Struggling with writing a Care Act Needs Assessment? As a Newly Qualified Social Worker a few years ago, I understood that to become effective at what I do as a social worker, there was a need for me to write good Care Act 2014 needs assessments.

So, What is a Care Act Needs Assessment? 

A needs assessment is carried out by social services to decide your care and support needs. This will enable them to determine priorities and allocation of resources which will help and support you to live the life you want. 

Assessments form the core of what social workers do.

I remember being advised to read other assessments, to have an idea on how to write mine. However, this was very confusing as everyone had their own writing style.

I realised that there are some key elements you need to cover when completing a needs assessment. I use this guide in practice and it helped me complete holistic assessments and determine how a person qualifies for care.

Remember to familiarise yourself with the Care Act 2014 and the Care Act Guidance.

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The Care Act Needs Assessment Made Simple and Possible

How you plan your needs assessment should be based on individual circumstances, the social care needs of the individual, and your own professional judgement. You are likely to need to do more research on tools or questions you may want to ask when completing a needs assessment under the Care Act 2014.

What is a Care Act Needs Assessment in Adult Social Care?

• Needs assessments are for adults (18 years of age or over) who may require support with their day to day living because of a physical, mental or any other illness. The need may also be age related.
• A needs assessment is carried out to determine what help an individual requires.
• It is used to gather information to understand an individual’s presenting problems, and to assess the effectiveness of any interventions or programs.

What Does the Care Act Say About Needs Assessments?

Section 9 of the Care Act 2014 states that “where it appears to a local authority that an adult may have needs for care and support, the authority must complete a needs assessment”.

Section 10 of the Act also highlights the need to assess a carer who appears to have needs for Care and Support. However, in this guide, focus will only be on considerations when completing a needs assessment for an adult under section 9 of the Act and the interventions you may want to think about.

Key Points to Remember

Before sharing information, consider the following;

• Seek informed voluntary consent which aligns itself with confidentiality and where this can be overruled. Example when a person lacks capacity or where there are issues around safeguarding.
• Only share information on a need to know basis with other agencies.
• That the person has the right to refuse an assessment (s.11 (1) of the Care Act) unless the adult lacks capacity to refuse the assessment and the authority is satisfied that carrying out the assessment would be in the adult’s best interests, or the adult is experiencing, or is at risk of, abuse or neglect (s.11 (2) of the Care Act 2014).
• Consider who will support the individual in the assessment.
• I consider whether they need an interpreter or an Advocate. If the person is deaf or blind, the Care Act states that the assessment should be carried out by an appropriately trained professional.
• Include your professional judgement and take into account the views expressed by the individual.

How Should you Carry out a Care Act Needs Assessment?

No one size fits all! The decision on how you complete a needs assessment will depend of individual circumstances.

When completing a needs assessment, I disregard any current support in place. I also determine how the person’s illness is affecting their ability/inability to achieve each eligibility outcome. For example, because of this illness, what is the individual struggling with? What are they able to do?

Depending on individual’s communication needs, I use Tell me, Explain and Describe (TED) questions throughout my assessment to help me gather more information through one question rather than a range.

Considerations

• I consider how the person would contact me after the assessment. I usually have complimentary slips/cards which I give to individuals after an assessment. You can get cheap copies from Amazon.
• I consider potential barriers to communication because of a disability or age-related disability. I consider life-changing situations that may affect the assessment process, such as critical illness or bereavement.
• I use short sentences and repeat information to ensure that the individual has understood what we have discussed. I paraphrase and summarise where appropriate and allow time for people to ask me questions.
• I consider services already involved in the individual’s care and support. For example, a District Nurse.
• I consider how long it takes them to complete tasks in each area of need identified as this will influence the care and support plan.
• I consider planning for emergencies when a carer may not be able to provide support (i.e., contingency plan).

Who Should you involve in the Needs Assessment?

It is always helpful for family members or a carer to be present during an assessment. However, the individual must consent to this and sometimes you realise that having someone else present might not be appropriate. For example, it may cause the person to become agitated, feel uncomfortable or there may be some form of coercion or safeguarding concerns.

I do not assume that the individual is happy to have a family member or carer present. Always ask.

Proportionality and Appropriate Assessments

• I consider how to make the assessment proportionate. This means that if I identify that an individual has needs in an area, it is appropriate for any assessment to be undertaken in those areas identified.
• Where their needs are complex, I consider specialist input, such as a Speech and Language Therapist or an Occupational Therapist.
• Appropriate assessments should be person centred and collaborative in nature, ensuring that the individual and their carers understand the process.
• I consider how I can provide as much information as possible about the assessment process, in a format that is accessible for the person during the initial contact.
• I take a printed sheet highlighting what an assessment is and why we carry out need’s assessment in adult social care.

