How To Get Help From Social Care Services Updated: January 2014 Review Date: January 2015 Different Strokes 0845 130 7172 or 01908 317618 info@differentstrokes.co.uk Who is this booklet for? If you or someone you care for needs help from Social Care Services, you have a right to ask for a “social care” (sometimes also called a “community care”) assessment of your needs. The assessment is used to agree what support you need and to develop your care plan. Do you have questions? Would you like to speak to someone with personal experience of stroke? Call our Helpline: 0845 130 7172 or 01908 317618 9:00 to 5:00 Monday to Friday Or write to: 9 Canon Harnett Court Wolverton Mill Milton Keynes MK12 5NF Email: info@differentstrokes.co.uk Website: www.differentstrokes.co.uk Facebook: www.facebook.com/groups/differentstrokesuk Twitter: @diffstrokes 2 Contents This booklet is split into different sections and you may find that not all of it applies to you. It is worth keeping as a reference tool. You may find that some parts become more useful as your situation changes in the future. Chapter Page 1 Introduction 4-5 2 Social Care Needs (Community Care) Assessment 6-9 3 Support for Carers 10 4 What say do I have regarding my care? 11 5 Will I be charged for care? 12-13 6 Personal Budgets & Direct Payments 14-15 7 Complaints or appeals 16-17 8 Useful contacts 3 18 1 Introduction What is Social Care? Stroke is the single biggest cause of adult impairment and disability in Britain. Social Care Services have a statutory function to help people in need, including stroke survivors and their carers, to access support services in the community. Social care is support arranged by local authority social services departments to help people with their personal care needs and daily living activities. These services aim to promote people's wellbeing and independence by supporting them to:  Live independently and safely  Have as much choice and control over their lives as possible.  Live in their own home, if they wish, or other accommodation of their choice.  Find out about services and support available and how to get access to them.  Get the support that they need in local and ordinary settings.  Be safe from abuse. The social care support that stroke survivors need varies depending on the impairments the stroke has caused, e.g.  Loss of or impaired mobility  Sight impairment  Memory loss 4  Aphasia/communication problems  Depression, etc Social care usually supplements the informal care provided by family and friends, or replaces this where people do not have such support. Examples of help from social care include:  Help to get up /go to bed  Help with toileting, washing, bathing/ showering and dressing  Help to take medication  Help to move and get about  Help with meals and drinks  Help to claim benefits  Provision of equipment and adaptations  Provision of activities outside the home  Advice, information, counselling and support An assessment of your needs might therefore help to identify:  what you need or would find helpful  what is available to you locally  and what you might be eligible to get financial help with. NB: Having an assessment doesn’t mean you are automatically entitled to services. This advice mainly relates to adult care in England and Wales. 5 2 Social Care Needs (also known as Community Care) Assessment Local authorities are legally required to carry out an assessment of anyone living in their area who may need community care services. These assessments are arranged through Social Services. You can either contact your local authority directly or ask your GP to refer you. If you are recovering from a stroke in hospital and may need care support, ward staff will usually direct you to your local Social Services department. There may also be a hospital social worker who can assist. The NHS & Community Care Act 1990, section 47, entitles you to this assessment of your needs. The assessment looks at which difficulties or challenges you have due to your condition, and what help or support might help you to overcome these. It will take into account your personal circumstances, how the stroke has affected you and how your needs can best be met. This information will documented in a care and support plan. It’s important to know that an assessment does not automatically result in care being provided (see pages 8 to 9). What does an assessment cover? It might include:  a risk assessment of your living arrangements to see whether any equipment or adaptations might be helpful – e.g. a seizure alarm, a shower adaptation, or furniture protection  whether you might benefit from having extra support, such as a carer or personal assistant, either at home or when you go out  whether you meet the criteria to be allocated a personal budget, which you can use to pay for any help or care that you need. 6 The local authority then uses the assessment to decide whether you need a particular social care or community care service and, if you do, whether it can be provided by the local authority. The help you are eligible for depends on your level of need (how your stroke affects you) and your financial situation. Your financial situation should not influence the assessment of your needs - an eligibility assessment