Introduction to policy guidance
Our policy on eligibility for adult care and support is to comply with what the Care Act (2014) says about eligibility and follow the Care Act’s statutory guidance.
This policy guidance outlines how:
- we assess people’s eligibility against the national criteria
- to apply for an assessment
1. Eligibility criteria for adult social care and support
1.1 The national eligibility criteria ensure that all local authorities meet the same minimum level of needs. If an adult meets the three elements of the criteria detailed below and is ordinarily resident in Devon, we have a duty to ensure their needs are met:
- 1.1.1 The adult’s needs arise from or are related to a physical or mental impairment or illness.
- 1.1.2 As a result of the needs, they are unable to achieve two or more specified outcomes (see Appendix A).
- 1.1.3 As a consequence there is, or is likely to be, a significant impact on their wellbeing.
1.2 The Care Act does not require that individuals have a formal diagnosis of a physical or mental impairment or illness. Instead, local authorities must make a judgement based on the assessment process. However, assessors will need to be assured that an individual’s needs are not caused by circumstantial factors, but by a physical or mental impairment.
2. Carer’s eligibility criteria
2.1 The Care Act introduced national eligibility criteria for carers. Eligibility is based on the impact a carer’s need for support has on their wellbeing. A carer will have eligible needs if:
- 2.1.1 Their needs arise as a consequence of providing necessary care for an adult.
- 2.1.2 As a result of their needs their health is deteriorating or is at risk or they are unable to achieve specified outcomes (see Appendix A).
- 2.1.3 As a consequence there is, or likely to be, a significant impact on a carer’s wellbeing.
2.2 Eligibility determination is made regardless of whether or not the adult who the carer cares for has eligible needs.
2.3 The carer must, however, be providing ‘necessary’ care. If the carer is providing care and support for needs that the adult is capable of meeting themselves, the carer may not be providing necessary support.
3. How do I arrange an assessment?
3.1 An assessment must be provided to all people and carers who appear to need care and support, regardless of their finances or whether the local authority thinks their needs will be eligible.
3.3 An online self-assessment is available following the completion of our self-help tool. A paper copy or Word document can also be requested from Care Direct. This provides an opportunity for you to gather information and think about your needs before a full assessment. Devon County Council can assist you with completing a self-assessment.
3.4 An assessment could be an individual assessment or a combined assessment with a carer and the person for whom they care. Where relevant, it could be undertaken jointly with contribution from others, including the NHS.
3.5 A copy of the assessment will be sent to you. This will clearly indicate whether you are eligible for support.
4. What if my needs do not meet the eligibility criteria?
4.1 If your needs do not meet the eligibility criteria, we may look at how we can signpost you to alternative support that is available. For example, this may include suggesting services available to you in your community. We may encourage an individual to seek medical diagnosis or support from healthcare services where appropriate. In exceptional circumstances, we may offer funded support.
4.2 We are not under any legal duty to meet non-eligible needs.
5. What can I do if I don’t agree with the assessment?
5.1 We will always explain the decisions we make about your eligibility against the national eligibility criteria, and we must record your views if they are different to the decision we make.
5.2 Both you or your representative must always be informed of your right to make a complaint using our complaints procedure, if you remain unhappy with our assessment and decision.
5.3 Section 13 of the Care Act 2014; The Care and Support (Eligibility Criteria) Regulation 2014 and Section 6 of Care Act Statutory Guidance provide further details on eligibility and the eligibility criteria.
Appendix A: The Care and Support (Eligibility Criteria) Regulations 2014
Strategic owner: Keri Storey, Head of Integrated Adult Social Care Operations
Business owner: Tina Ramage, Principal Social Worker
Author: James Martin, Policy Manager
Date of approval and commencement: 2015
Last review date: February 2023
Last reviewer: Becki Billing, Senior Policy Officer
Next review date: Quarter 4, 2024/25
Changes at last review: Minor terminology changes