Adult carer transition in practice under the Care Act 2014

Version 1: Published March 2015

Introduction

The Care Act 2014 places a duty on local authorities to conduct transition assessments for children, children’s carers and young carers where there is a likely need for care and support after the child in question turns 18 and a transition assessment would be of ‘significant benefit’ (see below). This resource should be read in conjunction with the statutory guidance underpinning the Care Act, [1] in particular chapter 16: ‘Transition to adult care and support’.           

The resource explores how the provisions in the Care Act around transition can be put into practice for adult carers as the young person they care for moves into childhood. We know that this can be a difficult time for adult carers, because the young person they care for will often be leaving full-time education and require very different care and support as an adult building an independent life. Adult carers have in the past had to give up full-time work in order to provide more support.

Definition of an adult carer

An adult carer within the context of the Care Act provisions relating to the transition to adult services is ‘an adult (including one who is a parent of the child) who provides or intends to provide care for the child’ (Care Act 2014, clause 60(7)).

An adult carer in this situation may also be a parent carer as defined in the Children Act 1989 (section 17ZD(2), as inserted by section 97 of the Children and Families Act 2014): ‘“parent carer” means a person aged 18 or over who provides or intends to provide care for a disabled child for whom the person has parental responsibility’.

An adult is not defined as a carer if they provide services through voluntary work or under the provision of a contract.

Transition in the Care Act 2014 and the Children and Families Act 2014

The Care Act places a duty on local authorities to assess adult carers before the child they care for turns 18, so that they have the information they need to plan for their future. This is referred to as a transition assessment.

The Care Act places a duty on local authorities to conduct a transition assessment for an adult carer where it appears that the carer is likely to have needs for support after the young person they care for turns 18, and where they think that there would be ‘significant benefit’ to the carer in doing so (see below).

On the basis of a transition assessment, local authorities must give an indication of whether the carer is likely to have eligible needs for support under the adult statute, advice and information on what can be done to meet eligible needs, and advice and information on what can be done to prevent or delay the development of needs.

Section 97 of the Children and Families Act 2014 introduces a new duty on local authorities (inserted into the Children Act 1989) in relation to a parent carer of a disabled child, to assess whether it is appropriate for them to provide, or continue to provide, care to that child. On the basis of this assessment, local authorities must consider whether the parent carer has needs for support and whether these and any needs of the child they care for can be satisfied by services under section 17 of the Children Act 1989.

Adult carers of children for whom they do not have parental responsibility may also be assessed and supported under section 1(2) of the Carers (Recognition and Services) Act 1995. An adult does not need to have parental responsibility for a child in order to qualify for a transition assessment under the Care Act 2014.

These provisions work alongside measures in the Care Act 2014 for assessing adults to enable a ‘whole-family approach’ to providing assessment and support. Both the Care Act and the Children and Families Act include provision that assessment can be joint.

A whole-family approach means making sure that any assessment takes into account and evaluates how the needs of the person being cared for impact on other family members including siblings who may or may not be providing care. This approach also allows the local authority to combine an adult carer’s needs assessment with any other assessment in relation to the carer, the person being cared for or another member of the carer’s family.

The Department of Health has published good practice guidance on whole-family approaches to assessment [2]

The provisions for young carers included in the Care Act 2014 link with provisions in the Children and Families Act 2014 to provide a clear framework for local authorities to take a whole-family approach to assessing and supporting adults and young carers and deliver support in a coordinated way.

It is therefore the responsibility of councils to coordinate the support of those who have been using children or transition services with the support provided by adult services. Examples from good practice suggest that the willingness of services such as social care, education, housing, employment and health to work together with families can make a difference to the future of young people and their carers.

Identification

The Care Act 2014 requires councils to assess the needs of an adult carer where there is a likely need for support after their 'child' or young person turns 18 and it is of significant benefit to the carer to do so.

Local authorities need to consider how to identify carers as early as possible in the same way as they have to identify a young person likely to have care and support needs as an adult. This will enable them to ensure the timeliness of their intervention. In other words, if the assessment and plan are done ‘late’, the benefit to the carer will not be as significant as if they are done at the right time to maximise the choice and wellbeing of that person. Map the process from identification (adult carer), though assessment advice and information to transition.

