Department of Adult Social Services

Assessment, Eligibility and Review Policy and Process V 12 – 5th

May 2016

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Department of Adult Social Services

Assessment, Eligibility and Review Policy and Process V 12 – 5th

May 2016

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Policy: Assessment, Eligibility and Review

Purpose: To explain the policy which must be adhered to when undertaking the assessment, eligibility and review process

Scope: Everyone working within the assessment, eligibility and review process

Contact point: Department of Adult Social Services

Approved by:

Mr Graham Hodkinson

Version:

Version 12 – 5th May 2016

Title:

Director of Adult Social Services

Review date:

June 2017

Date:

June 2016

Department of Adult Social Services

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Overview

In April 2015 new legislation called The Care Act 2014 was introduced in England in order to make care and support services better and more consistent across the country. The focus is firmly on the person rather that the service and the new law empowers people to be involved and in control of their care journey and in turn maximise their potential to live a full and meaningful life. Wellbeing is at the core of the Act and it’s aspiration is for local authorities to help prevent, reduce or delay the onset of care and support services to help people stay healthy and independent for as long as possible. Information and advice services are seen as having a vital role in this process. There will also be new systems in place around payments and charging. It was also planned that from April 2016 a cap on care costs would be introduced as well as an extension to the financial limits which determine who receives financial support. However the Government have now postponed these changes until 2020.

Care and support is a term used to describe the help which some adults need to live as well as possible with any illness or disability they may have. It can include help with things like getting out of bed, washing, dressing, getting to work, cooking meals, eating, seeing friends, caring for families and being part of the community. Care and support includes the help given by family and friends, as well as any provided by Wirral or other organisations. People who are Carers will be offered a Carer’s assessment and, if eligible, their own support plans

Wirral Metropolitan Borough Council (Wirral Council) has developed a number of policy documents to describe the process which is followed by the Council in relation to the care and support needs of adults in its communities.

Each policy reflects the over-arching commitment to put the person at the centre of all decisions which are made. The focus on personal wellbeing, information, choice and control is at the heart of how care and support is provided by Wirral.

All Wirral Metropolitan Borough Council Department of Adult Social Services policies and procedures must be read in conjunction with the following:

Legislation The Care Act 2014 Chapter 23 Part 1 Care and Support, General responsibilities of local authorities. Mental Capacity Act 2005 Deprivation of Liberty Safeguards Human Rights Act 1998 Children and Families Act 2014 Statutory Guidance Care and Support Statutory Guidance 2016 Wirral Policy and Procedures Referral and First Contact Support Plan Safeguarding Financial (deferred payments and charging) Carers

Department of Adult Social Services

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Primary legislation to be repealed or disapplied Title of legislation to be repealed, in whole or in part National Assistance Act 1948 Health Services and Public Health Act 1968 Local Authority Social Services Act 1970 Chronically Sick and Disabled Persons Act 1970 Health and Social Services and Social Security Adjudications Act 1983 Disabled Persons (Services, Consultation and Representation) Act 1986 National Health Service and Community Care Act 1990 Carers (Recognition and Services) Act 1995 Carers and Disabled Children Act 2000 Health and Social Care Act 2001 Community Care (Delayed Discharges etc.) Act 2003 Carers (Equal Opportunities) Act 2004 National Health Service Act 2006

Secondary legislation to be revoked

Title of instruments to be revoked, in whole or in part Approvals and directions under S.21(1) NAA 1948 (LAC (93)10) National Assistance (Assessment of Resources) Regulations 1992 National Assistance Act 1948 (Choice of Accommodation) Directions 1992 National Assistance (Residential Accommodation) (Relevant Contributions) Regulations 2001 National Assistance (Residential Accommodation) (Additional Payments and Assessment of Resources) Regulations 2001 Delayed Discharges (Mental Health Care) (England) Order 2003 Delayed Discharges (England) Regulations 2003 National Assistance (Sums for Personal Requirements) Regulations 2003 Community Care (Delayed Discharges etc.) Act (Qualifying Services) Regulations 2003 Community Care Assessment Directions 2004 Community Care, Services for Carers and Children’s Services (Direct Payments) (England) Regulations 2009 NHS Continuing Healthcare (Responsibilities) Directions 2009 Ordinary Residence Disputes (National Assistance Act 1948) Directions 2010

