Modernising Community Care - The Housing Contribution: Page 5

Modernising Community Care - The Housing Contribution

5.0 INDIVIDUAL ASSESSMENTS AND REASSESSMENTS

General Approach

5.1 Only through careful assessment of individual needs can appropriate packages of care, accommodation and other support services be put in place.

Routes into Community Care and Implications for Assessments

5.2 Assessment of needs is an integral part of providing services in the public and social housing and care sectors. People looking for assistance may take a variety of different routes into housing and community care services depending on the profile of their needs, their existing contacts and their understanding of the system. These can include: -

contact with housing departments as a result of a housing problem or a particular housing requirement. Housing departments may then assess the person's needs in relation to statutory homelessness responsibilities or to identify the level of priority for re-housing. This process should also trigger access to various staying put options if relevant;
initial contact with social work, perhaps through home carers. Social work will undertake community care assessments to identify needs for care services for those already living in the community, or those being discharged from hospital, whether from long stay or acute. Social work may also identify housing and care needs through assessments under the Children's (Scotland) Act 1995;
the GP or other medical practitioner, such as district nurse or community psychiatric nurse who may then form the "route in" to a wider range of services;
housing associations, voluntary bodies or private sector landlords from whom they are already receiving services or accommodation, particularly when their needs are or become complex and exceed the capacity of existing provision;
release from prison, either on a statutory order, licence or voluntarily. Contact is normally with the criminal justice social unit section in the relevant local authority social work service;
referral by a care and repair project that has arranged repair, improvement or adaptation to the house of an elderly or disabled owner occupier and where it is recognised that additional support is required;
hospital discharge.

5.3 The lead in assessing a person's needs can be taken forward by a single service, normally the social work department, with input from health and housing planning partners. Partners should therefore put in place an agreed approach to the assessment process. Without such co-operation the risks are: -

needs may not be recognised and adequately addressed with the consequence that service responses will run the risk of failing;
the users will be subject to a series of assessments, which may duplicate and cause considerable frustration and time delays. For example, homelessness, housing allocation, the Children (Scotland) Act 1995, and full community care assessments could be applied to a single case;
agency responses will not be co-ordinated and the chances of a satisfactory outcome will be reduced;
resources will be wasted which could have been used to assess more people more quickly;
the user may become demoralised and confused with the risk that, in order to prevent constant assessment, they accept housing that is unsuitable in meeting their needs.

Opportunities for Improvement

General

5.4 There are a number of opportunities for avoiding fragmentation of assessment processes and unco-ordinated service responses by collaborating on assessment. This can be by: -

agreed approach to assessment;
undertaking assessments jointly;
developing a system of shared assessments;
incorporating opportunities for self assessment.

Screening

5.5 Whichever approach is adopted to interagency assessment, the statutory agency approached first should be able to carry out a broad initial screening assessment to identify which should be the lead agency, and which assessments should be relevant, and initiate any referrals or further assessments required. This will require staff who receive initial approaches to be aware of the services, accommodation and assessments available from other providers. Housing bodies in the local area should develop with social work and health (community health services and the primary health care team) an agreed approach to assessing need, including this initial screening. This should be undertaken irrespective of whether there are systems in place locally of joint assessments or shared assessments. There should be a clear understanding of each other's terminology and interpretation of requirements and in this regard joint awareness training may be useful.

Agreed Approach to Assessment

5.6 The locally agreed approach should include: -

agreed assessment criteria for all applicants who have housing, support and care needs. This should be based on agreed definitions of housing need;
agreed methods of referral and assessment, such as timetables for action, who may assess and a common assessment form. In relation to the housing aspects, this would need to include: -
- details of available accommodation;

- whether that accommodation is unsuitable, and if so why;

- form, type and location of any new accommodation required;
means by which users and carers are involved in the assessment process taking account of carers' statutory rights to a separate assessment. This should include consideration of: -
- information and advice to be provided;

- what choices are available to fulfil their future housing requirements;

- the extent to which self assessment of housing needs is possible;

- the role, and housing and other needs of the carer;
an initial assessment procedure for those people who present more complex needs. This initial assessment should attempt to: -
- clarify the person's immediate accommodation and personal needs, including any more obvious support/care needs;

- clarify the needs of any carer, including their housing requirements;

- assess the need for referral and for collaboration, including the option of a joint assessment, if this would assist with the identification of needs and effective solutions;
making arrangements for initial assessments that will be particularly appropriate in cases of emergency/immediate needs. In these instances a system of "fast track" assessment will be appropriate;

obtaining agreement on the definition of housing need, particularly if there are a range of housing providers involved.

Inter-Agency Assessment Protocols

Renfrewshire's protocols aim to provide all agencies with practical guidance in the assessment of community care needs where appropriate accommodation is necessary to maintain people at home or in homely settings. One of the stated intentions is to facilitate housing involvement in the assessment process. The protocols include: -

referral forms jointly agreed between social work and housing agencies;
a commitment to sharing information, subject to proper regard to the confidentiality of the client, in relation to referral assessment and care packages;
specified timetables for responding;
specified procedures and timetables for handling referrals from housing agencies and potential breakdowns in care or support arrangements;
a process for reviewing the protocols including at a senior level within the authority.

