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 from 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 also a number of 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 else, the person making the referral must get the individual's consent before contacting the local authority. Some people with dementia may lack the ability (known as 'mental capacity') to give this consent.
Assessments in Welsh
If the person needing the assessment would prefer that it is carried out in Welsh, they can request this. The local authority must then meet this request. This should not create any delay in the assessment process.
What to expect
A care needs assessment will usually involve a series of questions, often in the form of a discussion. The assessment is designed to find out the individual's 'personal outcomes' - that is, what the person's needs are and what support they want in order to achieve their aims. For example, the person might struggle with cooking and so want the support to be able to cook their own meals. To do this, the assessment considers five key elements:
- The person's circumstances - for example, do they have any illnesses or mobility problems, and do they live alone?
- The person's outcomes - what the person wants from the assessment, such as being able to go out shopping or seeing friends.
- Any barriers to the person achieving those outcomes - for example, any mobility problems.
- The risks to the person if the outcomes are not achieved - for example, they may wish to be able to go out and do their own shopping, and if they can't there is a risk to their health and well-being.
- The person's strengths and capabilities - the assessment should also focus on what someone can do, such as being good at organising their own budget or understanding their own diet.
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 the result of a change in needs. As people with dementia often have more complex needs, telephone assessments are generally not appropriate. They should not be used as the only method of assessing care needs.
Some local authorities may also expect the person to complete the assessment on their own and return it in the post. This is unacceptable and you should insist on a personal visit as set out above.
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
- Make notes outlining what needs you have, and what care and support you would like.
Think about what you want the outcomes of the assessment to be.
- Consider whether there is any equipment or assistive technology that you may benefit from.
- 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, because 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 Wales. These are summarised in the box below.
If someone is told that they do not have eligible care needs, but they believe they do, they will need to put in a complaint (see 'Complaints' below). They should outline why they believe their needs do meet the criteria.