It is important that children’s and adult services (including education and health) work together to develop methods of identifying carers who are supporting a young person approaching 18, taking account of the fact that many people will not self-identify as carers. A whole-family approach with protocols in place across a wide range of local partnerships will enable local authorities to be better coordinated.

Methods of identifying carers include:

Timing of a transition assessment

Adult services must assess the needs of a young person’s carer where there is a likely need for support after the young person turns 18 and it will be of significant benefit to the carer to do so. ‘Significant benefit’ refers to the timing of such an assessment. Paragraph 16.10 of the Care Act statutory guidance [1] sets out the factors to consider in determining when an assessment will be of significant benefit for a young person.

The assessment must be conducted early enough to allow time to plan and put support in place before the young person being cared for turns 18. In general it will make sense to conduct a transition assessment of an adult carer around the same time as for the young person they care for, although depending on the circumstances this may not be in the form of a joint assessment.

Young people receiving care and support may be subject to the Mental Capacity Act 2005 (MCA):

The right of young people to make decisions is subject to their capacity to do so as set out in the Mental Capacity Act 2005. The underlying principle of the Act is to ensure that those who lack capacity are supported to make as many decisions for themselves as possible, and that any decision made or action taken on their behalf, is done so in their best interests. This is a necessity if the transition assessment is to be person-centred.

For young people below the age of 16, local authorities will need to establish a young person’s competence using the test of ‘Gillick competence’ (whether they are able to understand a proposed treatment or procedure). Where the young person is not competent, a person with parental responsibility will need to be involved in their transition assessment – or an independent advocate provided if there is no one appropriate to act on their behalf (either with or without parental responsibility). [3]

The presumption of competence at the age of 16 under the Mental Health Act 1983, as well as the increased freedoms that often come with post-16 education, mean that young people and their carers can often face many issues similar to ‘adulthood’ transition around this time. Practitioners should bear this in mind when considering the timing of full transition assessments. An early transition assessment that frames the changes at 16 as a step in a broader journey towards adulthood can be very helpful for both the young person and their adult carer.

Transition assessments under the Care Act 2014

Chapter 16 of the Care Act statutory guidance [1] sets out the requirements of a transition assessment:

The transition assessment should support the young person and their family to plan for the future, by providing them with information about what they can expect. All transition assessments must include an assessment of:

  • current needs for care and support and how these impact on wellbeing;
  • whether the child or carer is likely to have needs for care and support after the child in question becomes 18;
  • if so, what those needs are likely to be, and which are likely to be eligible needs;
  • the outcomes the young person or carer wishes to achieve in day-to-day life and how care and support (and other matters) can contribute to achieving them.

Transition assessments for young carers or adult carers must also specifically consider whether the carer:

  • is able to care now and after the child in question turns 18;
  • is willing to care now and will continue to after 18;
  • works or wishes to do so;
  • is or wishes to participate in education, training or recreation.

The same requirements and principles apply for carrying out transition assessments as for other needs assessments under the adult statute (chapter 6 sets out the requirements and principles for carrying out needs assessments under the adult statute). [4]

The requirements that apply equally to transition assessments as other Care Act assessments include:

As the statutory guidance also notes:

Some carers may need support in recognising issues around sustainability, and in recognising their own needs. This will allow local authorities to make a realistic evaluation of the carer’s present and future needs for support and whether the caring relationship is sustainable. Where appropriate these views should be sought in a separate conversation independent from the adult’s needs assessment. [5]

After many years of caring for a young person with a disability, adult carers may not have considered fully what their options and support needs are as their focus may have been on the young person’s care rather than on developing their own independence. Adult service practitioners have to be mindful of this and ensure that the carer is given time to consider their own needs independent of the young person’s move to adult services.

Practitioners must also ensure that an adult carer appreciates the presumption of the young person’s capacity to make decisions for themselves. Young people approaching adulthood will have ambitions for their own future. Transition to adulthood should be a time for them to pursue opportunities, develop independence and become responsible (as far as possible) for managing their own finances and where they wish to live.

