1. Putting the Care Act into practice: For Information and Advice Providers

2. 2 Applying the Care Act to Practice Overview The Care Act 2014 relates to the provision of care and support for adults. It sets out the responsibilities of Local Authorities to provide information and advice to all citizens, to assess anyone with the appearance of needs, and to provide care and support to all those assessed as having eligible needs under a new national eligibility criteria. Learning outcomes This session will enable you to understand and cascade:  The key principles of the Care Act 2014 and how it will be delivered in Norfolk  Information and advice requirements under the Act  The role of an independent advocate and when one would be appointed  Making an eligibility determination  Support for carers  Key changes in financial support for adult care

3. 3 Timeline Date May/June 2013Formal Bill Summer 2013Consultation with Local Authorities September 2013Norfolk County Council sent response to consultation 15 May 2014Care Bill became the Care Act June 2014Consultation on draft regulations and guidance for April 2015 September 2014Norfolk County Council sent response to consultation October 2014Regulations introduced to Parliament and Guidance published January 2015 (due Nov/Dec 2014) Launch of consultation on draft regulations and guidance for the introduction of: the cap on care costs; extension to the means tests; and care accounts April 2015Implementation of a number of requirements October 2015Regulations introduced to Parliament and Guidance published April 2016Implementation of the Dilnot requirements

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5. The Care Act 2014 replaces : 5 1948 1960… 1970… 1980... 1990… 2000… 2010… National Assistance Act 1948 NHS and Community Care Act 1990 Carers (Recognition and Services) Act 1995 Chronically Sick and Disabled Person Act 1970 Community Care (Direct Payments) Act 1996

6. Part 1: Background 6 Assessment and eligibility Charging and financial assessment Care and support planning Personal budgets and direct payments Review Key processes Prevention Integration, partnerships and transitions Information, advice and advocacy Diversity of provision and market oversight Safeguarding General responsibilities and key duties Wellbeing Underpinning principle

7. Part 1: Background 7 Self-help information Websites, leaflets, NHS Choices etc No interaction Assisted information Telephone helplines, directories, libraries, one stop shops, CAB, charities, information centres, GPs, frontline staff etc Limited to moderate interaction Advice Telephone lines, information centres, one stop shops, CAB, support groups, carers centres, CIL, social workers, GPs, outreach staff/workers etc Moderate to high interaction Specialist advice and advocacy Independent financial advisers, legal help on complex matters in specific areas of law, independent advocates High interaction

8. Part 1: Background  Local authorities do not have to provide all elements of this service:  Coordinate, ensure coherence of overall offer, signpost to relevant information & advice providers  What needs to be provided:  Information about care and support in Norfolk  How people can access this  Financial information and advice about care and support  How to raise concerns about the safety or wellbeing of someone who has care and support needs 8

9. Part 1: Background  The local authority must provide financial information and advice, including:  understanding care charges  ways to pay  money management  As well as identifying those who may benefit from independent financial advice or information and help them to access it  Broader awareness raising about how care and support is funded 9

10. Part 2: Independent Advocacy 10  Duty to arrange for independent advocate Is there an ‘appropriate individual’ – a carer, friend or relative – that can facilitate their involvement?  Agree ‘appropriate individual’  Provide support and make adjustments Yes No Might this person have difficulty in being involved? Can they be better supported to enable their involvement? [Reasonable adjustments under the Equality Act 2010] Yes Do they still have ‘substantial difficulty’ in being involved? Yes

11. Part 2: Independent Advocacy 11 Understanding relevant information Retaining information Using or weighing up the information Communicating their views, wishes and feelings

12. Part 2: Independent Advocacy 12 Considerations Who is appropriate to support and represent the person? Is a family member or friend an appropriate individual? Must Be able to facilitate the individual’s active involvement with the process The person who is supported must agree to the suggested ‘appropriate individual’ Must NOT Be someone already providing the person or their carer with care or treatment in a professional capacity or on a paid basis. It cannot be a paid carer, GP, nurse or key worker etc.