should always precede the financial assessment. Your local authority may then meet some of your needs (depending on its criteria for funding - see pages 8-9). If it’s not able to pay for the support, you will usually be told what services and help are available but you’ll have to pay for these yourself. Who gets social care? If you are eligible for funded support, the second stage of the assessment process involves an analysis of the amount of assistance you require with specific tasks such as washing, bathing/showering, dressing, etc. This assessment will produce a cost for the care support needed. A care plan will then be produced setting out how this is to be delivered. If it has been identified that you will need continued nursing care when you are discharged from hospital, a Continuing Health Care (CHC) checklist will be completed by the hospital. If your needs meet the threshold you will be referred for a full CHC assessment undertaken by the local Commissioning Group (the NHS body which plans and funds healthcare). This assessment considers your needs in several areas such as breathing, continence, medication and behaviour, and determines whether your continuing care needs qualify for full NHS funding of your care. If they don’t meet the threshold for full funding, you may be able to receive the Registered Nursing Care Contribution (RNCC) if you require continued care in a nursing home. If you or your carer do not agree with the CHC assessment, you are entitled to request that your needs are reassessed. 7 What are the eligibility critieria for funding social/community care? Local authorities use a set of eligibility criteria to determine who is eligible to receive community care services. These are set out in the 2010 national guidelines from the Dept of Health called 'Fair Access To Care Services'. This enables them to ensure that those in greatest need and at highest risk receive services. It also ensures that anyone requesting a service is dealt with fairly. These guidelines categorise what the risk to independence would be if your needs are not met. There are 4 categories:  Critical (People who are in a crisis situation or are actually at risk or pose a serious risk. Vital family or other social roles and responsibilities cannot or will not be undertaken.)  Substantial (People and/or carers who are having significant difficulties in coping and are potentially at significant risk. The majority of family and other social roles and responsibilities cannot or will not be undertaken.)  Moderate (People and/or carers who are finding it hard to cope and there is some risk to their health. Several family and other social roles and responsibilities cannot or will not be undertaken.)  Low (People whose quality of life could be improved but their situation is stable and there is no risk to them or their carers.) Councils are allowed to decide whether they have enough resources to provide help for all 4 eligibility criteria bands, or just for some of them. Many local authorities have decided they only have resources to provide services to people in the “critical” and “substantial” bands. People falling into the low and moderate bands may only receive information and advice on how to access community based alternatives which best meet their needs. 8 What happens if you are not eligible for funded support? Your local authority will write and tell you whether you are eligible or not. Advice, information and signposting to other sources of help will normally be given to those assessed as falling into the moderate or low priority bands. Assessment decisions can be challenged, and in such cases a reassessment will usually be carried out. See the Complaints and Appeals section on page 16. And what if my needs change? Following the initial assessment, your needs will usually be assessed 4 weeks afterwards to ensure the service you are receiving meets your needs. If necessary, changes to the support will be made. It is then usual for subsequent reviews to take place at yearly intervals. If, however, your needs change between assessments, you should contact the local social services office which carried out the assessments. 9 3 Support for Carers What support is available to carers? The bulk of care is provided informally by relatives and friends. If you are a carer who provides a substantial amount of care on a regular basis, you are entitled to an assessment in your own right, as many carers need their own support in order to continue caring. This can either be carried out at the same time as the assessment of needs of the person you are caring for, but if you prefer it can often be carried out separately. When assessing your needs the local authority will take into account the overall impact of your caring role on you as an individual. This might include the need for home help, for equipment or for respite care. However, the local authority does not have a duty to provide services to carers as a result of their assessment. If you receive Disability Living Allowance (middle or higher care rate) or the Personal Independence Payment and are being looked after by someone who spends at least 35 hours doing this, that person may be eligible to claim Carers Allowance (£59.75) a week if she/he earns less than £100 per week after tax. The local authority welfare benefits service can help with the claim if you are receiving a local authority funded service. There is a wide range of information for carers on the NHS Carers Direct pages. Go to www.nhs.uk/CarersDirect/guide/assessments/Pages/ Carersassessments.aspx or call Carers Direct on 0300 123 1053 from 9am to 8pm on weekdays and from 11am to 4pm at weekends. 