Department of Adult Social Services

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1.0 Policy name

Assessment, Eligibility and Review Policy

1.1 Purpose

The purpose of Wirral Borough Council’s (Wirral Council) Assessment and Eligibility for Care and Support Policy is to explain the statutory framework under The Care Act 2014 which must be adhered to when assessing people over 18 for care and support.

2.0 Introduction

The assessment and eligibility process is one of the most important elements of the care and support system. It is the start of a personal journey with Wirral Council and is a key interaction between Wirral and an individual, whether an adult needing care or a Carer. It should not be seen as a gateway to care but a critical intervention in its own right. It is designed to help people understand their situation and the needs they have, to reduce or delay the onset of greater needs and to access support when they require it.

In addition people who care for someone are entitled to a Carer’s Assessment which will look at how caring affects a person’s life and their mental, physical and emotional wellbeing. A Carer is entitled to a Carer’s assessment even if the person they care for does not get any help from the Council.

3.0 POLICY

3.1 Assessment

The aim of the assessment process is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing.

The nature of the assessment will not always been the same for all people and could range from an initial contact which helps a person with lower needs to access support in their local community to a more intensive, on-going process which requires the input of a number of professionals over a longer period of time.

People will be encouraged to provide information on-line which will be used to inform and shape the assessment and direct the next stage. Wirral Council will explore a proportional response firstly through information and advice resources as the initial assessment may identify needs which can be supported through universal services. If a face to face assessment is requested or ascertained as being required then this will be arranged.

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Wirral Council will:

• carry out an proportional assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care

• act immediately if the initial contact has identified that an adult has an urgent care and support need. The assessment will be paused to be resumed later so a fuller assessment can be identified

• ensure the assessment is person-centered throughout • consider providing information and advice or other preventative services if a

person has needs which are not eligible for publically funded care and support • ascertain whether an individual is able to be involved in their assessment and

provide access to an independent advocate to support the person’s involvement in the assessment if required

• ensure that a person has capacity to fully assess and reflect their own needs; this must be done in their best interest in accordance with the Mental Capacity Act.

• focus the assessment on the person’s needs and how they impact on their wellbeing, and the outcomes they want to achieve.

• involve the person in the assessment and, where appropriate, their Carer or someone else they nominate

• consider other things besides care services that can contribute to the desired outcomes (e.g. information and advice on preventive services, community support, local voluntary groups)

• use the new national minimum threshold to assess eligibility for publicly funded care and support.

• ensure that the assessor is appropriately trained. • establish consent to an assessment and carry out an assessment in a manner

which is appropriate and proportionate to the needs and circumstances of the individual to whom it relates

• inform the person that the assessment will be recorded and ensure consent is given for this.

• identify if there is an adult providing care and support to the person being assessed and, if so, offer a Carer’s Assessment

• Identify if there are any children (under 18 years) providing care and support

3.2 Eligibility (See Appendix 2 Eligibility decision process and Appendix 3 Carers eligibility decision process)

3.2.1 Needs

National Eligibility Criteria for adults with care and support needs

The Care and Support (Eligibility Criteria) Regulations 2014 set out national eligibility criteria for access to adult care and support, and for access to Carer support in England. All local authorities must comply with this legislation

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This replaces the existing eligibility framework, which was set out in the 2010 Department of Health guidance Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care, and was also referred to as Fair Access to Care Services (FACS) and local thresholds.

The new national minimum threshold for eligibility was implemented in April 2015 and it provides more transparency on what level of need is eligible. It will help Wirral Council assess whether earlier provision of information and advice or preventative services would delay a person from developing needs which meet the eligibility criteria or whether long term care and support might be needed

This means that the Council can support people as early as possible to help maintain wellbeing and independence, and potentially delay a situation where longer-term care and support might be required.