13. Part 2: Independent Advocacy Case Study Mishal Do you think Mishal has substantial difficulty in being involved in the assessment process? What steps would you take to support her involvement? 13

14. Part 3: Assessment and eligibility determination  Information, advice and preventative services come first  Assessment is a critical intervention  An assessment will involve:  Identifying the outcomes important to the individual to maintain or improve their wellbeing  Looking at what’s good, at the person’s networks, whole family approach  Providing information and advice and preventative services that will help to achieve those outcomes or reduce or delay needs from arising  A decision on whether the person has eligible care and support needs  How care and support might help achieve the outcomes that are important to the individual and address their needs 14

15. Part 3: Assessment and eligibility determination 15 Deferred payment agreement Information, advice, preventative services Assessment Are their needs eligible? YES NO (written explanation) Financial assessment Advice and information Appearance of needs, strengths-based New eligibility threshold Written explanation & advice Universal scheme

16. Part 3: Assessment and eligibility determination The Act introduces a national eligibility threshold: All THREE conditions must be met for a person to have eligible needs.  whether the person has needs due to a physical or mental impairment or illness  whether those needs mean that they are unable to achieve two or more specified outcomes  as a consequence there is, or is likely to be, a significant impact on their wellbeing Eligibility determination must be made without taking into account the needs that are being met by a carer 16

17. 17 Part 3: Assessment & eligibility determination An adult meets the eligibility criteria if: Their needs are caused by physical or mental impairment or illness As a result of the adult’s needs they are unable to achieve two or more specified outcomes As a consequence there is or is likely to be a significant impact on the person’s well-being This includes conditions such as: Physical illness or disability Mental illness Sensory impairment Learning disability Cognitive disability or illness Brain injury Impairments that arise from substance misuse Frailty All the above can be based on the assessor’s judgement and formal diagnosis is not required. Step 1:

18. 18 Part 3: Assessment & eligibility determination An adult meets the eligibility criteria if: Their needs are caused by physical or mental impairment or illness As a result of the adult’s needs they are unable to achieve two or more specified outcomes As a consequence there is or is likely to be a significant impact on the person’s well-being The specified outcomes are: Managing and maintaining nutrition Maintaining personal hygiene Managing toilet needs Being appropriately clothed Being able to make use of the home safely Maintaining a habitable home environment Developing and maintaining family or other personal relationships Accessing and engaging in work, training, education or volunteering M aking use of necessary facilities or services in the local community including public transport and recreational facilities or services Carrying out any caring responsibilities the adult has for a child Step 2:

19. 19 Part 3: Assessment & eligibility determination As a result of the adult’s needs they are unable to achieve two or more specified outcomes An adult is to be regarded as being unable to achieve an outcome if they: are unable to achieve it without assistance; are able to achieve it without assistance but: doing so causes them significant pain, distress or anxiety; doing so endangers or is likely to endanger health or safety; takes significantly longer than would normally be expected. Step 2:

20. An adult meets the eligibility criteria: Their needs are caused by physical or mental impairment or illness As a result of the adult’s needs they are unable to achieve two or more specified outcomes As a consequence there is or is likely to be a significant impact on the person’s well- being Wellbeing:  Personal dignity  Physical, mental & emotional health  Protection from abuse & neglect  Control over day to day life  Participation in work, education, training and recreation  Social and economic wellbeing  Domestic, family and personal relationships  Suitability of living accommodation  An individual’s contribution to society 20 Part 3: Assessment & eligibility determination Step 3:

21. Part 3: Assessment & eligibility determination Case Study Dina Do you think that Dina has eligible needs? Use the eligibility table to evidence your answer

