Practice example: Supported self-assessment
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.
- What needs to be taken into account to ensure the assessment is appropriate and proportionate?
- How will you ensure a strengths-based approach has been considered?
- Who will be involved with the assessment?
- Does the local authority assessor who is working with the person need to have specific training and expertise?
- In preparing for the assessment, what additional issues or obstacles need to be considered (if any) – and how can they be dealt with?
- How will you ensure the person considers their needs over an appropriate period of time to ensure that they have all been accounted for?
- How is the whole family approach taken into account during a supported self-assessment?
- What information and advice would be helpful?
- What preventative measures (to prevent, delay or reduce needs) will you consider, and how will you identify these with the person?
- Is it useful to seek the views of people in regular contact with the person completing the self-assessment?
- Are you sure the person wants to have a self-assessment?
- Is supported assessment an appropriate mechanism for the individual, for instance do they have capacity to respond?
- Has the individual been provided with all the relevant information to enable them to complete a supported self-assessment?
- How will you assure yourself that the self-assessment is an accurate reflection of the person’s needs?
- Are you confident that the results of the assessment, particularly from the adult, can be independently validated?
- What else might you need to think about in relation to this example?
Ensuring the assessment is proportionate and appropriate
- Ability to express wishes, preferences and desired outcomes. Mrs Z is fully able to identify and express her needs and how she would like to live her life. The needs she has due to multiple sclerosis do not impact on her capacity to understand the process, her ability to collate information, articulate her needs or to complete the assessment form.
- Severity and extent of needs. Mrs Z has physical health needs which impact most of the specified outcomes in the eligibility criteria, however, apart from a need to be considerate of the time required to complete the process, they do not prevent an effective supported self-assessment. The most important consideration for practice in this context is the degree to which the supported self-assessment process is able to accurately report the extent of need. Mrs Z’s experience and the support provided to her ensure this is the case, verified by the assessor’s assurance on completion.
- Potential fluctuation of the person’s needs. Mrs Z’s needs fluctuate considerably during the day and over periods of time, within well understood limits. The assessor must ensure sufficient time is allowed to complete the supported self-assessment to adequately consider and capture Mrs Z’s fluctuating health needs.
- Other information and assessments. Mrs Z is already known to social services and local health care professionals. The assessor gathers – with Mrs Z’s consent – all existing information: previous needs assessments; care and support plans; GP, district nurse, physiotherapist and occupational therapist’s views. This information is then examined to establish what is relevant at this point so that the assessor has sufficient and appropriate background information to avoid asking Mrs Z unnecessary questions.
- Relevance of assessment questions for the case. Mrs Z has the appearance of needs across most – if not all – the specified outcomes in the eligibility criteria. The self-assessment has to proportionately explore those areas where existing information does not provide a complete picture of her needs. Therefore the assessor must ensure Mrs Z has all existing information to allow her and her sons to fully explore how the situation has changed.
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:
- Mrs Z is capable, articulate and able to fully understand the assessment process, not least because of her previous experience.
- Mrs Z wants to lead her own assessment as she believes she understands her needs and the life she wants to live better than anyone else.
- Her family are fully engaged in her care and are supportive of her needs and the assessment process.
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.
- Do the needs for care and support arise from a physical or mental impairment or illness?
- Do these needs mean the adult is unable to achieve two or more of the listed outcomes?
- 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?
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.
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.
- It has been identified that a continuing health care checklist should be completed, along with and a full decision support tool for a personal health budget. Mrs Z’s GP is making home visits and the district nurse visits twice a week. The social worker from the local authority will ensure there is no repetition by coordinating the assessment of needs with the interventions from the GP and district nurse, along with the decision support tool for the personal health budget.
- Once the decision support tool is completed, the recommendations will need to be approved, and a decision made on the level of personal health budget Mrs Z will receive. With her direct payments and personal health budget, the aim is that she will have a combined health and social care budget within her control.
- The experience from previous care planning is that it is a challenge to find good person-centred care for Mrs Z. Working together, the assessor and Mrs Z agree that employing a personal assistant is the most appropriate way to provide care and support. This fits with Mrs Z’s personality, her requirement to engage with care providers and her desire develop a relationship with which she is comfortable. Mrs Z is provided with advice on acting as an employer, the process of interviewing, making an appointment and the responsibilities that go with this. This allows her to make an informed choice on the benefits and drawbacks of this option. She decides to appoint a personal assistant, with whom she develops a good relationship. She is happy with the care provided.
- How does the result concur with your assessment of the situation?
- What else did you think about?
- What else might apply/be relevant to your authority?
- What might you do differently?
- What have you learned?