Assessment and services from your local council in England

Transcription

1 Guide Guide 12 Assessment and services from your local council in England This guide explains about how to ask for a needs assessment and what support services you may receive from your local council if you are assessed as being in need of support or assistance. Our free advice service offers expert independent advice on social care, welfare benefits, and befriending schemes. Call to arrange an appointment to speak to one of our advisers or [email protected] All our free guides and factsheets can be ordered by phone or (as above) or downloaded from

2 Contents What is a needs assessment? Page 3 The care and support plan Page 11 What types of services are available? Page 13 Eligibility criteria Page 14 Asking for a review or reassessment Page 16 Carers assessments Page 18 Charging for care and support Page 19 Using direct payments or a personal budget Page 22 Refusing services Page 25 Making a complaint Page 27 Guide 12: Assessment and services from your local council in England 2

3 1 What is a needs assessment? If you feel that you need some help to manage your daily living tasks at home, you should contact your local council s social services department and ask for a needs assessment or care assessment. The results of this assessment will be used to decide what tasks you need support with, whether your care needs meet the local council s eligibility criteria and what support services you will be offered. Social services have a legal duty to assess anyone who appears to be in need of support services, regardless of income and savings. The needs assessment should not cover any financial matters, except to ensure you are receiving the benefits you are entitled to. Only if it is agreed that social services are to provide you with support services, should you be asked about your income or savings (see chapter 7). When you contact social services you may be asked some basic questions such as your name, address, age, who your doctor is, who your next-of-kin is, the state of your health and what difficulties you are having. It is a good idea to have this information to hand so you are clear about what you want to tell them. The contact details for your local social services department are usually available in your local telephone directory or on the council s website. Alternatively, you could ask a family member, carer or GP to contact social services for you and ask for the needs assessment on your behalf, although social services may Guide 12: Assessment and services from your local council in England 3

4 need to check with you that the person has your permission and agreement to do this. Types of needs assessment The type of needs assessment you receive will depend on the type of care you need. For example, if you are having difficulty preparing a hot meal you may be assessed for this by having a simple conversation and then be provided with a Meals-on-Wheels service. If you have more complicated needs, you should receive a more detailed face-to-face interview. You will normally only have one needs assessment, covering both your health and social care needs, so that you avoid having to repeat the same information to different professionals. However, this may mean that your assessment will need information provided by other agencies, for example, social services, the NHS, the council s housing department, and/or the Pension Service. Where does the assessment take place? Most types of needs assessments are carried out in your own home, normally by a member of social services, such as a social worker or a care manager. In some cases though, your assessment may be carried out in hospital, in a GP surgery or in social services head office. Self-assessments Many councils have introduced the option of self-assessments to allow you to assess your own care needs. A self-assessment may be available as a paper questionnaire or as an online form on the council s website. Guide 12: Assessment and services from your local council in England 4

5 If you complete the assessment online, you should receive an instant reply saying whether you may be able to receive support from social services. However, if more details are needed, your self-assessment may be followed by a face-to-face needs assessment with a social worker. Alternatively, if you are not able to complete a self assessment or you simply prefer not to, you should still be able to ask for a face-to-face assessment with a social worker. What happens at the assessment? A social worker or care manager should consider and make a note of your needs. They will ask you questions about your current situation and discuss with you what tasks you can do, what tasks you can do with some difficulty and what tasks you cannot do at all. The assessment will measure your level of care needs and the possible risk if you are not provided with support services. This will then be compared with the descriptions of care needs that the council will agree to meet according to their eligibility criteria (see chapter 4). Remember that your needs assessment is a chance for you to have your say. It is important that you explain how you feel about your current situation to make sure that your views are included in your assessment. For example, if you have been assessed as needing residential care and want to move into a care home or sheltered accommodation in a different part of the country, it is important for you to make this clear during the assessment, and to say why. What will I be asked about during the assessment? Guide 12: Assessment and services from your local council in England 5

6 All the different aspects of your life should be looked at during your needs assessment, including any emotional, psychological or physical care needs. These areas of your life, sometimes referred to as domains, are assessed by the social worker and will help to decide what support you should be provided with. It is important that all the following areas are covered during the assessment: Your point of view: - any problems and issues in your own words - your expectations and motivation. Personal care and physical wellbeing: - whether you can look after yourself - whether you have any problems with your teeth and gums - any problems with your feet - any pressure sores or skin breakdown - any difficulties with mobility - any problems with continence. Clinical background: - any medical problems you have currently or you had in the past - whether you have had any falls - any medication you take. Disease prevention: - your blood pressure - your weight and nutrition Guide 12: Assessment and services from your local council in England 6

