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Minimum Standards for Carer's Assessment and Support
Introduction
The Community Care and Health (Scotland) Act 2002 affirms that carers who intend to or provide a 'substantial amount of care on a 'regular basis' are entitled to an assessment of their ability to provide or to continue to provide care ('carer's assessment'), independent of any assessment of the person they care for. Young carers under 16 have the same rights to assessment. N.B. The term "ability to care" in this context does not imply a negative view of the carer's competence or skills.
As set out in Scottish Executive Circular CCD2/2003 'The fundamental principle underlying the new legislative provisions is that local authorities, the NHS and other support agencies should recognise and treat carers as key partners in providing care.' The circular also emphasises that support for carers should be designed to empower carers to make the most of their potential and opportunities, rather than allowing them to be confined or isolated in their caring role'
The minimum information standards detailed below are intended to support the above purpose and in turn achieve good outcomes for carers.
Definition of an unpaid carer
The legal definition of a carer is someone who provides substantial amounts of care on a regular basis for either an adult or a child, where that adult or child receives, or is eligible to receive, support services under the Social Work (Scotland) Act 1968 or the Children (Scotland) Act 1995. A carer is generally defined as a person of any age who provides unpaid help and support to a relative, friend or neighbour who cannot manage to live independently without the carer's help due to frailty, illness, disability or addiction.
Summary
In order to achieve good outcomes the carer's assessment has to:
- Identify the care provided by the carer
- Establish what level of care the carer is willing and able to provide, and help them to determine whether their caring role is sustainable
- Identify current and potential risks to the carer's health and wellbeing as a result of the caring role
- Determine what resources the carer needs to support them in their caring role, and agree how these resources can best be provided
- Determine what resources the carer needs to enable them to have a life of their own, and agree how these resources can best be provided
- Determine what the carer needs to maintain and improve their own health and wellbeing, and agree how these resources can best be provided
- Take the carer's views into account when agreeing any support to the carer and cared-for person
The minimum standards are listed under the following headings:
- Caring Situation
- Carer Responsibilities
- Health and Wellbeing
- Life of your own
- Supporting the caring role
Recording of data items
It is not necessary to record every item for every person subject to a carer's assessment, only those items appropriate for that carer. However to meet the standards, tools and electronic systems should have the capability to record all data items which are contained within the standards.
Data Items
Person Details (Carer and Cared for Person)
- Structured Name or Unstructured Name
- Person Birth Date
- Person Identification
- Address
- Associated person (relationship to cared-for person)
The data items above are detailed in the 'Minimum Standards for Personal Details Section' (Pages 12 - 18) and are selected from the Social Care Data Standards Manual, version 2.0 (August 2005).
| Type of Standard |
|---|
Summary of Caring Situation 1. Has the cared-for person(s) had an assessment of their needs? Yes/No 2. If Yes, provide details of assessor and date of assessment 3. If No, provide details E.g. cared-for person refusing assessment 4. Summary of cared-for persons situation E.g. document any relevant illness or disabilities 5. Reason given for requesting carers assessment | Information Standard |
Unpaid Carer Responsibilities 1. Are you/do you have any of the following responsibilities? - Appointee, Yes/No
- Guardian: Financial, Yes/No. Welfare, Yes/No. Both Yes/No
- Named person, Yes/No
- Power of attorney: Continuing (financial), Yes/No,
- Welfare, Yes/No.
2. Do you need any specific support in managing any of these responsibilities? Yes/No 3. If Yes, provide details 4. What services and support do you have? e.g. - Current services
- Other people who are carers
5. How do you feel about your caring role, e.g? - willingness to continue caring if appropriate
- satisfaction with current services and support
6. Does your caring role impact on other responsibilities, for example, childcare, employment, family? Yes/No 7. If Yes describe 8. What care do you provide? E.g. - What tasks do you carry out?