It should also help the person needing care or their Carer to think more broadly about what support might be available in the local community or through their support network to meet their needs and support the outcomes they want to achieve.

The national eligibility criteria require that in order for needs to be eligible for publically funded care and support, Wirral must consider whether:

• 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 specified outcomes (which are described in Appendix 2 )

• as a consequence of being unable to achieve these outcomes there is, or there is likely to be, a significant impact on the adult’s wellbeing.

Eligibility assessments will consider the overall impact on wellbeing of the person’s needs. People whose needs are demonstrated as having a significant impact on their wellbeing will be considered as being eligible for support. Information and advice on community based services will be given regardless of a person’s financial situation or eligibility.

The eligibility determination must be made without regard to whether a Carer might be meeting those needs at the given time.

National Eligibility Threshold for Carers

Carers are entitled to a Carer’s Assessment and may be entitled to support in their own right. The national eligibility threshold for Carers is also set out in the Care and Support (Eligibility Criteria) Regulations 2014. This is based on the impact a Carer’s needs for support impacts on their wellbeing. Carers' assessments must seek to ascertain whether they are willing and able to continue to provide care and to establish not only the Carer’s needs for support but also the sustainability of the caring role itself, which includes both the practical and emotional support the Carer provides to the adult.

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Wirral Council must consider whether:

• 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 the Eligibility Regulations apply to the Carer and;

• as a consequence of the fact there is, or there is likely to be, a significant impact on the Carer’s wellbeing.

The use of the word ‘eligible’ in this policy only refers to the needs of adults with care needs and Carers with support needs, not to their financial resources or other circumstances.

3.4 Outcomes

Outcomes for the Adult with care needs

Wirral Council will consider whether the adult is unable to achieve two or more of the following outcomes when making the eligibility determination.

• managing and maintaining nutrition

• maintaining personal hygiene

• managing toilet needs

• being appropriately clothed

• being able to make use of the adult’s home safely

• maintaining a habitable home environment

• developing and maintaining family or other personal relationships

• accessing and engaging in work, training, education or volunteering

• making use of necessary facilities or services in the local community, including public transport and recreational facilities or services

• carrying out any parental responsibilities for a child

Outcomes for Carers with support needs

The Carer will be considered eligible if

1) the Carers physical or mental health is, or is at risk of, deteriorating or

2) the Carer is unable to achieve any of the following outcomes:

• carrying out any caring responsibilities the Carer has for a child

• providing care to other persons for whom the Carer provides care

• maintaining a habitable home environment in the Carer’s home, whether or not this is also the home of the adult needing care

• managing and maintaining nutrition

• developing and maintaining family or other personal relationships

• engaging in work, training, education or volunteering

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• making use of necessary facilities or services in the local community, including recreational facilities or services

• engaging in recreational activities.

A Carer is to be regarded as being unable to achieve an outcome if the Carer:

a) is unable to achieve it without assistance; b) is able to achieve it without assistance but doing so causes the Carer

significant pain, distress or anxiety; or c) is able to achieve it without assistance but doing so endangers or is likely to

endanger the health or safety of the Carer, or of others.

In order for the Carer to be considered for support the effect of the caring on the Carer must meet (a), (b) or (c)

3.5 Wellbeing

Wirral Council will consider the adult’s needs and whether their inability to achieve the outcomes above cause, or risk causing, a significant impact on their wellbeing.

The Council must consider whether:

• the adult’s inability to achieve the outcomes above impacts on at least one of the areas of wellbeing.

• the effect of the impact on a number of the areas of wellbeing mean that there is a significant impact on the adults overall wellbeing.

The term ‘significant’ is not defined by the regulations and must therefore be understood to have its everyday meaning. Wirral Council will consider whether the adult’s needs and their consequent inability to achieve the same in all relevant outcomes will have an important, consequent effect on their daily lives, their independence and their wellbeing.

