4. What will the assessment involve?
The purpose of the assessment is to find out what the person's needs and circumstances are, and what support they need. It is good practice for individuals and their carers to be fully involved in their own assessments and care planning. They play an important part in working out what services they need from the HSC trust and how their needs can be met. This is called person-centred planning.
The assessment may include finding out about:
- the person's current living and care arrangements
- the person's health and disabilities, and what they are and are not able to do
- the person's concerns, and how they want to be supported; this may include details of the types of service sought and how they want the support to be arranged
- the concerns of any carers.
It may help to write down any important points before the assessment.
Assessments may involve a professional visiting the person and any carer to establish what needs the person has. The person may be asked to complete a questionnaire about their needs, which is often called a 'self-assessment'. When someone is asked to complete a self-assessment, this should be part of the process of a wider assessment. People with dementia can be given assistance when filling in self-assessment forms, to ensure that all of their needs are considered.
In Northern Ireland, the Single Assessment Tool has been developed for assessing the health and social care needs of older people. 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.
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, 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.
Who carries out the assessment?
The local HSC trust's social services department is responsible for co-ordinating the assessment. The assessments may involve other professionals, such as doctors, nurses or representatives from other organisations, who can provide information or take part. Therefore, someone can expect a social worker to co-ordinate and carry out parts of the assessment, but they should not be surprised if another professional were also to assess them. The assessment may be completed in one visit or, if there are more complex needs, spread over several weeks.
Unpaid carers over the age of 16 are entitled to an assessment of their own needs if they are providing, or intend to provide, substantial care on a regular basis. Carers can request an assessment of their own needs, even if the person they are caring for is not being assessed.
It is important that the local HSC trust considers needs that are already being met or will be met by the carer when making a community care assessment. One way to help ensure this is under the Carers and Direct Payments NI Act 2002. This enables carers to request an assessment of their own needs at the same time as the person they are caring for is being assessed. Carers can also ask for a direct payment so that they can arrange the service for themselves (see 'Direct payments' below).
The Carer's Support and Needs Assessment component of the Single Assessment Tool should be used for assessing the needs of carers in all programmes of care. This ensures a standardised approach to assessment regardless of their location across Northern Ireland. The assessments 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 HSC trust decides if a person is entitled to receive services by comparing the person's needs with eligibility criteria set regionally by the Department of Health, Social Services and Public Safety (DHSSPSNI).
An example of eligibility criteria currently being used are the regional access criteria for domiciliary care. These define four separate bands of need – critical, substantial, moderate and low – which reflect the severity of risk to a person's independence if these needs are not met. Owing to financial pressures on their resources, HSC trusts will only meet critical and substantial domiciliary (home) care needs.
Potential problems with arranging an assessment
A person should not be refused an assessment for any of the following reasons:
- The local HSC trust believes the person will not meet its criteria. Trusts must not refuse people without obtaining adequate 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.
- They do 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 (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 HSC trusts should publish their estimated timescales. If the wait appears unreasonable, the relative or carer should complain to the HSC trust concerned.
There may be situations where two HSC trusts dispute which of them is responsible for a person's care, and this could delay the assessment. In law, the HSC trust where the person lives at that time has the responsibility.