The Care Act

What you need to know

HTTP://WWW.SKILLSFORCARE.ORG.UK/STANDARDS/CARE-ACT/CARE-ACT.ASPX

Fiona DennySuffolk County Council Adult & Community Services

Liz TaylorSuffolk Brokerage

Key principles and standards (1)

• An assumption that the individual is best placed to judge the individual’s wellbeing.

• Considering the individual’s views, wishes, feelings and beliefs.

• The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist.

• The need to ensure that decisions are made having regard to all the individual’s circumstances.

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Key principles and standards (2)

• The importance of the individual participating as much possible.

• Achieving a balance between the individual’s wellbeing and that of any friends or relatives who are involved in caring for the individual.

• The need to protect people from abuse and neglect• The need to ensure that any restriction on the

individual’s rights or freedom of action is kept to the minimum.

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The framework of the Act and its statutory guidance

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The well-being principle

Local authorities should also have regard to other key principles when carrying out their activities, such as beginning with the assumption that the individual is best-placed to judge their well-being.

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“The general duty of a local authority, … in the case of an individual, is to promote that individual’s wellbeing”.

Well-being - definition

Well-being is a broad concept, and the statutory guidance defines it as relating to the following nine areas in particular:

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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 relationships Suitability of living accommodation The individual’s contribution to society.

Costs are capped

There is a cap on expenditure on eligible care from April 2016

Every year the local authority •Reviews your care needs and financial situation•Keeps a record, from April 2016, called a care account, of how much eligible care you have needed in total

How much you might pay for yourcare and support depends on your financial situation

You have a financial assessment to see what you have to pay

If you have care and support needs, you could be supported by…

Assessment of the care and support you need, and eligibility for state support

Information and advice on local services and how much they cost

Reablement, rehabilitation and other free services

How will people experience the new system in 2016/17?

Support from family, networks community…

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Changes to assessment, eligibility and financial assessment process

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Deferred payment

agreement

Person appears to have needs

Assessment

Conversation

Are their needs

eligible?

YES NO (written explanation)

Financial assessment

Advice and information

Appearance of needs, strengths-based

New eligibility threshold

Written explanation & adviceUniversal

scheme

Information and Advice

The guidance states that:

“The breadth of the circumstances under which information and advice must be provided, and the overall duty to promote individual wellbeing, means that local authorities must ensure that the subject matters covered by their information and advice available to people in their areas go much further than a narrow definition of care and support” (3.23).

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What is information and advice?

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National eligibility framework•The Act introduces a national eligibility threshold:

whether the person has needs due to a physical or mental impairment or illness

whether those needs mean that they are unable to achieve two or more specified outcomes

as a consequence there is, or is likely to be, a significant impact on their wellbeing.

•Local authorities can also decide to meet needs that are not deemed to be eligible if they choose to do so.

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An adult meets the eligibility criteria:Their needs are caused by physical or mental impairment or illnessAs a result of the adults needs they are unable to achieve two or more specified outcomesAs a consequence there is or is likely to be a significant impact on the person’s well-being

Wellbeing:Personal dignityPhysical, mental & emotional healthProtection from abuse & neglectControl over day to day lifeParticipation in work, education, training and recreationSocial and economic wellbeingDomestic, family and personal relationshipsSuitability of living accommodationAn individuals contribution to society

The specified outcomes are: 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

New national eligibility threshold

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Interpreting the eligibility criteria

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An adult meets the eligibility criteria if:Their needs are caused by physical or mental impairment or illnessAs a result of the adults needs they are unable to achieve two or more specified outcomesAs a consequence there is or is likely to be a significant impact on the person’s well-being

An adult is to be regarded as being unable to achieve an outcome if the adult:is unable to achieve it without assistance;is able to achieve it without assistance but:

doing so causes them significant pain, distress or anxiety;

doing so endangers or is likely to endanger health or safety;

takes significantly longer than would normally be expected.

National carers eligibility framework•The Care Act strengthens the rights of carers.