22. Time for a break! 22

23. Part 4: Carers The Care Act strengthens the rights and recognition of carers:  Improved access to information and advice  Emphasis on prevention  Adults and carers have the same rights to an assessment on the appearance of needs  A local authority must meet eligible needs of carers and prepare a support plan  A carer should be kept informed of the care and support plan of the person they care for 23

24. Part 4: Carers  Information, advice, preventative services  Carer’s assessment a critical intervention  An assessment will cover:  The care provided  The outcomes that matter to the carer  The impact this care is having on their physical, mental and emotional health and ability to undertake activities outside of caring  Sustainability of the caring role  Information, advice and preventative services that could assist the carer  Eligibility  Support plan 24

25. Part 4: Carers  The Act introduces a national carers’ eligibility threshold:  whether the carer’s needs are due to providing necessary care for an adult  whether those needs puts the carer’s health at risk or means that they are unable to achieve specified outcomes; and  as a consequence there is, or is likely to be, a significant impact on their wellbeing 25

26. 26 Part 4: Carers A carer meets the eligibility criteria if: Their needs are caused by providing necessary care for an adult. As a result: their health is at risk or they are unable to achieve specified outcomes As a consequence there is or is likely to be a significant impact on the carer’s wellbeing The specified outcomes are: Carrying out any caring responsibilities the carer has for a child Providing care to other persons for whom the carer provides care Maintaining a habitable home environment Managing and maintaining nutrition Developing and maintaining family or other personal relationships Engaging in work, training, education or volunteering M aking use of necessary facilities or services in the local community including recreational facilities or services Engaging in recreational activities

27. 27 Part 4: Carers A carer meets the eligibility criteria if: Their needs are caused by providing necessary care for an adult. As a result: their health is at risk or they are unable to achieve specified outcomes As a consequence there is or is likely to be a significant impact on the carer’s wellbeing A carer is to be regarded as being unable to achieve an outcome if the carer: is unable to achieve it without assistance; is able to achieve it without assistance but: doing so causes them significant pain, distress or anxiety doing so endangers or is likely to endanger health or safety

28. A carer meets the eligibility criteria if: Their needs are caused by providing necessary care for an adult. As a result: their health is at risk or they are unable to achieve specified outcomes As a consequence there is or is likely to be a significant impact on the carer’s wellbeing Wellbeing:  Personal dignity  Physical, mental & emotional health  Protection from abuse & neglect  Control over day to day life  Participation in work, education, training and recreation  Social and economic wellbeing  Domestic, family and personal relationships  Suitability of living accommodation  An individual’s contribution to society The specified outcomes are: Carrying out any caring responsibilities the carer has for a child Providing care to other persons for whom the carer provides care Maintaining a habitable home environment Managing and maintaining nutrition Developing and maintaining family or other personal relationships Engaging in work, training, education or volunteering Making use of necessary facilities or services in the local community including recreational facilities or services Engaging in recreational activities 28 Part 4: Carers

29. Case Study Dora Do you think Dora has eligible needs? Part 4: Carers

30. Part 5: Summary 30 Information advice & prevention Reablement Assistive technology Services available in the community Independent financial advice Assessment Outcomes Networks Information & advice Eligibility determination Eligible needs met through care and support plan Universal services Personal networks & communities Funded services (PB) Non-eligible needs Information Advice Signposting

31. Part 6: Financial changes  Care Act guidance:  Must/Should/May  Reasonable  Proportionate  Accessible 31

32. Part 6: Financial changes 32  Intermediate care including reablement (for up to six weeks)  Aids, and minor adaptations of less than £1,000  Care and support provided to people with CJD  After care/support provided under Mental Health Act 1983 s117  NHS services  Any services which an authority is under a duty to provide through other legislation Where services remain non-chargeable:

33. Part 6: Financial changes Right person, right place, right time: 33  Enduring Power of Attorney (EPA);  Lasting Power of Attorney (LPA) for Property and Affairs;  Lasting Power of Attorney (LPA) for Health and Welfare;  Property and Affairs Deputyship under the Court of Protection; or  Any other person dealing with that person’s affairs (e.g. someone who has been given appointee-ship by the Department for Work and Pensions (DWP) for the purpose of benefits payments).

