Articles in Category: Carers' Support and Assessment

Legislation

on Monday, 03 June 2013. Posted in Carers' Support and Assessment

Disabled Persons (Services Consultation & Representation) Act 1986 section 8

This requires that, during an assessment of a disabled person, the ability of carers who provide substantial amount of care on a regular basis is taken into account.

Carers (Recognition and Services) Act 1995

This Act requires the social services authority (if so requested) to carry out a separate assessment of the carer (a “Carers’s assessment”) at the same time as it assesses the person for whom the care is provided.

The act applies both to adult and young carers regardless of the age of the person for whom they provide care.

It defines the carer as an individual who provides or intends to provide a substantial amount of care on a regular basis. For the purposes of the
Act the term carer includes people who may or may not be a relative, and who may or may not be living with the person for whom they are caring. The Act excludes volunteers who provide care as part of their work for voluntary organisations and anyone who is providing care by virtue of a contract of employment or any other contract. This would include anyone who is providing personal assistance for payment, either in cash or in kind.

Carers and Disabled Children Act 2000

This Act gives carers a ‘right’ to a carer’s assessment if they are aged over 16 years old and are providing or intending to provide regular and substantial care for someone aged over 18 years. Carers are entitled to an assessment even when the person they care for refuses to have an assessment or having had an assessment refuses to accept services.

It also includes the right for parents of children with disabilities to request an assessment

It provides the power to provide services for carers in their own right, following an assessment of their needs as well as the power to charge for those services.

The act introduced Direct Payments (i.e. cash instead of care) to parent carers, carers for their own services and young disabled people aged 16 and 17 years.

The Carers (Equal Opportunities) Act 2004

This places a duty on social care to inform carers of their right to request a carer’s assessment. It also gives the provision for a local authority to
ask another statutory authority or body (such as housing, health, education and other local authorities) to assist in planning the provision of services to carers or to provide services that may enhance the carer’s ability to provide care. The other authority must give the request due consideration.

In relation to work, training education and leisure the Act amends both the Carers (Recognition and Services) Act 1995 and the Carers and Disabled Children Act 2000 by ensuring that carer’s assessments must include consideration of whether carers work, or wish to work, and are undertaking or wish to undertake, education, training or any leisure activity.

Work and Families Act 2006

The Work and Families legislation came in 2006, and allows carers of adults the same right to request flexible working as carers of children. Employers do not have to agree to the request, but must make a good business case if refused.

The Children and Young Persons Act 2008

This requires local authorities to make adequate arrangements for short break provision for Disabled Children. In addition the Welsh Assembly Government has a range of powers to inspect, regulate and issue statutory guidance in respect of local authority services under the Local Authority Social Services Act 1970, the Care Standards Act 2000 and the Health and Social Care (Community Health and Standards) Act 2003. It also has powers to direct the NHS under the National Health Services (Wales) Act 2006.

Carers Strategies (Wales) Measure

In January 2012 the Carers Strategies (Wales) Measure 2010 came into force. This legislation places a duty on the Local Health Boards to lead on preparing and implementing a carer’s information and consultation strategy. For Cardiff and the Vale the lead health Board is the University Health Board (UHB) who working in partnership with several stakeholders including, Vale Council, Cardiff Council, Vale Council for Voluntary Services (VCVS), Cardiff’s
Third Sector Council (C3SC), Third Sector representatives, Carers representatives and additional UHB services have began this work. At current a working group made up of the above have helped the UHB produce a draft outline of the strategy and what will be included.

Strategies will:

  • set out how information and guidance will be provided to carers, that will assist them in carrying out their caring role effectively; and
  • set out how carers will be consulted and involved in decisions affecting them and those they care for.

LHBs are designated as the ‘lead authority’ in the Regulations. They will be required to lead the work to develop and implement the Strategies, working in partnership with Social Services.

‘Carers and their rights: the law relating to carers’, published by Carers UK by Professor Luke Clements.
www.carersuk.org/professionals/order-publications

This fifth edition includes updates based on a number of statutory and case law developments since the last edition, implementation of the Carers (Equal Opportunities) Act 2004 and the Work and Families Act 2006, the impact of the Equality Act 2010 and coincides with the first tangible impacts of the Carers Strategies (Wales) Measure 2010.

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Appeals, Complaints and Comments

Appeals, Complaints and Comments

You can appeal against a decision if you disagree with it.  Examples of the sort of decision you can appeal against are:

  • a decision that you do not appear to need an assessment.
  • following a specialist or comprehensive assessment, a decision that you do not qualify for a service.
  • if you think you need more services or different services from those which are proposed or being provided.

You can complain if you think the processes have not been followed properly or because the quality of your service is poor.

There are several ways of dealing with disputes ranging from the informal to the formal, by contacting a councillor, AM or MP to a judicial review or an appeal to the European Court.