3.6 Information and Advice

Wirral Council recognises that information and advice is fundamental to enabling people, Carers and families to take control of, and make well informed decisions about, their care and support and how they fund it. Not only does information and advice help to promote people’s well-being by increasing their ability to exercise choice and control it is also a vital component of preventing or delaying people’s need for care and support. Types of information and advice include:

• What sort of care and support is available on Wirral, including information on how to choose providers

• How to access care and support

• How to access independent financial advice

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• How to raise concerns about the wellbeing of an adult who may need care and support (safeguarding)

Information and advice is an on-going duty throughout the care process and should be offered during assessments, care and support planning, reviews and safeguarding.

3.7 Prevention, reducing or delaying needs

It is important that the care and support system works to actively promote wellbeing and independence and does not just wait to respond when people reach crisis point. To meet the challenges of the future is also important that the care and support system intervenes early to support individuals, helps people retain or regain their skills and confidence and prevents need or delays deterioration wherever possible.

Wirral Council will consider the following during the assessment and eligibility process:

General services for everyone

• provide universal access to good quality information;

• support safer neighbourhoods;

• promote healthy and active lifestyles;

• reduce loneliness or isolation;

• encourage early discussions in families or groups about potential changes in the future

• Early intervention

• targeted interventions aimed at individuals with an increased risk of developing needs;

• targeted interventions at Carers, including those newly taking on a caring role

• Preventing deterioration of an existing problem

• helping Carers maintain a life outside of caring/have an awareness of their physical and mental health needs

3.8 Fluctuating need

Sometimes a person’s needs may change and therefore assessments should reflect a comprehensive picture of people's needs - including how they change over time. For example needs which:

• may not be apparent at the time of the assessment; but • have been an issue in the past; and • are likely to arise again in the future.

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Needs may not fluctuate just because of a condition but also because of changing circumstances, such as changes in employment or education, or the transition to adult services which may be the case for Young Carers entering adulthood.

An accurate assessment of any fluctuation requires practitioners to give consideration to the needs of a person and their Carer over an appropriate period of time to understand the full implications of their condition and circumstances.

3.9 Independent Advocacy

In order to strengthen the voice of people who use care and support services and their Carers, Wirral Council can arrange an independent advocate to help them through the process of assessing, planning and safeguarding. The Council will do this if:

• the person has substantial difficulty in being fully involved in the assessment, support planning and review processes

• there is no-one appropriate available to support and represent the person’s wishes.

3.10 Next Steps

Wirral Council must provide the adult to who is being assessed with a written record of their needs or Carer’s assessment. If the person asks the Council to share the record with anyone, it must do so. If an independent advocate has been involved in the process, the Council should also inform them of the outcome of the assessment in order for the advocate to help the person understand the implications of the assessment.

As a minimum this assessment must record:

• the adult’s care needs – including any supporting information from any combined or joint assessment

• the Carer’s support needs – including any support information from any combined or joint assessment

• the individual’s outcomes – which in this context refer to the outcomes set by the person for themselves and not those associated with the eligibility determination

• the impact on the individual’s wellbeing of their care needs • any care being provided by a Carer (this should still be recorded for the care

planning process, if the person has eligible needs)

3.10.1 Assessed eligible needs

Where there are no assessed eligible needs

• where the person is found to have no eligible needs for publically funded care and support but there are other ways in which those needs can be met, Wirral

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Council must provide information and advice on what can be done to meet or reduce the needs (for example what support might be available in the community to help the adult or Carer) and what can be done to prevent or delay the development of needs in the future.

• Wirral Council should consider how this package of information can be tailored to the needs which the person does have, with the aim of delaying deterioration and preventing future needs, and reflect the availability of local support

• Wirral Council will offer to develop a support plan to meet a person’s needs or a support plan for a Carer

Where there are eligible needs

If the adult has some eligible needs Wirral Council must:

• agree with the adult which of their needs they would like the Council to meet. The person may not wish to have support in relation to all their needs – they may, for example, intend to arrange alternative services themselves to meet some needs. Others may not wish for the Council to meet any of their needs, but approach the authority only for the purposes of determining eligible needs.