7 - the vaccinations you have had - whether you drink or smoke - whether you take regular exercise - whether you have regular cervical and breast screening. Senses: - whether any sight or hearing problems cause difficulties. Mental health: - any mental health problems (such as depression) - problems with your memory. Relationships: - the relationships with people you have and wish to maintain - if you have a carer or someone who looks after you. Safety: - whether you have been abused or suffered from neglect - any problems with personal safety - whether you are a threat to other people s safety. Your immediate environment and resources: - whether you are able to look after your home - whether your accommodation is suitable - if you need any advice about finances or welfare benefits - whether you can get to the shops and other facilities and services. Lifestyle choices: - where you want to live Guide 12: Assessment and services from your local council in England 7

8 - your wish to maintain hobbies and interests. Who should be present at my needs assessment? You can have someone with you during the assessment if you would like this, such as a family member, friend, carer or an independent advocate. This may be very helpful if you feel you may have difficulty in explaining your situation. Other people involved in your care, such as a care worker, community nurse, sheltered housing warden, GP or medical specialist may also be involved in your assessment, as long as you are happy with this. Occupational therapists and physiotherapists are also often involved in needs assessments. They may suggest whether you would benefit from aids, adaptations to help with mobility or doing regular exercises. If a partner or a friend is caring for you, your carer can ask for their own assessment of needs, known as a carer s assessment, so that they can be supported in their caring role and can take part in activities outside of their caring role (see chapter 6). Things to remember when having a needs assessment - Make sure you mention all your needs: the assessment is your chance to explain what you need help with. - If you think you may not be able to remember everything you need to say, write it down beforehand and keep your notes handy during the assessment. - If you feel that the assessment did not go well, or you missed out something important, contact the social services to ask them to look at the assessment again. Guide 12: Assessment and services from your local council in England 8

9 - If you are unhappy with the final outcome of the assessment, don t give up: you have the right to ask for a review or you can make a complaint. How quickly should a needs assessment take place? How long you may have to wait for an assessment will depend on your situation and also on the number of assessments that need to be carried out in your local area. Good practice guidance says that social services should provide needs assessments within a reasonable time, although this is not clearly defined. As a guide, the Local Government Ombudsman has suggested that waiting more than four to six weeks may be unreasonable. Many social services departments have their own local targets for carrying out assessments. If the council fails to meet its own targets, or fails to assess you within what you feel should be a reasonable time, you can make a complaint (see chapter 10). If your care needs suddenly increase, or your existing care arrangements break down, an urgent assessment of your needs can also be arranged by social services. They also use their discretion to provide you with an emergency care package, if you are seen to be in need of this, until a full assessment can be carried out, although once a full needs assessment has been completed, your care package may completely change. If you are refused a needs assessment If you are refused a needs assessment, it may be helpful to write a letter to social services explaining your difficulties in Guide 12: Assessment and services from your local council in England 9

10 more detail. You should keep a copy of this letter for your own records. You can also ask your carer, someone who knows you, an independent advocate or your GP to send in more information about your care needs. It may be helpful to ask for a copy of your local council s eligibility criteria so that you can see how they decide who is eligible for support services (see chapter 4), and then take advice if necessary about how your care needs fit into the eligibility criteria. If you are not satisfied with the response from the council to your letter, you can make a formal complaint (see chapter 10). Guide 12: Assessment and services from your local council in England 10

11 2 The care and support plan If it is agreed, following your needs assessment, that you are eligible to receive home care services from the council, or to receive funding from the council if you are moving into a care home, you should be given a written care and support plan. Your care plan should be agreed between you and your social worker. The care and support plan should state all your individual care needs, including your emotional, psychological, cultural, social and spiritual needs as well as your physical care needs. The care and support plan should also explain how you will receive the support you need. If you are provided with a service, the care plan should give details about who will provide this service along with the contact details of the person to contact if you have a problem. You have the right to receive a copy of your care and support plan. If you do not receive a copy, you can ask for one. If you feel that your care and support plan does not fully reflect your needs, you should raise any concerns with your social worker. You may want to add more information or suggest an amendment (for example, your need to move to sheltered housing or a care home closer to your family to maintain relationships). Both you and the social worker should sign and date your care and support plan once you are happy with it. However, if you are unhappy with your care and support plan and have been unable to resolve the issue with your social worker, you can consider making a complaint (see Guide 12: Assessment and services from your local council in England 11

