The Care Act What you need to know

Fiona Denny Suffolk County Council Adult & Community Services Liz Taylor Suffolk Brokerage

Key principles and standards (1) An assumption that the individual is best placed to judge the individual’s wellbeing. Considering the individual’s views, wishes, feelings and beliefs. The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. The need to ensure that decisions are made having regard to all the individual’s circumstanc es. 17 December 2014Version 1.13

Key principles and standards (2) The importance of the individual participating as much possible. Achieving a balance between the individual’s wellbeing and that of any friends or relatives who are involved in caring for the individual. The need to protect people from abuse and neglect The need to ensure that any restriction on the individual’s rights or freedom of action is kept to the minimum. 17 December 2014Version 1.14

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The framework of the Act and its statutory guidance 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

The well-being principle Local authorities should also have regard to other key principles when carrying out their activities, such as beginning with the assumption that the individual is best-placed to judge their well-being. 7 “The general duty of a local authority, … in the case of an individual, is to promote that individual’s wellbeing”.

Well-being - definition Well-being is a broad concept, and the statutory guidance defines it as relating to the following nine areas in particular: 8

 Personal dignity (including treatment of the individual with respect)  Physical and mental health and emotional wellbeing  Protection from abuse and neglect  Control by the individual over day-to-day life (including over care and support provided and the way it is provided)  Participation in work, education, training or recreation  Social and economic wellbeing  Domestic, family and personal relationships  Suitability of living accommodation  The individual’s contribution to society.

Costs are capped There is a cap on expenditure on eligible care from April 2016 Every year the local authority Reviews your care needs and financial situation Keeps a record, from April 2016, called a care account, of how much eligible care you have needed in total How much you might pay for your care and support depends on your financial situation You have a financial assessment to see what you have to pay If you have care and support needs, you could be supported by… Assessment of the care and support you need, and eligibility for state support Information and advice on local services and how much they cost Reablement, rehabilitation and other free services How will people experience the new system in 2016/17? Support from family, networks community… 10

Changes to assessment, eligibility and financial assessment process 11 Deferred payment agreement Person appears to have needs Assessment Conversation 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

Information and Advice The guidance states that: “The breadth of the circumstances under which information and advice must be provided, and the overall duty to promote individual wellbeing, means that local authorities must ensure that the subject matters covered by their information and advice available to people in their areas go much further than a narrow definition of care and support” (3.23). 12

What is information and advice? 13 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

National eligibility framework The Act introduces a national eligibility threshold:  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. Local authorities can also decide to meet needs that are not deemed to be eligible if they choose to do so. 14

An adult meets the eligibility criteria: Their needs are caused by physical or mental impairment or illness As a result of the adults 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 individuals contribution to society 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 Making 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 New national eligibility threshold 15

Interpreting the eligibility criteria 16 An adult meets the eligibility criteria if: Their needs are caused by physical or mental impairment or illness As a result of the adults 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 An adult is to be regarded as being unable to achieve an outcome if the adult: 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; takes significantly longer than would normally be expected.

National carers eligibility framework The Care Act strengthens the rights of carers. Carers can be eligible for support in their own right (however our approach should be to look at support needs in an holistic way)  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.  Local authorities can also decide to meet carers’ needs that are not deemed to be eligible if they chose to do so. 17

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 well-being 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 significant pain, distress or anxiety, or is likely to endanger health or safety 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 18 Carers’ eligibility threshold Handout 9

Advocacy Where the local authority considers that a person has substantial difficulty in being involved with their care and support then they must consider whether there is anyone appropriate who can help the person to be fully involved, eg family member or friend. If there is no one appropriate, then the local authority must arrange for an independent advocate to support and represent the person in the assessment, care and support planning and the review. 17 December 2014Version 1.119

20 Assessment What are the needs and outcomes the person wants to achieve? Eligibility determination Are the person’s needs eligible? Met needs What needs can be/are being met through non- service provision? Unmet needs Are included in the personal budget

SLCC Assessment Conversations 21

Safeguarding Safeguarding now has a statutory base Local authorities are required to: – Make enquiries – Set up a Safeguarding Adults Board – Arrange for an independent advocate where appropriate – Co-operate with each of its relevant partners

Safeguarding Six Key Principles Empowerment – personalisation, presumption of person-led decisions and informed consent Prevention – it is better to take action before harm occurs Proportionality – proportionate and least intrusive response Protection – support and representation for those in greatest need Partnership – local solutions through services working in their communities Accountability – accountability and transparency in delivery

Charging changes from April 2015 Intermediate care is brought into line with NHS funded intermediate care Deferred Payments nationally available from April 2015 where previously only available in some areas Cannot charge a carer for services provided to the person they care for, even if this is to meet the carer’s needs for support 17 December 2014Version 1.124

Limits the amount people have to pay towards their eligible care and support needs and extends the point at which help is available. For the first time creates protection from the risk of catastrophic care costs for those unlucky enough to face the highest costs. A new partnership between the individual and the state that is fair for all. Funding reforms – April 2016

26 Element of reformHow this will be delivered Extend means-tested supportRevised upper and lower capital limits Care cap introduced£72,000 set in regulations Recording the cost of meeting eligible needs Personal Budget Independent Personal Budget Care costs only, not accommodation / ‘hotel’ costs or daily living costs Progress towards the capCare accounts & annual statement Support after reaching the capLA has ongoing duty to meet eligible needs Different approach for those of working age Free care for life (zero cap) for those born with an eligible need or who develop one in early life

Eligibility for LA support: Assets above the limits – pay for everything Between the upper and lower limits tariff income applies Assumes for every £250 of assets, can afford to pay £1 per week towards cost of care Tariff income + actual income = contribution to costs Care HomeAll Other Settings 2015 – upper limit£23, – lower limit£14, – upper limits£118,000 unless a property disregard applies £27,000 Or if a property disregard applied in a care home 2016 – lower limit£17,000 Extension to means tested support

Summary for Providers: New Opportunities Services aimed at prevention such as the different forms of intermediate care Independent advocacy Personal budgets and direct payments New services as a result of integration Delegation of local authority functions More demand for carer support