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1.3.9 Carers' Assessments - Practitioner's Guide

Contents

  1. Introduction
  2. Who is a Carer
  3. Adult Carers
  4. Young Carers
  5. Parent Carers
  6. Carers Assessment Aim
  7. Information and Advice
  8. Breaks
  9. Carers Services
  10. The Legal Framework
  11. Good Practice Guidance
  12. Prompt Sheet for Carers Assessment


1. Introduction

When visiting clients, it is important to check whether there is a carer or a young carer (they may not always be present) and whether they need support. There may be more than one carer involved. It is important to provide them with information regarding the Carer’s Assessment, the local Carers Centre and where to get support. Carers may need help to self-identify. People often only see themselves as a partner, parent, relative or friend.

Under the Carers (Equal Opportunities) Act 2004, the Local Authority has:

  • A duty to inform carers of their entitlement to an assessment of their needs,
  • A duty to consider a carer’s outside interests when carrying out an assessment and take into account whether the carer:
  1. Works or wishes to work,
  2. Is undertaking or wishes to undertake, education, training or any leisure activity.


2. Who is a Carer

Carers are people who provide care for friends, family, partners or relatives with a physical or mental illness/disability, learning disability or frailty that require help to live in the community.

The carer may or may not live with the person they look after. They may be a long distance carer. The care they provide may be personal care, practical help, emotional support or supervision. The care is not carried out or provided by virtue of a contract of employment or as a volunteer for a voluntary organisation.


3. Adult Carers

Carers aged 16 and over who provides or intend to provide a substantial amount of care on a regular basis for another individual 18 years of age or over may be entitled to a Carers Assessment.

There is no definition of “substantial” or “regular” in the Carers and Disabled Children Act 2000 and Carers (Equal Opportunities) Act 2004. In any situation it is the impact of the caring role on the individual carer that needs to be taken into consideration. It is not only time spent each week. The whole caring situation needs to be taken into account. This should include the carer’s age, health, their employment status, education, interests and other commitments such as parenting and additional caring roles.  


4. Young Carers

A young carer is a person under 18 years of age. Young carers aged 16 or 17 years of age may be eligible for a Carer’s Assessment “in exceptional circumstances only”. That is, in the rare circumstance where it is in the best interests of the young person to be supported, to take on the caring role for a period, for example if a parent is terminally ill.

As a fundamental principle, it should not be assumed that children should take on similar levels of caring responsibilities as adults.

In dealing with the needs of children (including those aged 16 and 17) the Framework for the Assessment of Children in Need and their Families remains the main source of guidance for local authorities.

There may be a difference of views between children and parents about appropriate levels of care. Such differences may be out in the open or concealed. The resolutions of such tensions will require good quality joint working between adult and children’s social care services as well as co-operation from schools and health care workers. This work should include direct work with the young carer to understand his or her perspective and opinions. Major support for the young carer can be accessed directly or by referral to the three Carer’s Centres in the county, through their Young Carers’ Projects.

Young carers can easily be overlooked. It is important to establish whether there are children in the household and the extent of their caring role. Young people and their parents are often silent about the extent of the support a child or young person provides, through fear of separation, guilt, pride and a desire to keep it in the family. The identification from black and minority ethnic groups is even more difficult due to cultural and religious differences.


5. Parent Carers

Parent carers are people with Parental Responsibility for a disabled child under the age of 18 years, who provide or intend to provide a substantial amount of care on a regular basis.

This is to ensure that children brought up by grandparents and others with parental responsibility are not disadvantaged.


6. Carers Assessment Aim

The aim of the assessment is to improve the outcome for the carer. The government’s aim is to support people who choose to care and to help maintain their health and well being. This may be achieved by listening to carers and looking to achieve outcomes which, while helping them to care, take into account the carer’s life beyond their caring.

The assessment of the person’s ability to care must now take into consideration whether the carer works or wishes to work or undertake training or education. The assessment must also include consideration of whether the carer wishes to access the sort of leisure opportunities that the rest of us take for granted.

The assessment must be approached from the point of view of the carer, not the cared for, or service led. The carer should define what sort of help is a priority for them in their particular situation and what outcome they want.

The outcome should sustain the carer and their health and well being in the caring role. It should reduce risk to its sustainability.

The most likely result of the assessment is that good quality community care services will be provided to the cared for person, giving the carer a break). In addition, the Local Authority must consider the information and decide whether to provide services directly to the carer (carers services).


