Finding out what help someone needs and who can provide it

 

 

 

 

   DISC

   Oxford Dementia Centre

   Institute of Public Care

   Roosevelt Drive

   Oxford OX3 7XR

   Tel: 0845 120 4048

   www.disc.org.uk

   email: info@disc.org.uk

 

 

 

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This fact sheet offers information about why the person you care for might benefit from a community care assessment; how to obtain one; who undertakes the assessment; what it will contain and the grounds on which you may or may not receive a service.

 

You may also find the following fact sheets helpful:

 

·        What is dementia?

·        Assessment and diagnosis

·        Treatment and therapy for people with dementia

·        Looking at your needs as a carer - having a carer’s assessment

·        Making the decision about future plans for care

·        Getting help through financial benefits

·        How will the cost of a care home be paid for?

·        Visiting a care home

 

Why ask for help?

 

Caring for someone with dementia is likely to affect every aspect of your life - your finances, health and well-being, family life and any time you may have had to yourself.

 

That is why it is so important to find out what support is available – do not wait until you are desperate before accessing help.  Someone with dementia will often have complex and varied needs.  For example, as well as short-term memory loss, they may be more prone to falls, have eating or swallowing difficulties, continence problems, have mood swings or periods of extreme confusion.  As a carer you cannot be a 24 hour a day, 7 days a week, resource.  It is not unknown for the carer to become exhausted and ill as a result of their caring role.  It has been shown that carers who access help and support suffer less with stress and depression and may carry on caring for longer.

 

Even though you may feel able to provide care without any additional support at this time, it is worth contemplating what would happen if a sudden emergency should arise, eg, you were ill and could not look after the person you care for.  Who would know about them, how could continuity be maintained and what would you do?

 

There are two good reasons for planning help in advance:

 

·               Services that exist to support people remaining in their own home for as long as possible could be accessed more easily if someone is already known to them eg respite care.

·               The presence of a care plan will mean that the needs of the person have been written down making caring easier.

 

What if I don’t want to go to social services?

 

There are services available that you can access without having to contact your local authority (social services).  For example support groups, lunch clubs, sitting services and day centres.

 

You can arrange services directly yourself.  Often there is a charge for services, although some are free.  This will depend on the area you live in.  If you purchase the care yourself, make sure you talk to the care agency about the help you feel is needed, the sort of skill the person coming to provide care will need to have and how much the service will cost.  Make sure that the agency is a “registered care provider”, this means that they have conformed to government legislation and monitoring.

 

However, we would advise that it is always worth talking to a care manager from social services even if you don’t want to go through an assessment of need.  The situation which exists now may not apply in the future and you may require more help.

 

Going ahead with an assessment

 

If more structured help or “hands on care” is needed, you may want to look at services provided by, or through, the local authority.  In order to gain access to those services, the cared for person should have a “formal assessment of need”, which is undertaken by the local authority.

 

If the person you care for is assessed as needing certain services, such as help getting up in the morning, then the local authority has the duty to provide a service. The local authority has a duty to tell you that you have a right to an assessment of your needs as a carer, and to consider your assessed needs when providing services to the person you care for.  You should be given a copy of the Government Leaflet “How to get help in looking after someone: a carer’s guide to a carer’s assessment”.  Ask for a carer’s assessment for yourself – this can be carried out at the same time as the person you care for, or you can ask to have an assessment without the person you care for being present.

 

These assessments are a right under section 47 of NHS and Community Care Act, 1990 and the Carers Recognition and Services Act 1995 and are free.

 

 

Who do I contact to ask for an assessment?

 

Contact your local authority that provides social services (sometimes called Health and Social Care). 

 

Tell them that you want to make a referral.  You will be asked to give your name, address, telephone number, who you are phoning on behalf of, their date of birth and the GP with whom they are registered.

 

If you do not want to make the contact yourself, then anyone can make contact on your behalf, for example:

 

·               A friend, relative or neighbour

·               Your GP

·               A local voluntary organisation such as the Alzheimer's Society

·               DISC

 

 

How long after asking for an assessment will one take place?

 

When you make contact ask how quickly the assessment will take place.  This will depend entirely on how urgent the need is.  The Local Authority social services will prioritise.

 

There are no set government timescales, but each social services department will say what they expect their response time to be in a locally produced document called "Better Care Higher Standards".  The department has to publish this document annually to say what services they offer, how much they cost, and how long it will take before they are available.

 

Different types of assessment

 

Assessments are sometimes called by different names, for example Community Care Assessment or Needs Assessment.  There has recently been a change which is designed to make assessment easier.  This is called the Single Assessment Process.  The intention is that people can be assessed for a range of health and social care services using just one procedure.  This may be just the initial contact and assessment, or could be followed by more complex or detailed assessments undertaken by other professionals eg physiotherapists and community psychiatric nurses.  This should mean that information is shared, with your permission, by professionals involved and an integrated care plan is produced giving a fuller picture of the person’s needs.

 

This should be helpful to people with dementia and their carers as they often have more complex needs and a variety of support services are required.

 

Try to get a named co-ordinator when the assessment is carried out as this means that one person will have the overall responsibility for the process and you can contact them.  You have a right to a copy of any assessment.

