Implementing the Care Act for Blind and Partially Sight People: Regulations and Guidance

Implementing the Care Act for blind and partially sight people: Regulations and guidance summary for Local Authorities

March2015

There are 1.86 million people in the UK living with sight loss. By 2020 this number is predicted to increase by 22 per cent and will double to almost four million people by the year 2050.

The loss of sight can have a profound impact. Everyday activities such as making a cup of tea, reading, cooking, shopping and using the internet become a challenge. New skills and strategies have to be learnt to be able get around the home safely, to go outside, cross roads and avoid hazards. For many people there is the additional fear of how they will be able to continue with work.

The Care Act and accompanying statutory regulations and guidance will significantly improve social care provision for blind and partially sighted people. For the first time, rehabilitation services for blind and partially sighted people are acknowledged in statutory guidance.

Overview:This document sets out five key areas of the regulations and guidance which have a direct impact upon blind and partially sighted people.

1. Preventing, reducing or delaying needs (including rehabilitation)

• Local authorities must provide minor aids and adaptations up to the value of £1,000 free of charge, for the purpose of assisting with nursing at home or aiding daily living.
• Rehabilitation for blind and partially sighted people should be provided based on assessed needs, and therefore not be limited to 6 weeks
• Rehabilitation support should be subject to eligibility criteriawhen designing services, councils need to develop a local approach and understand and plan for local needs

1. Assessment and eligibility

• Self assessment forms must be provided in an accessible format
• Assessments must be carried out by a person who has the necessary skill, knowledge and competency.
• The assessment process starts from the moment a person is in contact with the local authority, and the person is entitled to have their needs assessed.

1. Information and advice

• Local authorities must have due regard for the needs of people with a visual impairment in the provision of information and advice services.

1. Charging

• It is recommended that rehabilitation support for people with a visual impairment is not charged for beyond six weeks due to the clear benefits it has on preventing care needs and delaying hospital admissions

1. Registers
2. local authorities must maintain registers for blind and partially sighted people
3. local authorities should make contact with an individual within two weeks of the CVI (Certificate of Visual Impairment) being issued

Details of Care Act

1.Preventing, reducing or delaying needs

Both regulations and guidance cover prevention. The regulations set the framework for “intermediate care and reablement support services” and “community equipment (aids and minor adaptations)” and the charging for such provisions.

Aids and adaptations

The Care and Support (Eligibility Criteria) Regulations 2014 state thatclearly that there should be no charge for aids and minor adaptations provided at a cost of £1,000 or less;

Interpretation

2. “Community equipment (aids and minor adaptations)” means an aid, or a minor adaptation to property, for the purpose of assisting with nursing at home or aiding daily living and, for the purposes of these Regulations an adaptation is minor if the cost of making the adaptation is £1,000 or less;

Services to be provided free of charge

4. A local authority must not make a charge under regulation 3(1) where the provision made under section 2(1) of the Act is –

(a) a service which consists of the provision of community equipment (aids and minor adaptations);

(b) intermediate care and reablement support services for the first 6 weeks of the specified period or, if the specified period is less than 6 weeks, for that period.

Aids and adaptations should include any equipment which is recommended through a rehabilitation intervention, or through an assessment and that this may include white canes, kitchen equipment, magnification equipment and screen readers (this is not an exhaustive list).

Rehabilitation services

Rehabilitation services for blind and partially sighted people are formally recognised within statutory guidance. Guidance defines rehabilitation to include ‘living skills and mobility training for people with visual impairment’ (2.13). Rehabilitation support for visually impaired people is recognised as form of intermediate care and reablement. The guidance states that rehabilitation should not be limited to 6 weeks.

From 1 April 2015, eligibility criteria must not be applied to accessing rehabilitation services.

The guidance also sets out that local authorities must consider the impact and consequences of ending preventative services and that poor exit strategies can have a significant impact on preventing, reducing and delaying needs (paragraph 2.62).

2.3. The local authority’s responsibilities for prevention apply to all adults, including:

adults with needs for care and support, whether their needs are eligible and/or met by the local authority or not (see chapter 6).

Delay: tertiary prevention

2.9. These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible.

Tertiary prevention could include, for example the rehabilitation of people who are severely sight impaired (see also chapter 22 sight registers). Local authorities must provide or arrange services, resources or facilities that maximise independence for those already with such needs, for example, interventions such as rehabilitation/reablement services, e.g. community equipment services and adaptations and the use of joint case-management for people with complex needs.

Intermediate care and reablement

2.13. The term “rehabilitation” is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these capabilities have been lost due to illness or disease. Rehabilitation services can include provisions that help people attain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.

