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

• a person’s condition may affect their lives very differently over time, for example:
• physical – conditions such as multiple sclerosis or Parkinson’s
• mental – such as bipolar affective disorder or depression.

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.

• Environment: for example, changes such as cold weather in winter can impact on mobility and pain due to arthritis.
• Changing circumstances: for example, if the person has caring responsibilities for a child of school age, the demands of term-time and holidays may have a varying impact on their wellbeing.

For carers with support needs

• Their own condition: it is important to recognise that carers themselves may be coping with a condition of their own, with corresponding good and bad days.
• The impact of the fluctuations in the needs of the person they provide care for on their own wellbeing. The demands of coping with a bad day or series of bad days may have significant physical and emotional impact on their own wellbeing.
• Their circumstances, for example:
• changes in employment which place more demands on their time, reducing the time they can dedicate to their wellbeing outside caring responsibilities
• a single parent with children at home will face the demands of holiday and term-time childcare
• a divorced parent will face varying demands on their time depending on whether the child/children are with them.

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:

• subject to eligibility determination, contingency planning for events built into care plans to allow rapid response to access extra support
• the provision of preventative interventions to delay or prevent the development of further needs in the future.

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.