 

Who comes to carry out the assessment?

 

Usually the assessment is carried out at the person’s home by a designated officer - this may be a social worker, nurse or other professional involved in the person’s care -they will contact all the people who are already involved.  You, as the carer, and the person being assessed, should be encouraged to participate as fully as possible in the assessment.

 

What will the assessment ask about?

 

The assessment is to find out how much help someone needs during the day and/or night.  If there is a typical day for you and the person you care for, what would it be like?  Try writing down what you have to do.  What would the day and night be like for the cared for person if they were on their own?  What do you do to help them?   What can they do for themselves?

 

The following checklist may help in thinking about the amount of care and time that someone needs:

 

Personal Care

 

·               Can the person get out of bed without help?  Do you have to lift them at all?

·               Can the person you care for, wash and dress themselves?

·               Can they manage to get in and out of the shower or bath?

·               Can they get drinks or meals for themselves?

·               Do they remember to eat and drink?

·               Are they able to go to the toilet on their own?

·               Do they need help going to bed?

·               What happens if the person needs to get out of bed during the night?

·               Do they need prompting with some or all of these tasks?

 

Healthcare including nursing and psychological needs

 

·               If they take medicines can they manage to do this themselves?

·               Do they need prompting?

·               Is there a problem with continence?

·               What is their mood like? Are they agitated, upset, angry?

·               Is their behaviour difficult to cope with?

·               What is their behaviour like? Does it change through the day / evening / night?

·               Is the person safe to be left on their own?

 

Social Needs

 

·                                Is the person isolated living alone at home or alone for long periods? Would they benefit from some form of stimulation during the day such as a day

centre?

·               Would you benefit from a break if they attended a day centre?

·               Can the person communicate with other people or do you have to be there to explain?

 

Accommodation

 

·               Does the person's disability require any adaptations to the house?

·               Can they manage the stairs? (You may have considered making changes, getting advice on aids and adaptations from an Occupational Therapist could be helpful)

·               Are they entitled to a Disabled Facilities Grant?

 

When the assessment is completed what happens next?

 

The assessor completing your assessment will decide if the person you care for is eligible for services, using a set Eligibility Criteria.

 

A local authority may take into account their available resources when deciding how to respond to an individual’s assessment.  However once the authority has indicated that a service should be provided it is under a legal obligation to provide or arrange it.  It will not be possible for an authority to use budgeting difficulties as a basis for refusing to provide services.

 

To help them decide who gets a service local authorities have developed eligibility criteria.  They are based on risk assessment principles and have to be published by the local authority.

 

For example, the eligibility criteria might show that people are categorised as follows:

 

High Priority Someone is likely to suffer serious physical harm within 72 hours if a service is not provided.

 

Medium / High Someone is likely to suffer serious physical harm within 28 days if the service is not provided.

 

Medium – Someone is likely to suffer measurable harm (which is not minor) within 3 months if the service is not provided.

 

Low – Someone, although not at risk of physical harm, is likely to suffer serious social isolation if a service is not provided. (In some areas people classified as low priority may not receive a service).

 

 

What a care plan should include

 

If the person is eligible for services, the outcome of the assessment will be set down in writing in an individual care plan.  The care plan should incorporate a range of services to make it easier for you to continue caring.  Your assessed needs as a carer should be considered when providing services for the person you care for.

 

What the care plan should say

 

·               What services are going to be provided e.g. home care, day care, or respite care and by whom

·               How long they will be staying

·               How much any service will cost

·               When the plan will be reviewed

 

The local authority must make it clear which services are for you and which are for the person you are looking after.  Services cannot be withdrawn unless a re-assessment of their needs takes place.

 

Direct Payments

 

From April 2003 all local authorities have to offer people receiving care at home money instead of arranging services for them.  This is called a direct payment. The purpose is to give people more control, choice and flexibility over the services they receive by purchasing the service themselves with that money.

One essential qualification is that the person receiving the service must be able to manage the service themselves or with assistance from an advocate.  This causes difficulties for people with dementia. Discuss this option with the care manager or social worker.  If an Enduring Power of Attorney (EPA) is being considered and Direct Payment had been preferred in the past, this should be specified when the EPA is being drawn up.

 

If you are using the Direct Payment to employ home carers privately rather than through a care agency, you may need to advertise a position, draw up a contract and arrange to pay their tax and national insurance.  It can be complicated but if direct payments are offered in your area there should be a direct payments officer who will be able to help and advise you.  Your care manager will know about this option.

 

Telephone: 020 7587 1663, text: 020 7587 1177 or visit the following website: www.ncil.org.uk for advice and information. 

 

 

Who makes sure that the plan happens? 

 

The Care Manager.

 

How often will the plan be reviewed? 

 

A Care Plan should be subject to regular review.  You, or the person being cared for, can ask for a review at any time.

 

 

 

 

This fact sheet can be made available in large print.

 

We are constantly looking to improve our information.  It helps if you let us know whether the information in this fact sheet was/was not useful and if there are other fact sheets that you would have found helpful that we have not yet provided.

 

While the information contained in this fact sheet is believed to be correct, DISC does not accept liability for any error/s it may contain.