12 chapter 10). For more information, see our guide, Complaints about community care and NHS services in England (Guide 18). Guide 12: Assessment and services from your local council in England 12

13 3 What types of social care services are available? Following your assessment, social services will look at whether some or all of your assessed care needs will meet their eligibility criteria for care services. This eligibility criteria sets out the groups of people that need to receive support from social services (see chapter 4). Social services must provide or arrange the support services that they have assessed you as being eligible for. Support services can include help with washing, dressing etc, attending a day centre, or being provided with disability equipment. These services are often referred to as community care services or social care services. The collection of support services is often known as a care package. Support services may be provided directly by social services or social services may commission other organisations - for example, private home care agencies or charities, such as Age UK ( ageuk.org.uk ; ) or the Royal Voluntary Service ( royalvoluntaryservice.org.uk ; ) - to provide support services. Alternatively, you could arrange your own support services by receiving your Personal Budget as a direct payment from social services (see chapter 8). Some parts of your care package may be provided by the health service, for example, a community nurse or community psychiatric nurse. Housing departments may also provide services connected to care. Guide 12: Assessment and services from your local council in England 13

14 4 Eligibility criteria Each council is allowed to take its own finances, local population needs and local costs into account when setting its eligibility criteria, ie how it decides to provide care and support. However, the criteria should be based on national guidance, which outlines the following four nationally defined levels of care need which are: - critical - substantial - moderate - low. These are based on the risks to a person s independence, health, safety, dignity and well-being if support services are not provided. Councils do not have to meet all these four levels of care need. In fact, increasingly, councils are restricting the number of people they provide support services to due to funding pressures. For example, you may find that your local council is only providing services to people who have critical and substantial care needs. These usually cover people in high risk, life-threatening circumstances or where there are serious concerns about their safety or wellbeing. Councils are advised that they should not restrict support services to only those with the very highest needs (although there is no absolute requirement for them to provide certain services). Instead they are asked by the Government to consider providing preventative services at an early stage, to enable people to stay at home for as long Guide 12: Assessment and services from your local council in England 14

15 as possible and to avoid people developing higher level care needs later on. Councils should publish information on their eligibility criteria to local residents. Guide 12: Assessment and services from your local council in England 15

16 5 Asking for a review or reassessment If your care needs change, or if you do not feel that your first assessment took all of your needs into account, you can ask for a review or re-assessment from social services which should look at any areas that have been missed. You should try to contact the person who carried out the first assessment, or you can contact the duty social services desk. If this request for a review is refused or you are still not satisfied with the re-assessment, you could consider making a complaint (see chapter 10). If you have been told you are not entitled to services as you do not meet the social services eligibility criteria (see chapter 4), you should still receive a written statement following the assessment. This statement should explain why you are not entitled, and detail any needs the council cannot meet, ie any unmet needs you may have. The council should explain whether the need is unmet because your care needs do not meet the council s eligibility criteria. However, if they say that your need is not met because the council currently does not offer the service that you require, they have a duty to provide you with advice and information and offer an alternative service, or ensure that another organisation provides the service for you. A review of your needs should be held within three months of first receiving services and at least every 12 months after that. This should be specified in each local council s Better Care Higher Standards Charter which sets national standards for social care, health and housing services. It explains what levels of service and support people can Guide 12: Assessment and services from your local council in England 16

17 expect from social services, and what they can do if they feel these standards are not being met. Guide 12: Assessment and services from your local council in England 17

18 6 Carers assessments If you have a relative or friend who regularly helps to care for you, they may wish to ask for an assessment of their own needs to enable them to receive support, or be involved in activities outside of their caring role. This is known as a carer s assessment. A carer s assessment may be carried out at the same time as, or separately to, any assessment you may receive as the cared-for person. The support given following the assessment could either include a sit-in service, a carers training session, a respite break or a day centre placement for you, so that your carer can go to work or attend social events. Or the support may be given directly to your carer. For more information about carer s assessments, carers support services and Carer s Allowance, see our guide, Carers: what support is available (Guide 10). Guide 12: Assessment and services from your local council in England 18