About You Section

Here, I try to discover as much as I can about the person. I ask about their personal and family background and find out whether there have been any recent events or changes in their lives which have affected their day to day living or overall wellbeing.

• I find out how long they have lived in their accommodation for and whether they live alone. I consider how the person has dealt with setbacks.
• I always determine areas of the person’s life they most enjoy or value. I encourage them to discuss both short-term and long-term goals. I discover any preferences regarding culture or religion.
• This information can be especially useful when completing a personalised care and support plan if the person has eligible needs under the Care Act 2014. I also find out about their strengths and the resources available to them.
• I follow a strength-based and person-centred approach in my assessments. I encourage the individual to discuss what is going well in their lives and their own abilities and what is available in the community.
• My focus during an initial contact is to find out about the individual’s strengths and assets in the community. At this stage, I explore how I can connect the person to things that may help them live their lives the way they want based on their strengths and resources. I always seek their views on what they want to do in their lives as lives.
• I record any views friends or family may have about the individual’s care and support. I discover what they think is most important to the individual and why.
• I find out whether they have concerns about how others treat them. This is to ascertain whether there are any safeguarding concerns. Note that some people may not be able to express any concerns if there is a carer or family member present in the meeting. Pay attention to nonverbal cues and arrange to see this individual alone another time if required.

Home and living situation

I find out how long a person has lived at their accommodation and who owns the property. I consider whether this accommodation is temporary or permanent. This will help me think about supporting the individual to explore other accommodation options.

I find out whether they have any concerns about their accommodation. Do they have adequate heating and the last time they completed a gas safety check? I look into a referral for grants such as cold weather payments or the need for a fire risk assessment referral.

Interventions to think about when complete a needs assessment under the Care Act 2014

• Fire safety assessments
• Housing applications
• Referral for repairs
• Gas safety checks

Maintaining a habitable home environment

I find out what the person can do to keep their home in a sufficiently clean and safe condition. Are they able to do any housework tasks or do they have difficulties completing these tasks? If they have difficulties, I find out what can help them achieve goals in this area or the level of support required. For instance, maybe a person cannot move items in their way, I consider whether a grabber may help them with this.

I find out from the individual whether they can do their laundry, change their bedding, use household appliances safely, whether there is a fire alarm and do they have any awareness of safety? For instance, will they be able to clean spillage or ask for help to have this cleaned knowing it may cause a fall?

I observe whether there is any evidence of hoarding or body odour. I ask how they support their pets and find out whether there are any concerns. This is because any animal welfare concerns should be highlighted and reported. Personally, I report any concerns to the Royal Society for the Prevention of Cruelty to Animals (RSPCA)

Interventions to think about 

• Consider a fire assessment referral
• Consider an Occupational Therapy referral for a home assessment
• Consider referral to Assistive Technology
• Consider referral to the Royal Society for the Prevention of Cruelty to Animals (RSPCA) if you have concerns around the welfare of pets.
• Consider cleaning services–if a person is in receipt of PIP or Attendance Allowance, this can be used to fund such services.

Paperwork and finances

I find out what benefits they are in receipt of. I determine how they manage their finances and paperwork or who supports this. If there is already support in place, I find out how this is being carried out to rule out any safeguarding concerns. For example, I will ask whether they have enough money at all times, whether they have paid all bills.

I ask how they respond to correspondence and how quickly. How do they pay their internet, utility and any other bills? I consider how they manage their financial affairs and whether there is any Lasting Power of Attorney for Property or Financial affairs in place.

If they do, I ask whether there are any concerns with this arrangement. If they have no LPA and would like to know more about it, I provide information following the Gov.UK information here at https://www.gov.uk/lasting-power-attorney-duties/property-financial-affairs

If there are indications of financial abuse, it should follow the appropriate safeguarding procedure.

Interventions to think about 

• Capacity assessment around finances – read article on Getting Capacity Assessments right
• Welfare Benefits team or services within your local authority
• Community law referral
• Citizens Advice Bureau (CAB) referral
• Age UK referral

Managing and maintaining nutrition

I find out how the person plans, budgets and shops for both essential and non-essential items.  Are there any shops nearby and how are they able to get there? I consider how they carry items back home? I discuss the possibility of shopping online if this is something they are interested in doing.

Is the person able to prepare their own meals/snacks safely? Are there any risks, such as falls or burns, when completing this task? How often a day do they have a meal? I consider whether they are on any special diet and how they maintain this diet. I consider how they carry their cup or plate to the table and how safe this is.

