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Care in the community

Care in the community simply means enabling people to live in the community, usually in their own homes, with the support and assistance they need. Some disabled people may prefer to live in sheltered housing, residential care or in a nursing home and these options should be available to people who need them (see Accommodation).

Social services departments are responsible for assessing people’s needs for community care services and for making arrangements to provide them with the services they need. Assessments will also include looking at their need for a place in sheltered housing, a residential care or nursing home, and taking account of their carer’s ability to continue caring, if appropriate (see Carers). Note that Local Authorities are entitled to take their budgets into account when making decisions on what support they will offer.

Registration

Every local authority has a duty to keep a register of disabled people in its area. Registration is voluntary but nothing is lost by being registered; indeed it may entitle you to certain concessions, for example free fares on public transport. Anyone whose disability is "substantial and permanent" can be registered, but you do not have to be registered in order to qualify for an assessment of need or for the provision of services. Registration is generally the responsibility of the social services department.

Assessment of Need

At the request of a disabled person or their carer, the social services department must by law assess the disabled person’s need for any or all of a range of community care services, which are listed in Section 2 of the Chronically Sick and Disabled Persons Act 1970. These are:

  • Practical help in the home (eg a home help)

  • A radio and/or television and help in using the library;

  • Lectures, games, outings and any help needed to take advantage of educational facilities;

  • Help with travelling to any of these or similar activities;

  • Adaptations or special equipment needed in the home for the greater safety, comfort or convenience of the disabled person;

  • Holidays;

  • Meals, either in the home or at a local centre;

  • A telephone and any special equipment needed to use it.

Disabled young people leaving full-time education also have the right to an assessment of their need for any or all of these services. Local Education Authorities have to notify social services departments eight months before the expected leaving date of anyone with a Statement of Special Educational Needs. The social services department then has to carry out an assessment of their needs within five months of receiving the notification. For more information on this, see Education and Training.

Social services departments are encouraged to take a flexible approach to the provision of services and they must undertake assessments on an individual basis. It is not acceptable to assess someone against blanket criteria of need, but each person’s individual circumstances must be taken fully into account. If, for example, your social services department said that only people who were housebound, lived alone and were over 80 years of age qualified for a home help, it would be acting unreasonably and could be challenged. In other words, community care services should be designed to meet the needs of users, rather than users being moulded to fit the services, and assessments should be made on the basis of what the client needs and not on the basis of what is available.

Service Provision

If you are assessed as needing services, the social services department has a duty to ensure that they are provided. Increasingly, social services departments are allocating a social worker or occupational therapist to act as a care manager, whose responsibility it is to arrange for the provision of services, to arrange packages of care where appropriate and to liaise between the various local authority departments or other agencies providing community care assistance. Since the social services department itself does not necessarily have to provide the services required - meals on wheels, for example, are often provided by a local voluntary organisation or the WRVS under contract to the local authority - this care management role is very important.

Charges

The local authority may make a charge for any service it provides or arranges, but if a means test of any kind is carried out to determine the level of charge to be made, the mobility component of Disability Living Allowance cannot be taken into account. Your service cannot be taken away if you do not or cannot pay, but the local authority can seek to recover through the civil court any money you owe. If you cannot afford to pay the charge you should ask for a review.

Complaints

If you are unhappy with your assessment or the services provided, talk it through with your care manager or social worker first. If you are still dissatisfied, use the social services’ complaints procedure to take things further. You might feel that you would benefit from advocacy support in dealing with local authorities and, if so, Citizen Advocacy Information and Training (CAIT) has a nationwide list of Citizen Advocacy Schemes in operation.

Direct Payments

The Community Care Direct Payments Act 1996 allows social services departments to pay money to a disabled individual so they can buy in their own care services on a private basis, either in total or alongside local authority-provided services, if the individual so wishes. Again, an assessment of your needs is the first step. Direct payments are limited to people over 16 and under 65 (extended to people over 65 from April 2000) and can only be used to pay for care at home, or short periods of respite care to give your full-time carer a break.

Direct payments offer greater flexibility and user-control of services. For example, you could come to an arrangement with the social services department whereby it provides a home help to do the cleaning and basic shopping twice a week, and with a sum of money which enables you to recruit and employ your own personal care assistant. There are various things to take into account when considering this option, such as your duties and responsibilities as an employer, but the autonomy and control it gives you could outweigh any administrative vexations.

The Independent Living Fund

If you are between 16 - 66 years of age, in receipt of the highest rate of the care component of Disability Living Allowance or Attendance Allowance, live alone (or with someone who cannot provide all the care you need) and have a low income, you might be eligible for payments from the Independent Living Fund to put towards your personal care costs. You have to apply to the social services department first, and the Fund can supplement local authority services up to a maximum of £500 a week per person.

Further Information

A useful publication for people who wish to receive direct payments is "Recruiting and Employing a Personal Care Worker" from the Disablement Income Group.

The National Centre for Independent Living is the main body providing information on direct payments and personal assistant schemes.

Carers association

We are indebted to RADAR for providing the information for this section.