10 4 What say do I have regarding my care? If you need to use local authority social care services, then choice and control are important principles (Independence, Choice & Well-being, Department of Health, 2005). It’s important as you start to recover that you decide what your priorities are in terms of your recovery, goals and how you want your support needs to be met. Therapists and others caring for you will also have an input. For health and wellbeing reasons, the key priority is usually placed on assistance to maintaining personal hygiene and other aspects of personal care such as:  medication  maintaining an adequate diet  fluid intake, etc. Other factors such as promoting good mental health and reducing social isolation will also be important priorities. The amount of support you need and the cost will be worked out (using the Resource Allocation System - RAS), and a Personal Budget will then be set (see page 14). 11 5 Will I be charged for care? Unlike healthcare, there may be a charge for social care depending on your circumstances. A financial assessment (means test) will establish how much you should contribute towards the cost. Charging regulations apply nationally. Assets worth less than £14,250 are disregarded but if you have assets above this amount, you will be required to pay a % toward your care. The upper limit is £23,250 in England or £23,750 in Wales, at this level you are currently required to pay for all of your own care. (Personal care for those with eligible needs is currently provided free of charge, regardless of financial circumstances, in Scotland and Northern Ireland.) The value of any property is not taken into account if you or a family member previously dependent on you continues to live in the property. Care provided in the home is generally charged by the hour. Charges vary by local authority. Some but not all local authorities set a cap on the amount charged for care services. Any charge should not leave you unable to meet your usual outgoings (see Charges for Domiciliary Care Services, Disability Law Service, 2009). Intermediate care, designed to promote re-ablement provided at home or in a care home following discharge from hospital, is usually provided free for the first 5 or 6 weeks. If you are eligible for local authority funding assistance and you choose or your care has to be provided in a care home, the home may charge a top-up (third party payment) in addition to what the local authority will pay. You (or someone 12 assisting you) are responsible for this additional payment. When carrying out its financial assessment, the local authority will identify whether you are entitled to claim any benefits such as Employment & Support Allowance, Personal Independence Payment, Housing Benefit, etc. They will help you to maximise your income and help you to claim for these. If you are not eligible for local authority-funded care you will be referred to the Citizens Advice Bureau or another welfare rights agency to make the claim. What help can I get if I need equipment or home adaptations? If you are leaving hospital, or intermediate care, an occupational therapist will assess and provide as required equipment such as walking aids, hospital/profiling bed, commode, etc. The occupational therapist may also visit your home to check whether any changes are required. These can involve, amongst other things, moving furniture around, e.g. if you cannot manage stairs and need to sleep downstairs, advice on ramps, stair-lifts, wet-rooms etc and what funding assistance is available. If you are eligible, the local authority social services department can fund major items (stair-lift, wet room) by providing a Disabled Facilities Grant. To qualify, the work required must be necessary and appropriate to meet your needs. It must also be reasonable and practical given the age and condition of your property. Contact your local Social Services department to see if you are eligible and which conditions apply. 13 6 Personal Budgets & Direct Payments Personal Budget If you are eligible for funded social care, you will be set a Personal Budget. This is an amount of money the local authority allocates for your care, based on its assessment of your needs. This is part of a new process designed to give people greater control over the way they receive their support. You can be put in charge of this ‘budget’ either by telling the local authority how you would like it spent, or by the council giving you the money so that you can directly pay for your own care (a direct payment). More information on Personal Budgets is available on the Disability Rights UK Factsheet F59 at www.disabilityrightsuk.org/personal-budgets or call its Independence Living Adviceline on 0300 555 1525 on Monday or Thursday from 9am to 1pm. Direct payments These are payments made directly to you by social services so that you can buy care services for yourself or for the person you are caring for. By giving you the funds directly to spend yourself, the idea is that you have more independence with greater choice and control over your life as you are able to make your own decisions about how your care is delivered. If you are unhappy with the services you’re getting, you can decide to change who gives you the care services without the process of going through the local authority. If you're already getting support from social services, you can now ask to change over direct payments instead. 