What is a care needs assessment?

The first step is the same for everyone, whatever the bank balance

In England, a council must assess the needs of any adult who appears to need care and support. How much money or savings the person has makes no difference to that duty, which is set by section 9 of the Care Act 2014 (opens in a new tab).

So the starting point is the same for every family, including those who expect to pay for care themselves. The council first looks at what help the person needs. Only after that does it work out who pays.

A council that tells a family to find and pay for a care home before anyone has assessed the person needing care has the order the wrong way round. A registered manager taking that family's first call needs to know this, and so does a commissioner whose team runs the council's front door.

Each UK nation runs its own system

Social care is devolved, so the four nations of the UK each set their own rules. The assessment described here is England's. It rests on the Care Act 2014 and the Care and Support (Eligibility Criteria) Regulations 2015, in force since 1 April 2015.

Wales has its own law, the Social Services and Well-being (Wales) Act 2014. Scotland and Northern Ireland each run their own separate systems.

The trap is assuming the English tests carry across. A family moving someone between nations, or a care group with homes in more than one, should not expect the same eligibility tests, the same order of steps or the same terms. The rest of this piece is about England.

Who can have one? Anyone who appears to need care

A care needs assessment is how a council decides whether an adult has needs for care and support and, if so, what those needs are. The duty applies however serious the council thinks the person's needs are, and however much money they have.

It is free. Anyone can ask their council for one, by phone or online (opens in a new tab). It can be done face-to-face, over the phone, online or as a self-assessment.

Savings are no reason to refuse or delay an assessment

The duty sits with the council. Because it does not depend on the person's money, savings are no reason for a council to refuse an assessment or to push it down the queue.

A family that plans to pay can ask for an assessment and should get one. A family that has already started looking at homes can ask the council to assess at the same time. Looking at homes does not cancel the council's duty.

What the assessment covers, and what you will be asked about

The assessment is meant to look at a life, not a list of tasks. Whenever a council carries out a care and support function such as an assessment, it must promote the person's wellbeing. The statutory guidance counts personal dignity, physical and mental health, safety, and taking part in work, education or recreation (opens in a new tab) as part of that wellbeing.

The questions follow from what the council has to decide. Expect to talk about everyday things: eating and managing meals, washing, using the toilet and getting round the home safely.

Expect to be asked what lies behind any difficulty, such as an illness or impairment, and what effect it is having on the person's health, safety and daily life. A relative who knows the detail helps the person give a full picture.

Three national tests decide who is eligible, and all three must be met

The council decides, but it does not write the rules. Eligibility is set nationally, and the council applies it.

Under the national eligibility criteria (opens in a new tab), an adult's needs qualify only if three conditions are all met. First, the needs arise from a physical or mental impairment or illness. Second, as a result, the adult cannot achieve two or more specified everyday outcomes, such as managing nutrition, personal hygiene, toileting or using the home safely.

Third, being unable to achieve them has, or is likely to have, a significant impact on the person's wellbeing. Fail any one test and the needs are not eligible.

Take a man who, after a stroke, can no longer make meals safely or wash himself, and whose health is suffering as a result. His needs come from an illness and he cannot achieve two of the outcomes. If the council judges the effect on his wellbeing significant, all three tests are met.

Had he struggled only with cooking, he would not meet the bar on that alone, however hard that one thing is.

How long is the wait? Ask your own council

Families will want to know how long an assessment takes. There is no standard wait for a registered manager to quote, so the answer has to come from the council itself.

The practical steps are simple. Ask early, ask for the carer's assessment in the same call, and ask the council how long its own wait is.

The carer can ask for an assessment too

The person doing the caring has rights of their own. Someone who cares for another adult can ask for their own, separate carer's assessment (opens in a new tab), which is free. It can be arranged at the same time as the cared-for person's needs assessment.

Carers face an equivalent eligibility test. Under the same regulations, a carer's needs qualify (opens in a new tab) if they arise from providing necessary care for an adult, have a specified effect on the carer, and as a result have, or are likely to have, a significant impact on the carer's own wellbeing.

A registered manager talking to a worn-out relative can point to this directly. Asking for both assessments together saves the family a second round of calls.

After the assessment: a plan with a weekly figure

Where needs are eligible, the result is a care and support plan. It sets out what matters to the person, what they can do themselves, what equipment or care they need, what family and friends think, and who to contact with questions.

It also covers how and when care will happen. For a carer, the plan also covers respite options, local support groups and training such as safe lifting.

Then there is the money. The plan includes the person's personal budget and direct payments (opens in a new tab): the weekly amount the council will spend on their care. That weekly figure is where the money starts to move, and it only exists once needs have been assessed.

The means test is the second question, never the first

Who pays is a separate question, asked second. If the needs assessment finds the person needs help, the council then arranges a financial assessment (opens in a new tab), the means test, to see whether, and how much, it will contribute towards the cost.

The two steps answer different questions. The needs assessment asks what help the person needs. The financial assessment asks who pays for it, and current GOV.UK charging guidance sets out the capital and income limits it uses.

This is why a person with savings still gets the first step. Their wealth may decide who pays later on. It does not decide whether their needs are looked at.

Asking about savings first breaks the sequence

The common failure is to ask the second question first. Because the duty to assess does not depend on how much money someone appears to have, a council that tells a person to arrange and pay for their own care before carrying out a needs assessment is not following the sequence the Care Act sets out.

How often this happens is not known. The order itself is clear, and that gives a family something firm to stand on: a person told to sort it out themselves can still ask the council for a free needs assessment.

A commissioner whose team runs the front door carries that risk directly. Any first conversation that starts with savings, property or income before needs runs against the statutory order, whatever the person's likely final bill.

The cost of getting it wrong is not only the person's. Without an assessment there is no record of eligible needs, no care and support plan, no weekly figure and no carer's assessment offered alongside. If the money question comes first, how many people never have their needs written down at all?