34. Part 6: Financial changes Charging Policies and Schemes 34  Residential Charging Policy  Non-Residential Charging Policy  Deferred Payments Scheme  Debt Recovery Scheme

35. Part 6: Financial changes 35 Residential Care Charges - 1st April 2015 Norfolk County Council’s Residential Charging policy (based on the Guidance in the Care Act). Differences, the policy:- 1.Removes the need to disregard the property for people who have been self-funding and their capital has fallen below £23,250. 2.Sets out our criteria for disregarding property and introduces a Disposable Income Allowance for those entering into a Deferred Payment Agreement.

36. Part 6: Financial changes  Non-residential charges - 1st April 2015 36 Non-residential charges -1st April 2015 Norfolk County Council’s Non-Residential Charging policy (based on the Guidance in the Care Act). Differences:- 1.Arrangement fee for self-funders 2.Individual financial assessments 3.Deferred Payments offered to those in Supported Living/Housing With Care but no 12 week disregard. 4.Financial assessments for people in prison. 5.No charge for Carers.

37. 37 Deferred Payment Agreements - From April 2015 HASSASSA is repealed under the Care Act. A Universal Deferred Payments Scheme will operate for those entering residential care/HWC/SL after 1 April 2015. Will be offered to all who meet the criteria. Will charge an administration charge. Part 6: Financial changes

38. 38 Deferred Payment Agreements - From April 2015 Interest will accrue on the balance – 2.65% as at April 2015 – calculated daily and applied four weekly. Will pursue after 90 days where the person has died. There will be an equity limit – value less 10% less £14,250. Anyone awarded Continuing Health Care should still make a part- payment towards their DPA. Have to provide a six monthly statement.

39. Part 6: Financial changes Deprivation of Assets  Deprivation of assets refers to where a person has intentionally deprived themselves of or decreased their overall assets in order to reduce the amount they are charged towards their care.  If a person deliberately tries to avoid care and support costs through deprivation of assets, we may charge the person as if they still possessed the asset. 39

40. Part 6: Financial changes Recovery of debts  The existing powers under S22 of HASSASSA 1983 will no longer apply from 1 April 2015.  We must negotiate and mediate wherever possible and ensure the person is advised of the charge in a timely manner.  As a last resort we can pursue the debt via the County Court. 40

41. Part 6: Financial changes Exercise 1: Marjory’s mum has dementia and Marjory has been caring for her for some time but is now struggling with this. Marjory is really worried about finances and whether her mother can afford to pay for care. What would you advise Marjory to do? 41

42. Part 6: Financial changes Exercise 2:  Bob Jones has recently been gifted a property from his father. His father has just moved into residential care and Norfolk County Council has asked Bob to provide some information about the property. Bob is really worried about this and comes to see you for some advice on what to do. What advice would you give Bob? 42

43. Part 7: Learning resources and training planning This session covers:  An overview of the learning resources available  How you will disseminate the information in your organisation 43

44. 44 Part 7: Learning materials A workbook  written for learning facilitators, includes exercises, suggested group discussions, points of reflection and scenarios. A PowerPoint presentation  To be used alongside the workbook Resources list  As well as resources used today we have provided a list of other sources of learning information Social Care Information and Learning Services (SCILs) 44

45. 45 Part 7: Planning Discuss in groups – How will you disseminate information about the Care Act in your organisation? For instance have you?  read the relevant sections of the Act, regulations and guidance  a good understanding of best practice  chosen the most suitable modules for your learning programme  mixed questions, exercises and case studies from the workbook or from other topic areas  designed your training to maximise the experience and learning outcomes for your participants (if so how) 45

46. 46 Thank you…and goodbye! 46