Adult carers may approach the point of transition with the assumption that, if a residential placement for the child they are caring for is coming to an end, they will need to leave full-time employment. As the Care Act statutory guidance [6] notes:

The SEN code of practice [7] sets out the importance of full-time programmes for young people aged 16 and over. For instance, some sixth forms or colleges offer five-day placements which allow parents to remain in employment full time. However, for young people who do not have this opportunity, for example if their college offers only three- day placements, transition assessments should consider if there is other provision and support for the young person such as volunteering, community participation or training which not only allows the carer to remain in full time employment, but also fulfils the young person’s wishes or equips them to live more independently as an adult. (see SEN Code of Practice chapter 8 on preparation for adulthood, and chapter 4 of this guidance on market shaping).

Good transition conversations should include a clear indication to a carer of what support the person they care for would be entitled to if they were not willing/able to continue to provide care. This will not necessarily lead to them going through with that option, but may open up a conversation about a reduced caring role that allows the carer to pursue or maintain education/employment opportunities.

Practitioners also need to provide information to carers on what is available to carers to help them focus on their own needs rather than on the person they have been caring for. Families with young people who are preparing for the transition to adulthood are often only interested in getting the support right for their family member and they will say ‘get the support right for my son/daughter and then it will be right for me’. They do not always see the importance of getting the support right for themselves (for example meeting their own mental or physical health needs) in order for them to adequately maintain their caring role. This may lead the family carer to gloss over their needs and issues to concentrate on their family member during the assessment process, perhaps not fully considering the potential changes to their own life. Practitioners should be aware of this and take it into consideration during the assessment.

Approaches to assessment

A whole-family approach to assessment can help to identify individual needs, aspirations and goals of each family member as well as collective strengths, resources and mutual desired outcomes. Family assessments are a good opportunity for practitioners to work together to identify the impact of caring on the carer and the support that they, as well as the young person they are caring for, would like to receive in the future.

Transition can have a significant effect on other family members and it is important to review how family members’ needs might change as a result of it. Local authorities must assess whether an adult carer’s needs for support might increase, and provide any information, advice or support planning required in relation to any identified needs.

The power to join up assessments can be important at transition and the Care Act statutory guidance provides the following examples of assessments that could be combined:

... if an adult is caring for a 17 year-old in transition and a 12 year-old, the local authority could combine:

  • the child’s needs assessment of the 17 year old under the Care Act;
  • any assessment of the 17 year old’s needs under section 17 of the Children Act;
  • any assessment of the 12 year old’s needs under section 17 of the Children Act;
  • the child’s carer’s assessment of the adult under the Care Act; and
  • the parent carer assessment of the adult under the Children and Families Act. [8]

    •  

So joined-up assessments for the carer and the young person can be combined if appropriate and timely. However, where assessments are combined it is important that each individual has a chance to have a private conversation with the assessor in case there are areas they wish to identify and explore separately.

A ‘tell us once’ approach to coordinating assessments is less stressful for carers. A designated key worker can be helpful as they can be a single point of contact for the family and help to integrate services.

It is important that local authority assessors check whether any other organisations or services have completed an assessment, for example adult social care and children’s services or the NHS. This is particularly important in a situation where the carer themselves may have health needs. Local authorities can work with another organisation such as the NHS to carry out an assessment if the person agrees to this taking place. Working together will avoid duplication of information, help coordinate more effective support and develop a plan that works for everyone within the family. Such an approach can be particularly important to families who are moving from children’s to adult services.

If a transition assessment is carried out as it should be, there should not be a gap in the provision of care and support. The local authority must continue to provide any existing services until any new arrangements are in place.

Assessments can take different forms depending on the person’s preference to express their personal views and how they wish to express their needs and requirements. Because of the sensitive and complex issues at play, the default assumption should be that at least one face-to-face meeting will be required for transition assessments. However, there is no one approach that will always be appropriate, and sometimes people may prefer a telephone or supported self-assessment.

Forms (paper or online) for some people can be off-putting, cause anxiety to those completing them and, if completed incorrectly, take more time to process than if a face-to-face assessment had been arranged. Adult carers may find standard adult assessment forms to be written in professional jargon and therefore difficult to understand. It may be possible to offer a mix of approaches where basic information is collected online to support a more targeted face-to-face discussion on a carer’s support needs (either with the person they care for or in a separate meeting if this feels more comfortable for the carer).

Any approach to online assessment should also consider very carefully how to ensure that any default assumptions that caring must continue will be challenged to encourage aspirations about the future.

