:
- equipment and adaptations
- the services of a care agency chosen by the individual
- short break services (respite)
- the services of a personal assistant employed to help with a range of tasks
- day care
- signposting to information, advice and voluntary sector services.
Alternatively, it could be that the person's needs would be best met through care in a care home.
The person's needs are assessed against specific eligibility criteria. These criteria are set by the local authority in line with national guidance. If the person's needs meet these criteria, the local authority must provide services, arrange for alternative services to be provided by someone else, or provide a budget for the person to arrange services themselves.
It is not necessary to wait for a diagnosis of dementia before requesting a community care assessment. What matters is that the person requires care or support. The local authority cannot arrange services unless this assessment has taken place. In an emergency situation, services may be provided before a full assessment has been carried out.
How an assessment is arranged
The assessment can be arranged by a variety of people.
- The person's GP, consultant or another health or social care professional can make a referral to the local authority for assessment.
- The person who is seeking support and care can contact the social services department at the local authority for an assessment. Another person (such as a carer or relative) can also do this on their behalf.
- A hospital social worker can make a referral (if the person is in hospital).
Anyone making a referral must get consent from the person they are referring, prior to contacting the local authority (unless the person lacks the ability to give this consent).
What does the assessment involve?
The purpose of the assessment is to find out what the person's needs and circumstances are, and what support they may require. Individuals and their carers should be fully involved in assessments and the planning of any care and support that follows. The person seeking support should be at the centre of the decision-making process that determines how their needs will be met. This approach is referred to as personalisation, which aims to put people at the centre of their own care, giving them independence, choice and control over the services they use.
The assessment includes finding out about:
- the person's present arrangements for living and care
- the person's health and disabilities, and what they can and cannot do
- the person's concerns and how they want to be supported; this may include giving details of the types of service sought and how they want the support to be arranged
- the concerns of any carers.
It may help for the person or their carer to write down any important points they want to raise before the assessment.
Before a face-to-face assessment, the person may be asked to complete a questionnaire about their needs. This is often called a self-assessment, and can be part of the process of a fuller assessment. People with dementia can be assisted when filling in self-assessment questionnaires, to ensure that all their needs are considered.
The local authority cannot refuse to give a person with dementia a face-to-face community care assessment based on their answers to these initial questions. While some parts of the assessment can take place over the telephone or online, the complex needs of a person with dementia cannot be fully assessed in this way.
People's needs for community care, healthcare and any other services (such as housing) can be assessed using this one procedure. The assessment may be completed in one visit or, if there are more complex needs, spread over several visits. This single assessment procedure aims to lessen the need for repeat assessments and for different agencies to ask the same questions. It should also enable the various professionals involved to get a fuller picture of the person, and to work together closely to ensure that the person receives the best possible care.
An assessment cannot be refused on the grounds that it appears that the person will pay for their own care (see 'Paying for services' below).
Where the assessment takes place
The assessment is often carried out in the person's home. 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 their carer.
If the person being assessed is in hospital, in some areas the local authority may arrange for an assessor to visit their home before they are discharged, to get a better idea of their living situation.
Who carries out the assessment
The local authority social services department is responsible for co-ordinating the assessment. Other professionals, such as doctors, nurses or representatives from other agencies or organisations, may also provide information or take part.
When making a community care assessment, it is important that the local authority considers needs that are being met - or will be met - by the carer. One way to help ensure this is for the carer to ask for a carer's assessment, in addition to the community care assessment for the person they care for. Unpaid carers over the age of 16 are entitled to an assessment of their own needs (eg the need for a break or other social contact) if they are providing, or intending to provide, a substantial amount of care on a regular basis.
The person being cared for does not have to be involved in the carer's assessment, although it is also possible to offer a joint assessment of the carer and the person being cared for.
The Carers and Disabled Children Act 2000 extends carers' rights so that they can request an assessment of their own needs, even if the person they are caring for is not being assessed. This enables local authorities to provide carers with their own services. This may be in addition to services provided for the person being cared for, but carer's services can also be provided when the person being cared for is not receiving them. The Act does not define what these services can be, only that a carer's service can be anything that could 'help the carer care for the person cared for'.
