Care Act 2014: Overview

• The Care Act 2014 is being overviewed, focusing on specific provisions for care and support this week.
• Safeguarding of Adults under the Act will be focused on the following week.

Replacement of Previous Laws

• The Care Act 2014 supersedes several prior legislations
• These are the National Assistance Act 1948
• NHS and Community Care Act 1990
• Community Care (Direct Payments) Act 1996
• Chronically Sick and Disabled Person Act 1970
• Carers (Recognition and Services) Act 1995

Aims

• Aims include clarifying relationships between care provision, support, MCA05, and MHA83
• Strives for greater cohesion between healthcare and social care
• Seeks more opportunities for contracting out local authority responsibilities, increasing the care market economy, but with exceptions

Core Concepts

• The Act promotes wellbeing, as outlined in Section 1
• Focus is on preventing, reducing, or delaying the need for care and support (s2)
• It Includes co-production, recognizing individuals as experts in their needs
• People should be included in assessment and decision-making
• Provides protection, minimum interference in rights, and collaboration in commissioning services, as per the Act's regulations and statutory guidance

S1(2) Wellbeing

• Promoting individual well-being is key
• Local authorities are responsible for promoting individual well-being when exercising their functions
• "Well-being" relates to personal dignity, treatment with respect, physical and mental health, emotional well-being and protection from abuse and neglect
• It also relates to control over day-to-day life, including care and support, participation in work, education, training, recreation, social, and economic well-being
• Plus, it includes domestic, family, and personal relationships
• This includes suitability of living accommodation, and the individual's contribution to society

Provision for Community Care

• Section 2 introduces the duty to prevent needs from arising
• Section 3 focuses on greater integration of budgets with NHS
• Larger pooled budgets are available for key pressure points
• Step-down and re-ablement services aim to get people out of the hospital faster, which is exemplified by the Better Care Fund

Assessing an Adult in Need

• Section 9(1) dictates that if a local authority believes an adult requires care and support, they must assess
• The assessment determines if the adult needs care, support, and what those needs are
• Section 9(3) specifies that assessment applies regardless of the anticipated outcome
• Draft guidance suggests the assessment adopts a "whole family" approach, focusing on desired outcomes
• Section 9(5) states assessments must involve the person, their carers, and anyone else the person wants to include to the extent of capacity
• It should involve anyone who "appears to the authority to be interested in the adults welfare" if they lack capacity
• The assessment and eligibility process serves as the primary interaction between the local authority and the individual
• It is a critical intervention for understanding situations and accessing support
• Assessments should be appropriate, proportionate, and conducted by agencies working together to avoid multiple assessments

Refusing Assessments

• Section 11 grants individuals the right to refuse assessment if they have the capacity to decide
• The local authority proceeds if the assessment and possible care would be in the person's best interests per MCA05 principles
• Also if the person is at risk of abuse or neglect

Eligibilty Criteria

• An adult meets certain requirements
• Their needs stem from a physical or mental impairment or illness
• The adult's needs prevent them from achieving two or more of the specified outcomes
• Consequently, there is, or is likely to be, a significant impact on the person's well-being

Specified Outcomes

• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs and being appropriately clothed
• Being able to use 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
• This includes public transport and recreational facilities or services
• Also, it includes carrying out caring responsibilities for a child

Case Study: James Smith

• James Smith is 32 years old and lives alone in a rented flat
• He has been unemployed for two years due to mental health issues
• James has Generalised Anxiety Disorder (GAD) and recurrent depression
• He has minimal family contact and a few distant friends
• James struggles with daily living tasks, feels isolated, and experiences worsening anxiety

Needs Assessment: James

• The local authority is referred from his GP requesting a Care Act needs assessment and a social worker conducts the assessment
• James consents to assessment because it is person-centered
• The social worker considers James' physical, mental, and emotional wellbeing
• James is encouraged to identify what he can do independently

Impact on James

• James neglects bathing due to lack of motivation and anxiety
• He skips meals or eats unhealthy takeaways and his flat is cluttered
• James feels isolated and avoid socialisation
• James is unable to work due to severe anxiety
• Missed rent payments and mounting debts are issues
• He lacks engaging leisure activities and has worsening depression

Outcome of Assessments: James

• The assessment highlights James' mental health condition compromises his wellbeing across multiple areas
• The social worker decided that James meets the national eligibilty criteria which is used to develop a support plan
• Communtiy mental heath services is contacted
• Financial and health support will be given to James

Assessing Carers' Needs

• Previous legislation allowed, but did not require, assessment of carers
• Section 10 now mandates assessing carers' needs for support and what those needs might be in the future

Advocacy

• Section 67 of the Care Act 2014 requires local authorities to provide independent advocacy
• It is for individuals with substantial difficulty in the care process who lack appropriate support and duty applies from initial contact
• Substantial difficulty includes understanding, retaining, using, or communicating information
• An independent advocate must be provided if someone has "substantial difficulty" in being involved (S67(4)) and lacks support
• Citizens Advice Sheffield provides advocates

Financial Assessment

• There are financial assessments completed to see if they can pay

Social Care and the Ability to Pay

• Social care is not free, unlike health care
• Eligible individuals are financially assessed
• Those on minimum benefits may pay a small amount while others contribute more
• The local authority covers the difference between the package's cost and the person's contribution
• Individuals earning enough pay the full care cost
• Local authorities have financial teams for light-touch or thorough assessments

Direct Payments

• After eligibility is reached, the local authority must explore if individuals want services or money to manage the commissioning of care
• Allows for choosing services or employing personal assistants
• This route offers a flexible, person-centered approach to care (s31/32)

Tasks

• Evaluate how the wellbeing principle's apply
• Identify ways to promote independence, dignity, and social inclusion
• Determine if the patient(s) meet the eligible criteria and determine what their specified outcomes are

Case Study 1: Jenny

• Jenny is 43 years old and has multiple sclerosis
• She experiences difficulty managing daily tasks, has no immediate family, and is increasingly isolated because of mobility problems
• She would eventually like to return back to work, or volounteer

Case Study 2: John

• 32-year-old John was referred by his mother for an assessment
• He is unemployed and still lives with his mother who is getting older
• John takes care of his personal hygiene but the mother does all the housework
• John needs to be intellectually stimulated, and a near chess club would be beneficial to him
• He is not confident attending due to anxiety

Case Study 3: Sara

• 78 year old Sara lives alone in a 2 stone building and suffers from arthritis and is recoving from surgery
• She has limited mobility, cannot use the stairs, struggles to prepare meals and maintain personal hygiene
• She needs to take regular medication and often forgets
• The house is becoming very messy and she struggles to take care of it