Eligibility for care and support

Local authorities, or councils, have a threshold for the level of social care they provide, which is meant to balance people's need for social care services with how much the local authority wants to spend on those services. If they do not provide social care services to everyone who needs them, they must make sure those with the greatest need are prioritised. These thresholds are known as 'eligibility criteria'

The Care Act 2014 introduced national minimum eligibility criteria. This means there is a national minimum threshold at which disabled and older adults - and their carers - are entitled to support. This replaces the old 'FACS' criteria of low, moderate, substantial, and critical.

The minimum threshold is based on identifying how a person's needs impact on their ability to achieve certain 'outcomes', and whether this has a significant impact on their wellbeing.

The terms 'outcomes', 'significant impact' and 'wellbeing' are very important when looking at eligibility for care and support. We will explain these in a bit more detail here.

There are two types of outcomes that are important:

• Desired outcomes: These are the outcomes a person wants to achieve so they can lead their life in a way that maintains or improves their wellbeing. Desired outcomes will vary from one person to another because each individual is different. These are the outcomes that the needs assessment should focus on.
   
• Eligibility outcomes: These outcomes set out the minimum level of support that local authorities must provide under the national threshold. These are the outcomes that the decision as to whether someone is eligible for support or not should be based on.

There is one list of eligibility outcomes for adults with care and support needs and another list for carers with support needs

As a result of your needs, you must be unable to do two or more of the following things:

Outcomes for adults with care and support needs:

• 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 for a child

As a result of your needs, you must be unable to do any one of the following things:

• Outcomes for carers with support needs:
• Carrying out any caring responsibilities for a child
• Providing care to other persons for whom the carer provides care
• Maintaining a habitable home environment in the carer's home, whether or not this is also the home of the adult needing care
• 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.

The definition of the word "unable" is important. The Care Act states that being "unable" to do something actually means that without help, you would be in "significant pain, distress or anxiety", or it would take you significantly longer.

What has a 'significant impact' on someone will be different from one person to another. The information gathered in the needs assessment must be looked at fully to establish whether there is indeed 'significant impact' on the person's wellbeing.

Significant impact could be caused directly, if a person is unable to achieve two or more of the eligibility outcomes and this affects at least one area of their wellbeing in a significant way.

Significant impact could be caused cumulatively, if a person has needs across several of the eligibility outcomes at a relatively low level but as these needs affect them in various areas of their life, the overall impact on their wellbeing is significant.

For example, a person could be struggling to manage and maintain their nutrition, personal hygiene and toilet needs due to a lack of social interaction and reducing mobility around their home. This means they are very close to being unable to meet these outcomes, but each of the individual care and support needs are relatively low. However, looking at all their various needs together adds up to a significant impact on their wellbeing.

Significant impact could also be caused by a 'domino effect', if currently a person has needs in relation to few eligibility outcomes, but it can be anticipated that in the near future other outcomes will be affected, causing a significant impact on their wellbeing.

For example, a person could be struggling to maintain relationships with their family and in accessing their local community, but currently not have any problems with managing and maintaining their nutrition, personal hygiene, toilet needs or a habitable home environment. However, they are depressed, which affects their ability to socialise. As a result, their emotional situation is worsening further so that it is clear that in the near future they also will not be able to manage or maintain nutrition, personal hygiene, toilet needs or a habitable home. Therefore, the impact on their wellbeing is significant.

'Wellbeing' is a general term that applies to lots of different areas to someone's life. In terms of the Care Act, it is described in relation to the following areas:

• Personal dignity
• Physical and mental health and emotional wellbeing
• Protection from abuse and neglect
• Control by the individual over their day-to-day life
• Participation in work, education, training or recreation
• Social and economic wellbeing
• Domestic, family and personal issues
• Suitability of living accommodation
• Contribution to society.

All of these things are as important as each other - there is no 'hierarchy'. There is also no single definition of wellbeing, as what this means will depend on the individual, their life and their aspirations. Looking at all these areas is vital to getting a clear understanding of a person's views and what wellbeing is to them.

The process
Eligibility for social care is determined through a 'needs assessment'. This means whether someone is eligible for support or not must be decided after a needs assessment has been carried out on that person.

Your local authority has a legal duty to carry out an assessment if it appears you may need social care services. It is a low threshold to trigger the duty to carry out an assessment - this means the local authority should just look at whether there is any realistic prospect that you may need services, and if so, you should be given an assessment.

The local authority should carry out an assessment of your needs, focussing on your desired outcomes. It should then look at whether you are unable to achieve two or more of the eligibility outcomes in your day-to-day life, and if as a result there is a significant impact on your wellbeing. This mustn't consider whether a carer might be meeting your needs at that time.

Determining if you're eligible for support

To have eligible needs, your needs must be caused by or related to a physical or mental impairment or illness. Whilst this is not the sort of language we would use; a learning disability is considered a mental impairment.

If the local authority determines that your needs are

1. Caused by a physical or mental impairment or illness,
2. That you are unable to achieve two or more of the eligibility outcomes
3. That this has a significant impact on your wellbeing, then your needs are eligible for support.

This means the local authority must meet those needs

Support for carers
For the first time, local authorities have a duty to meet the eligible needs of carers. This is really important as it means more carers have a right to support to help them maintain their own wellbeing whilst undertaking their caring responsibilities.

Prevention
The minimum eligibility criteria apply to all local authorities across England and no local authority can restrict eligibility beyond this level - though they can choose to be more generous and provide support to people whose needs are not considered eligible. This means that local authorities can - and should - support people as early as possible to help maintain wellbeing and independence , and potentially prevent or delay more intense or longer-term care and support