Local authorities cannot take into account a carer's ability to pay when they are deciding whether the carer would benefit from receiving services. However, the carer may have to pay for services they receive under this Act, subject to their financial means. If the local authority does agree to fund services to meet the carer's needs, the carer can ask for a direct payment so that they can arrange the service for themselves (see 'Personal budgets and direct payments' below).
A carer's assessment must consider 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 the same opportunities as those without caring responsibilities.
Eligibility criteria for services
The local authority decides if a person is entitled to receive services by comparing the person's needs with eligibility criteria that it has set. Each local authority sets its own criteria, meaning they vary from area to area. The local authority can choose to fund care that falls within up to four separate bands of needs. These bands reflect the level of risk to a person's independence if these needs are not met. The levels are: critical, substantial, moderate and low. Because of financial pressures on their resources, most local authorities will only fund people's needs that are considered to be critical or substantial.
Each local authority should publish its eligibility criteria. Once it has set these criteria, it cannot refuse to offer services, or offer less suitable services, simply because it is short of resources. However, local authorities review their criteria once a year, and can reduce the level of services they provide. When this happens, people receiving services must be reassessed against new eligibility criteria to see if they still qualify. This may mean that some people whose needs have not changed find they are no longer entitled to services that they received before.
Potential problems with arranging an assessment
The local authority cannot refuse an assessment simply because they believe the person will not meet its criteria. Most local authorities will filter those approaching them for support, but they must not screen out people without getting enough information. If it can be shown that the person may need services, an assessment must be carried out. A phone assessment is not appropriate for assessing complex needs, and a person with dementia should not be ruled out at this stage.
The local authority cannot refuse an assessment if they don't have enough staff to carry out an assessment, or because the person appears to have enough income or savings to pay for their own care services.
If the request for an assessment is refused, the person, their carer or relative should write to social services explaining the circumstances in more detail. Alternatively, they can ask a professional or advice agency to write on their behalf. If they are still unsuccessful, they can make a complaint (see 'Complaints' below).
Even if an assessment has been agreed, there may be a wait before it takes place. There are no guidelines on how long people should expect to wait for an assessment, but local authorities should publish their estimated timescales. If the wait seems to be unreasonable, the person or their carer can complain to the local authority.
Producing a care plan
Once it is decided that the person has eligible needs, the local authority has a duty to provide sufficient support so that these needs are met. At this stage, a care plan is written (sometimes called a support plan). This describes which services are to be provided. The person with dementia and their carer should be closely involved when this plan is written.
The care plan should include:
- the needs that have been identified
- the desired outcomes
- the support to be provided to meet the assessed needs
- assessment of any potential risk to the person or others
- a plan for dealing with emergency changes
- the support that carers are willing and able to provide
- the result of the financial assessment
- the date that the plan will be reviewed.
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 services are provided, so that they can contact them if there are any difficulties.
People who pay for their care privately can still benefit from a care plan, to help them make the best use of their resources.
In some areas people with dementia and their carers may be able to seek assistance from organisations that provide an independent 'brokerage service'. These services help people to understand the care planning process, and also to get involved in various aspects of this process, including the writing of the care plan and deciding what services the person chooses. For more information see factsheet 473, Personal budgets.
How services are arranged
Services can be provided directly by the local authority or arranged through other agencies, such as voluntary or private organisations. Alternatively the local authority may give the person with dementia or their carer - if they are considered to be a 'suitable person' - the option to arrange the support services (see 'Personal budgets and direct payments' below).
Some services, such as community nursing, are arranged through the GP, either directly or after discussion with social services.
How long services take to arrange
Once it has been agreed that services are needed, the local authority must ensure that these are provided, although there may be a wait while they are organised. There should not be excessive delay. If there is likely to be a wait, the local authority must find another way to meet the assessed need until the desired service can be provided. In some cases, the local authority may provide a service straight away.