- How often?
| Information standard |
Quality of Life for Carer | Type of Standard |
|---|
C Health and Well-being 1.Does your caring role affect your physical, mental and emotional health and well- being? Yes/No 2. If Yes, detail 3. What can be done to address this? 4. Does your health affect your ability to care? Yes/No 5. If Yes, provide details 6. What can be done to address this? | Information Standard |
D. Life of your own Education, training and lifelong learning 1. Is there an issue with balancing caring with education, training and lifelong learning? Yes/No 2. If yes, describe specific issues/difficulties 3. What can be done to address this? Employment 1. Is there an issue with balancing caring with employment? Yes/No 2. If Yes, describe specific issues/difficulties 3. What can be done to address this? | Information Standard |
Social Life, leisure activities, religious and cultural activities 1. Is there an issue with balancing caring with social Life, leisure activities, religious and cultural activities Yes/No 2. If Yes, describe specific issues/difficulties 3. What can be done to address this? Relationships 1. Are there any issues that impact on the caring role? Yes/No 2. If Yes, describe specific issues/difficulties 3. What can be done to address this? 4. Does the caring role impact on your key relationships? Yes/No 5. If Yes, describe specific issues/difficulties 6. What can be done to address this? | Information Standard |
Level and management of finances 1. Are there any issues? Yes/No/Refused to disclose/Not Assessed 2. If Yes, describe specific issues | Information Standard |
Data Item | Description | Field Length | Format | |
|---|
Has an income maximisation assessment been offered? | Has the unpaid carer been offered an income maximisation assessment? | 1 | Character | Data Standard |
3. If the unpaid carer has not been offered an income maximisation, provide details. | |
E. Supporting the caring role Emergency/Crisis Planning 1. Are there any measures in place for emergency or crisis planning? Yes/No 2. If Yes, what are these measures? - If No, what would need to be done if an emergency arose?
The future (explore concerns and plans for the future) 1. Are there any potential changes in the future which may affect your caring role? Yes/No 2. If Yes, what are these? 3. What can be done to address this? 4. What are your hopes, plans for the future? | Information standard |
Summary of Support Needs Summary of support needs which have been identified during the assessment process to support the carer in their caring role. The summary should include support needs regarding tasks that the carer would prefer not to do. It should identify any areas of disagreement, e.g. between carer and cared-for person or the carer and assessor. | Information standard |
Identified Actions and Agreements Identified actions and agreements to address the support needs of the carer. The intervention/activity/resource that is required to address the support needs may relate to a particular task, resource or behaviour and may also relate to the requirement for a further assessment. The intervention should reflect the carer and assessor's agreement regarding the action/resource which is best to address the support needs. Several interventions may meet one support need or one intervention may address more than one support need. E.g. - Information,
- Breaks from caring
- Carer training
- Emotional support
- Practical support
- Financial advice
1. Are there any identified needs that can't be met at the moment? Yes/No 2. If Yes, detail these and possible consequences | Information standard |
Data item | Description | Field Length | Format | |
|---|
Date Support Plan Agreed | The date on which all contributors have agreed its content. This is an overall, generic date and is not specific to individual components of the plan. It is the date that needs and interventions are agreed and the date from which interventions are measured against. E.g. 01/01/2007 | 10 | CCYY-MM-DD | Data Standard |
Date Support Plan Ended | The date on which it is decided the Support Plan is no longer required or has no current relevance. E.g. 01/01/2007 | | CCYY-MM-DD | Data Standard |
Reason Support Plan Ended A record of why the Support Plan has been ended. E.g. - All support needs have been addressed
- Assessment of person's needs is required
- Support was refused
- Carer has died
| Information Standard |
Arrangements for Review 1. Does the carer feel that their needs are being addressed/met? Yes/No 2. If No, provide details Agreement should be reached and recorded as to whether the review of the carers support needs will be reviewed in conjunction with the review for the cared for person or separately. | Information Standard |
Data item | Description | Field Length | Format | |
|---|
Anticipated/Planned review date of the carer support plan | The date on which it is intended to review the overall identified needs and interventions. This should be no more than a year from the date of the agreed plan. E.g. 01/01/2007 | | | Data Standard |
Contact 1. Has the carer been verbally informed/given written advice as to who is the single point of contact to coordinate the contributions to assessments and the delivery of support? Yes/No 2. If No, provide details | Information Standard |
Carer's Assessment
Guidance for National Standards
1. Introduction
1.1 Right to assessment
The Community Care and Health (Scotland) Act 2002 affirms that carers who intend to or provide a 'substantial amount of care on a regular basis' are entitled to an assessment of their ability to provide or to continue to provide care ('carer's assessment'), independent of any assessment of the person they care for. Young carers under 16 have the same rights to assessment. NB. The term "ability to care" in this context does not imply a negative view of the carer's competence or skills.
