10 Assessment of carer’s needs for support
This clause creates a single duty to undertake a “carer’s assessment”. This is comparable to the duty in clause 9. The aim of the assessment is to determine whether the carer has support needs and what those needs may be. A “carer” is defined as any adult who is caring, or intends to care, for another adult. This would not include anyone who cares for someone as part of their employment or as voluntary work. However, the local authority may still assess such a carer if it considers that under the particular circumstances there is a reason to carry out the assessment, for instance, where someone who had previously been an unpaid family carer begins to receive some payment for their caring role, and so may not otherwise be entitled to a carer’s assessment.
This duty replaces existing duties in relation to the assessment of adult carers in section 1(1) of the Carers (Recognition and Services) Act 1995 and section 1 of the Carers and Disabled Children Act 2000. However, the new duty does not require (as the previous provision did) that the carer must be providing “substantial care on a regular basis”.
(1) Where it appears to a local authority that a carer may have needs for support (whether currently or in the future), the authority must assess—
(a) whether the carer does have needs for support (or is likely to do so in the future), and
(b) if the carer does, what those needs are (or are likely to be in the future).
(2) An assessment under subsection (1) is referred to in this Part as a “carer’s assessment”.
(3) “Carer” means an adult who provides or intends to provide care for another adult (an “adult needing care”); but see subsections (7) and (8).
(4) A carer’s assessment must include an assessment of—
(a) whether the carer is able, and will continue to be able, to provide care for the adult needing care, and
(b) whether the carer is willing, and will continue to be willing, to do so.
(5) A local authority, in carrying out a carer’s assessment, must have regard to—
(a) whether the carer works or wishes to do so, and
(b) whether the carer is participating in or wishes to participate in education, training or recreation.
(6) A local authority, in carrying out a carer’s assessment, must so far as it is feasible to do so consult—
(a) the carer, and
(b) any person whom the carer asks the authority to consult.
(7) An adult is not to be regarded as a carer if the adult provides or intends to provide care—
(a) under or by virtue of a contract, or
(b) as voluntary work.
(8) But in a case where the local authority considers that the relationship between the adult needing care and the adult providing or intending to provide care is such that it would be appropriate for the latter to be regarded as a carer, that adult is to be regarded as such (and subsection (7) is therefore to be ignored in that case).
In (6), the adult should be present at the assessment if possible to verify needs
Response to 10-1
Early identification of the skills required by the carer in their caring role need to be the focus of the intervention. Too late will already have had a negative impact on the carers health and well being
1. No person should be forced into a full time carer role due to non provision of care-workers. for example I have lost £200k over 4 years in earnings due to this.
2. Care provision companies should be made legally liable to provide cover when contracted to do so, especially when carees safety is at risk, it should not fall on the family to provide backup.
3. Caree needs more protection under law against proven bad , low quality provision.
4. Having made a carer assessment of needs that document needs to be an active doc not filed somewhere as having been done.
Family carers should if they want be able to apply for certificated recognition of the skills they have gained from caring, so that if re entering the workforce at a later date their skills and time spent taking care of their family member is a legally recognised qualification.
Again there are a lot of words used around the simple task of providing a carer with an assessment. item 6 ? what on earth does this mean ? must as far a feasable to do so consult with the carer ? what a load of rubbish !
If carrying out an assessment on somebody it’s a basic that you have to consult with them !
In my area assessments are done on carers by the family carer team,part of adult social services.They are done over the phone.I don’t have any evidence that they co-ordinate with the dept carrying out a care assessment on the service user the carer is looking after.The whole process needs looking at again,and a more co-ordinated approach needs to be done.
You are so right!
It is great to hear that others are talking about the lack of appreciation – I believe that we the carers need to get together and unite against the injustice, oppression and neglect of human rights that we face daily.
