The health and social care assessment in Northern Ireland

A local health and social care trust has a duty to assess the care needs of a person with dementia. This page looks at how someone with dementia can get a care assessment including the process for application and what to expect.

What is a health and social care assessment?

Anyone with dementia is entitled to an assessment of their needs by the local HSC trust. This is called a ‘health and social care assessment’ (assessment of need). It should identify what the person’s needs are, and what support would meet these needs. It also helps the local HSC trust to decide whether or not they will pay towards meeting these needs. 

Examples of the kinds of services someone could be assessed as needing include personal care, day care, equipment and adaptations, respite care or care in a care home. 

You don’t need to wait for a diagnosis of dementia before requesting an assessment. The local HSC trust cannot refuse to carry out an assessment, even if they think the person will have to pay for their own support and care.

The information in the assessment will be helpful, even if the HSC trust does not pay towards the care and support. You can use the information to discuss care and support needs with other organisations and companies such as home care agencies. 

However, the HSC trust does not have a duty to arrange services unless an assessment has taken place, so it’s important to get an assessment.

For more information see Paying for care and support in Northern Ireland

Getting a health and social care assessment 

There are a number of ways someone can get an assessment. The person with dementia can ask for one themselves. You can also ask your local social services at your HSC trust for one on their behalf. This department may be called different things in different areas – for example, ‘older person’s services’. You can find their contact details: 

  • online 
  • at the GP surgery 
  • at the local library.

Other people can also arrange the assessment on behalf of the person, such as: 

  • the person’s GP, consultant or another health or social care professional such as an occupational therapist 
  • a carer or relative 
  • a hospital social worker (if the person is in hospital). 

If you ask for an assessment on behalf of someone, you must get their consent first. Some people with dementia may lack the ability (known as ‘mental capacity’) to give this consent. You can still ask for an assessment, as long as it is in the person’s best interests. 

Potential problems with arranging an assessment

A person should not be refused an assessment, even for any of the following reasons: 

  • The local HSC trust believes the person will not meet its criteria. Trusts must not refuse people without having enough information. If it can be shown that the person may need services, then an assessment must be carried out. They may refer the person to non-HSC trust services where appropriate. 
  • The trust does not have enough staff to carry out an assessment. 
  • The person has 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 the trust 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.

Who does the health and social care assessment? 

The local HSC trust’s social services department will carry out most assessments. This will normally be done by a social worker (they may be referred to as an assessor). They may ask for other professionals to be involved, for example the person’s doctor or a nurse. 

You and the person with dementia should be fully involved in the assessments and care planning. You play an important part in working out what services you need from the HSC trust and how your needs can be met. 

What to expect from a health and social care assessment

An assessment of need will include answering questions, which should be given in advance. 

The Single assessment tool is used to carry out these assessments. This is the paperwork and guidance that professionals use to record the person’s information. It’s used to avoid or reduce repeat assessments, and so that the same questions aren’t asked by different professionals.

These questions will help the local HSC trust to find out about the person’s: 

  • physical health 
  • mental health and emotional wellbeing 
  • awareness and ability to make their own decisions 
  • medicine management 
  • communication 
  • walking and movement 
  • personal care and daily tasks 
  • living arrangements 
  • relationships with friends and family and whether they provide care to anyone else 
  • finances and leisure activities 
  • quality of life, their goals, wishes and preferences for their future.

The assessment will also cover: 

  • whether the person works or is in education or training 
  • whether there is a carer. 

These questions and answers are then discussed together with those present at the assessment. 

The assessment may be completed in one visit or, if there are more complex needs, spread over several weeks. 

Where does the health and social care assessment take place? 

A face-to-face assessment usually takes place in the person’s home. This can help the assessor to know what care and support they need. If the assessment is arranged elsewhere, it should be somewhere convenient for the person and you, their carer. 

Assessments should not take place over the phone or via letter as needs must be properly assessed. If the person with dementia is offered a self assessment questionnaire or telephone assessment, they can ask to have the assessment in person. They should explain why they need a face-to-face assessment.

If a face-to-face assessment is still not offered, they can make a complaint about the lack of support they are receiving in having their needs assessed. 

It’s important to note that if there are lockdowns or restrictions due to coronavirus, it may not be safe for you or others to have a face-to-face assessment. If this happens, then speak to your assessor about how they can support you with your assessment at this time. For example, a phone assessment may be sufficient, or you may prefer a virtual assessment if this is something that is available in your area. 

