This is the second post in my series on Care Act needs assessments. You can read the first part here. That post discussed the start of the process, and issues practitioners have to be mindful of at that stage. This post explores the eligibility criteria against which assessments must be conducted. These criteria are set out in the Care and Support (Eligibility Criteria) Regulations 2014 and elaborated on further in chapter 6 of the Care and Support Statutory guidance.
The criteria differ depending on whether the assessment is identifying the needs of an adult with care and support needs, or of a carer. So we will look at both.
As set out in regulation 2 of the Regulations, for an adult with care and support needs, the test contains 3 elements:
- the adult’s needs arise from or are related to a physical or mental impairment or illness;
- as a result of the adult’s needs the adult is unable to achieve two or more of the outcomes specified; and
- as a consequence there is, or is likely to be, a significant impact on the adult’s well-being
The first element is usually fairly straightforward as all it requires is to identify a physical or mental impairment or illness. Nothing specifically states that this impairment or illness has to be diagnosed by a doctor, but assessors will usually speak to medical professionals involved with the person to ensure they have an accurate understanding of the person’s illness or impairment.
As to the second element, the outcomes set out in the regulations are
(a) managing and maintaining nutrition;
(b) maintaining personal hygiene;
(c) managing toilet needs;
(d) being appropriately clothed;
(e) being able to make use of the adult’s home safely;
(f) maintaining a habitable home environment;
(g) developing and maintaining family or other personal relationships;
(h) accessing and engaging in work, training, education or volunteering;
(i) making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
(j) carrying out any caring responsibilities the adult has for a child.
To be eligible for care and support from the local authority, the individual must be unable to achieve 2 or more of these outcomes and that inability must be caused by their impairment or illness (not some other factor). This sounds straightforward, but isn’t always. People are inherently unpredictable after all.
The regulations also provide assistance as to what ‘unable to achieve’ an outcome means. The element of the definition that comes up the most often in practice, is that the person is unable to achieve the outcome if they are unable to achieve it ‘without assistance’. This translates in the statutory guidance as the concept of assessments being ‘carer blind’. The local authority won’t be obliged to meet needs that are being met by a carer who is willing to continue to provide that support, but those needs must still be assessed and recorded appropriately. This enables contingency planning.
Interestingly, what the statutory guidance doesn’t set out is whether equipment should be considered as ‘assistance’ for these purposes. If, for example, an individual is only able to maintain their personal hygiene with bathing equipment in place, it isn’t clear if that should be considered as them being able to achieve the outcome, or unable to achieve it because they need ‘assistance’ from the equipment in place. So this will likely need to be considered on an individual basis.
An individual is also to be treated as unable to achieve an outcome if they are:
- able to achieve it without assistance but doing so causes them significant pain, distress or anxiety;
- able to achieve it without assistance but doing so endangers or is likely to endanger the health or safety of the adult, or of others; or
- able to achieve it without assistance but takes significantly longer than would normally be expected
The regulations also account for fluctuation of needs, which is an important consideration for a lot of people. Many conditions can create varying symptoms depending on any number of factors such as fatigue, having a cold, the weather, emotional state etc and so a snapshot of an individual’s presentation on any one day is unlikely to give a practitioner an accurate picture of a person’s strengths and needs. So where there is a potential for fluctuation in needs, the practitioner should assess over ‘such a period as is considered necessary’. This leaves a suitable amount of flexibility for an individualised approach to be taken.
And that is a real theme through the statutory guidance. It is very clear that there is no ‘one size fits all’ approach to needs assessment. And the focus should also be on empowering and enabling people. But we’ll discuss that in more detail in the next post.
The final element of the criteria is the impact being unable to achieve these outcomes has on their well-being. This is a very subjective test, which puts significant emphasis on the individual’s own experience, as highlighted by the wording of s1 Care Act 2014 (the wellbeing duty) which requires the practitioner to start from the assumption that the individual is best placed to judge this impact and taking their views into account. S1 Care Act 2014 also contains a list of wellbeing factors. But we’ve listed enough factors today so I’ll let you check those out yourself.
For carers, there is another 3 stage test with a very similar format, contained in regulation 3. The test is:
- the needs arise as a consequence of providing necessary care for an adult;
- the effect of the carer’s needs is that any of the circumstances specified in paragraph (2) apply to the carer; and
- as a consequence of that fact there is, or is likely to be, a significant impact on the carer’s well-being.
As above, the practitioner must first identify that the carer s indeed providing care for an adult (support for carers looking after children is set out in different legislation). That care must be ‘necessary’ although I have not come across a situation where a practitioner has said that the care being provided isn’t ‘necessary’. It’s possible, but unlikely in my opinion.
The third element is the same as above, so i won’t repeat it, so we will finish by looking at the second element of the criteria. For carers, the outcomes do differ, and these are:
(a) the carer’s physical or mental health is, or is at risk of, deteriorating;
(b) the carer is unable to achieve any of the following outcomes—
(i) carrying out any caring responsibilities the carer has for a child;
(ii) providing care to other persons for whom the carer provides care;
(iii) maintaining a habitable home environment in the carer’s home (whether or not this is also the home of the adult needing care);
(iv) managing and maintaining nutrition;
(v) developing and maintaining family or other personal relationships;
(vi) engaging in work, training, education or volunteering;
(vii) making use of necessary facilities or services in the local community, including recreational facilities or services; and
(viii) engaging in recreational activities.
There are still some similarities, but it is not necessary for the carer to be unable to achieve 2 or more outcomes, only for one of the circumstances to apply. There must still be a link between their caring role and the circumstances, rather than as a result of any unrelated factor.
The definition of being ‘unable to achieve’ an outcome is the same as above, as is the allowance for fluctuations.
We’ll discuss individualised and proportionate assessments in the next post, and in the final post on this topic, we’ll look at considering evidence and dealing with disagreements.
In case it isn’t obvious from the fact that I still haven’t identified the authority i work for, the views expressed in this blog are my own and not the opinion of that local authority.