7. Information and Advice

All carers should be given basic information.

This is defined as a minimum set of information, for example:

  • Phone numbers for emergencies,
  • National voluntary sector contact information,
  • Local numbers,
  • National financial support lines,
  • General advice, i.e. back care, moving and handing, alarms,

Two booklets – ‘A Guide to Carers’ Assessments’ and ‘A Guide to Carers’ Organisations and Helpful Contacts’ are available from customer services on 01865 375515 or the Oxfordshire website.

Note for Care Managers

This should only be used for one-off pieces of advice. If someone will need ongoing financial advice, welfare benefits advice and assistance or other longer-term support it should be recorded under “Carers Services”.


8. Breaks

As defined by the Carers Grant Guidance; a “break” is one which actually gives the carer a break from direct responsibility of supervising or caring for the relevant person by providing a service to the person. This could include Day Care at home or elsewhere, Relief to Care, Residential/Nursing Respite Care and Domiciliary Care.


9. Carers Services

The Carers and Disabled Children Act 2000 enables local councils to offer direct carers’ support. Carer’s services are services which are provided directly to the carer. These services are provided to support the carer in their caring role and help them to maintain their own health and well being. These could be a holiday for the carer, a day out for the carer, driving lessons for the carer, equipment to support the carer in their role, emotional support groups, or alternative therapies or counselling for the carer: whatever will provide the best outcome for the carer.


10. The Legal Framework

10.1 The Right to a Carers Assessment

All carers (aged 16 and over) of adults aged 18 and over and parent carers of disabled children have a right to a Carer’s Assessment of their ability to provide and continue to provide care:

  • If the person they care for is/may be eligible for services from Adult’s or Children’s Social Care.
  • If they provide or intend to provide a substantial amount of care on a regular basis.
  • If according to the carer, caring has a major impact on their life.

Carers have a right to an assessment of their capacity to continue to provide care for another individual even if the cared for person declines an assessment or services.

Where a satisfactory level of information about the carer and the cared for already exists, (for example, where the cared for person has already been assessed but does not want a service but meets the Directorates’ eligibility for services), it may be possible to proceed with the assessment of the carer’s needs without further enquiry.

Where the cared for person has not been assessed, and there is no record of a recent assessment for the cared for person, the local authority needs to ensure that a reasonable judgement about whether the conditions that give rise to the right of assessment have been met.

Where the cared for person is not known to the Directorate -in most cases where a carer is requesting an assessment and there is no record of a recent assessment having taken place, the local authority should first approach the cared for person to offer an assessment.

If the cared for person is not willing to be assessed, the local authority should use the Contact Assessment on either the cared for person or the carer themselves to make a reasoned judgement about the need to conduct a Carer’s Assessment. This could involve contacting their GP, carers’ organisations etc. To assist in this process Oxfordshire has produced a form on advice from the DoH. The Confirmation of Carer Status Form can be used to endorse their caring status while maintaining the privacy of the cared for person if that is their preference.

10.2 Caring at a Distance and Across Boundaries

Particular difficulties may be faced by carers who care for people who live a long way away or across local authority boundaries. Problems may be increased when caring for more than one person. These factors should be taken into account when carrying out a Carer’s Assessment. Local Authorities need to work in partnership to ensure carers’ needs are appropriately assessed and supported.

The basic principle is:

  • Where the carer cares for one person who is eligible for support by community care services, it is the cared for person’s local authority who has responsibility for the Carer’s Assessment and provision of service, even if the service is arranged in a different local council area.
  • Where the carer is caring for two people who live in two different authorities, those authorities should agree between then how best to conduct the Carer’s Assessment and provide the services.

Carers Assessments can be provided as a joint carer/client Assessment or as a separate Carer’s Assessment. It may be that a joint assessment is carried out in the first instance and a separate Carer’s Assessment is carried out at a later date.

10.3 Carers Recognition and Services act 1995

This Act gives carers who provide substantial and regular care for someone who is eligible for community care services or a disabled child the right to request a Carer’s Assessment. Carers’ needs are to be taken into account when services are provided to the user.

10.4 The Carers and Disabled Children act 2000

This Act gives carers the right to an assessment of need even if the person they care for refuses an assessment, and to receive services in their own right, which can be made through direct payments.

Assessment information gathered during an assessment under the Carers (Recognition and Services) Act 1995 can be taken account of in assessment conducted under the Carers and Disabled Children Act 2000 and vice-versa.

