Eligibility Criteria Policy for Adults and Young Carers for Social Care Support

The Carers (Scotland) Act 2016, enacted on 1 April 2018, places legal duties on each local authority to establish dedicated Carers’ local eligibility criteria.

It defines this as “local eligibility criteria are the criteria by which the local authority must determine whether it is required to provide support to carers to meet carers’ identified needs”. The legislation also sets out a duty on each local authority to publish its local eligibility criteria.

The purpose of this policy is  to set out clear guidelines that aim to ensure the equitable allocation of social care resources to the adult and young carers of service users living in East Dunbartonshire. The policy aims to serve as a procedure for staff and as a reference document for elected members, carers, service users, members of the public and other stakeholders.

East Dunbartonshire HSCP has a statutory responsibility to assess for and where eligible provide support to adult and young carers to meet those needs.

The support that is required to meet carers’ needs can vary enormously; from information and advice services; to advocacy services; income maximisation services; technology enabled care; local community assets; through to home based social care support; to centred-based support; short breaks and equipment and adaptations.

Through the use of self directed support options, some support can be provided by the HSCP directly, either provided by in-house or externally commissioned services; some support can be provided from the independent sector and some support services may be organised directly by the carer, depending on the self directed support option chosen.

Eligibility criteria recognise ‘urgency’ and ‘risk’ as factors in the determination of eligibility for social care support services. Where a carer is eligible, the urgency of that individual’s needs should be kept in focus in determining how to respond to their support needs.

Eligibility criteria are a method for deploying limited resources in a way that ensures that resources are targeted to those in greatest need, while also recognising the types of low-level intervention that can be made to halt the deterioration of people in less urgent need of support. This must be applied strictly in line with risk and need and cannot be simply based against wishes, preferences or quality of life elements.

The policy set out below considers both (a) the severity of the risks and (b) the urgency for intervention to respond to the risks. Some levels of risk will call for the provision of support as a high priority whilst others may call for some support provision, not as a high priority but managed and prioritised on an on-going basis.
Some may not call for any paid social care support at all as resources using other assets or universal services may be the most appropriate way of addressing the need.

In other circumstances, the assessment may indicate a potential requirement for support provision in the longer term, which requires regular review. As part of the process for assessment and considering whether a carer’s needs call for the provision of support, practitioners will consider how each individual’s needs match against eligibility criteria in terms of severity of risk and urgency for intervention. 

The policy applies to all carers including young people identified as carers.

The assessment of the carer’s needs are clearly distinguished from any consideration of available resources for the implementation of the support plan. After the assessment and application of eligibility criteria, full account should be taken of the Partnership’s cost limitations when developing the Support Plan. Consideration should be given to best value and other assets i.e. Personal Assets (personal finances, skills and experiences); Community Assets (clubs, groups, forums); and Carer Assets (family, friends and peer support) when support planning to ensure that we consider the most economic way of meeting eligible needs.

Practitioners, as well as following the priority/risk matrix when applying eligibility criteria, also need to follow this policy in relation to cost limitations.

The need to consider whether a limitation will apply on the cost of a carer’s support package will include consideration of:

• An assessment of need via the Carer’s Assessment and Support Plan/Young Carer’s Statement
• Determining whether the carer is eligible for support, with reference to the eligibility criteria outlined in this policy
• Prioritisation of need
• Identification and costing of support packages to meet assessed needs
• Calculation on an on-going basis as to whether the total cost of the support package provided exceeds the cost limitations based on equivalency model.

The following chart indicates the progression from assessment to the potential provision of support. It illustrates the process of determining eligibility and how the intensity of risk and potential access to support services is determined using this criteria.

This policy makes use of the four categories of risk within the Scottish Government’s National Eligibility Framework and in line with East Dunbartonshire HSCP’s ‘Eligibility Criteria Policy for Adults and Community Care Services’.

Critical risk: Indicates that there are critical risks to the carer’s ability to continue in the caring role and likely to call for immediate or imminent intervention and/or provision of social care support for example: health breakdown requiring hospital admission, risks to the health and safety of the carer and/or cared for person.

Substantial risk: Indicates there are significant risks to the carer’s ability to continue in the caring role with a likely call for immediate or imminent intervention and/or provision of social care support for example: relationship between carer and cared for person at serious risk of breakdown.

Moderate risk: Indicates there are moderate risks to the carer’s ability to continue in the caring role, which may call upon the legal power for the provision of some social care support (in exceptional circumstances), or the provision of and signposting to other universal services.

Low risk: Some quality of life issues but low risks to the carer’s ability to continue in the caring role. There may be some need for alternative support, advice or referral to other services (e.g. health, voluntary organisations, and community groups).

No risk: No risks identified to carer’s ability to continue in the caring role. No further action or advice, information, simple services arranged or facilitated; referral to other services (e.g. health, voluntary organisations, community groups).

The framework acknowledges that, in managing access to finite resources, local authorities; health and social care partnerships and their partners focus first on those carers assessed as having the most significant risks to their continued ability to undertake the caring role and impact on the carer’s own health and wellbeing.

Where adult carers are assessed as being in the ‘critical’ or ‘substantial’ risk categories their needs will generally call for the provision of support to reduce these risks to a moderate level,
although this may not always equate to paid social care support depending upon the assessed need and outcome. We will look to maximise the potential of informal supports, community and personal assets to reduce risk wherever possible.

Where eligibility is determined to fall into the moderate category for adult carers, the response of Social Work Services will be to provide the individual with advice/information and/or to signpost towards direct access to community resources. Exceptions can be made where the absence of statutory social work involvement will lead to an aggravation of the carer’s needs resulting in greater expense to the local authority on a later occasion. In these circumstances a short term intervention may be offered, focussed on reducing these risks on a  sustainable basis. Interventions of this nature will not normally continue beyond a six-week period, but this may be extended if the benefits for so doing are demonstrable, explicitly time-limited and authorised by senior management.