People's circumstances change, so the services they receive should be reviewed from time to time. Local authorities do this through review meetings to see whether the person's care needs have changed. Care plans should be reviewed within the first three months and then annually, or as needs change.
If there is a change of circumstances for the person with dementia or their carer, and they feel that they need more help or different kinds of services, they should contact the local authority. This should be done even if a regular review is not due.
Paying for services
The local authority can charge for the services it arranges. This is based on a financial assessment of the person receiving the services.
The procedures for charging for care in the person's own home, the time it takes to assess whether someone has to pay, and the amounts charged, all vary between local authorities. Charges should always be 'reasonable'. Government guidance sets out a broad framework for local authorities to follow, so that people can afford to receive services.
The local authority will calculate the cost of the services to be provided (such as home care, meals, or transport) and then financially assess the person - using the local authority's own charging policy - to see how much the person can contribute to the cost of these services. The local authority must provide a breakdown of how they worked out the charge.
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 local authority whether it can reduce or waive the charge. A service cannot be discontinued simply because a person is unable to pay.
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 532, Paying for care.
Personal budgets and direct payments
A personal budget is an allocation of funding given by a local authority to someone who has had their care needs assessed. The allocation may be:
- retained by the local authority and set aside for the person's needs
- managed through an Individual Service Fund, which is paid to a third party, such as a care agency
- managed through a user-controlled trust, which is run by trustees and spent on the person's behalf
- a direct payment to the person, a carer or (if the person lacks mental capacity and is unable to make decisions for themselves) a suitable person.
If the person or their carer decides that they want the local authority to retain their personal budget, they should still be involved in deciding which services should be commissioned to best meet their needs.
The person or their carer may choose to be given a 'direct payment' from the local authority so they can arrange services themselves. The local authority must be satisfied that the person is willing and able to manage a direct payment, either alone or with assistance.
Direct payments offer more choice and flexibility when choosing services to meet care needs. Managing them can sometimes be complicated, so the local authority must help the person managing the direct payment to find local support services. These support services may come from voluntary or charitable organisations.
If the person lacks the mental capacity to consent to a direct payment, a 'suitable person' can receive and manage the direct payment on their behalf. The suitable person may be an attorney under a registered Lasting Power of Attorney or Enduring Power of Attorney, or a court-appointed deputy. However, a carer, relative or friend can sometimes be a suitable person and manage the direct payment. The local authority must be satisfied that the suitable person will act in the best interests of the person with dementia. Financial records relating to the direct payment must be kept and made available to the local authority.
For more information on personal budgets, see factsheet 473, Personal budgets.
If the person with dementia or their carer has a complaint, it is advisable to try to resolve it with the person they have contact with, such as the assessor or care manager. There may simply have been a failure in communication or a misunderstanding that can be easily put right. 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 required services are not provided, or are unsatisfactory
- there is a dispute about the amount of personal budget that is allocated.
If the local authority complaints procedure does not resolve the issue either, someone can take their complaint to the Local Government Ombudsman (see 'Other useful organisations' at the end of this factsheet).
Find out more
Each local authority has its own assessment procedure, and their social services department will publish information on:
- who is eligible for assessment
- how to apply
- what kinds of services might be arranged
- how to make representations (speaking about the matter on behalf of the person) and complaints.
Write, phone or call in to your local authority adult social services department to ask for the appropriate leaflets. The address will be in the phone book under the name of the local authority, or on the gov.uk website. Leaflets should also be available at local libraries.
Other useful organisations
Local Government Ombudsman
PO Box 4771
Coventry CV4 0EH
T 0300 061 0614
Independent organisation that investigates complaints about councils and care providers and looks for a resolution.
Last reviewed: March 2014
Next review due: April 2015
Reviewed by: Alison Campbell, Care Manager, Sunderland City Council and Graham Munn, Commissioning Manager, Mental Health, Hertfordshire County Council
This factsheet has also been reviewed by people affected by dementia. A list of sources is available on request.
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