Practice example: Supported self-assessment

Background

Mrs Z is 56, and has a diagnosis of multiple sclerosis among other conditions. She used to work as a health therapist, but is unable to continue this due to her ill health. She is divorced, and has two sons who are supportive, although live away from home. She has a small personal network of friends.

Mrs Z has previously taken a direct payment to meet her needs. She finds it difficult to source carers who will care for her in a way that suits her gentle personality. She sources her respite from a specialist centre which offers alternative treatments. 

Mrs Z has been known to the local authority for five years. She has recently had her annual review where it was identified that her needs had changed. As a result, it was agreed that she would have a fresh assessment, using the information the local authority already has about her as a starting point, to avoid duplication.

A local authority must offer a supported self-assessment if the adult is willing and able to undertake one. In this case the authority considers that Mrs Z has the capacity to undertake a self-assessment, understands she would like to do so and that she has support available to her, if required, to enable her to carry it out. The assessor and Mrs Z agree that this is the most appropriate method.

The process and timing of the supported self-assessment is agreed between Mrs Z and the assessor. Mrs Z will complete the assessment with support from one of her sons.  The assessor provides a form which has been adapted from the standard assessment form used by the local authority. This collects the same information as the standard form and is set out more clearly. The assessor ensures Mrs Z knows how to get in touch if and when she has any questions during the process. The timeframe is agreed with the assessor, who is conscious of the requirement for this to be appropriate to Mrs Z’s needs, and that the process should not take too long, to avoid any further deterioration. The assessor tells Mrs Z that the assessor’s role is to support Mrs Z through the process, answer any questions she may have and provide any information she may need. She also explains that part of the role is to assure the local authority that Mrs Z’s self-assessment is an accurate reflection of her needs and the outcomes she wants to achieve in her day to day life. The assessor and Mrs Z agree that to do this it will be helpful to include Mrs Z’s sons, her GP, her district nurse and her personal assistant.

Mrs Z and her family have agreed the assessor will receive an electronic version of the completed self-assessment. Mrs Z owns and is familiar with an iPad and will use this to complete the forms.

The assessor is experienced in assessing people with multiple sclerosis, and from previous cases recognises the deterioration Mrs Z describes in her self-assessment. To ensure the assessment is a complete and accurate record, the assessor contacts Mrs Z’s district nurse and her personal assistant for confirmation.

Mrs Z uses her own skills in the process, based on her previous professional experience, as well as relying on support from her sons and, on rare occasions, the assessor. She decides to carry out the assessment in the mornings as she feels her health is better at that time of day.

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.

Ensuring the assessment is proportionate and appropriate

Proportionate

Appropriate

Given the circumstances of the case, the assessor offers a supported self-assessment as the most appropriate method of establishing Mrs Z’s needs prior to any determination of eligibility, because:

On completion of the supported self-assessment and eligibility determination, the assessor explores with Mrs Z which of her needs are eligible, how they have progressed over time and how her eligible needs will be met by the local authority. 

Determining eligibility

  1. Do the needs for care and support arise from a physical or mental impairment or illness?
  2. Do these needs mean the adult is unable to achieve two or more of the listed outcomes?
  3. As a consequence of being unable to achieve the outcomes, is there, or is there is likely to be, a significant impact on the adult’s wellbeing?

Outcomes

Determination. This supported self-assessment identified that Mrs Z continues to have eligible needs and her care plan needs revising.

Condition 1.  Mrs Z’s needs are caused by several physical illnesses.

Condition 2. Mrs Z is unable to achieve more than two of the eligibility outcomes as part of her daily life, including: maintaining her personal hygiene; getting dressed and undressed; getting around her home; meal preparation and making drinks; and cleaning and maintaining her home. She experiences difficulties in accessing local facilities or services, and maintaining meaningful relationships with others.

Condition 3. This has a significant impact on Mrs Z’s wellbeing in relation to relationships, physical health and emotional wellbeing.

Next steps

How the adult’s eligible needs might be met

The changes in Mrs Z’s circumstances are related to an increased need arising from her multiple sclerosis.

Reflection points