2. Support for people with dementia: the care needs assessment
A local authority (also known as local council) has a duty to assess the care needs of a person with dementia. The assessment will determine what care needs they have, and whether the local authority will contribute towards meeting them. Any person has a right to this assessment, even if they will end up paying for their own care.
The process is called a 'care needs assessment'. The aim is to work out exactly what the person's needs are, and the level and type of care and support required to meet these needs. It will also help the local authority to decide whether or not someone is eligible for care and support funded by the council. Even if the person is not eligible, the care needs assessment may still be useful, as it might provide valuable information on the kind of care and support that is required, and which can be accessed through other options. A local authority cannot refuse to carry out an assessment because they think the person will not be eligible for funded care and support.
Getting a care needs assessment
There are a number of ways someone can get an assessment. The person needing the assessment can request it themselves via their local authority's social services department (this may be called different things in different areas, eg Adult services). To find out how to contact your local authority, see 'Other useful organisations'. Alternatively, contact details should be on a Council tax bill or available at the GP surgery or local library. There are other people who can arrange the assessment on behalf of the person:
- The person's GP, consultant or another health or social care professional can make a referral to the local authority.
- A carer or relative can contact the local authority asking for an assessment.
- If the person is in hospital, a hospital social worker can make the referral.
If the assessment is requested on behalf of someone, the person making the referral must get the individual's consent before contacting the local authority. Some people with dementia may lack the ability (mental capacity) to give this consent.
What to expect
A care needs assessment will usually involve a series of questions, often in the form of a discussion, which the person should be given in advance. They are designed to find out:
- 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 thoughts, and how they would like to be supported
- the concerns and thoughts of any carers.
Not all assessments are done face to face. It may be done through a self-assessment form: a questionnaire for the person to complete themselves. (This may also be done before a face-to-face assessment.) People with dementia can be assisted, for example by a social worker at home, when filling in self-assessment questionnaires, to ensure that all their needs are considered. Some local charities may also help with this.
Some local authorities may carry out phone assessments, but this is only appropriate when the person's needs are not complex, or where the person is already known to the local authority and the assessment is a result of a change in needs. As people with dementia often have more complex needs, telephone assessments are generally not appropriate, and should not be used as the only method of assessing care needs.
Where the assessment takes place
A face-to-face assessment usually takes place in the person's home. This gives a clearer picture of the care and support they need. If the assessment is arranged elsewhere, it should be somewhere convenient for the person and their carer.
Who carries out the assessment?
The local authority adult services department will carry out most assessments. This will normally be by a social worker. They may organise for other professionals to be involved if this is needed, for example the person's doctor or a nurse.
The care needs assessment: tips for people with dementia
If you have dementia and are having a care needs assessment, there are a few things you can do to prepare, and things to do during the assessment. These suggestions will also be useful for someone caring for a person with dementia who is about to have an assessment.
Preparing for the assessment
- Look through the assessment questions you should have been given in advance and think about your answers. For example, you may be asked about what support you feel you need.
- Make notes outlining what needs you have, and what care and support you would like.
- Start a diary outlining what daily tasks you need support with.
- Consider what care and support you might need in the future as your condition progresses (this can include equipment).
- Collect any other supporting evidence. For example, the GP or other health or social care professionals may have a reason to comment on any medical needs that you have.
- Make a list of any medication you are taking and for what conditions.
- Make sure any carers or relatives that you wish to be present at the assessment are available.
During the assessment
- Be honest. Some people feel they need to hide their condition and the problems they are having from professionals. However, the purpose of the assessment is to see how your needs can be met, so it's important that you are honest and get the most from the assessment.
- Outline the support you currently get from carers and family. This is important: even if your family will continue to do this for you, your care plan should cover what would happen if they could no longer provide this support.
- Share your wishes and desired outcomes - what you want, for example to feel safer or to have more activity. If you (or your carer) have an idea of what care and support you would like, you should share this in the assessment. It doesn't necessarily mean you will get it, but the assessment should consider what support you and your carer would like. As well as practical care, you should also think about equipment and other items.
Eligibility for support from the local authority
Once an assessment has been completed, the local authority will establish whether or not they will fund care and support for the person. In working this out, they will consider whether or not the person has what is called an 'eligible care need', and also their financial situation.
An eligible care need is the level of need that a person must have for the local authority to consider funding it. There are national eligibility criteria that apply across England; these are summarised in the box below.