How can an accurate picture of fluctuating needs under the Care Act be established?
Determining the extent of fluctuating needs is a decision that must be made on a case-by-case basis but, in practice, practitioners will be required to:
- Establish what impact can be reasonably expected from knowledge of people with similar conditions or circumstances, which can be based on the practitioner’s own experience and may also require advice from someone with expert knowledge about a specific condition.
- Encourage the person and their carer to keep a diary to record the ‘good’ and ‘bad’ days to ensure need, and the impact it has on desired outcomes individually and collectively, is captured in its totality wherever possible to ensure the record is as holistic as possible.
- Establish how long a ‘suitable time’ might be to assess need fluctuation – for example, ask the person a series of questions, along the lines of:
- How are you today? (Is it a ‘good’ day?)
- How long since you last had a bad day or series of bad days?
- How often does it get bad?
- How long is it since you have felt at your best?
- Establish the extent of the fluctuation in relation to severity, duration and frequency – for example, you could ask:
- How good/bad does it get?
- What does a ‘bad’ day or series of days prevent you from doing? (To establish the impact of the fluctuation on desired outcomes)
- How often do things change?
- Who helps you on a bad day?
- What helps you on a good day?
- If the person cannot answer these questions due to capacity or communication issues, ask the opinion of their carer or advocate and other relevant healthcare professionals on these issues.
- The impact on carers must also be considered – first by establishing if they themselves have a condition requiring care and support, and then by establishing:
- the extent to which the fluctuation in the person’s needs has an impact on their wellbeing
- the extent to which their circumstances and environment cause a fluctuating impact on their wellbeing.
- If the carer cannot answer these questions due to capacity or communication issues, ask the opinion of their advocate.
The local authority should assure itself that the information provided can be reasonably relied upon.