Contact: Joyce Smith, Principal Officer, Community Care Section, 0141 842 5140

Joint Assessments and Shared Assessments

General

5.7 Whilst a locally agreed approach is an essential minimum, housing bodies may wish to go beyond this minimum level of information sharing and collaboration and consider joint and shared assessments. Many users may prefer joint or shared assessments since they avoid a succession of assessments of a single person by separate assessors.

Joint Assessments

5.8 Social work co-ordinated joint assessments involve looking at housing, health and social care together in the assessment of a persons needs. This approach flows from agreements on a system of "triggers" agreed between the agencies which, when present in an individual, results in a joint assessment. Alternatively, joint assessment can be related to access to a particular project.

Joint Individual Needs Assessment

The Moray Council has developed a pilot "Scatter Flats" initiative to assist individuals with mental health problems to sustain tenancies. The scheme is aimed at those who have experienced or would be likely to experience difficulty if housed through the normal housing allocation process and who, in addition, would benefit from independent living with a planned outreach support network in place.

The pilot scheme, involving four one-bedroom properties taken from mainstream Council housing stock, is running for 12 months with the option to extend the scheme to other housing providers. A multi-agency assessment panel - involving principally housing and mental health social work staff - decides allocation priorities. Individuals are initially offered a tenancy under the same conditions as a temporary homeless unit, but with the understanding that the tenancy could become a secure one if progress confirms that the individual can sustain independent living.

Contact: Mike Martin, Moray Council, 01343 557001

5.9 Joint assessments will not be appropriate for all cases because they can be very resource intensive. Joint assessments should therefore be targeted on those who present highly complex sets of needs that can only be met adequately through the input of a number of agencies.

5.10 Joint assessments can be undertaken by a standing group of staff drawn from the different agencies or, alternatively, by an ad hoc grouping from the different commissioning agencies who have greatest knowledge of the type of needs demonstrated. Both approaches have their benefits. In general, however, it is likely to be more appropriate in the early stages of joint assessment for a standing group to be formed. This allows experience to be developed and any difficulties to be ironed out before rolling out the system more widely. Joint training may be useful.

Shared Assessments

5.11 Shared assessments involve one agency, whether social work, health or housing, undertaking the community care assessment on behalf of the others. This assessment is subsequently shared between all the agencies involved in developing the housing and care package. Joint training should be an integral part of this process.

5.12 A pre-requisite of this approach is that there is a clear agreement or protocol between the parties concerned on how shared assessments will be made, the criteria to be applied and the cases that can be handled in this way. This should take account of agency cultural and organisational differences.

5.13 There are advantages to this approach even though it undoubtedly involves the greatest development input: -

it enables a speedy assessment process for the users, since the agency where the user first presents can often undertake the assessment. This is particularly valuable for the local authority in relation to homeless people who also have care and support needs;
it can share the work involved in the assessment process between the agencies;
it helps agencies to gain a greater understanding of their respective roles.

Confidentiality

5.14 Better results for the individual will emerge from assessments where partners are fully aware of a person's circumstances. In some cases this may create tensions about the exchange of information between agencies. However, confidentiality concerns can be overcome by seeking permission from the user to share personal information with others. These concerns can be further alleviated by: -

inter-agency discussions on existing approaches to confidentiality;
agreement on information which should not be shared;
agreement on information which must be shared;
protocols between agencies on handling confidential information.

5.15 A useful device can be to separate between a common core that is automatically shared by all agencies, and other sections confined to individual agencies. Being clear about what type of information needs to be shared can also reduce confidentiality problems. For example, in the case of mentally ill people housing providers may not need to know the details of a psychiatric diagnosis, only that challenging behaviour has to be catered for.

Self Assessment

5.16 Finally, opportunities for self-assessment should be incorporated within the assessment process. For example, self assessment may be appropriate for relatively inexpensive aids and adaptations; in other circumstances, the user may well be best placed to identify which type of ramp would best suit their needs, or the design of a wet bathroom. Housing bodies cannot offer complete choice in this area any more than in others. Nevertheless, even within the constraints imposed by resources or policy, there will nearly always be alternatives available to the user though these will vary between areas. Where a user's first choice cannot be met, the use of alternatives should, where possible, always be discussed and considered with the user, their carer or advocate. The development of a product database or directory, which can be built up over time to facilitate this process would be useful. This might also include a facility to obtain feedback from users and carers on product suitability.

Care Plans and Reviews

5.17 The above comments on assessments also apply to the production of care plans, and care plan reviews, where housing is included in a package of housing and care services. Even if no housing issues arose in the initial assessment and care plan, agencies should be alert to the need to involve housing agencies if such issues arise in reviews. If housing providers become aware of the changing circumstances of an individual or are alerted to specific problems, they can also instigate action by inviting the social work department to take the lead in a care plan review.

Involvement of Users and Carers

5.18 By statute users and carers have to be involved in community care assessments. Users should also have a copy of the personal care record. This would be essential if the user was purchasing support services directly. Users and carers interests may not be the same, and carers (other than those under a contract of employment or working as volunteers for a voluntary organisation) have a legal right to request an assessment of their ability to provide substantial care on a regular basis. The results of the carer's assessment may affect the overall support services supplied.

5.19 An advocate can often represent a person whose needs are being assessed. Accordingly, the advocate should also be involved in the assessment process, if the user so wishes.