CARE BILL IMPLICATIONS FOR SELF FUNDERS
Important Notice: The financial cap due to be introduced in April 2016 is likely to be postponed
Most if not all Social Services across the country use a computer based assessment tool to generate an 'estimated budget' (EB). They then look to meet needs within this estimated budget. This on-line assessment tool has mainly been used to assess the care needs and costs for individuals who were not over the current LA financial threshold of £23,500 and has not generally been used for those above this financial threshold and who are classed as being self-funders. This electronic assessment process will be the assessment tool that is used to consider the care needs and costs for self-funders under the new Care bill to be introduced in April 2015 and will be of importance when the 'dilnot care meter' and financial cap is implemented in April 2016.
This Social Service assessment is a similar to the ‘decision support tool (DST) used in the CHC process to ‘score’ needs and consider eligibility for CHC. The on-line social services assessment tool also considers various areas of daily living (domains) and then the assessor 'scores' each one via a drop down box. Unlike the DST this 'scoring' of needs is not as a matter of practice open to consultation or discussion with the client/family or other professionals as in the DST process. It is the sole responsibility of the assessing social worker to 'score' need using this on-line assessment tool. However it is possible at a later date for there to be a challenge as to how needs have been scored in the assessment process.
The scores in-putted by the social worker will generate the 'estimated budget' (EB) and this will identify what the weekly budget is required to meet care needs. The added complication is that this EB can only be used to meet needs that meet the new eligibility criteria set out in the Care Bill. The Social Worker is responsible for identifying what needs are deemed eligible and what are not. Again, it is possible to challenge and appeal against their decision on eligible needs.
e.g: Mrs Smith has capital assets above the threshold of £23,500 and is classed as a self-funder. Social services assess, using the computer generated assessment tool and based on the scoring of the SW, it is identified that her estimated budget to meet eligible care needs amounts to £250 per week. This figure would then be used in the dilnot care meter and would then determine how quickly she reached her financial cap. A challenge may result in this budget being increased to a higher weekly amount which would mean the financial cap is reached sooner.
It is therefore very important for a self funding client that a Social Care assessment is carried before April 2016, as this is when the financial cap will be introduced and you would want your care costs identified by then so that the 'Dilnot Meter' can start running. It is anticipated that there will be a significant increase in referrals to Social Services as a consequence of ‘self-funders’ seeking assessments of need in the run up to April 2016. This increase in demand will add to their existing waiting lists. We would therefore advise that a formal referral is submitted to your Social Services department before April 2016. It may be sensible to do this from May or July 2015 onwards.
It is essential that the social care assessment of need is of a high quality and that the on-line assessment tool is completed correctly by the assessing Social Worker. If not then the process could be open to a challenge and appeal with the possibility of an amendment of the EB to a higher figure. (in the case example above, the £250 per week may rise to £350 per week after challenge and review). Obviously if the EB is raised to a higher figure this will be to the benefit of the individual in the long term with regards to reaching the financial cap sooner
The weakness in this computer generated assessment is that it is only as good as the data entered into it by the assessing social worker (SW). It is a fact that the scoring by the assessing SW can be very subjective and thereby open to review and challenge. Some assessors are overly generous in their scoring and others can be very hard. Either way the EB is affected by the assessment is scored as this will impact on what care costs count towards the 'Dilnot care meter' and how quickly the financial cap is reached.
In the local authority I recently worked for (and in all likelihood in every LA using the on-line assessment tool) they will regular monitor all the data generated by such assessments. This data has repeatedly shown that across each team there were significant variations in the estimated budgets generated by Social Care staff. The Authority recognised this problem and identified that the variations were due in the main to the subjective views of each individual assessor when in-putting data.
Because of this 'subjective bias' it is more than probable that if you gave the same case to 10 different assessors it is highly probable that you would get a different budget outcome from each assessment. As an ex Social Services manager I have recent experience of families and clients challenging the scoring of the on-line care needs assessment carried out by members of my team that led to a review and re-scoring of needs that resulted in a significant higher weekly estimated budget.
Whilst the CHC process is quite often flawed and open to appeal and challenge it is apparent that there will be equal if not greater need for scrutiny, challenge and appeal for Social Services assessments that impact on self-funders, their 'dilnot meter' and when they reach the financial cap.
The BBC have created a 'Care Calculator' and advise on aspects of the care bill.
See my article on CHC and the Care Act in this link