Information and advice

Having carried out a transition assessment, the local authority must give an indication of which needs are likely to be eligible needs (and which are not likely to be eligible) once the young person in question turns 18, to ensure that the young person or carer understands the care and support they are likely to receive and can plan accordingly. [9]

Where a carer needs support to care for the young person when they become an adult, the local authority will need to prepare a support plan and notify the carer if they have eligible needs. Where the carer’s needs will not be met by adult services, the local authority must explain why their needs are not going to be met. The local authority also has a duty to provide the carer with information and advice to help them decide on options that could prevent or delay their need for support in the future.

Carers can help to support each other and there are often carers’ forums organised by carers who have disabled children and/or young adults. Carers say that practitioners should be aware of these groups and refer people to them. Practitioners should consider whether early referral to such groups might be an appropriate support for carers who are preparing to provide care and support to a young adult.

Planning

Transferring from children’s to adult services will for some young people moving to adulthood take months to fully implement. (Preparing for Adulthood has some sample plans of young people likely to need adult care as adults.) Although not statutory, a transition plan will provide clarity to everyone (including the carer if they are continuing to care after the person becomes 18) about which services and professionals will be supporting them during the transition and other resources where they can receive support. If there are plans for more than one member of the family they should be developed in a coordinated way.

The transition plan must be flexible so that adjustments can be made at a later stage and there is an opportunity for the development of support that incorporates the carer’s needs. In some cases, the plan could form part of the assessment and be reviewed periodically as with any other assessment. As personal or family circumstances change, the transition plan can be updated and refined without having to conduct a new assessment.

The Care Act 2014 includes a specific power to begin meeting the needs of adult carers in advance of the child they care for transitioning to adult services, provided this does not overlap with services provided under children’s legislation:

In the case of an child’s carer, if the local authority has identified needs through a transition assessment which could be met by adult services, it may meet these needs under the Care Act in advance of the child being cared for turning 18. In deciding whether to do this the local authority must have regard to what support the child’s carer is receiving under children’s legislation. If the local authority decides to meet the child’s carer’s needs through adult services, as for anyone else under the adult legislation, the child’s carer must receive a support plan and a personal budget – as well as a financial assessment if they are subject to charges for the support they will receive. A local authority may not meet an adult carer’s needs for support under section the Care Act by providing care and support to the child cared for – this will always happen under children’s legislation. [10]

In transition planning, local authorities should consider whether this power can form a useful stage of transition. A good example would be starting direct payments to an adult carer in advance of formal transition in order to ease the process.

Transition itself

An effective transition assessment and plan will mean that, for families, the move from children’s services to adult social care is smooth and everyone understands where and how to receive support and care should they need it.

The Care Act 2014 provides continuity so that where a young person is receiving children’s services, those services are not stopped as soon as they turn 18, but continued until adult services have a plan in place or ‘relevant steps’ have been taken (see below). Local authorities have a duty to ensure that the family has adequate support so that carers can fulfil their own goals and potential.

The ‘relevant steps’ are if the local authority:

  • concludes that the person does not have needs for adult care and support; or
  • concludes that the person does have such needs and begins to meet some or all of them (the local authority will not always meet all of a person’s needs – certain needs are sometimes met by carers or other organisations); or
  • concludes that the person does have such needs but decides they are not going to meet any of those needs (for instance, because their needs do not meet the eligibility criteria under the Care Act 2014).

In order to reach such a conclusion, the local authority must have conducted a transition assessment (that they will use as a needs or carers assessment under the adult statute). Where a transition assessment was not conducted and should have been (or where the young person’s circumstances have changed), the local authority must carry out an adult needs or carer’s assessment. [11]

Obviously, such a scenario of not conducting a transition assessment is in the interests of neither the local authority nor the young person and should be avoided wherever possible. However, local authorities should be clear on the division of responsibility, including budgetary responsibility, where this situation does arise. The Association of Directors of Adult Social Services (ADASS) and the Association of Directors of Children’s Services (ADCS) are currently developing a Memorandum of Understanding for alignment of social services responsibility more broadly that will include suggestions for local policies around this.

Where a carer is not eligible for care and support needs for themselves or no longer wishes to care for a person when they turn 18, local authorities must provide appropriate information and advice on where to access alternative support if they require it either now or in the future.