Social Care Assessment & Eligibility

If you have a mental illness you may need support from social services. This page explains who is eligible for social care support and how you can get an assessment from your local authority. Your local authority has to follow The Care Act 2014.

Overview

  • Social services have to assess your care and support needs. They need to make sure your wellbeing and independence is the focus of the assessment.
  • Your needs could include: supported housing, employment, support at home and social inclusion or other things.
  • You should get services to make sure you don’t need crisis support in the future or to make sure your condition doesn’t get worse.
  • All local authorities must use the same eligibility criteria.
  • If your eligible needs are not already being met, then the local authority need to meet your needs.

The Care Act 2014 is the law which explains what your local authority must do to assess your care needs and your eligibility for care and support.

The ‘local authority’ or ‘LA’ is the organisation which manages public services in your area. Your local authority is responsible for social services. Local authority can be called ‘local council’. Local authority will be shortened to LA on this page.

Do I need social care services?

Why would I need social care services?

Your LA is responsible for your social care and support. They need to make sure your wellbeing is good.

If you need help and support to look after yourself then you can have an assessment by social services. For example, you may not be able to:

  • get out of the house,
  • keep in touch with friends and family,
  • get a job or take part in education,
  • clean your house,
  • prepare meals or go shopping,
  • keep safe,
  • manage your money,
  • take part in leisure activities, or
  • contribute to society (e.g. volunteering, being in a club or group).

If you have difficulties with these things, this is called having ‘needs’.

What is the difference between a health care need and a social care need?

There is no legal definition of the differences between health care needs and social care needs. Sometimes a person’s needs could be met by healthcare and social care. But the NHS provides the following definition:

A healthcare need focuses on:

  • the treatment or prevention of a disease, illness, injury or disability, or
  • the care or aftercare of a person with these needs.

A social care need focuses on giving help with:

  • activities of daily living,
  • personal independence,
  • keeping in touch with friends and family
  • protection of vulnerable people, or
  • access to a care home or supported housing.

Your LA is responsible for meeting your social care needs, but not your health care needs.

Preventing, reducing and delaying needs

The LA should provide information and activities aimed at people who don’t have a health or social care need, at the moment. These activities can include services, facilities or resources that may help a person to avoid developing needs for care and support in the future.

Your LA should give you support to make sure you do not develop needs in the future. They do this in 3 ways:

  • preventing you from developing needs,
  • reducing your needs, and
  • delaying your needs.

These are explained in more detail below

Preventing needs

Your LA should give you support to make sure you do not develop needs in the future. This is called preventing needs. This kind of information and support is for people who may have an existing physical or mental illness and are at risk of developing needs. They need to make sure that you:

  • can get good advice,
  • have a safe neighbourhood,
  • are active,
  • are healthy, and
  • are not socially isolated.

Reducing needs

The LA should offer more specific help to you if that help will slow down or reduce your needs getting worse or going into a crisis. For example, you might find you spend a lot of money when you are unwell. Your LA could offer you money management and debt advice.

Delaying needs

The LA should offer activities that help and support for people with one or more existing health problems or disabilities. The activities must help to slow down or stop the existing needs from getting worse. For example, this could include the supply of equipment, home adaptations or skills training to help a person remain independent.

Who is eligible?

Who can get social care services?

You can get social care support if you:

  • are over 18,
  • are ‘ordinarily resident’ of the local authority area, and
  • meet the eligibility criteria. (see section below).

Ordinarily resident refers to where you usually live. Sometimes this can be straightforward but it might not be clear cut, for example if you move between two areas.

The LA has to assess you even if they don’t think you will have any eligible needs. The LA has to assess you no matter how much money you have.

You can have an assessment if you are a carer.

You can find more information about ‘Carers’ Assessments’ by clicking here.

Information & advice

Can I get information and advice on social care?

Anyone can ask the LA for information and advice. They should give you information about care and support for you and anyone who cares for you.

This information must include:

  • how your local social care services work, any costs and how you pay for services,
  • how to get an assessment for social care and the eligibility criteria,
  • other types of care and support in your area,
  • how to get support and care,
  • how to get money advice for any issues relating to your wellbeing, and
  • who to tell if you think someone else is at risk of harm.