Charging for preventative support

2.59. The regulations require that intermediate care and reablement provided up to six weeks, and minor aids and adaptations up to the value of £1,000 must always be provided free of charge (see also 8.14).

2.60. Where local authorities provide intermediate care or reablement to those who require it, this must be provided free of charge for a period of up to six weeks. This is for all adults,irrespective of whether they have eligible needs for ongoing care and support. Although suchtypes of support will usually be provided as a preventative measure under section 2 of theAct, they may also be provided as part of a package of care and support to meet eligibleneeds. In these cases, regulations also provide that intermediate care or reablement cannotbe charged for in the first six weeks, to ensure consistency.

2.61.Whilst they are both time-limited interventions, neither intermediate care norreablement should have a strict time limit, since the period of time for which the supportis provided should depend on the needs and outcomes of the individual. In some cases,for instance a period of rehabilitation for a visually impaired person (a specific form of reablement) may be expected to last longer than six weeks. Whilst the local authority doeshave the power to charge for this where it is provided beyond six weeks, local authoritiesshould consider continuing to provide it free of charge beyond six weeks in view of theclear preventative benefits to the individual and, in many cases, the reduced risk of hospitaladmissions.

2.62. Local authorities should consider the potential impact and consequences of endingthe provision of preventative services. Poorly considered exit strategies can negate thepositive outcomes of preventative services, facilities or resources, and ongoing low-level careand support can have significant impact on preventing, reducing and delaying need.

Understanding local need

Local authorities should develop a local approach and understand and plan for local needs. They should also ‘consider the different opportunities for coming into contact with those people who may benefit from preventative support, including where the first contact may be with another professional outside thelocal authority (paragraph 2.38).

RNIB have produced a sight loss data tool which provides statistics on sight loss broken down to a local authority level for the UK. It is a free tool and provides information on

2.Assessment and eligibility

There are separate regulations for assessment and eligibility and joint guidance for both.

Eligibility regulations;

The regulations are set to be equivalent to substantial care needs under FACs. The Government have therefore set minimum eligibility criteria.

There are three tiers to the "test"

2.—(1) An adult’s needs meet the eligibility criteria if— (a) the adult’s needs arise from or are related to a physical or mental impairment or illness; (b) as a result of the adult’s needs the adult is unable to achieve two or more of the outcomes specified in paragraph (2); and (c) as a consequence there is, or is likely to be, a significant impact on the adult’s well-being.

The full list of needs is set out below and many blind and partially sighted people will experience difficulties in meeting these needs, to be able to qualify for support.

(a) managing and maintaining nutrition;

(b) maintaining personal hygiene;

(c) managing toilet needs;

(d) being appropriately clothed;

(e) being able to make use of the adult’s home safely;

(f) maintaining a habitable home environment;

(g) developing and maintaining family or other personal relationships;

(h) accessing and engaging in work, training, education or volunteering;

(i) making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and

(i) making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and

(j) carrying out any caring responsibilities the adult has for a child.

The regulations define what it could mean to be unable to do any of these above activities. Two of the four areas are of particular relevance: if they need assistance, or if they can do the activity without assistance but it takes significantly longer. Therefore a person with a visual impairment could qualify for support under this criterion.

The third tier of the "test" is whether the impact on the individual is "significant". Significant impact is not defined in the regulations, but the guidance states that;

6.110. The term “significant” is not defined by the regulations, and must therefore be understood to have its everyday meaning. Local authorities will have to consider whether the adult’s needs and their consequent inability to achieve the relevant outcomes will have an important, consequential effect on their daily lives, their independence and their wellbeing.

6.111.In making this judgment, local authorities should look to understand the adult’s needsin the context of what is important to him or her. Needs may affect different people differently,because what is important to the individual’s wellbeing may not be the same in all cases.

Circumstances which create a significant impact on the wellbeing of one individual may not have the same effect on another.

The guidance sets out further explanations of what may be involved with meeting an outcome. Many of the criteria reflect the everyday challenges blind and partially sighted people face. Of particular welcome is the inclusion of laundering of clothes in (b); maintaining of amenities in (f) as blind and partially sighted people are unable to read meters and correspondence, and therefore are unable to maintain their amenities; and the inclusion of getting around the community safely in (i).

(b) maintaining personal hygiene. Local authorities should, for example, consider the adult’s ability to wash themselves and launder their clothes.

(f) maintaining a habitable home environment. Local authorities should consider whether the condition of the adult’s home is sufficiently clean and maintained to be safe. A habitable home is safe and has essential amenities. An adult may require support to sustain their occupancy of the home and to maintain amenities, such as water, electricity and gas.

