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About eligibility criteria
Many people, at some time in their lives, develop a disability or long term condition and need additional support to regain abilities or maintain their wellbeing. Support may be based on general services in the community or from the council, from the NHS, or through Intermediate Care (jointly arranged therapeutic or rehabilitation services to improve recovery of abilities after an accident or period of ill health.
Where longer term support may be needed, including provision of equipment, support or care, eligibility criteria are used to ensure consistency about when a service is offered.
What are 'eligibility criteria'?
Eligibility criteria are used to decide whether people's needs qualify for support from social care or health services.
Where long term support is needed, people are usually referred to the local authority for social care services, equipment or housing adaptations, and the council has to use eligibility criteria for social care to decide whether people's needs qualify for further assessment or support.
Where long term support is needed due to a primary health care need, people may be eligible for NHS Continuing Health Care funding of their support. The Eligibility criteria for this are called Eligibility criteria for Continuing Health Care.
Other criteria determine whether housing related support can be provided, or health services, including health equipment.
Specific criteria operate for NHS funding of the Residential Nursing care Contribution (RNCC) if someone may go into a care home with nursing, and for continuing health care, which is the provision for NHS funding of care when it is due to a primary health need.
Eligibility criteria for social care
The Government's required framework for local councils' eligibility criteria "Fair Access to Care Services" defines people's needs into four bands:
- Critical
- Substantial
- Moderate
- Low
These are about need and risk of loss of independence, not about your own resources.
Councils are required to keep their criteria under review. In 2005 Coventry City Council changed its eligibility criteria following consultation so that 'critical' or 'substantial' levels of need fall within the criteria.
The areas of life where a risk may be critical or substantial are
- Threat to life
- Major health problems
- Loss of control over the person's environment (housing, finances, warmth, security)
- Risk of abuse or neglect
- Loss of control over the person's personal care routines
- Loss of control over appropriate occupation
- Loss of social support systems-informal carers and relationships
- Loss of important roles/responsibilities or posing a risk to others
There is provision for older people aged 65 or over to refer themselves through the Single Assessment Process. If you consider your needs are critical or substantial, you can start this by giving us information as a combined referral and assessment on the "Word" form at the bottom of the page. Please send, fax or email it to the nearest office -see this page. (If the person is in hospital discuss first with ward staff).
We will seek to establish your views of the issues and your desired outcomes. Follow these links for details of assessment processes and for the kind of services considered.
Where do charges fit in?
If your needs are eligible, there is also a financial assessment on your ability to pay towards the service. Follow these links for details of the arrangements for care homes and care packages at home.
If you might need different accommodation, such as a care home, there is a savings ceiling above which you may have to fund any placement. If you feel this applies to you, you are still eligible for assessment and advice before arranging any service and we advise this. If you do take a placement in a care home, we will advise you keep monitoring the figure (which is updated yearly by the Government), and contact the council shortly before your savings reach this level. For more details see our page on planning support if you have savings or assets.
How are ongoing arrangements and reviews managed?
Many people recover their ability to look after themselves with the right kind of support. Sometimes people need care services for a period of time.
When we plan care with you we co-ordinate the different services going in
for a person to
meet the overall objective. Some people opt for a direct
payment and then manage their own care.
We monitor and set up reviews as routine and at minimum intervals
of 12 months to ensure that needs are still being addressed the criteria still apply and arrangements are best in place to
meet planned outcomes. If the criteria do not apply we have to end funding for services and ensure you have advice on other
support, but this means that should you need services again, resources will be available.
What services can people have if they have moderate or low need?
The eligibility criteria above are for social care services and there are various other services that can assist people with moderate and low need. They may benefit from community health services, intermediate care, welfare benefit, advice on repairs or home safety checks. See our General Support page and if accommodation is unsuitable and you might consider sheltered or other accessible housing, see our page on "Supporting older People".
We also offer people with moderate or low need by offering advice and signposting to community supports to enable them to better care for themselves and maintain their lifestyle and independence.
There are also various initiatives to support people including older people maintain active lifestyles. See http://www.opin.org.uk/ and http://www.gethealthycov.org.uk/
Private Suppliers of equipment can be found at http://www.smilelocal.com/mobility_equipment_and_services/coventry
How does Coventry compare with other local authorities?
At the present most local authorities are meeting Critical and Substantial needs only, and the government is reviewing (spring 2008) how the "Fair Access to Care Services" framework is working.
For further information
Directorate Office
Civic Centre 1
New Union Street
Coventry
Tel: 024 7683 3478
On the Single Assessment Process-
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