I support what my fellow carers have said above . We are exploited every single day. We are ignored and invisible yet expected to pick up the lion’s share of care – often all the care.Telephone assessments are unsafe and should be banned. How can the assessor see if a Carers looks as if they are about to drop; or be sure the Carers is hearing them properly; or can judge if the Carer understands what is happening? This Bill offers us help with one hand and snatches it back with the other. Will Carers who have to pay seek the help we need? This will all end in tears until the DOH treats us with respect and values us for the contribution we make. If we are treated badly by this legislation – many of us will just walk away – if we can – and exercise our choice – not to care.
Where there is a carer their assessment should be an integral part of the service users assessment – undertaken by the person who establishes the needs of the service user and then the support that the carers require.
In simple cases a self assessment for ‘after the event’ situations is a viable tool carers are generally honest individuals who often understate their situation – all reviews should be a review of the service users care and the carers support requirements where that is relevant. Where a new assessment is triggered by a change in needs of the individual service user the carers needs should also be reviewed.
What about children that are carers?
Like usual a lot of talk but when it comes to action that is another matter. We, the carers, are the unpaid unappreciated part of the failing NHS, and I can not see anything to cheer about in the above legislation.
I think that there should be a radical reform, but the government showed its true views on carers when it squashed Barbara Kelley private members bill backed by Carers UK.
I have been a carer for over 17 years and never had an assessment of my needs, and probably never will, as I feel that this would mean that they would have to appreciate my position and needs, and there is probably a reluctance to do this as this will probably mean money.
The general tenor of this clause is to be welcomed but some of the wording needs attention, eg deletion of the phrase “so far as it is feasible to do so” in sub section 6. The meaning of “voluntary work” could be subject to misinterpretation. Would it be better to say “voluntary work on behalf of an organisation” or something similar
My question is what difference will further legislation make?
The 2004 Carers Act placed a duty on local authorities to ensure that ALL carers know that they are entitled to an assessment of their needs, including
a duty for councils to consider a carer’s outside interests (work, study or leisure) when carrying out an assessment and the Act was supposed to promote joint working between LAs and the health service to ensure support for carers is delivered in a coherent manner.
Of 5,000,000 carers, I estimate that 200,000 have been assessed, and roughly 134,000 received a service as a result of that assessment. Four in every thousand carers have received direct payments and six in every thousand received services as a result of a carer’s assessment – fewer than 1% of all carers appear to have benefitted from the existing legislation.
http://www.ic.nhs.uk/webfiles/publications/009_Social_Care/carersurvey0910/Survey_of_Carers_in_Households_2009_10_England_NS_Status_v1_0a.pdf
This estimate comes from The National Survey of Carers in Households 2009-10 , which included people who did not consider themselves to be carers but who were effectively doing this work – 48% provided 20+ hours per week of care, some caring for more than one person (not counting their own children in certain cases). One third had no regular contact with formal services. 11% of all carers reported receiving Carer’s Allowance and 27% received Disability Living Allowance/ Attendance Allowance.
Of carers who cared for 35 hours or more pw, 23% received Carer’s Allowance and 50% DLA/Attendance Allowance. 52% of carers said their health had been affected because of the care they provide; 34% reported feeling tired, 29% felt stressed, 25% cent had disturbed sleep and 9% reported feeling depressed. 42% said their personal lives had been affected because of the caring role & 26% felt their caring responsibilities had affected their ability to work or stay in employment.
YET only 6% of carers surveyed said they had been offered a carer’s assessment and of these 4% had been assessed. Admittedly, two out of three carers who had been assessed said they had received a service of some kind as a result: mobility aids (26%), services for the person they care for (22%), an assessment of the person they care for (21%) and direct payments (16%).
Every person that needs support will have a carer attached whether family, friend or neighbour. The person needing carer does not live in “isolation” and the person-centred approach and personalisation gives the impression that only the person that needs care is affected. However, the person being cared for is like a stone thrown into the pond….the ripples affect many people associated with the person being cared for, particularly the carer.
Thus, assessment of the carer needs to be done in conjunction with the cared for and not separate (unless specifically asked to be separate).
