The purpose of a needs assessment
If you need help to remain living independently in your own home or would like to move into supported accommodation to help maintain your quality of life, the first step you should take is to get a needs assessment. You can get this from the social care services department of your local authority. You have a right to this assessment and it’s free of charge.
Following the needs assessment, the local authority might recommend that you need services such as:
- practical support at home: prompts for medication, doing food shopping, laundry
- care at home: help with personal care, such as washing and dressing or supervision
- disability equipment or mobility aids
- home adaptations: stair lifts, grab rails
- assistive technology: personal alarm or telecare sensors
- sheltered housing or extra-sheltered housing
- information and advice on community support
- care in a residential or nursing home
- respite care.
However, you must meet certain eligibility criteria to qualify for local authority care, which can only be decided upon through a needs assessment.
Local authorities have a duty to assess the needs of anyone they think might have a need for support. This is regardless of your income or financial position. Your care needs should be reviewed first and the assessment will look at all aspects of your life – including physical and mental health, and general wellbeing – to identify your needs. If at least one of these needs meet the eligibility criteria (see below), a care plan is then agreed with you on the type of care and support that would best meet those needs.
Local authorities have a duty to assess the needs of anyone they think might have a need for support. This is regardless of your income or financial position.
If you’re eligible to receive local authority care services either at home or in a care home (but see below if you live in Northern Ireland or Scotland), your financial position will be taken into account. This usually happens before the care plan is drawn up, so be prepared to discuss your financial situation and provide details of income (including state and, if relevant, private pensions), and any savings you may have.
In Northern Ireland, you will only undergo a Health and Social Care financial assessment if moving into a care home.
In Scotland, people aged 65 and over who are assessed as needing services defined as personal care should not be charged for these services; the same applies for people of any age who are assessed as needing services defined as nursing care. The amount an individual contributes towards the remainder of their care home costs, covering accommodation, utilities and meals, will be determined following a financial assessment of your income and assets. More information on this is available on the Scottish Government’s website.
In Wales, regardless of your savings you will never have to pay more than £90 per week towards the cost of personal care services you have been assessed as needing.
Arranging a needs assessment
While each local authority in England must assess your needs according to a national set of eligibility criteria, the way in which the assessment is arranged may vary, but it should be made publicly available. This may be via the local authority website and in written form in places such as GP surgeries, hospitals and libraries.
This information will tell you where and how to apply for an assessment of needs, and how long you may have to wait.
Needs assessments can be arranged through:
- Your GP or adult social care services. If you’re not able to do this, they can give a friend or relative permission to arrange it on your behalf (and, if relevant, they may also want to have the carer’s assessment done at the same time).
- Your local authority website (in Northern Ireland and most areas of Wales, this isn’t possible).
Get on the radar as early as you can so they can come and do the assessment.
If the need for care has been triggered by an accident or illness resulting in a hospital stay, it's common for assessments to be arranged while you are still in hospital.
If you feel you would benefit from an assessment in hospital before you return home but haven’t had one, you should request this (see our discharge procedure article for more information).
Also see methods of assessment.
Who carries out the needs assessment?
A needs assessment is usually carried out by a practitioner from the local authority, such as an occupational therapist, nurse or social worker. You should have only one needs assessment, covering both health and social care needs, to avoid having to repeat the same information to different professionals. However, in practice, this rarely happens because different agencies often have their own assessment processes they stick to. The person carrying out the assessment might need to liaise with others to get information about your care needs.
They should also try to ensure that if there are needs that others are responsible for meeting, there is a coordinated effort: your GP, other health professionals involved with your care and the council’s housing department, for example.
Don’t be fobbed off if the local authority seems reluctant to carry out an assessment. If you feel that you’re being unreasonably refused an assessment, you may wish to make a formal complaint.
The needs assessment process
The practitioner assessing you should agree with you how to describe your situation. They then work out the various needs, which should have the following elements:
- What are the issues? What are the difficulties that you face on a daily basis?
- What difference would it make to your life if these issues or difficulties were tackled? What is the desired ‘outcome’?
- What services or support could bring these outcomes about?
With your permission, the practitioner may need to have a discussion with any relatives also involved with your care.
For a more detailed set of questions, see our preparing for the needs assessment article.
Through asking these questions, the practitioner can assess your level of care needs and the possible ‘risk’ if you’re 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, the 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 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 can’t achieve an outcome if they’re 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. Local authorities are required to ‘signpost’ you to other ways of meeting any of your presenting needs that fall outside the eligible needs.
The care plan and what happens afterwards
Following your assessment, you will receive a written copy of your care plan (in Wales, this is known as the care and support plan), which should suggest care and support solutions to help address your eligible needs, as shown here. It will also tell you which needs the local authority will meet.
|Issue||Possible outcomes||Possible services/support|
Mr S is unable to work
in the kitchen and cook.
To ensure Mr S has regular
meals that meet his
Re-learn how to cook/prepare
meals, or to have
all meals provided.
Mrs P lives alone and
regularly wanders out
of the house, putting her
in an unsafe situation.
|To keep Mrs P safe.|| |
Move to a care home, have a
carer to supervise at home,
or to provide a telecare alarm.
Miss A is unable to get
up the stairs and so has
to sleep downstairs
and use a commode.
To enable Miss A to use
the stairs again so that
she can sleep in her
bedroom and use the
Provide equipment (ie, stairlift)
to help her get upstairs,
or rehabilitation services
to re-learn skills and confidence.
If you don’t receive the care plan, ask for a copy of it. It’s important to check the documentation to make sure that the recorded assessment captures all of your needs, not just the ones the local authority regard as ‘eligible’.
Written details of the assessment should be checked, agreed and signed by both you and the local authority.
Getting the most out of a needs assessment
To make sure you get the best chance of having your needs met, it’s important to ensure the following things.
That all of your needs that require public funding are assessed and recorded: use our checklist in preparing for the needs assessment to help you get the most out of the interview.
- That the council says how it came to the decisions about how it categorised each need.
- For needs that the local authority decides fall outside the care outcomes, ensure the advice about how to meet them is feasible and practicable. Should you want to challenge the council's decision, this information will put you in a stronger position (see challenging a local authority decision).
I learned that you have to fill forms in truthfully but pessimistically: you have to show how difficult things really are and resist the temptation to be positive.
Remember that the assessor is ultimately responsible to the council and that the council has a limited budget. Although the local authority is duty-bound to assess those of your needs they decide are eligible, the assessor will have financial constraints they need to work within.
Postcode lottery in England
There is wide concern that there’s 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, this 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.
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