• consider how the Council may meet those needs. This does not replace or pre-empt the care and support planning process but is an early consideration of the potential support options, in order to determine whether some of those may be services for which the local authority makes a charge. Where that is the case, the local authority must carry out a financial assessment and Support Plan (See Support Planning Policy and Care and Support Planning section below).

• have a duty to meet any unmet eligible needs which have been identified as part of the assessment process.

• establish whether the person meets the ordinary residence requirement. In terms of meeting eligible needs the Council will establish that the person who has those needs is ordinarily resident in the local area. For Carers the person for whom they care must be ordinarily resident in Wirral. This is because Carers’ needs are met by local authorities where the adult with the needs for care and support lives, not the authority where the Carer lives.

3.11 Care and Support Planning

The development of a care and support plan should be person centered and person-led in order to meet the needs and outcomes of the person intended in ways which work best for them as an individual or a part of a family.

Both the process and the outcome should be built holistically around the person’s wishes and feelings and their needs values and aspirations irrespective of the extent to which they can choose or are able to actively direct the process.

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Following the needs assessment and determination of eligibility a plan must be provided where Wirral Council is required to meet needs under section 18 or 20 (1) of the Care Act or decides to meet its needs under section 19 (1) or (2) and 20 (6) of the Act. Where the Council is required to meet needs under Section 117 of the Mental Health Act 1983 this policy should be read in conjunction with chapter 34 of the Mental Health Act 1983 Code of Practice.

Some examples of ways of meeting needs:

• directly providing some type of support, for example by providing a reablement or short break respite service.

• arranging for a care and support provider to provide some type of support, for example by commissioning or contracting with a provider

• making a direct payment, which allows the person to purchase their own care and support or

• a combination of the above, for example directly arranging a homecare service whilst also providing a direct payment to meet other needs.

Wirral Council will consider how a person’s assessed needs will be met and will discuss with the person the options available for care and support to meet those needs. Some eligible needs will be met through community provision and in all cases universal services and preventative services will be suggested prior to the consideration of a funded service.

3.11.1 Support Plan

The Plan must include:

• the needs identified by the assessment

• whether, and to what extent, the needs meet the eligibility criteria

• the needs that the authority is going to meet and how it intends to do so.

• for a person needing care which of the desired outcomes care and support could be relevant;

• for the Carer, the outcomes the Carer wishes to achieve, and their wishes round providing care, work, education and recreation where support could be relevant. (see Carers Policy)

• the personal budget

• information and advice on what can be done to meet the needs in question and to prevent or delay the development of needs in the future.

• a contingency plan should the agreed care and support arrangements break down.

• where needs are being met via direct payments, the needs being met via the direct payment and the amount or frequency of the payments. It must be evidenced that a direct payment meets the assessed eligible need.

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Wirral Council must take into account the person’s needs and how they are being met and any needs which are being met by a Carer. The person may have assessed eligible needs which are being met by a Carer at the time of the plan – in these cases the Carer must be involved in the planning process.

The Council will take into consideration personal choice of service provider when preparing the support plan. The outcome will depend on suitability, availability and budget.

The plan must be developed alongside other plans (for example plans of Carers or family members or education, health and care plans) and should have regards to all of the person’s needs and outcomes when developing a plan rather than just their care and support needs.

3.12 Review of care and support plans

Wirral Council will review support plans on an annual basis or if the person’s needs or those of a Carer change significantly a re-assessment will be offered.

4.0 PROCESS

4.1 Assessment

New contacts made into the Department of Social Services will start their customer journey via the single point of access (previously this was known as the Central Advice and Duty Team CADT and First Contact team). The contact will be reassigned to the appropriate team via the Liquidlogic duty worktray.