(i) making use of necessary facilities or services in the local community including public transport and recreational facilities or services. Local authorities should consider the adult’s ability to get around in the community safely and consider their ability to use such facilities as public transport, shops or recreational facilities when considering the impact on their wellbeing. Local authorities do not have responsibility for the provision of NHS services such as patient transport, however theyshould consider needs for support when the adult is attending healthcare appointments.

Local authorities must take into consideration that eligibility for support does not rely on all outcomes to have a significant impact on wellbeing, but rather the cumulative impact must be considered.

6.109 sets out the cumulative impact – i.e. if a person meets 2 or more, it is not that these all must have a significant impact on wellbeing – but that the impact that they have combined.

It must be noted that if a person is found to have eligible needs, but their carer, partner is able to and willing to provide the support then the local authority does not have to meet that eligible need.

The carer is however, entitled to an assessment and will be assessed for their eligibility.

Assessment

Key to the assessment regulations is the strengthening and promotion of the role of self assessment which is “an assessment carried out jointly by the local authority and the individual to whom it relates”. It is welcome that within the regulations it is very clear that these should be provided in an accessible format.

(7) The information must be provided in a format which is accessible to the individual to whom it is given.

Other key features are that assessments are appropriate and proportionate and that the person is able to participate in the process as effectively as possible.

Assessments must be carried out by a person who has the necessary skill, knowledge and competency. However, a person carrying out an assessment for deafblind individuals must have specialist expertise.

Self assessment will have to be provided in an accessible format.

Training, expertise and consultation

5.—(1) A local authority must ensure that any person (other than in the case of a supported selfassessment,the individual to whom it relates) carrying out an assessment—

(a) has the skills, knowledge and competence to carry out the assessment in question; and

(b) is appropriately trained.

(2) A local authority carrying out an assessment must consult a person who has expertise in relationto the condition or other circumstances of the individual whose needs are being assessed in any casewhere it considers that the needs of the individual concerned require it to do so.

(3) Such consultation may take place before, or during, the carrying out of the assessment.

Requirement for specialist expertise – deafblind individuals

6.—(1) An assessment which relates to an individual who is deafblind must be carried out by a personwho has specific training and expertise relating to individuals who are deafblind.

(2) A local authority must facilitate the carrying out of the assessment by providing any personcarrying out such an assessment with any relevant information which it may have—

(a) about the individual whose needs are being assessed; and

(b) in the case of—

(i) a carer’s assessment, about the adult needing care;

(ii) a child’s carer’s assessment, about the child needing care;

(iii) a young carer’s assessment, about the adult needing care.

(3) In this regulation, an individual is “deafblind” if the individual has combined sight and hearingimpairment which causes difficulties with communication, access to information and mobility

The assessment guidance also sets out a number of areas which help to ensure that blind and partially sighted people receive an appropriate assessment.

• There is a clear expectation that the assessment process should start from when the local authority begins to collect that information about that person (6.2).
• Assessments ‘must follow the core statutory obligations’ but the process can be flexible. (6.4)
• The assessment aim is to identify needs and outcomes to help people improve their wellbeing (6.5). Outlined below

6.5.The aim of the assessment is to identify what needs the person may have and what outcomes they are looking to achieve to maintain or improve their wellbeing. The outcome of the assessment is to provide a full picture of the individual’s needs so that a local authority can provide an appropriate response at the right time to meet the level of the person’s needs. This might range from offering guidance and information to arranging for services to meet those needs. The assessment may be the only contact the local authority has with the individual at that point in time, so it is critical that the most is made of this opportunity.

Of significance is section 6.12, which sets out that eligibility can only be made on the basis of an assessment. Therefore a decision cannot be made as to whether someone is not eligible for care based upon their condition. An assessment must be carried out.

6.12.Eligibility determinations must be made on the basis of an assessment, and cannot be made without having first carried out an assessment. Once an eligibility determination has been made, and the local authority has determined whether it will meet the person’s needs (whether eligible or not),

The guidance also sets out that a local authority can pause an assessment, if they think that the person would benefit from preventative services.

Prevention and assessments

6.62.Where the local authority judges that the person may benefit from such types ofsupport, it should take steps to support the person to access those services. The localauthority may ‘pause’ the assessment process to allow time for the benefits of such activitiesto be realised, so that the final assessment of need (and determination of eligibility) is basedon the remaining needs which have not been met through such interventions. For example,if the local authority believes that a person may benefit from a short-term reablement servicewhich is available locally, it may put that in place and complete the assessment following theprovision of that service.