14 Managing direct payments When you or the person you're looking after receive direct payments, there will be various obligations. These include:  Keeping records and accounting for how the money is spent to social services.  Taking on the legal role of an employer if you're using the payment to pay for a care worker, and undertaking all the legal responsibilities that go with it. Help may be available from local organisations to manage the administration involved and other responsibilities. Direct payments can only be spent on things that will meet the assessed needs of the person getting them. The support you need and how it is to be delivered should be set out in the care plan which you should have a copy of. If you spend a direct payment on something that doesn't meet your needs, social services can recover the money from you. Social services can charge for some services that they provide, depending on your level of need and financial situation. This means that if you get direct payments, you may need to make a financial contribution towards the direct payment in some circumstances. If this is the case for you, your local social services should tell you if you'll need to contribute, and how much. Their charges must be fair and they must follow the rules described in the Department of Health’s Fairer Charging Policies at www.gov.uk/government/uploads/system/uploads/attachment_data/ file/208323/Fairer_Charging_Guidance_final_2013-06-20_rc.pdf More information on Direct Payments is available on the Disability Rights UK Factsheet F5 at www.disabilityrightsuk.org/community-care-directpaymentsor call its Independence Living Adviceline on 0300 555 1525 on Monday or Thursday from 9am to 1pm. 15 6 Complaints or Appeals If you are not happy with the assessment decision: Local authorities have a responsibility under the NHS & Community Care Act 1990 to enable individuals to complain about their social care services if they wish to do so. In the first instance, contact the person (or team) you have been dealing with, or the local authority’s complaints officer, to let them know what your concerns are and ask them to review the decision. Your local authority must have a clear reason for deciding:  not to place you in the residential care home you prefer  not to give you a direct payment or personal budget. They must tell you what decision they have made and why. Should you so wish, you can then make a formal complaint to your council about the decision. Every council must publish their procedures for dealing with complaints. Your local Citizens Advice Bureau can help you with this. If you are still unhappy with how your council responds to your complaint, you have the right to refer the complaint to the Local Government Ombudsman (LGO):  call the LGO Advice Team on 0300 061 0614  text ‘call back’ on 0762 480 3014  write to: The Local Government Ombudsman, PO Box 4771, Coventry CV4 0EH More information on making a complaint about local authority decisions is available on the Disability Rights UK Factsheet F6 at www.disabilityrightsuk.org/complaining-about-local-authority-decisions 16 Safeguarding vulnerable adults Illness, impairment and disability can engender feelings of dependency, vulnerability and risk. Social Services, in conjunction with the health service, police and other agencies, have a key responsibility to safeguard and protect vulnerable adults (No Secrets, Department of Health, March 2000). Abuse can take different forms, e.g. financial, physical, emotional, sexual, etc. If you have concerns about the way you or someone you know has been treated, contact the social worker who carried out your assessment or the local authority Adult Safeguarding Team. They will confidently investigate your concerns, and respond to them taking appropriate action depending on the circumstances. FOOTNOTE—This document was created with the assistance of a social worker who is himself a stroke survivor. 17 7 Useful Contacts 20 Great Dover St London SE1 4LX n/a 0808 808 7777 (Wed and Thurs from 10-12 and 2-4) website has information about local CAB offices advice@carersuk.org n/a www.carersuk.org www.adviceguide.org.uk 12 City Forum, 250 City Rd, LondonEC1V 8AF n/a Independent Living Advice Line: 0300 555 1525 (Mon or Thurs 9am to 1pm) n/a independentliving@ disabilityrightsuk.org n/a www.disabilityrightsuk.org www.gov.uk/apply-needsassessment-socialservices 0300 500 5000 (8am to 8pm weekdays, 9am to 1pm Sat) 0300 123 1053 (weekdays 9am to 8pm, 11am to 4pm weekends) enquiries@moneyadvice service.org.uk via website www.moneyadviceservice. org.uk/ www.nhs.uk/carersdirect/ Pages/ CarersDirectHome.aspx 18