The LA must make this information easy for you to find and use. If you need help to understand or remember the information or communicate your wishes then you can ask the LA to give you an advocate to help you. An advocate can attend meetings with you. They can make phone calls or send emails and letters on your behalf.

You can find more information about ‘Advocacy’ by clicking here.

How to get an assessment

How can I get a social care assessment?

This section covers:

  • The needs assessment
  • Can I refuse an assessment?
  • Who will do the assessment?
  • Social services and the Community Mental Health Team (CMHT)
  • What if I am under the Care Programme Approach (CPA)?
  • NHS Continuing care

You can refer yourself for a needs assessment. You can call your LA, write to them, visit the office or go on their website. You might also get referred for an assessment by a health professional that knows you, such as your GP or community psychiatric nurse (CPN).

The needs assessment

Your LA is responsible for your assessment. Social services will assess you to see how your illness affects you. This is called a ‘needs assessment’. They will assess your social care needs and the impact they have on your family or support network.

Your assessment must include:

  • how your needs affect your wellbeing, (see previous section)
  • what you want to do in your day to day life, and
  • if social care would help you do what you want to do.

The person assessing you needs to think about the following.

  • The support you may need that is not provided by social care.
  • Any support you need to prevent needs (see previous section).
  • Any advice and information that would help your needs (see previous section)

Before an assessment you can ask your LA for copies of the questions that you will be asked.

Your LA can assess your needs in the following ways:

Face to face: An assessor will do the assessment with you in person. This can be done at your home.

Supported self-assessment: You can do the assessment yourself. The LA can send you the form or you can download it from their website. You should only do this if you want to and you feel like you can. If you need support to fill out the form then the LA must help you.

Online or telephone assessment: If you are reviewing your support plan or you do not have many needs you can do it online or over the phone.

Joint Assessment: You can have an assessment with more than one agency at the same time. This is so that you don’t have to go through many assessments.

Combined Assessment: You and your carer can have an assessment at the same time.

The assessment process starts from when the LA starts to collect information from you. You will need to tell them as much information about yourself either by completing a form or they may contact you by phone. For example, they will ask you about:

  • your abilities and strengths
  • your communication style, and
  • any support you might need to do the assessment like an advocate.

This is to make sure that they can make the assessment personal to you.

If you find the assessment difficult to understand you may get an independent advocate. The LA has to arrange this if:

  • you have substantial difficulty in dealing with the assessment, and
  • there is no other suitable person to help you.

A suitable person could be a friend or relative. A person who gets paid to care for you is not a suitable person.

An advocate can help you with the assessment and speak on your behalf to tell the LA about your needs.

If you decide to have a supported self-assessment the LA needs to:

  • make sure you know how to get in touch with them,
  • agree a timescale you will do the assessment by,
  • make sure you can ask for them to help with the assessment at any point, and
  • make sure you understand what parts of the assessment you will do and what parts the LA will do.

Can I refuse an assessment?

You do have the right to refuse a social care assessment. But if you refuse an assessment, the LA does not have to do one. The LA has to check that you:

  • have mental capacity to refuse the assessment, and
  • are not at risk of abuse or neglect.

If you change your mind later then the LA must offer you an assessment.

Who will do the assessment?

A professional from the LA will do the assessment. This might be a social worker, occupational therapist or rehabilitation officer. The LA has to make sure that anyone who is doing assessment is fully trained. Professionals should have training to do assessments with people with mental illnesses. The LA can ask other services to do assessments or offer support and care; this is discussed in the next section.

Social services and the Community Mental Health Team (CMHT)

The LA can get other services to do assessments and give you support and care. They may do this if they think the other service has more experience in your area of need. For example, they may ask a community mental health team to do an assessment with you.

The LA is still responsible for the assessment and your support. This means that if you are not happy with the assessment then you need to tell the LA.

What if I am under the Care Programme Approach (CPA)?

If you have a complex mental health condition, you may get support under the Care Programme Approach (CPA) or the Proactive Care Programme. Under CPA, you will have a ‘care coordinator’ who manages your care.

If you have social care needs the LA and the NHS have to work together to meet your needs. They can do a joint assessment. They will have to have a multi-agency approach to support you.

You can find more information about CPA in our ‘Care Programme Approach’ by clicking here.