Also, it should be noted that sometimes the needs of the carer perhaps should be met first, because what may be of more importance is what can be done to support the carer to keep the carer caring and from not ending up also requiring care????
As a Private Domiciliary Care Company, that has cheosn not to be boxed in the list of the Local Authorities Preferred Providers , we have the taken the lrouuixus decision of not providing 15 minute calls, as we consider them nothing but bad practise! How can anyone profess to be acting in the best interest of the Service User when expecting a Support Worker to visit, pop a meal in the microwave, make a drink, tidy a kitchen area after using it, check the well being of their Service User and then write an accurate record of their visit?On the other hand, when providing a 30 minute visit, our Team Members cook a meal of fresh meat and vegetables, make a drink, chat with their Service Users, tidy round and know that they have left someone secure and feeling cared for!No Comparison! 15 minute calls should be abolished along with the insistence that our elderly population are alright with the provision of just a pop in service, a lack of nutritional dietary provision and a lack of dignity. I say again Bad practise!We have also had the first hand experience of being told by a prospective Service User when assessing their needs for self direct support, that the LA has told them they cannot use our Company, as we are not on the preferred list, and are too expensive! This was soon rescinded by them when I emailed the Commissioning and procurement officer with information from their own website, and copied in our local CQC Inspector! It cannot be denied that an overwhelming desire of not wanting to conform to the LA’s scheme of care provision by these preferred providers has left us out in the cold in our local area, but if providing quality care by team members that are paid well, listened to and trained extensively is our outcome, then we will carry on regardless!
Carers should have the same entitlement to assessment and support as the people they care for. It should not just be an add on.
The cared for’s wellbeing is dependent on the carer’s wellbeing.
There is currently a lottery with regards to what constitutes ‘substantial and regular’ – the removal of this requirement is welcomed.
If the number of carers assessments to be undertaken increases, concerns were expressed re whether LAs would have sufficient funding to undertake these. There would also be an increased requirement for these to be reviewed, again with funding implications.
If carers assessments are to be done jointly with those of the person they care for, will these be recorded in 1 document and if so, we will need to ensure that the carer’s element of it is fit for purpose.
The Group stated that carers information should be given by the GP and felt that the responsibilities of GPs/Health towards both adult carers and young carers should be emphasised. Not having information is an issue for all groups of carers and the Group felt that GPs/Health were often not as proactive as they should be.
These comments refer to Clause 10 and also cross with 13
Positive
• “Minimum” is clear, this is helpful as it was not clear before
• Very positive preventative approach
• Clear duty to assess
• Embedded assessment and self-directed support
Negative
• Needs to include financial assessments
• Needs to include outcomes
• No lower age limit
• Need guidance on privacy and separate assessments
• Nothing that forces LAs to charge
.
I think that this is clause is an excellent development in relation to the balance between carers and councils; my fear was that it was just going to concentrate on ‘ability’ and not ‘willingness’.
A carer has never been able to be made to care in this country; other consultees who think that they were forced into caring were probably actually making a choice, although maybe not one that made them happy all the time. It is clear that it is not wrong to say no; and it is not wilful neglect to draw a line and hand a dependent relative over to the State; that is the wonder of a safety net, in a civilised country.
However, the reality is that carers in the main do want to care, and many feel that it is their duty. That is only likely to continue and grow, as it will need to do, in terms of the demographic, if carers are appreciated, in all forms of legislation, and supported, and not disdained when they have had enough, for whatever reason. The sector needs a grown-up conversation, in my view, with carers – to this effect:
“Since this is all coming out of public money, we have to spend it fairly. Your current choice to provide informal care makes a massive difference to what we can afford to do for everyone, and the reward for that should be, and will be, a broader range of choice and more control for you and your loved one, than we could afford to provide longterm, if you withdraw your input. That is because it is legal for us to choose the setting in which we meet your loved one’s needs, but it will generally be better VALUE for them, you and us, if we can share the responsibility, through your input reducing the eligible need which we would otherwise have to provide for, or by placing your loved one in the cheapest not INappropriate setting.”
