The Role Of Social Services
Local authorities’ social services departments are often key to finding successful solutions to dilemmas about care. They play a lead role in assessing the need for services and will both provide and fund care services under some circumstances especially when you may not be able to make your own arrangements or when you cannot pay in full for the services you need.
Assessment for Community Care
Since 1993, local authorities and, through them, their social services departments, have been charged with; assessing people’s needs for community care services; and, where they have agreed that there is a need, with providing an appropriate service. Health authorities and, where appropriate, other professionals such as physiotherapists, are also required to take part in assessments.
‘Assessing needs’ simply means finding out what help or support you may need. The remit is to provide services which support people in their own homes, or to provide a placement in a care home. In either case, subject to a financial means test, there is likely to be a charge for services.
The only exception to this is where there is an assessed need for continuing health care, hospital or care from the district nurse, or when there is a short term need for rehabilitation. In such cases, the service will be provided free of charge.
People living in care homes receive free nursing care, but only when the nursing is carried out by a qualified nurse. There is a complicated ‘banding’ system which then determines just what discount you will receive. The accommodation and non-nursing costs will still have to be paid for.
Scottish readers will find the Alzheimers Scotland web site to be extremely useful reference to that country’s particular welfare, benefits and legal technicalities. Go to www.alzscot.org.
Anyone who believes that they need assistance, either to continue to live at home or because they can no longer manage at home, is entitled to ask for an assessment of need. You can also request an assessment if you are registered disabled, or if you are a carer (see below).
The assessment should focus on the following key aspects:
- The wishes and feelings you have about the way you would prefer to live.
- Your state of health – both physical and mental.
- Any risks your illness or disability may subject you to.
- Your home environment and its location in relation to your condition.
- Whether you have anybody who looks after you.
A close relative, carer or friend can be present during the assessment and would be able to contribute views to the Care Manager.
Although the social services department will take the lead, it is also required to involve the GP and other professionals from a Primary Care Team or Primary Care Trust – such as Practice Nurses, District Nurses, Health Visitors, Community Mental Health Nurses, Macmillan Nurses, Podiatrists, Community Dietitians, Counsellors and Psychologists.
Some authorities have set criteria to determine whether or not they will undertake assessments and will only assess your needs if you meet these criteria. You may, for example, be asked about your financial circumstances. If it seems likely that you would have to pay for the service you may be referred direct to the service provider, rather than being formally assessed.
Local authorities are required to provide information about how their assessment procedure works. This information should be available through the social services department, local library or your GP’s surgery. The information should also be available in Braille or on tape – in languages appropriate for all the local community.
If you are refused an assessment you can challenge the decision. You should write in the first instance setting out all the reasons why you think you should be entitled to the assessment.
The person who comes to assess your needs may be a care manager, or a social worker, or may be a community nurse or other professional. The way in which the assessment is carried out will also vary. There is no ‘right’ way to do it. However, the one thing which is important is that the person being assessed should be consulted about what they feel their needs are and about what kind of help they would like to have.
Age UK suggest that it might be useful to make a list of things you find difficulty in doing, or to keep a diary in which you make a note of things which are always difficult and things which you can sometimes, but not always, manage. You can then refer to this during an assessment.
The community care guidelines from the government state clearly that care services should be devised which meet people’s real needs, rather than trying to fit people into existing services. However, local authorities are entitled to take cost into account when they provide or arrange services – and you may not be offered what you want.
Local authorities are also now required to offer people the money to purchase their own services, as an alternative to providing the service. You can read more about ‘direct payments’ in Funding Your Choice.
Once the local authority has undertaken an assessment and decided that you are in need of community care they will consider your eligibility to receive a service. There are no nationally agreed eligibility criteria, so there is huge variation in what is available from area to area. This is sometimes referred to as the ‘postal code lottery’!
If your local authority decides that your needs do not meet its criteria for providing or arranging a service and they are not able to offer you any help, ask them to write to you stating their decision and the reasons for it. You could also lodge a formal complaint against the Authority. Local authorities are not, however, the only source of help and we suggest refer to our section on Staying at Home and perhaps also read Funding your Choice.