19 7 Charging for care and support The council can charge you for any care and support they provide for you, but it cannot charge anyone else, such as your partner or someone you live with. NHS health services, such as visits you may receive from a community nurse as part of your care plan, will be provided free of charge. To decide how much you should contribute towards the cost of your support services at home, social services will need to assess your income and savings (but not the value of your home). This is known as the financial assessment. Social services should publicise information on their charging policy and how they calculate how much you should pay. Each council can set their own rules for charging for care and support at home but their policy must comply with the government guidance Fairer Charging'.[1] If you have capital of more than 23,250, you may be charged in full for any services that you receive. Some councils are more generous and set a cap for the amount people have to pay or a capital limit which is higher than 23,250 but they are not allowed to set it any lower than that figure. Councils are also allowed to take into account income from any savings you have between 14,250 and 23,250. It will assume that you have an additional 1 a week tariff income for every 250 you have in savings between 14,250 and 23,250. The charges the council make as a result of the financial assessment must be reasonable and should not put you in Guide 12: Assessment and services from your local council in England 19

20 financial difficulty. They should not take your income below the level of the Pension Guarantee Credit entitlement (plus a 25% buffer ) which means you should not have less than per week for an individual, or per week for a couple to live on. The following case study gives an example of how the charging policy should work. For example, Linda is 70 and lives on her own. She needs some home care to help with personal tasks likes getting in and out of bed, and getting dressed, and she has a personal alarm system. Due to her food allergies, she has to pay for non-prescription medication, which costs her 20 per week. She receives Pension Guarantee Credit and Pension Savings Credit. As Linda has savings of 15,400, she is assumed to have tariff income from her savings which adds an extra 5 per week onto her actual income: Income State Retirement Pension Occupational Pension Tariff income from savings 5.00 Attendance Allowance Pension Credit Total income Allowances Pension Credit % buffer Disability-related expenditure Guide 12: Assessment and services from your local council in England 20

21 Total allowances Since Linda s total income is more than the basic living allowance that the council allows her to keep, she will be asked to pay the difference between the two amounts, which means she will be asked to pay towards her care costs. If you have difficulty paying the charges for support services, you can ask social services to consider reducing their charges. If you refuse to pay the charges, social services cannot withdraw the services but they are able to recover the payment later if it is established that the charges are reasonable. You may also be entitled to claim a benefit such as Disability Living Allowance, Personal Independence Payment or Attendance Allowance to help you pay for your support services. For more information, see our guide, Disability Benefits: Attendance Allowance, Disability Living Allowance and Personal Independence Payment (Guide 3). If your care plan says that your needs are too high to be met in your own home and they need to be met in a care home (assuming you agree to this), you will be charged under different guidance. For further information about charging for care home fees, see our guide, Care Home Fees: paying them in England (Guide 16). Guide 12: Assessment and services from your local council in England 21

22 8 Using direct payments or a personal budget Personal budgets - which everyone eligible for council support will have from 2013 onwards - can be provided as direct payments to allow people to have more choice and control over any assistance and support services they receive. What is a personal budget? A personal budget is the amount of money available from the council for your care and support, decided as part of your care plan. You can use this pot of money to purchase the support services you feel are most appropriate for your eligible needs. Alternatively, your personal budget can be held and managed as an account with your local council if you prefer, or held as an account with a third party, for example, a user-led or disability-led support service that can help manage the budget. You can choose to take money from your personal budget either in the form of a direct payment in cash, or as services arranged by the council, or a mixture of both. Although you will receive the personal budget, you can still choose to ask social services to arrange any support services you need. How are personal budgets worked out? The amount you receive in your personal budget is calculated using your local council s resource allocation system (RAS). Councils are currently using different resource allocation systems but they are usually worked out by you filling in a questionnaire and, depending on each Guide 12: Assessment and services from your local council in England 22