As set out in Scottish Executive Circular CCD2/2003 'The fundamental principle underlying the new legislative provisions is that local authorities, the NHS and other support agencies should recognise and treat carers as key partners in providing care.' The circular also emphasises that support for carers should be designed to empower carers to make the most of their potential and opportunities, rather than allowing them to be confined or isolated in their caring role'
1.2 Improving outcomes
As part of the National Outcomes Framework for Community Care, measures have been introduced to improve and increase the number of carer's assessments. These measures include new national standards for carer's assessments, this document gives local partnerships details of these standards by:
- Outlining the principles and values which should underpin the implementation of the standards in day to day practice
- Detailing the minimum information standards to be implemented
This guidance builds on and should be used in conjunction with previous guidance provided in:
- Carers - Community Care and Health (Scotland) Act 2002 - CCD 2/2003
- Guidance on Single Shared Assessment of Community Care Needs - CCD 8/2001
- National Training Framework for Assessment and Care Management (2006)
- Care 21 Report - The future of unpaid care in Scotland (2005) 1
2. Carers as key partners
2.1. Definition of a carer
The legal definition of a carer is someone who provides substantial amounts of care on a regular basis for either an adult or a child, where that adult or child receives, or is eligible to receive, support services under the Social Work (Scotland) Act 1968 or the Children (Scotland) Act 1995. A carer is generally defined as a person of any age who provides unpaid help and support to a relative, friend or neighbour who cannot manage to live independently without the carer's help due to frailty, illness, disability or addiction 2.
2.2 Carers as providers
There are 481,579 carers in Scotland (Census 2001), of whom 115,675 are caring for 50 hours a week or more. It is estimated that carers contribute £5 billion worth of care in Scotland each year (Carers UK 2002). Carers are providers of services, and as such they are key partners with Health and Social Care in providing community care services in Scotland. 'The fundamental principle underlying the new legislative provisions is that local authorities, the NHS and other support agencies should recognise and treat carers as key partners in providing care.' (Carers - Community Care and Health (Scotland) Act 2002 -Scottish Executive Circular CCD 2/2003). Treating carers as key partners is fundamental to the effective implementation of the carer's assessment and is the central principle upon which this guidance is built.
2.3 Appropriate terminology
Local partnerships should consider how best to refer to the assessment process. There is strong anecdotal evidence that carers find the term 'assessment' off-putting and judgemental, and therefore it becomes a barrier to involvement in the process. The terms 'carer support plan' and 'carer resource plan' are already in use in some local partnerships and more accurately reflect the aim of the process. Such terms may also help to engage carers more effectively as they reflect a partnership approach.
2.4 Valuing carers
Consultation with and research about carers provides a consistent and clear message about the way carers wish to be treated. They wish to be:
- Supported to make informed choices, including whether they want to care and the extent of
- The caring role
- Informed, skilled and equipped to manage their caring role
- Treated as partners with other service providers
- Valued and respected, and have their expertise recognised
- Heard and have a say in service provision and the shaping of services
- Enabled to have a life of their own
These aims are entirely in line with both the outcomes sought by the Executive as detailed in 3.1 below, and with the fundamental principle of treating carers as key partners. They are the principles against which the assessment process should be measured.
2.5 Resourcing carers
Just as Health and Social Care require resources to fulfil their role as care providers, so too do carers. The resources carers require can come in a variety of forms such as information and advice, breaks from caring, carer training, and financial advice. In order to agree and provide the most appropriate resources for each carer they have to be consulted and involved in discussions. The carer's assessment is the vehicle for this discussion. It provides the template around which this discussion can take place.
3. Outcomes and purpose of assessment
3.1 Outcomes for carers
The Executive's policy is to recognise and support carers, in order to achieve good outcomes for carers. Good outcomes for carers will occur when:
- The carer is able to cope with their caring role
- The carer can access a regular break from caring
- The carer is informed and knowledgeable about their caring role and the needs of the person
they care for
- The carer feels valued, supported and listened to
- The knowledge and expertise the carer has about the cared-for person is recognised and used
- The carer is able to have a life of their own
3.2 Purpose of assessment
In order to achieve the above outcomes the carer's assessment has to:
- Identify the care provided by the carer
- Establish what level of care the carer is willing and able to provide, and help them to Determine whether their caring role is sustainable
- Identify current and potential risks to the carer's health and wellbeing as a result of the caring role
- Determine what resources the carer needs to support them in their caring role, and agree how these resources can best be provided
- Determine what resources the carer needs to enable them to have a life of their own, and agree how these resources can best be provided
- Determine what the carer needs to maintain and improve their own health and wellbeing, and agree how these resources can best be provided
- Take the carer's views into account when agreeing any support to the carer and cared-for person
In summary 'Support for carers should be designed to empower carers to make the most of their potential and opportunities, rather than allowing them to be confined or isolated in their caring role' (Scottish Executive Circular CCD2/2003). The minimum information standards detailed in section 9 below are designed to fulfil the above purpose and in turn achieve good outcomes for carers.
