Who qualifies for our support?

Summary

This factsheet explains how we assess your social care needs, and how we decide if you are eligible for support from Adult Social Care.

September 2020 (FS1)

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Social care needs assessment

Anyone can ask us for information and advice, or an assessment of their social care needs. A social care needs assessment is where we look in more detail with you at your needs and strengths, to find out if you have eligible needs and what sort of social care support would help. When we carry out a needs assessment, we will think about things like:

  • your care and support needs – for instance, if you need help with getting dressed or support to get to work
  • the outcomes that matter to you and how they impact on your wellbeing – for example, whether you are lonely and feel isolated
  • your other circumstances – for example, whether you live alone or whether someone supports you
  • the urgency of your support

After we’ve assessed your individual circumstances to see what your needs are, we use the ‘eligibility criteria’ to work out whether you are eligible for support from Adult Social Care. 

In deciding what services and support to provide, all councils take into account demand, what is already provided and available resources. The government has set a national eligibility criteria as part of the Care Act. The aim of the criteria is to work out what your care and support needs are, and how they impact on your wellbeing. The criteria enables us to ensure that the limited budget local authorities have is spent on the people who most need care and support, and that all adults across the country have equal access to support. 

Not everyone is eligible, but even if you do not have eligible social care needs, we will give you information and recommendations about your options and support that could help you.


Eligibility criteria: what these say in full

For adults with care and support needs

You will be eligible for help from Adult Social Care if:

You have care and support needs as a result of a physical or mental impairment or illness.

Because of those needs, you cannot achieve 2 or more of the following outcomes:

  • manage and maintain your nutrition
  • maintain your personal hygiene
  • manage your toilet needs
  • clothe yourself appropriately
  • make use of your home safely
  • maintain a habitable home environment
  • develop and maintain relationships with your family
  • get and maintain work, training, education or volunteering
  • make use of important facilities or services in the local community, including public transport and recreational facilities
  • carry out any caring responsibilities for a child

And as a result of being unable to achieve 2 or more of the above, there must be, or potentially be, a significant impact on your wellbeing. 

Wellbeing relates to the following areas in particular:

  • personal dignity
  • physical and mental health
  • physical, mental and emotional wellbeing
  • being protected from abuse and neglect
  • having control over your day to day life
  • participating in work, training and recreation
  • your social and economic wellbeing
  • your domestic, family and personal relationships
  • suitable living accommodation
  • your individual contribution to society

For your needs to be considered eligible for support, you must meet all of the above 3 criteria.


If you are eligible

After your assessment, if we agree that you have eligible needs, you will be offered support in finding ways of meeting these needs. For more information on planning your support, see our factsheet Assessment, support planning and review.

When looking at options for meeting your needs we will also take into account any support you might already receive. For example, your partner, a family member or friend might help you get out and about or to cook meals.

We’ll also complete a financial assessment with you, to tell you what you will need to pay. Most people pay some or all of the costs of their care. For more information, see our leaflet: What you will need to pay towards the cost of your care and support.


If you are not eligible

If your assessment shows that you’re not eligible for help from us we’ll write to you to explain why, and give you information about what can be done to meet or reduce your needs. 

Support might be available in your local community, and this may help prevent or delay development of more care and support needs in the future. We’ll tailor information to your individual situation. You can contact us again at any time to ask for another assessment if you feel things have changed. 

If you’d like more information on community support and services in East Sussex, you can:

  • Call Health and Social Care Connect on 0345 60 80 191. 
  • Visit East Sussex 1Space, our online directory of care, support and wellbeing services.
  • Use the East Sussex Community Information Service (ESCIS) if you’d like further information on what’s happening in your community, like clubs, societies and events. 
  • Our Support With Confidence scheme provides a directory of providers who offer home care and support services for adults in East Sussex. All scheme members have been vetted and approved to ensure they are committed to the highest level of quality, safety and training.

 


Help for people who look after someone

If you look after someone, you may be a carer. The Care Act also sets a national ‘eligibility criteria’ for carers. If you look after someone, you can ask for a carer’s assessment. Even if the person you are caring for does not meet the eligibility criteria, or doesn’t want to have an assessment, you may still be entitled to support in your caring role.

If you’re under 18 and helping someone in your family who can’t look after themselves, perhaps because they are ill or have a physical or mental impairment, or have problems with alcohol or drugs, you might be a young carer.

If you’re identified as a young carer and want to have an assessment, we will consider the needs of everyone in your family. Adult Social Care and Children’s Services will work together to understand why you are caring, and what support you might need. We will also look at what help the person you look after might need.

More information and support for carers is in our leaflet: Do you look after someone?.


Eligibility criteria for carers (if you look after someone)

The carer’s eligibility criteria has three conditions:

Your needs are caused by providing necessary care for an adult, and as a result:

  • your physical or mental health is at risk of deteriorating
  • you are unable to achieve one or more of the following outcomes:
    • Carrying out any caring responsibilities the carer has for a child
    • Providing care to other persons for whom the carer provides care
    • Maintaining a habitable home environment
    • Managing and maintaining nutrition
    • Developing and maintaining family or other personal relationships
    • Engaging in work, training, education or volunteering
    • Making use of necessary facilities or services in the local community including recreational facilities or services
    • Engaging in recreational activities
  • As a consequence there is, or is likely to be, a significant impact on your wellbeing. 

After your assessment is complete, we will work out if you have eligible needs.

A note on what ‘necessary’ care is

To be eligible, the criteria says that you must be providing ‘necessary’ care to someone. If you are providing care and support for needs which the person you look after is capable of meeting themselves, it may not be considered ‘necessary’ support. In such cases, we will provide information and advice to you and the person you look after (if appropriate) on how they can use their own resources or what is available in the community to meet their needs. This approach helps delay the need for care and support services for you and the person you look after.


If you don’t agree with your assessment

In the first instance, it’s always best to talk to your social care worker, and ask them to reconsider the decision. You can do this in writing, or by talking to them, providing supporting information where you can. This is called an appeal.

Your social care worker will consider your appeal, and will work with you to try to reach an agreement you are happy with. If their decision does not change, your worker will refer the appeal to their manager for consideration, and they will let you know the outcome. 

If they stick with the original decision, and you are still unhappy or don’t agree, then you can make a complaint and you will be given information about how you can do this. If you feel you may need someone to help you speak up, you can ask your social care worker about how to get in touch with an independent advocate.


More information

See further leaflets and factsheets

Contact us to get more copies of this factsheet, or any of the other leaflets or factsheets mentioned.

Email: Health and Social Care Connect
Phone: 0345 60 80 191
Minicom : 18001 0345 60 80 191