Practice example: Eligibility (adult and carer)
Mr and Mrs T are a married couple with no children; Mr T provides care for Mrs T.
Mrs T is in her 30s and is registered partially sighted, with a marked deterioration in her vision over recent months. Her sight loss results from undetected uveitis associated with juvenile rheumatoid arthritis. Mrs T’s arthritis continues to affect her ability to walk, and to hold and use items with her hands. The severity varies: sometimes she is virtually incapable of holding anything or walking more than a few steps; at other times she is more able. Mrs T has particular difficulty with reading, performing tasks close up, cooking, cleaning and maintaining her home. She is also unable to go out and visit the shops independently.
Mrs T gets very frustrated and stressed because she is unable to cook and keep her home clean or go out. She particularly misses visiting her local church group. This also puts a strain on her marriage and pressure on her husband.
Mrs T has her mother and a sister nearby, but they are unable to provide support. Her mother is frail and her sister has young children to look after as well as a part-time job. Her friends help out occasionally, but due to their own responsibilities cannot commit to providing regular support.
Mr T is also in his 30s, works full time and has a history of intermittent bouts of mild to moderate depression.
He works in the stock room of a local DIY warehouse and is able to work relatively flexibly to fit around his wife’s needs, as the company and his immediate boss adopt a family-friendly and supportive employment policy. However, despite this support from his employer he struggles to work and care for his wife during the periods when she is more affected by her condition. This endangers the social contact Mr T’s job provides and which helps to preserve his own wellbeing and self-esteem.
Mr T is in regular contact with his network of friends, although he doesn’t see them as often as he would like. His family live close by, but again his mother and father are both frail and elderly. His sister and two brothers all have young families and work and education commitments that prevent them from helping him as much as they would like. They all recognise that Mr T is generally able to cope with his situation but occasionally needs a helping hand when he is at his lowest ebb.
The assessor offers Mr T a carer’s assessment at the time of Mrs T’s needs assessment because he appears to have needs for support in relation to his caring role. It is agreed by them all that the couple’s assessments will be combined.
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 answers to the first two questions above 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?
- Have you considered the individual’s needs over an appropriate period of time to ensure they have all been accounted for?
- What information and advice would be helpful?
- What preventative measures (to prevent, delay or reduce needs) will you consider?
- Have you considered the extent to which the adult’s needs meet the three conditions of the national eligibility criteria? (Have you looked at this in the context of their desired outcomes?)
- Have you considered the extent to which there is any impact on the carer’s ability to achieve the separate carer’s eligibility criteria? (Have you looked at this in the context of their desired outcomes?)
- What else might you need to think about with regards to this example?
A determination of eligibility cannot be made without a needs assessment. Determination must consider the minimum eligibility threshold criteria, which are:
- Do the needs for care and support arise from a physical or mental impairment or illness?
- Do these needs mean the adult is unable to achieve two or more of the listed outcomes?
- As a consequence of being unable to achieve the outcomes, is there, or is there likely to be, a significant impact on the adult’s wellbeing?
- 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?
Considerations in determining eligibility
Establishing the extent to which the adult eligibility outcomes are met.
- Are there care and support needs? Mrs T has needs arising from a physical illness, which impede her achievement of most of the specified outcomes in the eligibility criteria.
- Inability to achieve two or more of the listed outcomes. Mrs T is very aware of the impact of her condition and the effect it has on those around her, and the increased severity of her condition is making this worse. The assessor consults all those involved in her care (GP, district nurse, physiotherapist and occupational therapist) to gain a rounded view of her current needs. From this the assessor decides that she is, at a minimum, unable to maintain a habitable home environment, because cleaning causes her significant pain, and having an unclean home causes her anxiety. She is also unable to develop and maintain relationships without care and support.
- Is there a significant impact on wellbeing? Mrs T’s needs have a significant impact on her overall wellbeing. In particular the information gathered during the assessment indicates how she struggles with control of her day-to-day life. She is also unable to effectively participate in work or recreational activity, which impacts her social and economic circumstances. From this information the assessor determines that the combined influence of these factors has a significant impact on Mrs T’s overall wellbeing.
