The Care Act and implications for practitioners of the national eligibility threshold

The Care Act represented a fundamental shift for practitioners to thinking holistically about the assessment process and eligibility determinations. The key changes in the way eligibility is determined included the following:

• Eligibility determination must follow the completion of a needs assessment. The needs assessment must be appropriate, proportionate and holistic.
• Eligibility determination is no longer based on level of risk, but on the individual’s inability to achieve desired outcomes. However, the level of risk should be considered in relation to understanding individual needs and their impact on wellbeing.
• Practitioners are required to make professional judgements, using the information described and discovered during an assessment, on how specific needs and circumstances impact on an individual’s wellbeing. It is therefore vital to have good conversations during the whole process so that eligibility determinations can be clearly based on the information gathered and it is evident what needs to be considered.
• All needs must be accounted for and local authorities must ensure that the eligible ones are met. However, needs can be met through various means, ranging from care and support provided via the local authority or support by the carer, through to information and advice or targeted interventions.
• Practitioners are required to have:
  • knowledge of the related legislation and guidance
  • awareness of the information and resources available within the area they cover
  • confidence in their own decision-making.
• The eligibility determination is based on three conditions, which must be linked. It is important for local authorities to conduct the assessment in such a way that they can establish the links between the individual’s needs, their desired outcomes and the eligibility outcomes and assess the impact these have on the person’s wellbeing. 

The national eligibility threshold provides greater transparency in decision-making. The overall process should ultimately be a shared process with the adult/carer. The assessment/eligibility determination process should be done in partnership. However, the final decision regarding eligibility rests with the local authority.

Practitioners need to think broadly about what support might be available in the local community, including support for carers so that they are able to sustain their caring role. Similarly for carers, it may be sensible to invest in a little more care for the individual for whom they provide care to help improve the carer’s ability to sustain their support for that individual.