For young carers, moderate risks would also generally call for the provision of support to reduce risks to a low level.

This policy makes use of the four categories of risk within the Scottish Government’s National Eligibility Framework and in line with East Dunbartonshire HSCP’s ‘Eligibility Criteria Policy for Adults and Community Care Services’.

Critical risk: Indicates that there are critical risks to the carer’s ability to continue in the caring role and likely to call for immediate or imminent intervention and/or provision of social care support for example: health breakdown requiring hospital admission, risks to the health and safety of the carer and/or cared for person.

Substantial risk: Indicates there are significant risks to the carer’s ability to continue in the caring role with a likely call for immediate or imminent intervention and/or provision of social care support for example: relationship between carer and cared for person at serious risk of breakdown.

Moderate risk: Indicates there are moderate risks to the carer’s ability to continue in the caring role, which may call upon the legal power for the provision of some social care support (in exceptional circumstances), or the provision of and signposting to other universal services.

Low risk: Some quality of life issues but low risks to the carer’s ability to continue in the caring role. There may be some need for alternative support, advice or referral to other services (e.g. health, voluntary organisations, and community groups).

No risk: No risks identified to carer’s ability to continue in the caring role. No further action or advice, information, simple services arranged or facilitated; referral to other services (e.g. health, voluntary organisations, community groups).

The framework acknowledges that, in managing access to finite resources, local authorities; health and social care partnerships and their partners focus first on those carers assessed as having the most significant risks to their continued ability to undertake the caring role and impact on the carer’s own health and wellbeing.

Where adult carers are assessed as being in the ‘critical’ or ‘substantial’ risk categories their needs will generally call for the provision of support to reduce these risks to a moderate level,
although this may not always equate to paid social care support depending upon the assessed need and outcome. We will look to maximise the potential of informal supports, community and personal assets to reduce risk wherever possible.

Where eligibility is determined to fall into the moderate category for adult carers, the response of Social Work Services will be to provide the individual with advice/information and/or to signpost towards direct access to community resources. Exceptions can be made where the absence of statutory social work involvement will lead to an aggravation of the carer’s needs resulting in greater expense to the local authority on a later occasion. In these circumstances a short term intervention may be offered, focussed on reducing these risks on a  sustainable basis. Interventions of this nature will not normally continue beyond a six-week period, but this may be extended if the benefits for so doing are demonstrable, explicitly time-limited and authorised by senior management.

For young carers, moderate risks would also generally call for the provision of support to reduce risks to a low level.

The following table provides definitions of risk factors for each of the domains in the national eligibility framework adopted by the Partnership.

Where a carer has been identified as having ‘No Risks’ in any of the domains this will result in no further action being taken or the carer will be provided with advice, information, or referral to other universal services (e.g. health, voluntary organisations, community groups).

The Carers (Scotland) Act 2016 (Adult Carers and Young Carers of Terminally Ill Persons: Timescales for Adult Carer Support Plans and Young Carer Statements) Regulations 2021 was enacted on 31 July 2021.

The regulations state that when a referral is received for a carer, adult carer or young carer, who is providing unpaid care to a person who has been diagnosed as terminally ill, the following timescales should be adhered to:

• Offer of Adult Carer Support Plan or Young Carer Statement within two working days of receipt of referral
• Conversation regarding support needs to take place with the adult carer or young carer within five working days of receipt of referral
• Provision of eligible support for the adult carer or young carer within ten working days of receipt of referral.

A process of monitoring and review will be undertaken as required in response to changing circumstances e.g. changing needs as a carer’s circumstances change or the cared for person’s circumstances change which impact on the carer’s role. During the process of review, the eligibility criteria will still apply to identified needs: new and current.

The eligibility criteria policy seeks to ensure that existing resources are allocated on a fair and equitable basis. It is equally important to recognise that certain needs will continue to be ineligible for formal support. All needs for support services should be recorded following assessments and reviews, and a proper note kept of needs which are ineligible in line with the policy outlined above and the level of current resources.

The carer in these circumstances should also offered advice, information and signpost to informal support and community assets. The information gathered from recording ineligible needs will inform future planning and development activities.

“Personalisation enables the individual alone, or in groups, to find the right solution for them and to participate in the delivery of a service. From being a recipient of services, citizens can become actively involved in selecting and shaping the service they receive” (Scottish Government, 2009).

Self Directed Support is about making sure that people (carers and cared for persons) with health or social care needs are helped to find support to live the way they wish to lead their lives. Carers, cared for persons and their families can make informed choices. Most people who have social care needs will be able to receive an ‘Individual Budget’ so that they know what the cost of their support package is and can make the appropriate arrangements to purchase their support depending on the Self Directed Support option(s) chosen by the carer. Carers will have control over the way the money is spent and will receive as much or as little support to manage their budget, as they need.

The support is person centred and works towards the achievement of the carer’s individual outcomes. While the supports considered and agreed within the carer’s support plan/young carer’s statement will be personalised to them as an individual, the service descriptors below provide information on the most commonly used support services. The majority of these support services can be arranged using any of the self-directed support options (with the exception of re-ablement, intermediate care, long term residential or nursing home care and continuing in-patient health care).

All of the indicators set out in the eligibility criteria applies to young carers although some of the descriptions would change from those provided. The domains and indicators are linked to the eight wellbeing indicators of Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible, and Included as shown in the table below.

The use of the local eligibility criteria for young carers is in relation to the impact of the caring role on the young carer. The young carer might have other needs unrelated to the impact of the caring role. In these circumstances, they could be eligible for other services.