How are fluctuating needs under the Care Act assessed?

What do practitioners need to consider?

It is important to recognise that contact with a person at a single point in time will not necessarily provide a full picture of their needs. The experience of a person with care and support needs coping in situations where they have good days and bad days is invariably unpredictable, triggered by a range of circumstances, and is virtually impossible to capture in any one ‘snapshot’.  

To provide an accurate assessment of care needs – whatever form that assessment takes – the ‘good’ and ‘bad’ must be fully explored over a suitable period of time to provide as complete a picture of the range of fluctuation as possible. It is important to note that ‘suitable’ length of time in this instance will vary from person to person. Fluctuation may be short term over the course of a day or longer term over weeks or months.

Example issues, and this is not an exhaustive list, for practitioners to consider concerning fluctuating needs include:

For adults with care and support needs

Irrespective of the condition, the person may have low support needs on any ‘good’ day, but on more challenging ‘bad’ days these will be significantly higher. Therefore, an assessment made solely on a ‘good’ day will leave the person with significant negative impact on their wellbeing with no strategy in place to mitigate this.

For carers with support needs

Understanding the person’s history will enable a complete picture of their needs to be established, which may show a relatively ‘good’ condition (manageable periods) interspersed with episodic ‘bad’ (negative) events or a generally ‘bad’ standard (creating a challenging impact on wellbeing), interspersed with more severe episodes. An understanding of these issues will allow the local authority to develop as appropriate:

It is also important to recognise that fluctuation in needs may also have implications when considering eligibility and an accurate assessment of this is vital to ensure a correct determination is made.