NHS Continuing Healthcare (CHC)

Some people with long-term complex health needs get free social care arranged and funded by the NHS. This is known as NHS continuing healthcare. If your health care is paid for by CHC then your LA is not responsible for your support and care needs.

Can I get social care if I already get Section 117 Aftercare?

Section 117 aftercare should cover the cost of meeting your mental health care needs. If you have social care needs as well then you can still be assessed and supported by the LA.

If you have been discharged from hospital under sections 3, 37, 45A, 47 or 48 of the Mental Health Act 1983 then you are entitled to free aftercare, known as section 117 aftercare. If you are not sure what section you were detained under you should contact your GP or CMHT for this information.

Section 117 aftercare is there to help meet your needs due to your mental illness, and reduce the chance of your condition getting worse so you don’t have to go back into hospital.

Section 117 aftercare can pay for certain types of housing, free prescriptions, services in your home or in a day centre, and help to get supported employment.

You can find more information about ‘Section 117 aftercare’ by clicking here.

Decisions on eligibility

How does the local authority decide if I have eligible needs?

This section covers:

  • How do they decide if my need is because of a physical or mental impairment or illness?
  • How do they decide if my needs stop me from doing two or more specific things?
  • How do they decide if there is a significant impact on my wellbeing because I can’t do specific things?
  • What happens after my assessment?
  • What if the LA decides I don’t have eligible needs?

How do they decide if my need is because of a physical or mental impairment or illness?

There are standard eligibility criteria for all LAs in England. You will be eligible if:

  • your needs are because of a physical or mental health issue,
  • your needs stop you from being able to do two or more specific things (these are described in the table below), and
  • there is a significant impact on your wellbeing because you can’t do specific things (see first section).

The LA might need to talk to your family members or other people that support you to find out about your needs.

The LA has to assess you to see if your needs are because of a physical, mental, sensory, cognitive disability or illness, substance misuse or brain injury. You can be eligible for social care needs if you don’t have a diagnosis.

How do they decide if my needs stop me from doing two or more specific things?

The LA will assess you to see if you can do ten things. These are called ‘eligibility outcomes’. The table below explains what these are, what they mean and has some questions to get you thinking about how they might relate to mental illness.

Eligibility Outcome

Description Does this apply to me? Things to consider
a) managing and maintaining nutrition If you have access to food and drink to maintain nutrition and if you can prepare and consume food and drink.

Does your illness or the medication you take mean you do not eat and drink regularly?

Do you forget to eat or drink?

Do you need someone to remind you to eat or drink?

Can you go shopping for food on your own?

Can you make yourself something to eat?

b) maintaining personal hygiene Can you wash yourself and your clothes?

Do you wash yourself at least twice a week?

Do you need someone to remind you to wash yourself?

Do you have a washing machine?

Can you do your own laundry?

Do you remember to wash your clothes?

How many times do you wear your clothes before you wash them?

c) managing your toilet needs Do you have a toilet and do you know how to use it?

Do you need any help to use the toilet?

Does your medication cause incontinence?

Do you ever soil yourself?

d) being appropriately clothed Can you dress yourself and do you wear the right clothes for the weather?

Do you need anyone to help you get dressed?

Do you wear warm clothes in the winter?

Do you remember to wear a jacket when it’s cold or raining?

Are your clothes and shoes in good condition? Are there any rips, tears or holes in them?

e) being able to make use of the home safely Can you get around your house and use the kitchen and bathroom?Can you get in and out of your house easily?
 
f) maintaining a habitable home environment Is your home sufficiently clean and safe? Do you have water, electricity and gas?

Can you keep your house free from clutter and mess?

Do you find it difficult to do chores?

Do you find you have a lot of stuff which makes it hard to get around your house?

Do you find it hard to throw things away?

Do you remember to put rubbish out to get collected?

If you run out of gas or electricity can you go and get more on your own?

Do you forget to turn off the stove?

Do you forget to pay your gas or electricity bills? Can you resolve these issues by yourself?

g) developing and maintaining family or personal relationships Are you isolated or lonely because your mental health stops you from keeping personal relationships you have or making new ones?

Do you feel isolated? Do you feel you need more contact with people?

Does your mental health make it hard to meet people?

Do you get on with people you meet?