10.5 Carers (Equal Opportunities) act 2004

This Act seeks to give carers more choice and better opportunities to lead a more fulfilling life by ensuring that carers receive information about their rights under the Carers and Disabled Children Act 2000. It also ensures that carers’ assessments consider leisure, training and work activities, and provides for co-operation between local authorities and other bodies, including housing, education and health, in relation to the planning and provision of community care services that are relevant to carers. It introduces three new measures:

  • A duty on local authorities to inform carers of their entitlement to an assessment of their needs.
  • A duty on local authorities to consider a carers outside interests when carrying out an assessment and take into account whether the carer:
    • Works or wishes to work,
    • Is undertaking, or wishes to undertake, education, training or any leisure activity.
  • A duty on NHS organisations, local education authorities & local housing authorities to give “due consideration” to requests by the local authority to become involved in planning services for carers or to provide assistance to individual carers.


11. Good Practice Guidance

  • A carer may be identified by a number of different routes – see flow diagram below.
  • Any interaction with carers, formal or informal, should be seen as an opportunity to inform them of their rights to receive a Carer’s Assessment and of services such as Carers’ Centres who are able to support them.
  • Carers identified should be advised that they can take part in a Joint Carer/Client Assessment if the cared for person is in agreement or that they have a right to a separate Carer’s Assessment.
  • Care Managers/Social Workers should leave referral/self assessment forms for a carer to complete and consider a full assessment. These forms can be returned directly to the Care Manager/team involved.
  • Carers should be informed that they can have a friend or advocate present for their assessment.
  • Some carers will require longer than others to open up and share their concerns. Sometimes an assessment will be accumulative rather than a one off process.
  • A practitioner should be aware of issues of confidentiality that may need to be considered between the carer and the cared for person. This should be respected.
  • In exceptional circumstances it may be necessary to have a different person carry out the Carer’s Assessment from the cared for persons assessor.
  • A separate carer’s file must be opened where a carer has: a separate Carer’s Assessment and/or carer’s service following an assessment.
  • If carrying out a joint carer/client assessment the carer needs to be informed that their personal details will be recorded on the clients file and on our electronic record Framework-I.
  • The carer should be informed about the use of Framework-I and that the Out of Hour’s Duty Team will be able to access their details in an emergency.
  • Determine the support needs by considering the impact on;  
    • Health and wellbeing,
    • Ability to remain at work or return back to work,
    • Education, training and leisure,
    • Other relationships and responsibilities,
    • Income,
    • Cultural and religious needs,
    • Parenting capacity.

A carer should always receive a copy of their assessment and a signed Care Plan Agreement, with clear outcomes using;

  • Information and advice,
  • Breaks,
  • Carers services.

Record all Carers Assessments on Framework-I including information required for the performance indicators.

Review the carer’s care plan as part or the care plan review, and record on Framework-I when completed.


12. Prompt Sheet for Carers Assessment

This prompt sheet is here to help carer or Care Manager think through what you might want to consider as part of the Carer’s Assessment. When taking into account these prompts please give thought to not only how things are at present but how they may be in the foreseeable future.

Preferred Language

As well as being able to provide services for other languages please consider whether any other types of interpretation may be required.

Makaton sign language Deaf/Blind Manual
Hands on British sign Language
Electronic Communicator Other sign language

Carer's Views

1.

Carers Role and Autonomy

  • How do you see the current situation?
  • Do you feel that you have a choice in caring?
  • How willing are you to provide care? Are you willing to continue?
  • Are there any children living at home? Are they undertaking a caring role? How are they affected by the situation?
  • How is your relationship with the person you care for? Is it strained or has it become strained by the caring role?
  • Do you feel that your role will get more extensive in the near future/next 4 months?
  • Does your caring role undermine the relationship or other roles you have with the cared for person? e.g. being parent or breadwinner.
  • Has caring impacted on your religious/cultural needs?
2.

Existing Support

  • Social and Health care, Health professionals, friends, family, carers centre, young carer’s project worker, school/ college, other voluntary/private agencies.
  • Are you able to take an uninterrupted break? How often?
  • Do you get a break at appropriate times of the day/week?
  • Do breaks give you time for yourself apart from daily living tasks?
  • Who takes over when you’re away?
  • If things go wrong do you know how to complain?
  • What would happen in an emergency if you were prevented from caring?
  • Do you know who to contact in an emergency?
  • Are any plans in place?
  • Has the cared for person had a Social and Health Care Assessment?

Managing Daily Routines

3.