If a complaint or a dispute with social services arises, you may use the local authority's complaints procedure where the following procedures apply:

  • Anyone can make a complaint and can act on behalf of an individual. 
  • Complaints normally dealt with by an external provider may also be referred if the complainant is dissatisfied. 
  • The complaints process has three distinct stages.  You may make your initial complaint at either stage 1 or 2.

Stage 1 Local Resolution

Most problems are best sorted out by the staff who are working with you.  Contact the person in charge of your local services or contact the social services complaints officer who will speak to that person on your behalf.  You can do this face to face, by telephone in writing or by e-mail.  They will do their best to sort things out quickly.  This should be no more than two weeks.

Stage 2 Formal Consideration

If not satisfied at Stage 1 you can process your complaint to Stage 2.  Contact the social services complaints officer who will arrange for someone not involved providing your service to investigate your complaint.  You have the right to expect a response from the council within 5 weeks.  You may contact the complaints officer to make your initial complaint or after having spoken to the staff who work with you.

Stage 3 Independent Panel Hearing

if you remain unsatisfied at this stage you can ask for a review of how social services have dealt with your complaint by an independent panel. 

You may ask for more detailed information about the complaints procedure first to help you decide whether you want to make a complaint. 

Remember its your right to complain if you are not happy with the quality of the services you receive and it is social services duty to look into your complaint and try to resolve it.

Assessment

Assessment

Unified Assessment is the name given to the assessment process which involves health and social care professionals working together to assess and manage care and share information. Please note that the following guideline may need reviewing in light of recent legislative changes such as the Social Service & Well Being Act but principles remain similar. 

Assessments underpin any funding decisions that are taken so it is essential that you prepare for and participate in this process. If you do not agree with decisions you have the right to appeal against a decision and free advice and assistance is available. Please contact us for information if in any doubt.

There are three main stages in the process:

Stage 1 Assessment

This is the process of collecting information from the individual, the carers and others about the individual's needs and wishes.  Assessment should be carried out according to the following:

  • Local authorities have a duty to assess individuals if they have the 'appearance of need', including people with higher-functioning autism and Asperger's syndrome.
  • They aim to empower people, by enabling them to make informed choices and maximise their independence according to their individual circumstances. 
  • The main purpose of an assessment is to identify needs and how to meet them.
  • Assessments should be carried out without reference to financial resources, availability of local services or locally preferred options.
  • Authorities have a duty to provide users and carers with a full range of information about all services and the rights of users and carers.
  • Information gained during assessment is confidential and shared only if the law says it should be.  Users or their agents have a right to access the information under certain conditions. 
  • A care co-ordinator will carry out the assessments, who would usually be the most appropriate professional.
  • Assessments should be carried out in a timely manner, in informal settings such as the home, and be proportionate to the level of need. 
  • There are specific types of need included in government guidance.  All needs should be assessed in the light of their impact on independence, daily functioning and quality of life.  The focus should always be on outcomes for service users and their carers.
  • A person-centred approach should be taken during assessment and care planning.  Person-centred planning and reviews also take place in addition to an assessment, if appropriate.
  • Carers have a right to have their views acknowledged in the assessment process both in helping to identify the individual's needs and wishes and also to express their own views of the individual's needs and wishes as well as their own needs.  The role of carers continues once the individual has left the family home.

Carers may request an assessment both of their own ability to care for an individual and of their own need for services for themselves.  Carer's must be informed of their right to an assessment.

Stage 2 Making the Service Provision Decision

The service provision decision for social services makes clear which needs are eligible for support.  The needs identified as a result of the assessment will be considered with the service user/carer and agreement sought on the most appropriate way of meeting them.  This may involve support provided within the family network, by accessing voluntary sector services, statutory services or signposting to other sources of help and support.

The procedures to be applied are as follows:

  • All risks are balanced against the independence of the individual in the light of the four key factors of independence, i.e. the individual's autonomy and freedom to make choices, health and safety, management of daily routine and involvement in other activities. This is based on the what would happen if no help were to be provided.
  • There are four categories of eligibility (critical, substantial, moderate and low) laid down in the local authority's Eligibility Criteria.  Once the risks are assessed, professionals should determine the position of the individual's needs within these bands.  If the needs are above a threshold determined by the authority they become eligible needs and must be met.  A holistic approach is taken, according to the four key factors of independence, even though the needs are identified separately.
  • At this stage there should be no reference to financial resources, locally preferred options or the local availability of services.

Stage 3  Care Planning

This is the process of arranging provision of services:

  • Care planning should address the eligible needs of the individual, the views of the individual and of the carer(s) and cost considerations.  Services should be needs led with full information on a range of services. 
  • Care planning should be responsive to the age, living circumstances, location, disability, gender, culture, faith, personal relationships and lifestyle choices of users.
  • Care planning should be flexible and adaptable to desired outcomes and expectations.
  • Care planning should identify outcomes, i.e. the desired changes aimed at improving independence and quality of life.  A recordmust be made, with timescales for achievement.
  • Care planning should involve service users, carers and professionals in reaching an agreed care plan and identify the most appropriate aervices to acheive the desired outcome.
  • Care planning services should be provided as holistically as possible to suit individual needs and maximise their potential for independence.

