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19 Community care

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1. Introduction

2. Where do I start if I think I need help?

3. What kind of help is there?

4. Can I get help if I look after someone?

You have the legal right to an assessment, called a carer's assessment, if you provide a lot of care for someone and are not paid for it. A carer's assessment will look at whether the person you care for is getting the right support and services, and also at:

  • your needs;
  • whether you have a choice over the type of caring tasks you do and how long you spend doing them; and
  • whether your work, education, training and leisure needs are met.

If you’re a carer and you need support or advice, contact Carers UK or visit the government website www.direct.gov.uk/carers (see 'Further help').

What is the assessment for?
The aim of an assessment is to:

  • find out what sort of support you need;
  • decide which services you are eligible for; and
  • look at your finances to decide how much you should pay towards the cost of those services.

As part of the assessment you may be asked about:

  • the tasks you can and can't do;
  • the tasks you find difficult some of the time;
  • whether you have to follow a special diet; and
  • whether you have special needs (because of your religious or ethnic group, for example).

You (and anyone who cares for you) should be fully involved in the assessment, and you should get the chance to say what you feel you need. If you need an interpreter or advocate to help you, the council should provide one.

How is the assessment done?
Each council has its own way of working out what help you may be able to get. You can find out about your council's policies in its:

  • long-term care charter, 'Better Care, Higher Standards'; and
  • Children and Young Persons Plan.

You should be able to get these from the social services department. You may also find them in your GP's surgery, or local citizens advice bureau or library.

The assessment will normally be done in your home, but it could also take place at a social services centre, a day centre or your GP's surgery.

Social services should tell you how long the process is likely to take. In the case of older people, an assessment should be completed within 28 days of you asking for it, although complicated cases often take longer.

Who does the assessment?
The person assessing you will normally be from social services, though they may be from the NHS, and other relevant professionals may also be involved. For example, an occupational therapist may give advice on making your home easier for you to live in (for example, by fitting stair or grab rails, bath seats or special taps). Social services may also ask the council's housing department for its views on your accommodation, for example whether you need to move to sheltered housing.

What happens after an assessment?
Once the care assessment has been completed, the council has to decide whether it will provide or arrange care services for you. It does this by comparing your needs with its 'eligibility criteria' for community care services. Each council is allowed to decide how severe a person's need has to be before it will provide support – so whether you get this kind of help depends on where you live.

Government guidance says that in deciding who can get care, councils should take into account how far people would be at risk if they did not get help. But councils are allowed to 'ration' their services by limiting the number of people who can get them. They often do this by deciding that only those people who need a service most can have it. For example, you may need help with household cleaning, but you might not qualify to get it from the council if the council says it will usually only give that kind of help to people who also need help with washing and dressing.

If the council decides that you meet its eligibility criteria, it should then draw up a care plan (see 'What is a care plan?').

If the council decides that you do not meet its eligibility criteria, and will not provide help, it should tell you why in writing. If you don't agree with the council’s decision, you can challenge it (see 'What if I have difficulty getting the care I need?'). And even if you're not eligible for help, the council should still give you information and advice about getting care services.

What is a care plan?
A care plan should set out what you need, what you should get, who will provide it, what you might have to pay for it, and when the plan will be reviewed. If you have a carer, your plan should also show what help your carer has agreed to give you. You should be given a copy of your care plan.

Once your care plan has been drawn up, you should start getting that care promptly. Councils should not delay providing you with care, once they have assessed you as needing it, on the grounds that they lack financial resources. Councils are not normally allowed to have waiting lists for services, but if you do have to wait for a service you need (for example, because there is a shortage of suitably trained care assistants), then the council should make other arrangements for you in the meantime. If you are not getting the care that is set out in your care plan, see 'What if I have difficulty getting the care I need?'.

The council should look at your care plan from time to time, normally within three months of first providing the help and then at least once a year after that. But if your circumstances change at any point, you can ask to be assessed again. And if the council wants to take away or reduce what you get, it must reassess you first. It cannot take away services just because it is short of money, and it cannot take them away if that would leave you at 'severe physical risk'.

What if I need care mostly because of health problems?
If you need care because of ongoing health problems, you may be entitled to have the NHS arrange and pay for it. Your local primary care trust (in England) or local health board (in Wales) should arrange for an assessment to see if you are eligible for 'NHS continuing healthcare', which is a package of care that may include both health and personal care.

In England, you will first be 'screened', using a checklist, to see if your main need appears to be health-related. If it is, then you will be referred for a full 'multi-disciplinary' assessment, involving all relevant health and community care professionals. If the screening doesn’t show that your main need is health-related, you can still ask your primary care trust to give you a full assessment. (In Wales there is, for now, no screening stage – you go straight to the assessment stage.) For more about this process, see the Department of Health leaflet 'NHS continuing healthcare and NHS-funded nursing care' – see 'Further help' for how to get it.

The primary care trust should normally tell you whether you are eligible for NHS-funded continuing care within two weeks of being referred for an assessment.

If you are assessed as needing NHS continuing healthcare, this might be in your home with social services' support, or in a care home. In either case, the NHS should pay for all care related to your health.

What if I'm not eligible for NHS continuing healthcare?
If the primary care trust or local health board decides that you’re not eligible for NHS continuing healthcare, you will still be entitled to free NHS medical care, whether you're at home or in a care home, but you may have to pay for the non-medical parts of your care. How much, if anything, you may have to pay is explained on the following pages. The NHS will also pay for the nursing-care element of care if you need to go into a nursing home (see 'What if I need ongoing nursing care?').

What if I’m unhappy with the decision about my eligibility?
If you're unhappy with how the primary care trust or local health board decided that you were not eligible, you can complain to the trust or board. If you need advice, or help with preparing a complaint, contact the Patient Advice and Liaison Service (PALS) (in England) or your local Community Health Council (in Wales) – see 'Further help'.

If you are unhappy with the trust's or board’s response to your complaint, you may have a 'right to a review' by an independent panel of people (an independent review or IR). This is arranged by:

  • your strategic health authority if you are in England; or
  • the local health board if you are in Wales.

If you're unhappy with the IR's findings, you can complain to the Healthcare Commission (in England) or the Independent Complaints Secretariat (in Wales). If you are still unhappy, you can complain to the Parliamentary and Health Service Ombudsman (in England) or the Public Services Ombudsman (in Wales).

If you think the eligibility rules themselves are unfair, rather than how the trust or board has applied them, you can complain using the NHS complaints procedure (see 'What if I have a problem with NHS care?'). You can also do this if you're not happy with the package of care you are offered.

5. Who pays if I get care in my home?

6. What if I have to go into hospital?

7. What if I need to move into a care home?

8. What if I need ongoing nursing care?

9. Will I have to sell my home?

10. Can I claim any benefits if I am in residential care?

11. What choice of care home do I have?

12. What if I want to move to a care home that costs more than the council will pay?

13. What if my move into a care home is temporary?

14. What rights do I have when I am in a care home?

15. What if I have difficulty getting the care I need?

16. Further help

17. About this leaflet

The leaflets in this series give you an outline of your legal rights. They are not a complete guide to the law and are not intended to be a guide to how the law will apply to you or to any specific situation. The leaflets are regularly updated but the law may have changed since this was printed, so information in it may be incorrect or out of date.

If you have a problem, you will need to get more information or personal advice to work out the best way to solve it. See 'Further help' for sources of information and advice.

This leaflet is published by the Gurkha Free Legal Advice (LSC). It was written in association with Sue Bloomfield, a freelance consumer affairs writer.

Leaflet version: May 2008

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