If the person being assessed is in hospital, the HSC trust may also arrange for an assessor to visit their home. This allows the assessor to get a better idea of their situation before they are discharged.

Tips for people having a health and social care assessment

If the person with dementia is having an assessment of their needs, there are some things that can help them to prepare for it. They may want to make notes so they can take time to think about what support they need. 

It might seem like a lot for the person to think about, but even noting down some of the details listed here will help them to get more from the assessment. A carer can help the person prepare for an assessment and might also find these tips useful. 

Preparing for the assessment

  • A diary with details of what daily tasks the person needs help with can be helpful. 
  • What support does the person currently get from family and carers?  This is important because even if the person continues to get care and support from others, the care plan should cover what would happen if they could no longer give this support. 
  • Is there any equipment or assistive technology that would help? For example, an automated pill dispenser, or ‘smart’ home systems that can be set up to turn off lights. 
  • What care and support might the person need in the future as their condition gets worse? This can include equipment and assistive technology. 
  • Collect any letters from the GP or other professionals. This is called ‘supporting evidence’. For example, if the person has problems with getting about or walking, the GP might suggest ramps, grab rails or help with shopping.
  • Make a list of any medication the person is taking and what conditions they are for. Some medicines might be for more than one condition – you could ask a GP or pharmacist for clarification if you are not sure. 
  • Make sure anyone who the person would like to be at the assessment, such as a carer or relative, is available.
  • Think about what care and support would help and share this in the assessment. It doesn’t necessarily mean the person will get it, but the assessment should consider it. As well as practical care, think about equipment and other items such as devices that provide assistive technology. 

During the assessment

  • Be honest. Some people feel they need to hide the problems they are having from professionals. However, the point of the assessment is to see how the person’s needs can be met. 
  • Tell the assessor if there are things that the person wants to do.  For example: 
    • be more active 
    • stay living at home as long as possible 
    • engage more with the community by attending social groups and events 
    • have some help with activities such as shopping, going for walks or swimming. 

Getting support from the local HSC trust for people with dementia 

Once an assessment of need has been completed, the local HSC trust will decide if it will pay for care and support for the person. They will consider whether the person’s needs match the criteria (conditions) for providing care and support, as well as looking at their financial situation. For more information on the financial assessment see Financial assessments in Northern Ireland and Paying for care and support in Northern Ireland.

If the person you care for is told that they do not have eligible care needs and you believe they do, you will need to make a complaint. You should explain why you think their needs do meet the criteria.

Eligibility criteria 

The HSC trust will compare the person’s needs with eligibility criteria set by the Department of Health. These criteria consist of four bands of risk. The HSC trust will try to establish which risk band the person falls into. They will then use this to decide whether the person will receive services. 

The bands of risk are: 

When either: 

  • the person’s life is or may be threatened 
  • the person has significant health problems, or is likely to develop them 
  • the person has little or no control over their immediate environment 
  • serious abuse or neglect has occurred or is likely to occur 
  • the person is unable to carry out vital personal care or domestic routines 
  • the person is unable to carry out work, education or learning, or is likely to become unable to 
  • the person is unable to maintain relationships or social responsibilities, or is likely to become unable to 
  • the person’s hospital discharge is delayed, causing them a risk of infection or a loss of independence. 

When either: 

  • the person has only partial control over their immediate environment 
  • abuse or neglect has occurred or is likely to occur 
  • the person is unable to carry out the majority of personal care or domestic routines 
  • the person is unable to carry out many aspects of work, education or learning, or is likely to become unable to 
  • the person is unable to maintain the majority of relationships or social responsibilities, or is likely to become unable to 
  • the person is at significant risk of inappropriate admission to hospital or residential care.

When either: 

  • the person is unable to carry out several personal care or domestic routines 
  • the person is unable to carry out several aspects of work, education or learning, or is likely to become unable to 
  • the person is unable to maintain several relationships or social responsibilities, or is likely to become unable to. 

When either: 

  • the person is unable to carry out several personal care or domestic routines 
  • the person is unable to carry out one or two aspects of work, education or learning, or is likely to become unable to 
  • the person is unable to maintain one or two relationships or social responsibilities, or is likely to become unable to. 

HSC trusts must meet care needs that fall within the critical and substantial risk bands, and help for this cannot be sourced from elsewhere. They can choose to meet needs in the moderate and low risk bands, but legally they do not have to. 

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