23 answer, a set number of points is awarded. Each point has a set monetary value, for example, 7.50, which is then added together with all the points awarded to make up your total personal budget. However, this indicative amount must then be moderated to your specific eligible needs and altered by the council to make sure that all your needs (including any social, emotional or psychological needs) are met in full. This may mean your personal budget is then slightly increased or decreased. The reasons behind how much your resulting personal budget is worth must be explained to you (and this may give the cost of some local services) and you should request a written copy. What are direct payments? Direct payments are one way of using your personal budget. Rather than receiving services directly from social services, you can receive a cash payment from social services into a nominated account, which you then use to arrange your care and support services, as detailed within your care plan. This can be a good option if you want to have more flexibility about the times you receive services or more control over choosing a care worker. However, the direct payment must be used to meet your assessed care needs. For example, if it has been given to you to cover up to four visits from carers during the day, or other similar care needs/services, it cannot be used for night-time care. You are allowed to decide how you arrange those care services during the day, as the idea of personalisation is to enable you to be more creative in how you meet your care needs. Guide 12: Assessment and services from your local council in England 23

24 Social services (or a local user-led or disability-led service) should provide you with information and advice about the services available to enable you to purchase services to meet your needs. Social services should also provide you with details of a local support scheme (such as a user-led or disability-led organisation), which can help you with managing direct payments. Alternatively, Disability Rights UK ( , disabilityrightsuk.org ) can provide details of local schemes. The Penderels Trust also offer information and advice on personal budgets, direct payments and independent living as well as a menu of services ( , penderelstrust.org.uk ). For more information about personal budgets and direct payments, see our guide, Home Care: using direct payments and personal budgets (Guide 23). Guide 12: Assessment and services from your local council in England 24

25 9 Refusing services Social services may offer you services that you do not want to receive. For example, you may not want to go to a day centre or have care staff visiting you at home. If this happens you can discuss your concerns with your social worker or care manager and ask for your needs to be re-assessed. You do have the right to refuse services if you prefer, as long as you have mental capacity to understand the decision you are making. Social services cannot force you to receive help. It may be that you would be better off accessing a direct payment instead so you can arrange your own care (with support to do so if required). However, if you do refuse services you may not get the care and support that you need to stay at home safely. Whether the council could still intervene in your situation is hard to say, especially if you have the mental capacity to take and understand your decision. Ultimately, it will depend upon whether the council consider that you are at critical or substantial risk. Receiving enough care at home to live there safely may also depend upon your council s resources. For example, if you need more than four visits by carers during the day, the council may not provide extra services. This is because they can take their resources into account before providing these services. Even if you cannot arrange the additional support you need (for example, more carers during the day or night) via a private care agency or from informal carers, you can still decide that you want to stay at home. The council may ask you to sign a disclaimer stating that you Guide 12: Assessment and services from your local council in England 25

26 understand any risks that you may be taking and that you clearly have the mental capacity to take and understand your decision. Contact Independent Age ( ) for further advice. Guide 12: Assessment and services from your local council in England 26

27 10 Making a complaint You can complain to your council for any of the following reasons: - you are not satisfied with your needs assessment or care plan - you have been refused a needs assessment - you have experienced delays in getting an assessment - you are concerned about the quality of the services you are receiving. You can do this by verbally raising the matter with the staff concerned or by formally putting your complaint in writing using the local council s complaints procedure (or the Local Government Ombudsman if you are self-funding your care via a direct payment). A copy of the council complaints procedure should be available on the council s website or you may be able to obtain a copy by telephoning the council directly. When making a complaint, you may want to ask for the support of an independent advocate who can speak on your behalf to the professionals involved with your permission, or support you to have your voice heard. You can find an independent advocate by calling the Older People s Advocacy Alliance ( , opaal.org.uk ), POhWER ( , pohwer.net ) or in the south of England, SEAP ( , seap.org.uk ). To find out more about advocacy, see our guide, Independent advocacy (Guide 25). Guide 12: Assessment and services from your local council in England 27

28 For more information about making a complaint, see our guide, Complaints about community care and NHS services (Guide 18). Guide 12: Assessment and services from your local council in England 28

29 This guide is not a full explanation of the law and is aimed at people aged over 60. If you need any of this information in another format (such as large-print or Braille), please contact our Information Manager on or [email protected] If you have found our advice useful, please consider supporting us by raising money, volunteering or making a donation. We receive no state funding and rely on support from individuals, trusts and other sources to continue providing our services to hundreds of thousands of people in need. For further information on how to support us, please see our website independentage.org or call Independent Age Independent Age 18 Avonmore Road London W14 8RR View our page on Facebook T E [email protected] Advice line Follow us on Independent Age is the operating name of the Royal United Kingdom Beneficent Association Registered charity number