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

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

September2015

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.

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 (per item),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 not be subject to eligibility criteria.When designing services, local authoritiesneed to develop an approach to understand and plan for local needs.

Assessment and eligibility

• Self assessment forms must be provided in a format which is accessible to the individual.
• 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 has contact with the local authority, and everyone is entitled to an assessment.

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.

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.

Registers

• Local authorities must maintain registers for blind and partially sighted people.

Local authorities should make contact with an individual within two weeks of a CVI (Certificate of Visual Impairment) being issued.

Details of Care Act

1.Preventing, reducing or delaying needs

Both regulations and guidance contain a section onprevention. 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 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. This may include, white canes, kitchen equipment, magnificationand 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 a form of intermediate care and reablement. The guidance states that rehabilitation should not be limited to 6 weeks.

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.

Paragraph 2.13 clearly defines rehabilitation support as a form of preventative tertiary intermediate and reablement support. The guidance is then explicit that a local authority is responsible for providing preventative support to all adults, irrespective of whether the person has eligible needs. Eligibility criteria must not be applied to accessing rehabilitation services.

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).

Guidance 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).

2.62. 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.

Training

Local authorities are advised to consider securing specialist rehabilitation and assessment provision, in order to identify the specific needs of blind and partially sighted people and to maximise independence.

22.21. Local authorities should consider securing specialist qualified rehabilitation and assessment provision (whether in-house, or contracted through a third party), to ensure that the needs of people with sight loss are correctly identified and their independence maximised.

Certain aspects of independence training with severely sight impaired and sight impaired people require careful risk management and should only be undertaken by professionals withrelevant experience and training. This type of rehabilitation should be provided to the person for a period appropriate to meet their needs. This will help the person to gain new skills, for example, when training to use a white cane. As aspects of rehabilitation for people with sight loss are distinct from others refer to the Association of Directors of Adults Social Services’ (ADASS) position statement of December 2013.164

Charging

Rehabilitation is defined as an intermediate or reablement programme, and therefore must be free of charge for six weeks. However, because of the clear benefits of rehabilitation, and since the intervention will in many circumstance need to be provided for longer than six weeks, the government strongly urge local authorities not to charge for any it any stage.

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.

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 at

2.Assessment and eligibility

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

Eligibility regulations;The government has set theminimum eligibility criteria, at ‘significant’. This is roughly equivalent to ‘substantial under FACs.

The criteria for assessing whether a person has significant care needs, is divided into a three tier "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.

a)Physical impairment

Firstly the person must be an adult and have needs that have arisen from a physical or mental impairment or illness. Guidance defines physical impairment to include a person with a sensory impairment.

b)Unable to achieve outcomes

A full list of the defined outcomes is set out below. It is clear that many blind and partially sighted people will experience difficulties in meeting these outcomes, and should 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

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

The regulationsdefine what it could mean to be unable to do any of these above activities. Two of the four areasthat 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.

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 (b); maintaining of amenities(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 (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.

c)Significant impact

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.

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.

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.

Assessments

Self assessmentsKey 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.

Self assessment must 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.

Knowledgeable and competent staff assessments should beappropriate and proportionate and the person being assessed should be 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.

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.

Specialist expertise, assessment for deafblind individuals must be carried out by a person with the specialist expertise.

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

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