•Carers can be eligible for support in their own right (however our approach should be to look at support needs in an holistic way) The Act introduces a national carers’ eligibility threshold:

whether the carer’s needs are due to providing necessary care for an adult

whether those needs puts the carer’s health at risk or means that they are unable to achieve specified outcomes; and

as a consequence there is, or is likely to be, a significant impact on their wellbeing.

Local authorities can also decide to meet carers’ needs that are not deemed to be eligible if they chose to do so.

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A carer meets the eligibility criteria if:Their needs are caused by providing necessary care for an adult. As a result:their health is at riskor they are unable to achieve specified outcomesAs a consequence there is or is likely to be a significant impact on the carer’s well-being

A carer is to be regarded as being unable to achieve an outcome if the carer:is unable to achieve it without assistance;is able to achieve it without assistance but doing so causes significant pain, distress or anxiety, or is likely to endanger health or safety

The specified outcomes are:Carrying out any caring responsibilities the carer has for a childProviding care to other persons for whom the carer provides careMaintaining a habitable home environmentManaging and maintaining nutritionDeveloping and maintaining family or other personal relationshipsEngaging in work, training, education or volunteeringMaking use of necessary facilities or services in the local community including recreational facilities or services Engaging in recreational activities

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Carers’ eligibility threshold

Handout 9

Advocacy

• Where the local authority considers that a person has substantial difficulty in being involved with their care and support then they must consider whether there is anyone appropriate who can help the person to be fully involved, eg family member or friend.

• If there is no one appropriate, then the local authority must arrange for an independent advocate to support and represent the person in the assessment, care and support planning and the review.

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SLCC Assessment Conversations

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Safeguarding

• Safeguarding now has a statutory base

• Local authorities are required to:– Make enquiries– Set up a Safeguarding Adults Board– Arrange for an independent advocate where

appropriate– Co-operate with each of its relevant partners

Safeguarding Six Key Principles• Empowerment – personalisation, presumption of

person-led decisions and informed consent• Prevention – it is better to take action before harm

occurs• Proportionality – proportionate and least intrusive

response• Protection – support and representation for those in

greatest need• Partnership – local solutions through services working

in their communities• Accountability – accountability and transparency in

delivery

Charging changes from April 2015• Intermediate care is brought into line

with NHS funded intermediate care• Deferred Payments nationally available

from April 2015 where previously only available in some areas

• Cannot charge a carer for services provided to the person they care for, even if this is to meet the carer’s needs for support

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Limits the amount people have to pay towards their eligible care and support needs and extends the point at which help is available.

For the first time creates protection from the risk of catastrophic care costs for those unlucky enough to face the highest costs.

A new partnership between the individual and the state that is fair for all.

Funding reforms – April 2016

Funding reforms – April 2016

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Element of reform How this will be delivered

Extend means-tested support Revised upper and lower capital limits

Care cap introduced £72,000 set in regulations

Recording the cost of meeting eligible needs

Personal BudgetIndependent Personal BudgetCare costs only, not accommodation / ‘hotel’ costs or daily living costs

Progress towards the cap Care accounts & annual statement

Support after reaching the cap LA has ongoing duty to meet eligible needs

Different approach for those of working age

Free care for life (zero cap) for those born with an eligible need or who develop one in early life

• Eligibility for LA support:

• Assets above the limits – pay for everything

• Between the upper and lower limits tariff income applies

• Assumes for every £250 of assets, can afford to pay £1 per week towards cost of care

• Tariff income + actual income = contribution to costs

Care Home All Other Settings

2015 – upper limit £23,250 £23,250

2015 – lower limit £14,250 £14,250

2016 – upper limits £118,000 unless a property disregard applies

£27,000Or if a property disregard

applied in a care home

2016 – lower limit £17,000 £17,000

Extension to means tested support

Summary for Providers: New Opportunities

• Services aimed at prevention such as the different forms of intermediate care

• Independent advocacy• Personal budgets and direct payments• New services as a result of integration• Delegation of local authority functions• More demand for carer support