The Duty Worker will review the information on the contact and speak to the referred carer or appropriate person and gather more information and decide whether Urgent Response is required.

The team manager or advanced practitioner will have oversight of the incoming work and will make allocation decisions

• The Case Manager will look at the contact and check on Liquidlogic for prior or current involvements, support services or contacts;

• The Case Manager will contact the individual, their Carer or the person who has made the referral (within the agreed response time for their respective team) and a conversation will take place to explore what the current issues are and how urgent the request is;

• The Case Manager will make arrangements to visit the person to carry out the assessment where appropriate and update the case notes.

• Where identified the allocated case manager will make arrangements to start the assessment process and determine if Urgent Response is required.

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It is important for individuals to be aware, at the earliest and most appropriate point in the process that some services provided may be means tested and a financial assessment will determine their financial contribution in the event of a service being arranged for them. This is important so that he or she can decide whether to go through the support planning process or whether to arrange and fund their own support.

When conducting the assessment the Case Manager will:

• firstly identify whether there are any issues around safeguarding or mental capacity. (See Mental Capacity Act 2005 and Deprivation of Liberty Safeguards)

• establish consent to the person’s information being recorded and shared with certain organisations.

• identify whether any specialist assessment may be required and make arrangements for them (for example occupational therapy, continuing healthcare assessment)

• identify the person’s strengths, abilities and natural support systems

• ensure that they conform to the National Eligibility Criteria

• identify any areas which significantly impact on the person’s ability to carry out day to day tasks (see 3.2 Eligibility: Needs and Outcomes)

• conduct asset based assessments (See Appendix 4 Wirral Definition of Asset based assessment)

• ensure that either an eligible or non-eligible outcome is reached and recorded on Liquidlogic before the assessment is finished.

• ensure the assessment identifies eligible and non-eligible needs

• personalised information and advice must be made available regardless of eligible needs

• ensure the person is offered a printed copy of their assessment (whether they have eligible or non-eligible needs)

• ensure that the it is clearly identified whether assistance is required with a Support Plan

• ensure that Support Plans are offered to a person even if they have been identified as having non-eligible needs.

• provide information about charging and financial implications surrounding their Support Plan. If identified that a person needs a Support Plan with chargeable services then the case manager must initiate a pre-financial assessment on Liquidlogic

• keep full and accurate case records and complete a full and accurate record of the assessment on Liquidlogic (see Liquidlogic User Guide)

• comply with response times where they are set for certain services.

• complete the assessment within a reasonable period and in line with the individual service protocols. The person will be kept updated with regard to each stage of the assessment process.

Carer’s Assessment

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Case Managers will:

• offer a Carer’s assessment where a Carer has been identified. A Carer’s assessment can be done jointly with the person that they care for.

• ensure that the same considerations are applied to Carers when undertaking a Carer’s assessment. (See 3.2.1 National Eligibility Threshold for Carers and 3.4 Outcomes for Carer’s with support needs)

• ensure that the same considerations are applied to Carers when assisting the Carers to develop a support plan.

4.2 Review

Case Managers will:

• conduct an initial review after a six week period

• conduct an annual review, or earlier if a person’s circumstances change, for people who have a council funded care and support services

• ensure that the review includes the person, their carer and any other adult that the person chooses

• ensure that the review includes the person’s advocate where appropriate

• ensure that when undertaking the review consideration is given to whether the person’s eligible support needs could be enhanced by further rehabilitation or other universal services

• identify if the person’s eligible needs are being appropriately met by the current support arrangements or whether any changes to the support plan are required.

• keep full and accurate records of the review on Liquidlogic

When reviewing an adult with support needs, the Carer’s Assessment must also be

reviewed.

ENDS

Appendices

Appendix 1 – Customer journey (assessment and eligibility process) flowchart

Appendix 2 – Eligibility decision process

Appendix 3 – Carers eligibility decision process

Appendix 4 – Wirral definition of asset based assessments