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The Care Act 2014: Eligibility criteria

From April 2015, the Care Act introduces new national rules for deciding who is eligible for care and support.

However, local authorities will still decide whether you (and/or the person you care for) meet the new eligibility rules.

The eligibility rules for carers’ assessments will be different to those which will apply to the ‘needs assessment’ of the person you care for, and so they are each explained seperately below.

Carers

Following your carer’s assessment, to be able to receive services and/or direct payments from the local authority, the level of your need for support will need to meet a new minimum threshold. Where this happens you will meet the eligibility criteria and be said to have ‘eligible needs’.

Generally speaking, you will meet the new eligibility criteria if there is (or is likely to be) a significant impact on your wellbeing as a result of you caring for another person.

There are three questions that the local authority will need to consider when making their decision. If the answer is yes to all three questions, then you will meet the eligibility criteria.

Note: If you meet the eligibility criteria , the local authority has a legal duty to meet unmet eligible needs if you want them to. There may be a charge for this, see (page on charging).

If you do not meet the eligibility criteria, the local authority is still under a duty to provide you with advice and information. You will also be able to make a complaint about the decision through the local authority complaints procedure. You can find out more about how to do this by contacting the Carers UK Adviceline.

1. Are your needs the result of you providing necessary care?

The local authority may decide that the care you provide is not needed (e.g. they may think that the person you care for can reasonably be expected do the things that you are doing for them).

Alternatively, the local authority may decide that your needs or problems are the result of something other than your caring role.

2. Does your caring role have an effect on you?

Your caring role counts as having an effect on you if your physical or mental health is at risk of getting worse, or you are unable to achieve at least one of the following outcomes:

  • look after any children you have responsibilities for
  • provide care to any other people
  • maintain your home in a fit and proper state
  • eat properly and maintain proper nutrition
  • maintain and develop your relationships with family and friends
  • take part in any education, training or volunteering you may wish to
  • have time for social activities, hobbies etc

You will count as being unable to achieve any of the above outcomes where you:

  • need assistance to achieve the outcome
  • can achieve the outcome unaided but experience pain, distress or anxiety
  • can achieve the outcome unaided but doing so endangers, or may endanger your or another person’s health and safety

3. Is there, or is there likely to be, a significant impact on your well-being?

The definition of ‘well-being’ in the Care Act is very broad and includes things like personal dignity, control over your day to day life, participation in education, work or social activities, relationships with other people, having suitable accommodation, protection from abuse and neglect.

The word ‘significant’ is not defined in law and so it should be given its everyday normal meaning. If you think that the effect on you is noticeable or important, this could count as significant.

When making a decision about whether there is, or is likely to be, a significant impact on your wellbeing, there are certain principles the local authority must take into account. You can read more about these in our factsheet on assessments.

The person needing care

Following the needs assessment of the person you care for, in order to receive services and/or direct payments from the local authority they will need to have care and/or support needs that meet a new minimum threshold. Where this happens they will meet the eligibility criteria and be said to have ‘eligible needs’.

The fact that you may be meeting all the needs of the person you care for is irrelevant in deciding whether or not they meet the eligibility criteria.

There are three questions that the local authority will need to consider when making their decision. If the answer is yes to all three questions, then the person you care for will meet the eligibility criteria.

Note: If the person you care for meets the eligibility criteria, the local authority have a legal duty to meet any eligible care needs that are not already being met in some way (e.g. by yourself), so long as the person you care for wants this to happen. There may be a charge for this, (see page on charging).

If the person you care for does not meet the eligibility criteria, the local authority is still under a duty to provide the person with advice and information. You will also be able to make a complaint about the decision through the local authority complaints procedure. You can find out more about how to do this by contacting the Carers UK Adviceline.

1. Does the person you care for have care and support needs as a result of a physical or mental condition?

This can include physical, mental, sensory, learning or cognitive disabilities or illnesses, substance misuse or brain injury.  There is no need for a formal diagnosis.

2. Do the care and support needs of the person you care for mean that they cannot meet 2 or more of the following outcomes:

  • eat properly and maintain proper nutrition
  • maintain personal hygiene
  • manage toilet needs
  • dress appropriately
  • able to use  and move about the home safely
  • maintain their  home in a fit and proper state
  • maintain and develop relationships with family and friends
  • take part in any education, training or volunteering  they  may  wish to
  • be able to participate in  social activities, hobbies  and make use of public transport and local services
  • look after any children they  have responsibilities for

The person you care for will count as being unable to achieve any of the above outcomes where they:

  • need assistance to achieve the outcome
  • can achieve the outcome unaided but experience  significant pain, distress or anxiety
  • can achieve the outcome unaided but doing so endangers, or may endanger your or another person’s health and safety
  • can achieve the outcome with assistance, but it takes significantly longer than would normally be expected

3. Is there, or is their likely to be a significant impact on the person’s wellbeing?

The definition of ‘well-being’ in the Care Act  is very broad and includes things like personal dignity, control over your day to day life, participation in education, work or social activities, relationships with other people, having suitable accommodation, protection from abuse and neglect.

The word ‘significant’ is not defined in law and so it should be given its everyday normal meaning. If you think that the effect on you is noticeable or important, this could count as significant.

When making a decision about whether there is, or is likely to be, a significant impact on your wellbeing, there are certain principles the local authority must take into account. You can read more about these in our factsheet on assessments.

If your needs or the needs of the person you care for vary

Where the level of your needs or the needs of the person you care for vary (eg if the person you care for has a condition that means some days are much worse than others), then local authority must take this into consideration when applying eligibility criteria, so that there is a full picture of the level of need present.

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54 Camberwell Road, London, SE5 0EN
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