Practice example: Carer eligibility

Background

Mrs A has cared for her younger sister Ms M for 32 years. Ms M has been assessed as an adult with eligible care and support needs. She has communication difficulties, emphysema and paranoid schizophrenia. The care provided by Mrs A includes attending medical appointments with her sister to assist with communication, managing her home, household tasks and personal care, assisting with shopping and visiting her several times a day to ensure that she takes her medication. 

Ms M has no other family of her own, but her goddaughter, who is close to her, visits her once a week and has expressed her willingness to help with managing Ms M’s household tasks.

Ms M is not able to cook by herself, but she is able to heat prepared food and does not need prompting or assistance to eat. Mrs A, therefore, has to prepare her sister’s meals in advance or ensure she has adequate ready meals available. However, Ms M will eat all the available food in one sitting if unsupervised. This requires Mrs A to ensure only enough food for the next meal is available and all other food is securely stored away.

Mrs A has lived on her own since her husband died 10 years ago. Mrs A’s daughter lives a few miles away; she is married and has recently had a baby. Mrs A receives support from her GP to manage her high blood pressure. She has said to the GP on several occasions that she would like more time to herself, and more quality time with her friends and daughter. When asked why this is not happening, Mrs A is unable to identify the reasons, beyond the fact that she does not have time to attend social occasions as she once did, including attending the local community centre. The GP has noticed that her motivation is decreasing and thinks that her caring role may be more stressful or overwhelming for her than she is aware of.

Mrs A has expressed her desire to increase the quality of her relationships with her friends and daughter. The support she currently provides to Ms M, and the impact this has both on her available time and her emotional/physical health, prevents her from achieving this outcome.

Mrs A’s GP has referred her to social services for assessment as he is concerned that while she is managing currently and does not seem unwilling or unable to continue her caring responsibilities, they may have a negative impact on her in the medium term and result in a breakdown and complete inability to care for Ms M. Mrs A has not previously had an assessment of her needs as Ms M’s carer.

Preparing for an assessment

When preparing to make an assessment it is useful to ask yourself the following questions in relation to the legal duties for the Care Act 2014.

Determining eligibility

To be eligible for support, Mrs A must satisfy the minimum threshold for carers to ensure the local authority meets her needs in a fair and consistent way. The questions to ask in determining the extent to which the eligibility criteria are met are:

The assessor may also consider the impact of the responsibility of caring for Ms M on Mrs A beyond the eligibility criteria to determine if this is significant, including considering Mrs A’s needs holistically, taking into account the cumulative impact of low/medium-level needs. In this case the assessor takes account of factors that individually may not be significant. For example, Mrs A’s inability to develop and maintain family or other personal relations could be argued not to be significant in itself; however, when considered alongside the fact that she is also unable to make use of necessary facilities or services in the local community (also a low/medium need), the impact becomes significant.

Considerations in determining eligibility

The assessor gathers information during the assessment to inform and demonstrate the determination of eligibility for Mrs A as a carer with support needs.

Outcomes

Determination. Following a carer’s assessment, Mrs A’s needs were found to be eligible.

Condition 1. Mrs A’s needs for support arise because she is providing necessary care to Ms M, who is unable to undertake the tasks essential to maintain her wellbeing and meet her desired outcomes without the help of her sister.

Condition 2. Mrs A meets Condition 2 because her physical health is at risk of deteriorating (the stress she suffers as a result of her caring role could be a cause of her high blood pressure), and she is unable to achieve the minimum of one of the outcomes in the eligibility regulations i.e.:

Condition 3. As a consequence of being unable to meet the specified outcomes there is a significant impact on Mrs A’s wellbeing, including her physical and mental health, emotional, social and economic wellbeing, and domestic, family and personal relationships.

Next steps

How the carer’s eligible needs might be met

Following the carer’s assessment and the eligibility determination, the local authority puts a support package in place to enable Mrs A to sustain her caring role. This includes the following:

Reflection points