The Care Plan
If Social Services do agree to provide or arrange services, they should produce a care plan. The care plan will set out what services will be provided, when they will be received, what tasks will be undertaken and when these arrangements will be reviewed. You should be given a copy of your care plan, together with a written copy of the assessment. You should not sign any record of the assessment, unless you are entirely happy that it records your views accurately.
There is more about carers and services for carers elsewhere on this website – see Support for Carers. Local authorities now have a duty to offer a carer’s assessment, and to provide assessments of carers’ needs if they are requested to do so. This is applicable whether or not the authority is also undertaking an assessment of the needs of the person being cared for.
The community care services which your local authority can provide are set out elsewhere in this website. Look under Staying at Home, Sheltered Housing, or Care Homes, to find out in more detail what might be available.
Social Services may provide the service(s) themselves or they may contract with an independent voluntary or private organisation to provide the service. In theory, you should have some choice about the service provider assigned. In practice, there may be established contracts with organisations to provide services, especially where home care is concerned – so, there will be less opportunity for choice. However, in entering into a contract, the local authority will have ensured that the servicing organisation is reputable, with stipulated clear standards and that it is registered with the Commission for Social Care Inspection (CSCI) Tel: 0845 0150120..
The care manager
If you are receiving service at home, particularly if it is more than one type of service, you are likely to be assigned a care manager from the social services department. This may or may not be the same person who carried out your original assessment. The role of the care manager is to keep an overall eye on the services you are receiving (sometimes referred to as the ‘package’ of care services) and to ensure that they are operating smoothly and are still right for you. From time to time, the care manager will also arrange a formal review of the service arrangements.
The service plan
Very few local authorities will now provide assistance purely with domestic tasks, if that is all you need. Local authorities’ resources have to be concentrated on the most frail. Assisting people with personal care needs, such as getting dressed, having a bath or shower, getting to the toilet, or making a meal will be more likely to be the type of help provided – if the local authority agrees to provide a service.
The care plan will specify the tasks to be done and your service provider will have to stick to the plan. You should note that the care provider is then not allowed to change the specification, to include extra tasks you might want done. Of course, if you are paying for a service privately, you can decide just exactly what the staff do while they are with you.
If your need is for a care home, social services may help you to choose a home and assist with your move. They will certainly do this if your capital is below £23,250 and you are not able to pay the full cost of care or if, for reasons of mental or physical frailty, you are unable to arrange things for yourself.
There is also now much emphasis upon rehabilitation – to help you to become more independent again. If this is the intention, you will be offered the service for a clearly defined period only: 6-8 weeks is typical and the help will be focused on getting you to do things for yourself, rather than everything being done for you. There will be the clear expectation that the service level will be reduced when you are able to manage better and the service manager may visit you frequently to assess your progress. A short term service such as this may be free.
Local authorities are entitled to make charges towards the cost of community services and most of them now do so. There is no standard national level of charging for non-residential services and they do all vary. Recent Government guidance on charging suggests that considerable variation will continue.
One aspect of your initial assessment by Social Services will be some questions about your financial circumstances. It may even be that the financial assessment is done separately to the needs appraisal.
Fundamentally, Social Services’ charges are required to be ‘reasonable’. However, in some instances you might actually be able to purchase your own service more cheaply directly from the same organisation supplying the services – than by getting it through the local authority! (Obviously, you would then have much more control over the times and type of service you receive and, indeed, the staff delivering the service).
It should be noted that, as part of a care package, you will not be charged by your local authority for either loans of equipment or for making home adaptations, costing up to £1000 in each case.
To summarise, Social Services should tell you about the costs involved when you are offered care services and given the care plan. If you feel that costs are too high or that you simply cannot afford them, you should say so straight away. You can also find out more about costs and Direct Payments – where you receive money from social services to pay the service provider directly for the services you need in Funding your Choice.