The way the factors relevant to the council’s consideration are stated, seems to me properly to treat work, education and recreation, as pursuits that must be seen as critical to valuing carers as citizens, but of course the law itself will not determine how much work, education or recreation is it legitimate to want to do, if you have a relative or spouse who is in need? I think we need to wait and see how the criteria for needing services, or funding and not just wanting them, will be expressed.
I think that the last bit of the drafting is designed to sort out the issue when a person is a carer, and then starts to be paid for care, through a direct payment, or at least paid for part of their care. As I see it, that might be the only way of preserving the invaluable input of carers, as the economic demographic of the boom in people over pensionable age, and not enough of working age to pay for their care, hits home, and so long as something that is counted as a need, and not just as a want, is being provided informally, notwithstanding that some other input is now paid for, it seems to me that the Carer should not lose every other benefit that goes with that status.
Access to assessment will be affected by the intention to charge.
The real scandal of this Bill is that it offers wonderful changes with one hand and snatches them away with the other.
If a service user or carer has savings just above the limit – they could be deterred from seeking help by the proposed charges.When their resources fall below the threshold as they inevitably will – they are less likely to return for help – thus acting against the intention of the Bill to promote prevention.
The intention to charge Carers for services to help them save the State the fortune we do (£!!( billion per annum) – is outrageous and will also act against the intention of prevention.
As a Carer I should be using any savings I might have (which are low due to having to leave employment to care and a low State Pension due to insufficient qualifying years due to caring) for my own future care. If I use my resources to help me help the State care for my relatives – I will run the risk of being called “feckless” / “a scrounger” when I have to rely on the State for my own care. Where is the dignity in this? This is so wrong.
We welcome the requirement for assessment when it is recognised that someone ‘may have need’ of support. Even if someone is not eligible for formal care and support, the assessment process should be used to signpost them to informal support options.
There has to be clear communication between family carers and professionals making assessments. There is also a need for this role to be taken seriously when it comes to Data Protection and people who require support to claim benefits deal with doctors etc.
We welcome the re-stating of the requirement to assess carers’ need for support and their ability and willingness to continue caring, and the removal of the substantial and regular requirement.
In the light of carers’ experience so far, the assessment should be required to be separate but linked to that of the service user’s assessment, and there should be guidance to ensure that it takes place privately, in a separate room to the service user.
We would welcome carers’ assessment where there may be no local authority care and support involvement, such as those caring for someone with cancer, mental health issues or continuing health care. Sometimes an adult at hospital discharge may say they do not want care and support because their son/daughter will care… If there is no social care involvement carers are not offered an assessment.
It is clear that many of the above respondents are deeply concerned about the state’s recognition of the work and money carers save local authorities, benefits agencies and related organisations. Where is this explicitly stated in this document?
I would like to see the work carers do clearly documented, with the value of that care included in any assessment. I would also like to see in any bill and assessment an acknowledgement of carers’ contribution.
There is concern about the removal of the requirement that a carer must be providing ‘substantial care on a regular basis’ to be able to receive an assessment, it is felt this makes it unclear at what point a person becomes entitled to services as a carer, rather than them supporting as a family member for example. Much more clarity is needed on this.
However it is important to ensure appropriate advice and support is given early on to anyone providing any level of care, whether as a family member, friend or more substantial care on a regular basis, to help them maintain their own independence and help prevent the need for more intensive interventions at a later date.
I have been a carer for all of my adult life. From the age of 20 I was caring for a mentally ill relative. I cared for my mother post stroke 24/7 for five years when I was 45 and I did everything for her, including moving and handling by myself. this was regular and substantial caring. Over the next 20 years I have cared for other elders – at a distance – with a range of frailties and illnesses including terminal cancer. All the while I was doing this elder care – I was worrying/caring at a distance for my son who has a MH problem. I did not provide regular and substantial care to any individual. I did however struggle to juggle their care and support and had regular and substantial worry. It was this latter caring experience that caused me to break down – anxiety and panic attacks. Not the regular and substantial care of my mother when I was 45 that pole axed me – but the juggling of caring with my own family life when I was over 60!