Who do you go to if you need help or support?

h) accessing and engaging in work, training or volunteering Do you have the opportunity to apply yourself and contribute to society through work, training, education or volunteering if you want to? Do you need support to do these things?

Do you know where you would go if you wanted education, training or volunteering?

Do you think your mental health stops you from doing any education, training or volunteering?

Do you feel you are part of your community?

Would you need someone to go with you if you wanted to go on a course?

Do you need help with learning or remembering information?

i) making use of the necessary facilities or services in the local community including public transport and recreational facilities or services Can you get around safely using public transport? Do you need support to get around?  

Can you use public transport?

Do you need help getting to appointments?

Can you make new journeys on your own?

Do you know where you can go to do hobbies or activities?

Do you need someone to bring you to these places?

Do you feel able to use the gym or leisure centre?

j) carrying out any caring responsibilities the adult has for the child Do you have any caring or parenting responsibilities?

Do side effects of your medication mean you can’t get up in time to help your children get ready in the morning?

Do you feel your mental health makes it difficult for you to look after your children?

How do they decide if there is a significant impact on my wellbeing because I can’t do specific things?

The LA will assess each of these outcomes to see if:

  • you need help to do it,
  • you can do it without help but it causes you a lot of pain, distress or anxiety,
  • you can do it without help but it puts you or other people at risk of harm to health or safety, or
  • you can do it without help but it takes a lot longer than it would take other people.

If your needs usually change during the week, month or year the LA need to assess this. They will consider how you can do things at different points over the last year. This is so they can make sure you get support when you need it.

How does the LA assess the impact on my wellbeing?

If you meet two or more of the eligible outcomes from the table above the LA will ask you about the impact this has on your wellbeing. Wellbeing means:

  • being treated with respect and having self-respect,
  • good physical and mental health,
  • being safe from abuse or neglect,
  • being in control of your day to day life and being independent,
  • being involved in work, training or volunteering if you want it,
  • not being isolated and having enough money to live,
  • a good home life and relationships,
  • having somewhere to live, and
  • being part of society.

Significant impact can mean the following things.

  • You may have one need but it impacts on one area a lot.
  • You have a few needs but they are quite low but impact many areas.
  • You may have one need but this is likely to change and impact on other outcomes.

What happens after my assessment?

After your assessment, the LA will decide if you have eligible needs. If you have eligible needs they will give you a copy of their decision. They should also provide a copy to your advocate or carer.

You will have a meeting where they will:

  • ask you what needs you have that you want them to support you with,
  • decide how they will meet your needs,
  • do a financial assessment, and
  • make sure you meet the ordinary residence requirement.

The professional who assessed you has to show how they have made the decision and what evidence they used to do this. They need to show how they have linked the three parts, your desired outcomes, the eligibility outcomes and the impact on your wellbeing.

If you have eligible needs you will go on to the support and care planning stage.

What if the local authority decides I don’t have eligible needs?

If the LA decides that you don’t have eligible needs they should explain how they decided this. You can ask for a written record of how they made the decision.

If you don’t agree with the LA’s decision you could challenge this. An advocate may be able to help you challenge a decision.

They should give you information and advice about:

  • your needs,
  • what services you can use to reduce your needs, and
  • what you need to prevent or delay your needs being eligible in the future.

You can find more information about ‘Social Care – Care and Support Planning’ by clicking here.

Responsibility and payment

Who is responsible for my support and care?

Usually the local authority (LA) where you live will be responsible for your support and care needs. If there is a dispute, the LA where you are ‘ordinarily resident’ will have to meet your needs. As soon as you move into an area and plan to stay there you are ordinarily resident there.

You might move from where you are living into a care home or supported housing in a different area. If this happens, the LA where you were living before you moved is responsible for your support and care needs.

You may get accommodation as part of section 117 after-care if you have been under some sections of the Mental Health Act. The LA where you were living in before you went into hospital is responsible for your care.

You can find more information about:

  • Section 117 after-care by clicking here.
  • Supported housing by clicking here.

Who will pay for my social care?

Your LA has to arrange care and support for a person with eligible needs. Once they have carried out a needs assessment they will decide whether or not to charge for the care and support needed. If the LA decides to charge for care and support they must follow the rules set out in the Care Act.

You can find out more information about:

• Social care: Charging for non-residential services by clicking here.
• Care home fees – who pays? by clicking here.

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