- Does the person have fluctuating needs? Mrs T’s needs are increasing in severity, however, these vary over time with some days where Mrs T is generally able. Making an accurate assessment of any changes in eligibility will involve consideration of Mrs T’s condition over a suitable period of time, taking account of the views and experiences of Mrs T and her husband, and of health professionals who have worked with Mrs T over the years. The assessor’s experience of dealing with people with similar conditions in similar circumstances should also be taken into account. Based on the information gathered in this case it was determined that Mrs T’s needs did fluctuate during periods of inclement weather, and that this would need to be reflected in her care and support plan.
Establishing the extent to which the carer eligibility outcomes are met.
- Providing necessary care. During the assessment the assessor considers whether Mrs T would be unable to carry out these activities without the support of her husband, and whether this support is required to meet Mrs T’s needs. The assessor’s determination is that in this case Mrs T would be unable to continue to carry out normal day-to-day tasks without her husband’s help.
- Impact on health or daily life. The assessor considers the impact caring is having on Mr T’s physical and mental health and whether there are activities of his daily life that he is unable to carry out because of this. The assessor’s determination is that providing care for Mrs T has an impact on Mr T’s ability to be involved in relationships to the extent he would like, but doesn’t prevent him from maintaining them. Following the joint assessment, the assessor establishes that Mr T is able to achieve all the other listed outcomes.
- Impact on wellbeing. The assessor considers whether the time Mr T is spending caring for his wife impacts on his ability to meet his friends and family as regularly as he would like. The assessor has to consider whether there is significant impact on Mr T’s wellbeing, using the information from Mr T and his wife during Mr T’s carer’s assessment. The assessor determines that as a result of the provision of additional support to his wife, there will be no significant future impact on Mr T’s overall wellbeing.
Determination: Following a face-to-face assessment, Mrs T’s need were found to be eligible.
Condition 1. It is clear that Mrs T’s needs arise from a physical impairment.
Condition 2. Mrs T is unable to achieve more than two of the outcomes in the eligibility criteria within the regulations, including: being able to make use of her home safely; developing and maintaining family or other personal relationships; and making use of necessary facilities or services in the local community, including public transport and recreational facilities or services.
Condition 3. This significantly affects Mrs T’s wellbeing – i.e. in relation to her physical and mental health and emotional wellbeing; control over day-to-day life; and domestic, family and personal relationships.
Mr T’s needs were found not to be eligible.
Condition 1. Mr T’s needs for support arise because he is providing necessary care to Mrs T. The assessor gathers information that confirms that Mrs T is unable to do by herself the tasks that Mr T supports her with, and that currently there is no one else who could support Mrs T with these tasks.
Condition 2. Mr T does not however meet Condition 2 because, despite his caring responsibilities, he is able to achieve all of the outcomes in the eligibility criteria within the regulations – i.e. maintaining a habitable home environment; managing and maintaining nutrition; developing and maintaining family or other significant personal relationships; accessing and engaging in work, training, education or volunteering; making use of necessary facilities or services in the local community including recreational facilities or services; and engaging in recreational activities.
Condition 3. Although Mr T’s wellbeing is deemed to be at risk of being affected by his caring responsibilities, it is anticipated that the additional support provided to Mrs T will take some of the pressure off him, which in turn will have a positive impact on his wellbeing. Mr and Mrs T have both been put in touch with services that are available in the community that can support both their needs, such as Action for Blind People.
This outcome is dependent on Mr T being able and willing to continue to provide care for his wife; without this, the level of care the local authority would have a duty to meet Mrs T’s eligible needs in another way; it is also useful to combine their care and support plans.
How the adult’s eligible needs might be met
Following the determination that Mrs T’s needs were eligible, she is allocated a personal budget that she uses to employ a personal assistant for a number of hours a week to help her get to the shops, read labels and manage some personal care tasks. This helps to reduce Mrs T’s fatigue and to increase her emotional wellbeing and her personal control over day-to-day life.
She receives talking books from the local authority, and she and her husband are also put in touch with Action for Blind People’s confidence-building programmes. These support both the person with sight loss and their companion in adjusting to sight loss. The assessor contacts Mrs T’s church and arranges for one of the members to assist her in attending the church group fortnightly.
Mrs T is provided with a copy of her eligibility determination in large-print format, as agreed with her.
- 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?