Eligible Care Needs: What are they?

The Care Act 2014 introduced the concept of Eligible Care Needs in order to establish national criteria so there is no longer a “post code lottery” in terms of one local authority agreeing to pay for someone’s care and another refusing a broadly similar request.

Many of the articles in this section of my website deal with the financial implications of care and understanding these Eligible Care Criteria is of paramount importance, as much of what else I am commenting on elsewhere hinges upon Granny having Eligible Care Needs.

Fundamentally, Granny has to have Eligible Care Needs before the Local Authority will make a contribution to her care costs. Consequently, you may consider that Granny can no longer safely live in her own home and that she needs to go into a Care Home, but if the Local Authority doesn’t share that view, there will be no contribution to costs, regardless of whether Granny would qualify on financial grounds alone. The Local Authority may well consider that Granny can stay at home, supported by Carers.

So, with effect from April 2015, Granny meets the eligibility criteria if:

  • her needs arise from or are related to a physical or mental impairment or illness
  • as a result of these needs Granny is unable to achieve two or more of the activities of daily living specified below
  • as a consequence there is, or is likely to be, a significant impact on the Granny’s well-being.

The specified activities of daily living are:

  • managing and maintaining nutrition
  • maintaining personal hygiene
  • managing toilet needs
  • being appropriately clothed
  • being able to make use of Granny’s 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 Granny has for a child

For the purposes of the regulations, Granny is to be regarded as being unable undertake an activity of daily living if she:

  • is unable to achieve it without assistance
  • is able to achieve it without assistance, but doing so causes Granny significant pain, distress or anxiety
  • is able to achieve it without assistance, but doing so endangers or is likely to endanger the health or safety of Granny, or of others
  • is able to achieve it without assistance but takes significantly longer than would normally be expected.

Where the level of Granny’s needs fluctuates, in determining whether her needs meet the eligibility criteria, the Local Authority must take into account Granny’s circumstances over such period as it considers necessary to establish accurately her level of need.

The background to all of this is the parlous state of the public finances, with funding for Adult Social Services being cut. ADASS (The Association of Directors of Adult Social Services) commented in July 2014, “Adult social care services in England will soon be `unsustainable’ if current budgetary pressures continue, and significant measures are not taken to inject new money into local social care economies”. In 2018, the Local Government Association estimated that adult social care services faced a £1.5 billion funding gap by 2019/20, and £3.5 billion gap by 2024/25. It has only got worse since! It will come as no surprise, therefore, that there is pressure on the people conducting the needs assessments, some of which are outside agencies, to err on the side of declaring Granny’s needs as ineligible. It is as a direct result of pressure from ADASS that the care cap has been postponed.

Public policy is for Granny to stay in her own home as long as is reasonably practicable, but this is a double-edged sword as this means the Local Authority can claim Granny is not failing any of the activities of daily living because the carers they send are providing the requisite assistance. These are the notorious 15-minute appointments two, three or four times a day, often fulfilled by a plethora of underpaid and overworked individuals.

If you or someone you care for has a care issue, please do not hesitate to contact me for advice by completing the following form:

    - Care Fees Planning

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    About Clive Barwell

    Clive Barwell is one of the most experienced and qualified financial planners working in the later life market today, he specialises in advice and guidance for the over 55s. To ask Clive a question, please email him at info@clivebarwell.co.uk. Alternatively, you can follow Clive on Twitter, connect with Clive on LinkedIn or see Clive's profile on Google+.