Housing/Accommodation

  • Are there difficulties looking after your home and daily tasks such as shopping, cooking, cleaning etc.?
  • Are there difficulties with transport or rural isolation?
  • Are there accommodation issues for the person you care for such as adaptations needed or disrepair etc.?

Finances

  • Do you support the cared for person financially?
  • Is there financial hardship?
  • Any problems with debt/rent or mortgage arrears?

Health and Safety

4.

Your Health and Safety

  • Do you have any major/minor health problems?
  • Are you on medication/receiving medical treatment?
  • Are you receiving treatment that affects your role as carer?
  • Are you worried about your health?
  • Are you worried about your safety or that of the person you care for?
  • Is there a risk to your health from your caring role? Do any of the tasks put you or the cared for person at risk?
  • Do you need help dealing with the risk?
  • Do you find the caring role tiring?
  • Are you getting enough sleep?
  • Is your GP supportive in your caring role?
  • Is your GP aware that you are a carer?
  • Do you have any concerns about antisocial behaviour in public?

Your Emotional Well-being

  • Do you have emotional support?
  • Are you feeling low or worried?
  • Is stress, anxiety or depression present?
  • Do you have any other mental health concerns?
  • Does your caring role affect your other relationships?
  • Are there other pressures on you or your family?

Involvements

5.

Employment, Education, Training and Leisure Activities

  • What impact does caring have on your work/education or training?
  • Is there a risk that caring will affect these commitments?
  • Are you having to give up your work, education or training because of your caring commitments?
  • Do you wish to continue or return to work education or training?
  • Have options been explored or do you need more information?
  • Is your employer/school aware of your caring role? Are they supportive?

Breaks, Social Life and Wider Responsibilities

  • Are you able to keep up with hobbies and friendships outside caring role?
  • Do you get a chance to go on holiday with or without the cared for person?
  • What other responsibilities do you have outside of caring?
  • Does balancing these create any problems?
  • Do you have problems with pets?

Outcomes

6.

What Would Help?

  • What further information would be useful for yourself or the person that you care for i.e. Health advice, support, etc.?
  • Do you have information you need about other services?
  • Activities for the person you care for.
  • Someone to take over to give you a short break?
  • Would you like to know about day-care?
  • Would you like the cared for person to have respite away from home?
  • Would you like to look into full time residential options?
  • Do you need information on housing advice such as re-housing/ house renovation/ equity release etc.?
  • Do you need someone to talk to?
  • Are you aware of support groups/carers advocacy that could help?
  • What would happen in an emergency, or if you could no longer care?
  • Do you need to speak to someone about dealing with risk?
  • Do you need advice on benefits or Court of Protection?
  • Is there a need for specialist equipment such as hoists/ adaptations to the house?
  • Do you need advice for other family members?
  • If you have Internet access would it be helpful to have some website addresses?
  • Training or information on household duties such as cooking, finance etc.?
  • Training or information on health issues such as manual handling?

Ethnicity

Please consider the following categories and then select the one that you feel best describes your ethnic group.

Asian or Asian British any other Asian background Black or Black British any other Black background Mixed or any other mixed background
Asian or Asian British Bangladeshi Black or Black British African Mixed White and Asian
Asian or Asian British Indian Black or Black British Caribbean Mixed White and Black African
Asian or Asian British Pakistani Chinese Mixed White and Black Caribbean
White any other background White British White Irish

Any other ethnic group Not given

Information on the Collection of Ethnic Group Data

Why do we Need Ethnic Monitoring?

In order to ensure we are providing a service that meets the needs of the local population we need to:

  • Find out who is using our services,
  • Find out whether our services are accessible to everyone who needs to use them,
  • Identify which groups are under-using or over-using particular services,
  • Stimulate and guide staff response to the varied customs, beliefs and needs of different ethnic groups.

How Have Categories Been Selected?

  • These classifications are based on the ethnic group categories used in the 1991 Census, allowing comparison with Census data.
  • In Oxfordshire from 1 April 1995, all Social and Health Care clients have been asked for their ethnic group. This information will be recorded in line with the 1991 Census question to make data collection consistent.

Who will see This Information?

  • Information on an individual’s ethnic group is STRICTLY CONFIDENTIAL.

How do I Answer the Ethnic Question?

  • Firstly it is important to note that everyone has an ethnic group and can answer the question.
  • Using the prompt sheet please indicate the ethnic group category to which you feel you belong.

Click here to view flowchart.

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