Understanding and Applying Eligibility Criteria (Carers)

1. Using this Procedure

This procedure should be used following assessment to establish whether any of a carer's identified needs are eligible needs under the Care Act.

Anyone identifying the eligible needs of a person with Care and Support needs should refer to the relevant procedure for their team/service.

2. Understanding the National Eligibility Criteria

The National Eligibility Criteria for Carers with Support Needs is defined in Section 13 of the Care Act.

The National Eligibility Criteria for Carers with Support Needs

3. Applying the National Eligibility Criteria

When to apply the criteria

The criteria must be applied after needs have been established through a adult carers assessment.

The responsibility for applying the criteria

Under the Care Act the Local Authority is responsible for applying the criteria and making the final decision about eligibility. As such this is your responsibility as you are the Local Authority's representative.

How to apply the criteria

There are 3 steps to applying the criteria as set out below. For a carer to be eligible you must be able to answer 'Yes' to every step. As soon as you answer 'No' the carer is not eligible under the Care Act.

Step 1: Do the needs arise because the carer is providing necessary Care and Support?

In order for the carer to be deemed as providing necessary care and support to a person:

1. The person's need for care and support must have arisen from, or be the result of a mental or physical impairment or illness (and not a result of deprivation); and
2. The person must be unable to carry out the task themselves; and
3. The task being carried out must relate to one of the following recognised areas of need in the Care Act;

• Manage and maintain nutrition;
• Maintain personal hygiene;
• Manage toilet need;
• Being appropriately clothed;
• Be able to make use of their home safely;
• Maintain a habitable home environment;
• Develop/maintain family and other personal relationships;
• Access/engage in work, training, education or volunteering;
• Make use of community services;
• Carry out caring responsibilities for a child.

The outcome of step 1 will be one of the following:

1. The carer is not providing any necessary care and support function;
2. The carer is providing a mix of necessary and unnecessary care and support functions; or
3. The carer is proving necessary care and support functions.

If the carer is not providing any necessary care they are not eligible for Support under the Care Act, although they are likely to require good information and advice about the measures they can take and support outside of the Local Authority that may be available to them in their situation.

See: Providing Information and Advice, which includes access to local and national information and advice resources (general and specialist).

If a person is providing one or more necessary care and support function you should continue to step 2 in respect of the support needs that arise from carrying out those functions.

Step 2:  Is the carer's physical or mental health affected or deteriorating, or is the carer unable to achieve any of the listed outcomes?

This step should be carried out after step 1, where you will have confirmed that the tasks carried out by the carer are necessary.

Step 2 can be separated into 2 parts, and answering 'yes' to either will require you to move onto step 3.

Part 1: Is the carer's physical or mental health affected or deteriorating?

You must make a judgement about the impact that caring has had (or is likely to have) on the carers mental or physical health. This is a professional judgements and the carer does not have to be able to demonstrate that they have a physical or mental impairment to meet this step.

If the carer is found to have a mental or physical illness or impairment that is deteriorating naturally (not as a result of their caring role) they may be entitled to have a needs assessment to establish any care and support needs they may have in their own right, and this should be explained to them. If the carer wishes to pursue a needs assessment you should support them to access the right service using the team areas of this procedures site.

Part 2: Is the carer unable to achieve any of the listed outcomes

There are 8 carers needs-related outcomes listed under the Care Act:

• Carry out caring responsibilities for a child;
• Provide Care and Support to other adults;
• Maintain a habitable home environment in their own home;
• Manage and maintain nutrition;
• Develop/maintain family and other personal relationships;
• Engage in work, training, education or volunteering;
• Make use of community services;
• Engage in recreational activities.

You need to consider whether, as a direct result of caring the carer is unable to achieve any of the listed outcomes.

There are likely 3 possible options:

1. The carer is able to achieve the outcome;
2. The carer is unable to achieve the outcome; or
3. The outcome is not relevant to the carer (and therefore their ability to achieve it or not should be disregarded).

Unable to achieve

Under the Care Act a carer is deemed 'unable to achieve' a listed outcome if they are:

1. Unable to achieve it without assistance;
2. Able to achieve it without assistance but doing so causes them significant pain, distress or anxiety (this is a determination made using your own professional judgement about the impact that achieving the outcome has on the carer based on the available evidence);
3. Able to achieve it without assistance but doing so endangers or is likely to endanger the health and safety of the carer or others (if this is unclear there should be supporting evidence available regarding risk); or
4. Able to achieve it without assistance but takes significantly longer than would normally be expected (this is a determination made using you own professional judgement).

If the carer is unable to achieve 1 or more outcomes as a result of their caring responsibilities then you should proceed to step 3 to consider the impact of this on their Wellbeing.

If the caring role does not affect their ability to achieve 1 or more of the listed outcomes then they do not have eligible needs under the Care Act, although the carer is likely to need good information and advice about the measures they can take and the support that may be available to them in their situation.

Fluctuating needs

Where the carer's ability to achieve the listed outcomes fluctuates you must be satisfied that you established the level of need over an appropriate timeframe. You will know this if you have sufficient evidence to demonstrate:

1. The nature and frequency of fluctuations;
2. The impact of the fluctuations on other areas of need and Wellbeing.

It is important that there is a consistent approach to applying eligibility criteria when a carer has needs that fluctuate. This should allow for flexibility to capture specific needs but should also ensure a fair application to avoid variances in eligibility outcomes for carers who have similar needs.

Step 3: Is there consequently a significant impact on the carer's Wellbeing?

This step should be carried out after steps 1 and 2 have identified:

1. That the carer is providing necessary care; and
2. As a result of providing care the carer's mental or physical health has deteriorated or been affected (or is likely to deteriorate in the future); or
3. As a result of providing care the carer is unable to achieve 1 or more of the listed outcomes.

Step 3 involves understanding and making a judgement about the impact of the carer's inability to achieve the 1 or more outcomes identified on their individual Wellbeing. If the impact on Wellbeing is not significant then the need is not eligible under the Care Act.

There are 9 domains of Wellbeing described under the Care Act. See: Wellbeing Domains.

The impact of needs on Wellbeing for carers with similar needs in similar situations can be very different and you should not make assumptions. A range of factors will influence the impact of needs, including:

1. Personal resilience;
2. The personal preferences of the carer about how they live their life;
3. The strength and support of any informal networks of support;
4. How long the carer has been providing support to the person;
5. The financial circumstances of the carer; and
6. The accommodation type and area in which the person lives.

Meeting Ineligible Needs

Under the Care Act the Local Authority has a power to meet needs that have not been deemed eligible, normally under the remit of preventing a crisis or longer term needs through a short term intervention. However, this power should not be used routinely or without authority and you should familiarise yourself with the local policy for meeting ineligible needs.