Paper 1 : Matching Needs and Services and Managing Risks in Adult Social Care Guidance
Contents
Tables -
PURPOSE OF THE GUIDANCE
This guidance supports decision-making concerning all social care services and sets out the process steps to follow when assessing an individual and deciding eligibility for social care services. It then describes options to respond to both presenting and eligible needs.
It should be read alongside:-
- Fair Access to Care Services policy and practice guidance
- The Law in relation to Assessment and Provision of Community Care services
- Direct Payments Policy and Guidance
- Care Programme Approach, Valuing People and Care Management (including Single Assessment Process) Guidance
- NHS Continuing Care
FACS criteria DO NOT govern access to Disabled Facilities Grants, NHS and Housing services.
HOW TO USE THE GUIDANCE
This guidance has one over-riding message:-
NEVER MAKE ASSUMPTIONS – ALWAYS ASK IF UNSURE
- We are all different, therefore it is critical to ascertain the needs and wishes of each individual
- Dignity, Choice, Participation/ Involvement and Respect are the foundations of good assessment practice
- Incorporate a holistic approach to contact, assessment and care planning
- Always offer Direct Payments where the person or carer are eligible
- Use the good practice checklist on the Care Management process
- The role of practitioners is to be creative, flexible and innovative in responding to needs and promoting choice through a range of alternatives
CULTURALLY SENSITIVE PRACTICE
Assessments and any services arranged by Social Services must take account of an individual’s age, gender, ethnic group, religion, culture, disabilities, personal relationships or living and caring arrangements.
In undertaking assessments, commissioning services and agreeing care plans that are culturally competent you must consider the following:
- Have you received adequate training to deal with the assessments of people from the culture you are working with? If not, proceed with caution and raise the training need with your manager.
- Be aware of the individual’s wishes and beliefs - Always ask, never assume.
- Consider religious needs and requirements for worship - always ask, never assume.
- If the person’s first language is not English, use the Interpretation Service, DO NOT expect the family to undertake this task - always ask, never assume.
- Learn from the individual about specific health problems and daily care routines – standards and understanding of hygiene requirements, diet/food, dress, social and religious needs vary widely - always ask, never assume.
- Ensure practical care is delivered in a culturally sensitive way. Direct Payments may be helpful here.
PROCESS STEPS
The contact, assessment and care planning process must be person-centred. In most situations people should decide how far they wish to go in the process in consultation with the practitioner. Within this context practitioners should use the following steps at all levels of assessment and regardless of the possible service outcomes being considered.
Where individuals and carers disagree either with the process or decision making re eligible needs the Complaints process should be followed. (ref. FACS policy)
Stage 1 Identify Needs and Risks
- Involve the person, carer, family, friends (as appropriate) in identifying their own needs
- Listen and endeavour to understand the individual/carer experience of their situation including their values, views, opinions, and preferences
- Promote and encourage a greater degree of individual control and independence
- Involve the person/carer in identifying and analysing risks to independence, autonomy, safety and role (as appropriate)
- Ensure the person/carer is given relevant and timely information
- Look for creative options for meeting needs and managing risks
- With the person/carer explore the range of choices and options available to them
AT THIS STAGE YOU ARE NOT LOOKING FOR SERVICE SOLUTIONS
Stage 2 - Identify Solutions
Individuals and/or carers should play an active role in identifying possible ways of meeting needs and managing risks by working in partnership with practitioners to:
- Identify the range of solutions appropriate to the presenting needs and risks
- Explore their aspirations and preferences
- Identify their attitude to identified risks
CONSIDER ALL RELEVANT SOLUTIONS WITH THE INDIVIDUAL
Stage 3 - Agree the individual’s preferences
The practitioner should set out the range of relevant choices to meet the individual’s needs. Examples include:
- Information and advice. For example leaflets, websites, catalogues, details of private/ voluntary sector providers, demonstration centres/Help Lines
- Further assessment from Health, Social Services, Housing
- Trials with equipment/adaptations where appropriate
- Individual/family buys the item/services using own resources
- Support from carer, family or close friends
- Services from Social Services – at this stage the practitioner should explain the FACS process and options to meet eligible needs either through Direct Payment Scheme or via care management
MAKE NO ASSUMPTIONS ABOUT INDIVIDUAL'S PREFERENCES – ALWAYS ASK
Stage 4 - Agree person's preference for meeting presenting needs
Individuals and/or carers should work in partnership with practitioners to agree their preferences for meeting presenting needs. These might include:
- Individual/carer/family buys item/services using own resources
- Referral for Specialist Assessment/to new agency
- Referral to preventive services/other agencies
- Direct Payments
- Services arranged by Social Services
ONLY COMPLETE THE ELIGIBILITY CRITERIA CHECKLIST WHERE DIRECT PAYMENTS OR FUNDED SOCIAL CARE SERVICES ARE REQUESTED
Stage 5 – Managing Risks and Meeting Eligible Needs for funded social care
In order to identify whether a person/carer has eligible needs for funded social care or not the practitioner must:
- Complete the eligibility checklist based on assessment information about risks to independence, safety and role if needs are not addressed.