I welcome the change of definitions that will protect carers who have their health and wellbeing impacted by caring .
Additional comments.
Is there any money to implement it all?
Does the assessment include carers’ rights to flexible working?
Does it impose a duty on employers to grant this?
In our local authority they are struggling with the current requirement to undertake carers’ asssessments. How will they manage when cuts bite even harder?
An extension of adult carers rights are welcomed, but how will this be financed? We note the difference in treatment with young carers. Young carers who do not fall under ‘child in need’ provisions ‘may’ be assessed, following a request.
There is extensive research suggesting that many carers still don’t know about their rights to ask for an assessment under existing legislation. Our current research suggests that carers are unlikely to ask for an assessment unless they feel it will result in some practical support for them or the person for whom they care. Many carers want to put on a ‘brave face’ so practitioners need to be skilled in recognising when this is happening.
Carers
1. JRF is glad to see that carers are finally being given the recognition they deserve and will be entitled to their own assessments and services to support them in their caring role.
2. Unpaid carers are at a significant economic and social disadvantage, and this disadvantage falls disproportionately on women (Himmelweit and Land 2008).
3. Eligibility criteria for carers is welcome, but will need to be set with careful consideration of whether eligibility will be based on the amount or intensity of the care being provided by the carer, or by their own support needs irrespective of these other factors. JRF believes, for example, that carers’ need for support cannot be judged based on how long and frequently they provide care, as this takes no account of the nature or intensity of the care being provided (please see detailed JRF response to Law Commission Consultation on Adult Social Care, 2010).
4. JRF research dating back to 1998 into the social care assessment process found that there was a tendency for practitioners to categorise people as either ‘users’ or ‘carers’. This meant that the complex and changing patterns of caring relationships in many households were not taken into account in assessments. (Davis, Ellis and Rummery, 1998). It does not seem much has changed from this time, as many subsequent studies have identified the complexity of entitlement and eligibility for carers as a source of distress and frustration for both carers and those they care for. JRF would urge the government to take into consideration that many carers are also care users themselves, and as such the entitlement to an assessment and support for these two different roles will need to be made compatible.
5. Other research also suggests that many carers are resistant to asking for help and have a need to be seen to be coping (Philips, Bernard and Chittenden, 2002). As such, any attempt to simplify the existing assessment system and to promote access to benefits, entitlements and support is welcome.
6. A unified assessment process for carers and service users (where appropriate) would reap significant benefits in creating a clearer and more integrated (and person centred) approach to care and support but also to identify carers who might otherwise not alert local authorities to their carer status and need for support.
(Research referred to above can be found at http://www.jrf.org.uk)
Carers legally have a “right to a life of their own” so an Assessment of Needs for a Service User should automatically trigger an Assessment of Needs for the Carer. It should be mandatory and Carers should not have to ask for one to be completed.
What the current situation does is loose sight of the very valuable contribution that Carers do for the ones they care for and the cash value of the care they provide to the taxpayers of this country. If the Carer is not supported to have a “life of their” this can lead to a breakdown in the care provided with the subsequent consequences for the Service User and quite often emergency intervention by the Local authority.
Barchester Healthcare welcomes the move to establish a clearer right to an assessment for carers and linking this to eligibility criteria. It is potentially a step forward. However, allowing local authorities to charge for the services they offer (or gate keep for) is likely to mean that services will be expensive and unaffordable to many. The current position of carers is characterised by disappointments and low expectations; care managers respond with incomprehension or a sense of overwhelming need. It will take work to change this negative culture: carers and those they support are sceptical about this and many other areas of change in the current climate. A possible step towards improvement might be to encourage local commissioning initiatives based on co-operative work with carers and local providers, looking for personalised, innovative and affordable options for improving carer’s quality of life, perhaps with the public oversight of health and wellbeing boards.