I check whether the person can eat and drink independently. I find out whether any support required is for prompting/supervision/equipment. For example, someone with arthritis may benefit from easy-grip utensils

Has the person lost a significant amount of weight? Consider whether the person has swallowing difficulties (dysphagia)/risk of choking or any other health conditions which may require support from a health professional.

Interventions to think about 

• Speech and Language Therapy (SALT) referral
• Local home delivery services
• GP referral
• Occupational Therapy (OT) referral for aids and adaptations

Managing toileting needs

Here, I consider how long it takes for the person to get to the toilet. Are they able to do this independently or require some support? What sort of support is required? I consider whether they have mobility issues and do they use any aids.

Are they able to adjust their clothing after visiting the toilet and how long does it take? How do they wash up and change into clean clothing should they have an accident?  Do they lack voluntary control over urination or defecation?

Are there any adaptations in place to support them when accessing the toilet? I also use observation skills to discover whether there is any evidence of self-neglect or soiled clothing.

Interventions to think about 

• Referral to the Occupational Therapist for aids and adaptations
• GP referral
• Incontinence nurse referral

Maintaining personal hygiene

I find out whether the person’s disability or illness affects their ability to maintain their personal hygiene needs. Here, I ask the person to tell me how they complete their personal hygiene needs.

During this conversation, I note whether the person can brush and floss their teeth, wash their face and hands, use a shaver, clean their eyes, trim their nails, comb and style their hair, wash their body and how regularly they do this.

I find out whether they can perhaps wash the top half of their body but struggle to wash hard to reach areas. I observe whether there is any evidence of self-neglect based on appearance and presentation. However, it is also important to respect individual preferences in relation to hygiene, appearance and choice in the kind of support required.

I consider gender, dignity, culture and dignity. If support is required, I discuss the appropriate levels of support to maintain the standards they want during the care and support planning stage.

I consider any adaptations in place such as wet room, shower chair or grab rails. If there is none in place and this is required, I consider a referral.

I find out if they require regular support for a skin condition or to prevent one developing?  If the person has a skin condition/pressure sore or is at risk of one developing one, I check whether they require health interventions for prevention or treatment and whether this is daily or less/more than daily.

Interventions to think about 

• Referral to the Occupational Therapist (OT) for aids and adaptations
• Referral to GP / District Nurses

Being appropriately clothed

I consider whether the person faces any difficulties dressing or undressing. Are they able to wear appropriate clothing for the weather and occasion? This includes socks, shoes. I find out whether they have any difficulty putting on lower garments such as trousers, skirts, socks or difficulty getting undressed.

Can they undo their buttons and tie shoelaces? Do they use any modified clothing such as fasteners, such as Velcro or magnetic buttons? Do they need some prompting or reminding to get dressed or undressed? Consider how long it takes for them to dress or undress.  Does it cause any pain or make them tired?

Do they have any aids in place and if not, discuss aids such as a dressing stick, shoehorn, front-fasting bra, a leg lifter or side/back/front opening clothing? I consider safety risks when they are getting dressing or undressed such as slip or fall or getting too hot or cold because the individual cannot get their clothes on or off.

Interventions to think about 

• Referral to the Occupational Therapist (OT) for aids and adaptations
• Age UK for support with clothing supplies
• Referral to other charity organisations

Being able to use the adult’s home safely

I give consideration to how long it takes for the person to move around their home because of their disability or illness. Do they have a staircase? Could they benefit from a stairlift? Can they access all rooms in the house? Do they have difficulty getting in and out of the house? Do they need any walking aids or equipment to transfer, for instance, a hoist?

I also give consideration to risks involved in transfers. Observe whether there are any trip hazards in the home environment and consider good and bad days.

I usually ask the individual to describe a good day and a bad day. I discover how often they experience such days. I find out whether they need a wheelchair or have one already and find out when the wheelchair was last wheelchair service. I consider whether their weight may affect their ability to move around.

I record whether the person can get around their home in a reasonable time and with no difficulties or dangers (including any stairs), and whether there are any difficulties getting in/out of the house or chair.

I consider whether the person can stay comfortable and reposition when they want to. If aids are required to make this activity easier for them, I consider referral to the OT for bedside rails, specialist chair or a pressure relieving mattress.

I consider whether there has been any history of falls, which may indicate current risk. If there is a history of falls, how recent was this and what were the circumstances? Was medical help sought? How recent? Does the person worry about falling? In what situations? Include a history of falls in details of mobility needs. Consider possible causes (obstacles, lighting, limited joint movement).

