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Eligibility

After an assessment the practitioner will use the Care Act national eligibility criteria to determine what care and support needs are eligible for support from the council.

The national eligibility criteria tells practitioners to consider whether:

  1. The adult’s needs relate to a physical or mental impairment or illness
  2. As a result of those needs, the adult is unable to achieve two or more specified outcomes
  3. As a consequence, there is likely to be a significant impact on their wellbeing

An adult’s needs are only eligible when they meet all three of these conditions.


1. Needs

The need is because of a physical or mental impairment or illness, this includes:

  • physical
  • mental
  • sensory
  • learning or cognitive disabilities
  • illnesses
  • substance misuse
  • brain injury

A formal diagnosis of the condition is not required.


2. Outcomes

As a result of the needs, the adult is unable to achieve two or more of the following:

  1. Managing and maintaining nutrition;
  2. Maintaining personal hygiene
  3. Managing toilet needs
  4. Being appropriately clothed;
  5. Maintaining a habitable home environment
  6. Being able to make use of the home safely
  7. Developing and maintaining family or other personal relationships
  8. Accessing and engaging in work, training, education or volunteering
  9. Making use of necessary facilities or services in the local community including public transport and recreational facilities or services
  10. Carrying out any caring responsibilities the adult has for a child.

The adult is “unable to achieve” an outcome if:

  • they are unable to do so without assistance
  • doing so causes significant pain, distress or anxiety
  • doing so is likely to endanger their health or safety or that of others
  • doing so takes significantly longer than would normally be expected


3. Wellbeing

As a consequence of the adults needs, there is or is likely to be a significant impact on the adult’s wellbeing, including the following:

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

The council must consider whether the adult’s needs impact on the nine areas of wellbeing and make a judgment whether:

  • The adult’s needs impact on an area of wellbeing in a significant way
  • The cumulative effect of the impact on several areas of wellbeing mean that they have a significant effect on the adult’s overall wellbeing

The council should consider the impact of the person’s needs in the context of what is important to him or her. What is important to one person may not be the same for another.

The determination of eligibility must be based solely on the adult’s needs. Any care provided by a carer should not be taken into account. Support available from carers is considered at the support planning stage.


Carer’s Eligibility

Carers can be eligible for support in their own right.

The Care Act introduces a national eligibility threshold for carers. Their eligibility does not depend on whether the person they care for has eligible needs.

Under this, the council must consider whether:

  • The carer’s needs are due to providing necessary care for an adult
  • Those needs put 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

A carer’s needs are only eligible where they meet all three of these conditions.


1. Needs

The needs arise as a consequence of providing necessary care to an adult.

Is the care “necessary”?

If the carer is providing care and support for needs which the adult is capable of meeting themselves, the care may not be necessary.

In such cases the council should provide information and advice to the adult and carer about how the adult can use their own strengths or services in the community to meet their needs.


2. Outcomes

As a result of the needs either the carer’s physical or mental health is, or is at risk of deteriorating, or the carer is unable to achieve any of the following outcomes:

  1. Carrying out any caring responsibilities the carer has for a child;
  2. Providing care to other persons for whom the carer provides care
  3. Maintaining a habitable home environment
  4. Managing and maintain nutrition
  5. Developing and maintaining family or other significant personal relationships
  6. Accessing and engaging in work, training, education or volunteering
  7. Making use of necessary facilities or services in the local community including recreational facilities or services
  8. Engaging in recreational activities

The carer is unable to achieve an outcome if:

  • they are unable to do so without assistance
  • doing so causes significant pain, distress or anxiety
  • doing so is likely to endanger the health or safety of the carer or any adults or children for whom the carer provides care.


3. Wellbeing

As a consequence, there is or is likely to be a significant impact on the carer's wellbeing, including:

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

The council must consider whether the carer's needs impact on the nine areas of wellbeing and make a judgment whether:

  • The carer's needs impact on an area of wellbeing in a significant way
  • The cumulative effect of the impact on several areas of wellbeing mean that they have a significant effect on the carer's overall wellbeing

The council should consider the impact of the carer's needs in the context of what is important to him or her. What is important to one person may not be the same for another.

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