By Rachel Lewis.
In October 2017, Age Cymru published a report raising concerns about the state of social care for older people in Wales. The report, Crisis in Care? highlighted the experiences of older people accessing local authority care and support.
Since the introduction of the Social Services and Well-being Act in April 2016, the criteria for accessing care and support has changed. The new Act aimed to give people greater choice and control over their care by focusing on their strengths, capabilities and informal support networks. Although local authorities must carry out a care assessment whenever it appears that an individual may have needs for care and support, they only need to provide a care package to people whose needs cannot be met by information and advice, friends and family or community based preventative services.
Over the past 18 months, feedback form older people, Age Cymru’s local partners and calls to our national advice line have raised our concerns about the implementation of this new eligibility criteria. We are hearing that local authorities’ drive to provide information, advice and signposting is acting as a barrier to accessing that first step in the assessment process. We fear that local authorities are signposting to community services in place of carrying out an assessment of need.
For example, despite having a diagnosis of bipolar disorder and being the sole carer of both parents, aged 89 and 98, Mr M has been unable to access any form of formal assessment. His local authority uses a call centre to enable people to get in touch but Mr M has found call handlers very reluctant to assist. During one call they told him of all the things they could not assist with, rather than telling him of the services they could provide. On another occasion they told him to phone Age Cymru for assistance.
The new care assessment process is intended to provide older people with the tools and resources to manage their own care, however there are times when formal support is necessary. Without a thorough assessment of need, or any monitoring of outcomes for people who have been signposted to other services, it is unclear how local authorities can be confident that older people in their communities are not being left vulnerable through lack of support.
Over the past 12 months Age Cymru’s Information and Advice Line received over 4,500 calls relating to social care. The calls revealed that even when older people do receive a care assessment, the resulting care plan does not always deliver the care and support badly needed.
For example, Mrs G’s husband is in his 80s, has complex needs and following a hospital stay, has been reliant on his wife for personal care throughout the day and night. Unable to cope without night time support, Mrs G arranged for a private care service to assist her husband for several nights per week. The bill for this support was over £2000 a month. When Mr G was finally assessed, the care plan did note the need for night time care, but did not treat this as a responsibility of the local authority as it was judged that the family had managed to cover these requirements themselves. The expense of this privately arranged care meant that Mrs G tried to carry out as much of the care responsibility as she could manage, a situation she found very difficult.
It does appear that local authorities are making unrealistic assessments of the extent to which older people can manage their own care and that of their loved ones. This is placing unacceptable emotional and financial pressures on people already struggling to cope. Age Cymru is concerned that local authorities are expecting older people to rely too heavily on the goodwill of family members, their own financial resources and third sector organisations and are failing to deliver the support citizens in Wales are entitled to.
The decision not to fund Mr G’s night time care also seems to contravene Welsh legislation that states no one should pay more than £70 a week for domiciliary care for an assessed need.
18 months on from implementation of the Act, it is becoming clear that the new eligibility criteria’s focus on promoting self-reliance is being too easily interpreted by local authorities as a means to deny support to those who are struggling to cope alone. An assessment of how the new eligibility criteria is being implemented by local authorities is badly needed. Asking for care and support from a local authority should not be a complicated process. Older people in Wales should feel confident that they will be listened and will receive the care and support they are entitled to.
Rachel Lewis is a Policy and Campaigns Manager with Age Cymru.