- Give the person/carer choices and options as set out above regardless of whether the individual has risks above or below the Devon eligibility threshold.
- Consider appropriateness of NHS continuing care
- Ensure that any service responses to meet eligible needs are the minimum required for a cost-efficient and effective solution.
- Ensure that service responses are appropriate to the person’s age, gender, ethnic group, religion, disabilities, personal relationships or living and caring arrangements
- Discuss fully with the person/carer the option of Direct Payments to meet eligible needs
Stage 6 - Specialist services from other agencies
Health and Housing authorities have their own policies for determining how resources will be allocated to individuals. These are NOT subject to FACS. These include:
- Continuing NHS Health Care
- Housing Renewal Policies – includes Disabled Facilities Grant (DFG’s), Discretionary grants for relocation and repairs
- Housing Corporation policies
- Supporting People Services
- Funded Nursing Care
Presenting and Eligible Needs
The term presenting need defines all the needs that a person has, as described both at the first point of contact and throughout the assessment/review.
‘Eligible needs’ are needs that fall inside the Council’s eligibility criteria. Eligible needs are those that are:
- Above the threshold for services line based on the assessment information
- The individual is unable/does not wish to arrange the care and support for themselves
AND
- Assistance is not available from, or appropriately arranged by others such as family, the community, other agencies.
Principles when meeting needs and managing risks
When meeting needs and managing risks remember the following:
- To give people information at all stages so that they can solve their own problems where appropriate, regardless of whether they have needs above or below the threshold for services line.
- Consider ordinary community services.
- To take account and encourage the strengths of the individual to problem solve
- To consider the contributions of family, friends and other agencies such as Supporting People and the Independent Living Fund (ILF)
- To consider whether there is a need for NHS funded Continuing Care
- To actively promote the use of Direct Payments for people with eligible needs – and record the reasons why these are not taken up if this is the outcome
- To plan short term interventions to enable people to become independent without support from Social Services
- To plan interventions to assist people to live independently over the longer termTo ensure any service response is the minimum required to meet the eligible need, in the most cost efficient manner
Outcomes sought for people with eligible needs
Where eligible needs are identified the outcomes being sought from Social Services intervention will be one or more of the following:-
- To have promoted independence and choice for the person/carer
- To have enabled the person to continue living independently
- To have assisted the person to regain/develop/maintain his/her independence
- To have enabled the person to communicate effectively
- To have supported the carer to sustain their caring role
- To have enabled the person/carer to have achieved choice, inclusion, life long learning
- To have enabled the person to have learned orientation/mobility techniques
Direct Payments
Direct Payments must be discussed with all people (individuals/carers) who have eligible needs as a preferred method of meeting their needs. Most service users, even with substantial impairments, are eligible for Direct Payments – there are a few exceptions in law – see Direct Payments policy.
The person must be able to manage the Direct Payments (with substantial support if necessary). Being able to manage means the person being in control of who works for them and how the help is provided. For further guidance - see Direct Payments policy.
When discussing Direct Payments with people ensure the following are addressed:
- A person may have Direct Payments in lieu of any services directly arranged and funded by Social Services (refer to service access criteria for relevant service).
- A person or, in certain circumstances their representative, must be willing to receive Direct Payments and must want to be in control of and take responsibility for managing their support services.
- If Direct Payments are not the choice of the user, identify the reasons are record them.
Giving a Statement of Needs And How They Will Be Met
Whether people have eligible or only presenting needs (or a mixture) they must be given a statement of their needs and how they will be met.
This can be EITHER through providing a copy of the assessment summary for simple needs, or through a copy of the Care Plan for more complex situations. THERE IS NO CHOICE ABOUT THIS!
Tables:-
(29KB - pdf help)
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