Eligibility for social care

After the assessment, if the local authority decides that an adult has care and support needs, then they must make a decision on eligibility in all cases. They must use the care and support eligibility criteria set out in the Care Act regulations.

The Regulations give an initial three point test for a need to be considered eligible:

  1. The need must arise from or be related to a physical or mental impairment or illness
  2. It must lead (in combination with any other needs) to the person being unable to achieve two or more of the specified outcomes (listed below)
  3. These outcomes not being achieved must have a significant impact on the adult’s wellbeing.

Specified outcomes

The outcomes mentioned in the second of these requirements are given in the Regulations. They are as follows:

  • 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.

In the Regulations, a person is ‘unable’ to achieve an outcome if:

  • they need another person’s assistance to achieve it
  • they can achieve it without assistance but doing so causes them “significant pain, distress or anxiety”
  • they can achieve it without assistance but doing so is likely to endanger the health and safety of the adult or another person
  • they can achieve it but it takes them ‘significantly longer’ to achieve the outcome than would ‘normally be expected’.

Impact on wellbeing

Well-being is a very broad concept and is the major focus of the new social care law. It is impossible to define exactly, but it is defined in relation to the following areas:

  • personal dignity (including treatment of the individual with respect)
  • physical and mental health and emotional wellbeing
  • protection from abuse and neglect
  • control by the individual over day-to-day life (including over care and support provided and the way it is provided)
  • participation in work, education, training or recreation;
  • social and economic wellbeing
  • domestic, family and personal
  • suitability of living accommodation
  • the individual’s contribution to society

To be eligible the impact on wellbeing must be significant. What is significant to one person is not necessarily significant to another.

Needs met by carers

An assessment of a persons care and support needs should be ‘carer blind’. This means that needs should be assessed as though the person had no carer. It would, for example, be unlawful for a local authority to say that a person did not have a need for help going to the toilet at night just because that person’s husband has been helping with this for years. Just because a need is being met by a carer, does not mean that that need does not exist.

The Care Act Guidance states clearly that the contributions of a person’s carer towards their care needs can only be considered after the eligibility determination. These contributions will be taken into account when the care and support plan is drawn up – but only if the carer is willing and able to continue meeting needs.

Local authorities are not obliged to meet eligible needs that are currently being met by a carer; however they are obliged to make a note that these needs are eligible. This means that if the carer becomes unable or unwilling to continue their role, then the local authority already has a record and can step in immediately and ensure that the person’s needs continue to be met.

Example

Kim is deafblind. She is worried about being stuck at home, as this leaves her bored and socially isolated. She thinks that her care and support package should enable her to get out and about in her community and communicate with friends.

Kim has two aims here:

  1. Her first aim is to become less socially isolated, which matches up with one of the specified outcomes above – without support she is unable to meet the outcome of “developing and maintaining family or other personal relationships”.
  2. Her second aim is to get out and about and not be stuck at home. This matches up with another specified outcome – without support she is unable to meet the outcome of “making use of necessary facilities or services in the local community”.

Her inability to do this is making her depressed and isolated and so having a significant impact on her well being. They could relate to her well being in terms of mental health and emotional wellbeing, her social wellbeing, her participation in recreation and her control over her day-to-day life.

She therefore meets the eligibility criteria and would be entitled to support. Kim’s friends meet up for a drink in the local pub twice a week. In order to achieve aim number 1, Kim wants to go along and join in, however she needs a communicator guide in order to do so. Her need is for a way to communicate to her friends, and this need may be addressed at the care planning stage by providing a Communicator Guide.

Kim also wants to go to her local gym. This will keep her physically active and will get her out of the house regularly. The gym is a 20 minute walk and a bus ride away, however, and Kim does not feel safe making this journey on her own. Her need is to able to travel to and from the gym. Again this should be eligible, because it stems from her disability, relates to the specified outcomes and has the potential to affect her wellbeing. This need could be met by booking a Communicator Guide - this would be addressed in the care plan.

If Kim had a flatmate who also goes to the gym and is willing to guide her, then the local authority does not have to provide a Communicator Guide for Kim to go to the gym. The need is met by the flatmate as a carer. But the need to go to the gym should be recorded as an eligible need in case the flatmate stops being able to guide.

First published: Tuesday 31 March 2015
Updated: Tuesday 22 December 2015