3.3 The carer's perspective
The assessment of the cared-for person must take into account the views of the carer, in so far as it is reasonable and practicable to do so. For further detail on the standards relating to the carer's involvement in the assessment of the cared-for person see 'Section B - Carer's perspective' in the 'National Minimum Standards for Shared Care and Support Plan (Adult Client Groups).'
4. Having a choice
'Our society will allow carers to be people first and unpaid carers second who can fulfil their potential as citizens. Unpaid carers will be afforded the opportunity to choose when, and how, and if they care.' (Care 21 Report - The future of unpaid care in Scotland, 2005).
In giving practical effect to this vision and the role of carers as full partners local partnerships will as part of the assessment process:
- Consult the carer about the caring responsibility they are willing and able to take
- Not assume or take for granted that the carer's contribution will continue at any set level 3.
5. Record of the assessment
5.1 Content
The record of assessment (carer support/resource plan) will include:
- The overall needs identified with and for the carer
- The carer's role and the level and type of care provided so that changes in the carer's situation and needs are identified when the support/resource plan is reviewed
- A record of any decisions about sharing of information and consent given or refused
- A record of the resources or other services provided and any needs that are not met by these
5.2 Copy of the assessment
The carer should be given a record of the assessment (carer support/resource plan) in an accessible format.
6. Reviewing
6.1 Purpose of review
A review fulfils a number of different purposes which are to:
- Review the achievement of the support/resource plan
- Review the carer's satisfaction with the quality of the assessment process against the principles detailed in 2.4 above
- Review the carer's satisfaction with the quality of the resulting support and services against the outcomes detailed in 3.1 above
- Reassess current needs based on willingness and ability to care
- Review the support and services required
- Set the date for the next review
As with the original assessment the review findings should be recorded and the carer given a record in an accessible format.
6.2 Continuing choice
In order to ensure that carers' continue to have a choice about the level of care they provide regular arrangements to monitor and review the situation and the support being provided are essential and will be an integral part of a local partnership's assessment approach. The timetable and arrangements for a future review will be agreed with the carer as part of the initial assessment process (see section 9 - 3.4).
6.3 The carer's perspective
As with the initial assessment of the cared-for person the review process for the cared-for person must take into account the views of the carer, in so far as it is reasonable and practicable to do so. For further detail on the standards relating to the carer's involvement in the review of the cared-for person see 'Section B - Carer's perspective' in the 'National Minimum Standards for Review (Adult Client Groups).'
7. Who should assess?
Local partnerships have powers under Section 4 of the Social Work (Scotland) 1968 Act and Section 19 of the Children (Scotland) 1995 Act to involve other bodies or persons in helping them to carry out their functions, including voluntary bodies. The Single Shared Assessment and Carer's Assessment extend the opportunities to involve a range of staff and agencies in assessment, and stresses the principle that the most appropriate professional should be responsible for carrying out the assessment, co-ordinating any other contributions, and identifying the support or resources needed. All staff carrying out assessments should be familiar with the standards set out in this guidance. 4
8. Confidentiality
In all cases the carer must be given the opportunity to discuss their needs and views without the cared-for person being present. Consent should be sought to share information as part of the assessment process, and formally recorded where consent is given.
9. Minimum information standards
The carer's assessment/support/resource plan should meet the information standards as set out below.
9.1 Recording of data items
It is not necessary to record every item for every person subject to a carer's assessment, only those items appropriate for that person. However to meet the standards, tools and electronic systems should have the capability to record all data items which are contained within the standards.
9.2 Looking to the future
The carer's assessment will consult and involve the carer in discussions of the future as well as the present. It will enable the carer to discuss:
- Their aspirations and plans for the future, e.g. employment, education and recreational activities
- Their concerns and fears for the future e.g. health issues, the ability and willingness to continue to care
This anticipatory focus should be apparent throughout the assessment process.
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