Where there is a genuine choice of services, the authority may choose a service based on quality and cost, taking the user's and carer's preferences into account.  Cost ceilings may be used as a guide only and if lack of finance is a reason for making a choice, it must be shown by evidence.  The authority should not impose its own preferred models of care.

Reviews or re-assessments must take place regularly and have a review date.  They should focus on the needs of users and their carers and be evaluated according to a list of factors laid down in guidance.

Services may only be withdrawn if certain conditions are followed, i.e. if a full re-assessment has taken place to show that the individual no longer has eligible needs or if they can be met some other way.  There can be no assumption of alternative support from carers.  The withdrawal of services may go against the user's natural rights.

Users and carers may play an important role in monitoring services and may request support in doing so.  Should a service break down, the original need for the service still applies and it is the authority's duty to provide for it.

There is no charge for an assessment or for giving advice and information.  A person may have to pay for community care services depending on how much service they get and how much money they have.  See the section on financial matters for more information.  If eligible, they will receive free nursing care in their home or in a care home, although there may have to be a contribution towards other aspects of care such as personal care, food and accommodation costs.

Person Centred Approaches to Assessments and Care Planning

The Service Principles and Unified Assessment Guidance state clearly that social services and health should always take a person centred approach to assessment and care planning.  (It should be noted that a person centred approach is not the same as person centred planning.)

 

Also see Carers' assessment

Direct Payments

Direct Payments

What are Direct Payments?

Direct Payments are cash payments to an individual from a local authority that are an alternative to directly arranged community care services. Rather than the local authority social services department providing or arranging the community care services it has assessed you as needing, you receive money to enable you to arrange your own services, allowing you more choice and control over the way your care and support needs are met.

Direct Payments can be made to people who are eligible to receive support from Social Services, allowing them to arrange their own care by directly employing a personal assistant or contracting with an independent agency.

The payments are available to disabled adults and children, and can be made to people with physical or sensory impairments, learning difficulties or mental ill health. They are also available to non-disabled people who have caring responsibilities, allowing them to continue with their role of looking after a disabled adult or child. Older people who need support to continue living in their own home may also be eligible to receive Direct Payments.

Direct Payments give people the power to make their own care or support arrangements, putting the service user in control and offering much greater flexibility by allowing individuals to make arrangements that suit their lifestyles.

Direct Payments can now also be made to ‘suitable people’ assessed by the local authority as being able to receive a Direct Payment on behalf of someone without the capacity to agree to receive a payment. A ‘suitable person’ will usually automatically be someone who has the power to make welfare and health decisions granted by a Lasting Power of Attorney, or having been appointed by the Court of Protection. Such a person has to agree to become a ‘suitable person’.

Otherwise, the local authority can agree that someone else can become a ‘suitable person’ who is best placed to promote the interests, wishes, and beliefs of the person without capacity. There is a process of assessment to be followed in all cases.

The ‘suitable person’ will be required to sign the local authority’s ‘Terms and Conditions' agreement in order to receive a Direct Payment.

You may be given conflicting information on what and how direct payments are  to be used. Seek advice if you feel that you are being treated unfairly since many families have different experiences and decisions that you feel are unfair may be open to challenge! 

Information for Service Users

Information for Service Users

The Information Sub-group of the Cardiff and Vale Unified Assessment Project has produced 4 leaflets:

  1. Unified Assessment – Helping you achieve a better quality of life. This is for all the agencies involved, i.e. Cardiff Council and the Vale of Glamorgan Council, Health boards, the Trust and other partners. It is aimed at anyone wanting to know about UA - not just service users. It is introducing people to Unified Assessment.
  2. Your assessment This is a joint Cardiff & Vale of Glamorgan local authority leaflet. It does not include Health or any other partner. It is for people about to undergo an assessment for social care needs.
  3. Looking after your social care information This is also a joint Cardiff & Vale local authority leaflet for people about to undergo an assessment. It  may also be used whenever the local authorities collect information (especially when seeking permission to share information) and service users have not already had a copy or have lost their copy and forgotten what it said.
  4. Community Care Services – A guide to social services for adults This is also a joint Cardiff & Vale local authority leaflet. It is for people undergoing an assessment or review.

To obtain copies of the above leaflets, please contact the Cardiff Learning Disability Team or Vale Community Support Team
Copies of these leaflets can also be downloaded from the Councils’ websites:

Where a Unified Assessment has identified an area of need that is eligible for services and which meets the Fair Access to Care Services eligibility criteria, the Local Authority will identify and propose a care package that is suitable and appropriate to meet that assessed need. However, if the service user does not want the package offered but wants another package instead, the Local Authority is not obliged to provide that other package

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