Practice example: Carer eligibility
Mrs A has cared for her younger sister Ms M for 32 years. Ms M has been assessed as an adult with eligible care and support needs. She has communication difficulties, emphysema and paranoid schizophrenia. The care provided by Mrs A includes attending medical appointments with her sister to assist with communication, managing her home, household tasks and personal care, assisting with shopping and visiting her several times a day to ensure that she takes her medication.
Ms M has no other family of her own, but her goddaughter, who is close to her, visits her once a week and has expressed her willingness to help with managing Ms M’s household tasks.
Ms M is not able to cook by herself, but she is able to heat prepared food and does not need prompting or assistance to eat. Mrs A, therefore, has to prepare her sister’s meals in advance or ensure she has adequate ready meals available. However, Ms M will eat all the available food in one sitting if unsupervised. This requires Mrs A to ensure only enough food for the next meal is available and all other food is securely stored away.
Mrs A has lived on her own since her husband died 10 years ago. Mrs A’s daughter lives a few miles away; she is married and has recently had a baby. Mrs A receives support from her GP to manage her high blood pressure. She has said to the GP on several occasions that she would like more time to herself, and more quality time with her friends and daughter. When asked why this is not happening, Mrs A is unable to identify the reasons, beyond the fact that she does not have time to attend social occasions as she once did, including attending the local community centre. The GP has noticed that her motivation is decreasing and thinks that her caring role may be more stressful or overwhelming for her than she is aware of.
Mrs A has expressed her desire to increase the quality of her relationships with her friends and daughter. The support she currently provides to Ms M, and the impact this has both on her available time and her emotional/physical health, prevents her from achieving this outcome.
Mrs A’s GP has referred her to social services for assessment as he is concerned that while she is managing currently and does not seem unwilling or unable to continue her caring responsibilities, they may have a negative impact on her in the medium term and result in a breakdown and complete inability to care for Ms M. Mrs A has not previously had an assessment of her needs as Ms M’s carer.
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?
- How do the first two questions affect the way this assessment is conducted?
- Who will be involved with the assessment?
- Does the assessor 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?
- Should there be a carer’s assessment?
- Have you considered the individual’s needs over an appropriate period of time to ensure that they have all been accounted for?
- What is the impact on the whole family?
- Have you considered the extent to which there is any impact on the carer’s ability to maintain their normal daily life (e.g. looking after their family or continuing working), or to continue their caring role or if there is an impact on their health?
- Does the carer require training to help them in carrying out their caring role?
- What information and advice would be helpful?
- What preventative measures (to prevent, delay or reduce needs) will you consider?
- What else might you need to think about with regards to this example?
To be eligible for support, Mrs A must satisfy the minimum threshold for carers to ensure the local authority meets her needs in a fair and consistent way. The questions to ask in determining the extent to which the eligibility criteria are met are:
- Do the carer’s needs arise as a consequence of providing necessary care to an adult?
- Is the carer’s physical or mental health affected or at risk of deteriorating, or is the carer unable to achieve any of the listed outcomes?
- As a consequence of being unable to achieve any of the outcomes, is there, or is there likely to be, a significant impact on the carer’s wellbeing?
The assessor may also consider the impact of the responsibility of caring for Ms M on Mrs A beyond the eligibility criteria to determine if this is significant, including considering Mrs A’s needs holistically, taking into account the cumulative impact of low/medium-level needs. In this case the assessor takes account of factors that individually may not be significant. For example, Mrs A’s inability to develop and maintain family or other personal relations could be argued not to be significant in itself; however, when considered alongside the fact that she is also unable to make use of necessary facilities or services in the local community (also a low/medium need), the impact becomes significant.
Considerations in determining eligibility
The assessor gathers information during the assessment to inform and demonstrate the determination of eligibility for Mrs A as a carer with support needs.
- Person’s wishes, preferences and desired outcomes. Mrs A is clear about her desired outcomes; she wants to continue caring for her sister and wants to increase the time she spends with her friends and daughter.
- Providing necessary care. Providing the care necessary for Ms M prevents Mrs A from spending as much time as she would like with her daughter and her friends, and has a negative impact on her overall wellbeing. To make an accurate assessment of this requires the assessor to consider whether all the support she is providing is necessary. In order to do this, the assessor will have to establish:
- whether Ms M is able to do by herself any of the tasks that Mrs A supports her with
- what the impact would be on Ms M if Mrs A ceased supporting her in the tasks/areas in which she currently assists.
- Do the carer’s needs fluctuate? Ms M’s physical needs do not fluctuate and do not place additional care requirements on Mrs A, apart from what she normally provides. However, the recent birth of her granddaughter and issues associated with her high blood pressure mean that Mrs A’s ability to cope with caring for her sister fluctuates, and she requires more help at certain times.
- Has all the relevant information been gathered to make an eligibility determination? The assessor must use the information they have gathered in the carer’s assessment from Mrs A, and any other information provided by her sister or daughter, in making the eligibility determination. Mrs A is known to local health services, however as this is her first assessment she is not known to the local authority. The assessor should collate the information on Ms M’s condition along with the views of health care professionals in order to establish as complete a view as possible of the impact on Mrs A.
Determination. Following a carer’s assessment, Mrs A’s needs were found to be eligible.
Condition 1. Mrs A’s needs for support arise because she is providing necessary care to Ms M, who is unable to undertake the tasks essential to maintain her wellbeing and meet her desired outcomes without the help of her sister.
Condition 2. Mrs A meets Condition 2 because her physical health is at risk of deteriorating (the stress she suffers as a result of her caring role could be a cause of her high blood pressure), and she is unable to achieve the minimum of one of the outcomes in the eligibility regulations i.e.:
- develop and maintain family or other significant personal relationships
- make use of necessary facilities or services in the local community, including recreational facilities or services
- engage in recreational activities.
Condition 3. As a consequence of being unable to meet the specified outcomes there is a significant impact on Mrs A’s wellbeing, including her physical and mental health, emotional, social and economic wellbeing, and domestic, family and personal relationships.
How the carer’s eligible needs might be met
Following the carer’s assessment and the eligibility determination, the local authority puts a support package in place to enable Mrs A to sustain her caring role. This includes the following:
- The assessor, Ms M and Mrs A talk to Ms M’s goddaughter (Ms D) to explore the extent to which she is happy to take over the management of household tasks. Ms D agrees to share the responsibility for maintaining Ms M’s household with Mrs A.
- Mrs A receives information and advice about support and resources available in her area to allow her to make additional independent choices.
- The assessor identifies that Mrs A spends more than 35 hours a week looking after her sister and a review of any benefit entitlements is conducted.
- The care plan also identifies the need for regular respite for Mrs A, to ensure she recognises and is able to cope with the pressure that caring for her sister places upon her.
- The local authority reviews Ms M’s needs and agrees to provide more care and support that frees up Mrs A’s time to spend with friends and family.
- What else did you think about?
- What else might apply/be relevant in your authority?
- What might you do differently? Why?
- What have you learned?