Interventions to think about 

• Referral to the falls clinic for a falls assessment.
• Referral to Wheelchair services
• Referral to Occupational Therapist for bedside rails, specialist chair or a pressure relieving mattress.

Developing and maintaining family or other personal relationship

Here, I find out the relationships that are most important to the person and anything that they would like to improve or change. To start off with, I use a family tree and eco-map to establish the relationships individuals have with their family, neighbours, friends and services.

I establish how stable those relationships are and how often the individual sees them. I discover how they maintain contact with their friends and family. Do they visit, ring them or use the internet to maintain contact? Do these relationships have a positive or negative impact on their overall wellbeing?

I discuss with the person the level of support needed to maintain relationships and how often this support is required.

Interventions to think about 

• Referral to Assistive Technology
• Referral to befriending services
• Referral to Age UK

Making use of necessary facilities or services in the local community, including recreational facilities or services.

In this section, I find out from the person whether they can access the community and ascertain the support they need to stay safe out in the community.

Check whether the person can get out into the local community independently (consider walking, driving or using public transport). Are they vulnerable or a risk to others whilst out and about? Provide information regarding local community transport services as needed.

If support is required, could this just be regular checks by telephone, or is 1:1 or 2:1 supervision needed? Is the individual able to follow familiar routes independently, but not unknown places?

In addition, I explore the activities that are most important to the person and anything they would like to improve or change

I note any regular activities the person is involved in and enjoys and whether they feel this is sufficient (including any clubs attended, weekend and evening activities and regular visits to/from others). Are there things the person would like to do but cannot access/take part in due to their difficulties? I establish the support to engage in social activities. This could be support with transport or 1 2 1 support. I find this area is subjective and there should be realistic expectations set.

Interventions to think about 

• Referral to local transport services
• Referral to voluntary services
• Day centre opportunities.

Accessing and engaging in work, training, education or volunteering

Consider current paid employment or voluntary work situation and education/training situation.

If the person is in work and/or education/training, the nature of their involvement in each should be noted. Consider whether the person wants to be involved in work and/or education/training. Consider support that may be available via the Equalities Act 2010 access to work, the Job Centre or any other Charity Organisations to support people in/returning to work.

I also determine whether there is anything they would like to improve on with their work, training, education or volunteering. In addition, I explore the support needed to take part in these activities and how often.

Interventions to think about 

• Referral to the job centre
• Referral to charity organisations
• Explore any online training opportunities

Carrying out any caring responsibilities the adult has for a child

In this section, I consider whether the adult has any dependent children and whether their parenting or caring responsibilities is affecting their overall wellbeing.

I determine whether the individual has difficulties in providing and maintaining stable support? What would help? I consider the impact on any dependent children and what works well or not so well with their parenting/caring responsibility.

Other factors to consider

Day and Night time support

I consider whether the individual needs any support to stay at home during the day or night. If they do, I determine the level of support required. I discuss their ability to respond to emergencies and their perception of safety.  I check whether the person is safe to be left alone or at risk of harm to self/others. I find out the views of others on this with the individual’s consent.

I discuss their night-time needs and staying safe during the night and the level of the overall level of support during the night that the person requires to stay safe and comfortable. I find out if they have issues with sleeping, staying comfortable or perhaps with their continence care. This can help determine whether they require regular support, which may require wake in night support.

Mental Health

I find it always useful to find out about the mental health and wellbeing about an individual.

I consider whether the person has ever suffered from a serious mental health issue and whether they have any services involved with their support.

Does the person have a mental health diagnosis? Have there been any traumatic experiences in the past, which may have had a serious impact, such as post-traumatic stress disorder or depression? Consider referral for specialist assessment by a mental health team.

Medication

I also consider the medication they are on and whether they were prescribed these medications. I discuss how they administer their medication and find out whether they need support to remind, prompt or supervise them. I consider whether equipment or tele care can help.

The pharmacy is also able to support with preparing dorset boxes or blister packs. If this is the case, consider whether the person can take out the medication independently.

There may be the need to also refer to the Assistive Technology team for devices that can help improve an individual’s ability to take their own medication. For instance, an automatic pill dispenser or a reminder clock.

I also consider the last time the individual had a medication review. If it has been a while, I support them to arrange a GP visit.

Conclusion

I hope this article will help you write your Care Act 2014 needs assessment with confidence. If you would like to have a template, kindly email me at info@socialworkhaven.com.

The Care Act needs assessment criteria should be completed based on individual needs and circumstances.

You may want to also use this guide as a Care Act assessment checklist.

You can find the Care Act pdf and a Care Act 2014, easy read HERE. 

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