3 The care needs assessment process
The practitioner assessing your relative should agree with him or her how to describe their situation. They then work out their various needs, which should have the following elements.
1. What are the issues? What are the difficulties that your relative faces?
2. What difference would it make to your relative’s life if these issues or difficulties were tackled? What is the ‘outcome’?
3. What services or support could bring these outcomes about?
The practitioner will need to have a discussion with your relative to be able to do this, and also with your relative's agreement, with yourself and others as necessary. They should make a note of your relative’s needs and consider how to meet them. The discussions may explore areas such as:
- your relative’s current situation
- their daily routine
- what tasks they can do alone, can do with difficulty, or cannot do at all
- what difficulties they face.
For a more detailed set of questions, see our Checklist for preparing for the needs assessment.
Through asking these questions, the practitioner can assess your relative’s level of care needs and the possible ‘risk’ if they are not provided with support services. This should then be compared with the descriptions of care needs that the local authority has agreed to meet according to their eligibility criteria.
Needs assessment eligibility
In England, rather than using levels, as was the case before 1 April 2015, the new criteria for having eligible needs are based on three tests:
- If the adult’s needs arise from or are related to a physical or mental impairment or illness
- If, as a result of the adult’s needs the adult is unable to achieve two or more of the specified ‘care outcomes’
- If, as a consequence there is, or is likely to be, a significant impact on the adult’s well-being.
The ‘care outcomes’ that the local authority consider
- Managing and maintaining nutrition.
- Maintaining personal hygiene.
- Managing toilet needs.
- Being appropriately clothed.
- Being able to make use of the adult’s home safely.
- Maintaining a habitable home environment.
- Developing and maintaining family or other personal relationships.
- Accessing and engaging in work, training, education or volunteering.
- Making use of necessary facilities or services in the local community, including public transport and recreational facilities or services.
- Carrying out any caring responsibilities the adult has for a child.
The local authority will judge that a person cannot achieve an outcome if they are unable to achieve it without assistance, without significant pain, stress or anxiety, without endangering themselves or others, or if it would take significantly longer than would normally be expected.
The care outcomes should be recorded. Councils are required to ‘signpost’ your relative to other ways of meeting any of their presenting needs that fall outside their eligible needs.
Postcode lottery in England
There is wide concern that there is great variation around the country in the level of needs met. Prior to April 2015 each council could set its own eligibility criteria, although this was broadly the same for every authority, which could sometimes lead to people being eligible for services in one area but not another.
Since April 2015 and the introduction of the Care Act, people requiring care services in England have their needs assessed according to a set of eligibility criteria that are nationwide and therefore go some way to reducing the ‘postcode lottery’. However, councils still have some discretion in how they provide these assessments and how they arrange to meet the needs that they identify. Ultimately this can lead to two people in two different areas of the country receiving two different packages of care, although the outcome for both is that their assessed needs should be met.
Getting the most out of a care needs assessment
To ensure your relative gets the best chance of having their needs met, it is important to ensure the following:
- That all of your relative’s needs that require public funding are assessed and recorded.
- That the council says how it came to the decisions about how it categorised each need.
For needs that it decides fall outside the care outcomes, ensure the advice about how to meet them is feasible and practicable. This information will put you in a position to challenge the council’s decisions should the need arise (see Challenging local authority and NHS assessments).
For help and advice on preparing for the assessment, see Preparing for the needs assessment.
In Wales, the Social Services and Well-being (Wales) Act 2014 came into force from 6 April 2016 and services will be arranged through social services if your relative has eligible needs that can 'only be met through a care and support plan' or the council feels it is necessary to meet the needs of your relative 'in order to protect the person from abuse or neglect'.