What to do if you think your care and support needs are not being properly met

If you or someone you care about receives support from your local authority but you are worried that the current arrangements are not enough, you can ask for them to be reviewed.

The important question is whether the person's assessed care and support needs are actually being met safely and appropriately, and whether the support in place is helping them to maintain their independence and wellbeing.

What is the local authority responsible for?

In England, adult social care is governed primarily by the Care Act 2014.

Where someone appears to have care and support needs, the local authority has a duty to assess those needs. The assessment should consider:

• what the person can and cannot do;

• how their needs affect their wellbeing;

• the outcomes they want to achieve; and

• what support is required.

  
  

A person may have eligible needs where their needs arise from a physical or mental impairment or illness, they are unable to achieve two or more specified day-to-day outcomes, and this has a significant impact on their wellbeing.

These outcomes include things such as:

• eating and drinking adequately;

• maintaining personal hygiene;

• managing toilet needs;

• being appropriately clothed;

• being able to use the home safely;

• maintaining relationships;

• accessing work, education or volunteering; and

• accessing facilities and activities in the community.

  
  

The Care Act is intended to focus on the individual person's needs, rather than simply fitting people into existing services. Government statutory guidance states that local authorities must consider how to meet each person's specific needs rather than simply considering which service they fit into. (GOV.UK)

Look at what happens between care visits

If you are concerned about someone's care package, it can help to stop thinking initially about the number of hours being provided and instead look at what the person is actually able to do throughout the whole day and night.

For example:

• Can they get to the toilet when they need to?

• Can they safely get in and out of bed or a chair?

• Can they obtain food and drinks when they need them?

• Can they take their medication safely?

• Can they reposition themselves if there is a risk of pressure damage?

• Can they summon assistance in an emergency?

• Are they left somewhere for long periods because they cannot move independently?

• Are care tasks being completed safely, or are visits too short for what needs to be done?

• Can they maintain relationships, interests and some quality of life, rather than simply having their most basic physical needs addressed?

  
  

These practical examples can be much more useful than simply saying, "We don't think there is enough care."

Ask: "How is this need being met?"

One of the most useful ways to approach the local authority is to identify each concern and ask:

"How is this assessed need currently being met?"

For example:

"She cannot independently get to the toilet between care visits. Please explain how her need to manage toileting is being met under the current care and support plan."

Or:

"He cannot prepare a drink himself and is alone for several hours between visits. Please explain how his hydration needs are intended to be met during this period."

This keeps the discussion focused on the person's actual needs and risks, rather than immediately becoming an argument about a particular number of care hours.

Ask for a review

If circumstances have changed, the existing package is not working, or you believe important needs have been missed, ask the local authority for a review of the care and support plan.

The local authority's responsibility does not end when it puts a care package in place. Care and support plans must be reviewed to make sure the person's needs and intended outcomes continue to be met. A person can also request a review themselves. (GOV.UK)

It can be helpful to make the request in writing and be specific about why you believe a review is necessary. For example:

"We are concerned that some of the needs identified in the care assessment do not appear to be adequately met by the current care and support plan. We would therefore like to request a review. In particular, we would like the review to consider the following needs and explain how each is currently being met…"

Then list the concerns.

Describe what actually happens

Try to give concrete examples rather than relying on diagnoses.

For example, rather than:

"Dad has had a stroke and needs more care."

Explain:

"Dad cannot transfer from his chair without assistance. If carers leave him in the chair at 10am, he remains there until somebody next attends because he cannot move himself safely."

Similarly, rather than:

"Mum needs help with drinks."

Explain:

"Mum cannot stand or carry a drink independently. Once the drink left by her morning carer is finished, she cannot obtain another drink until somebody returns."

Specific examples help the assessor understand the real-world consequences of a person's condition.

Keep a record

If there are ongoing problems, it can be useful to keep a short record of what is happening.

Record things such as:

• when care visits take place;

• what support was required;

• needs which could not be met;

• occasions where the person had to wait for help;

• falls or near misses;

• missed meals or drinks;

• continence problems;

• deterioration in skin condition;

• distress or anxiety;

• family members having to provide unplanned care; and

• changes in the person's condition.

  
  

You may also want to record changes in things that are important to the person's wellbeing, such as becoming increasingly isolated, losing interest in activities or becoming less confident about leaving the house.

The aim is not to build a case against individual care workers. Often carers are working within the time and care plan they have been given. The record helps demonstrate whether the overall plan is realistic.

Don't assume family must fill every gap

Family support can be an important part of somebody's life, but the assessment should still identify the person's underlying care and support needs.

Government guidance requires assessments to consider the person's needs and circumstances, including the support available to them. The local authority should not simply overlook a need because somebody else happens to be helping informally. (GOV.UK)

If a relative is providing support, be clear about:

• what they are actually doing;

• how often they are doing it;

• whether they are willing to continue;

• whether it is sustainable; and

• the effect the caring role is having on them.

  
  

Carers may also be entitled to their own carer's assessment.

It is particularly important to be honest about the support family members are providing. What may have started as an occasional visit can gradually become several hours a week of shopping, appointments, paperwork, meals, medication and emotional support. It can become so normal that nobody notices how much the family is actually holding together.

Family support can be invaluable, but it should not automatically be assumed to be an unlimited or sustainable resource.

What if the person struggles to explain what they need?

The person should be involved in their assessment, care planning and reviews.

Where someone would have substantial difficulty understanding information, retaining it, using it to make decisions, or communicating their wishes, and there is nobody appropriate to support them, the local authority may have a duty to arrange an independent advocate. (GOV.UK)

Family members, friends or another appropriate person can also often help the individual prepare for meetings and explain what day-to-day life is really like. This can be particularly important where a person has difficulty communicating changes in their needs or may not recognise the extent to which they are struggling. The people who know them well may notice small changes in confidence, routine or behaviour that are not immediately obvious during a formal assessment.

What if there is an immediate safety concern?

Do not wait for a routine review if the current situation is presenting an immediate risk.

Tell the local authority clearly that you believe the situation is urgent and explain why.

Examples might include someone being:

• unable to access food or fluids;

• unable to toilet safely;

• repeatedly falling;

• at significant risk of pressure damage;

• left unable to move for prolonged periods; or

• unable to obtain assistance in an emergency.

  
  

The Care Act allows local authorities to meet urgent care and support needs before the full assessment process has been completed. (Legislation.gov.uk)

If there is a serious risk of abuse or neglect, this may also need to be raised as an adult safeguarding concern.

If you still disagree with the local authority

Start by asking the social worker, care manager or adult social care team to review the situation.

If the issue is not resolved, you can use the local authority's formal complaints procedure. It is usually helpful to clearly set out:

1. the person's needs;

2. which needs you believe are not being met;

3. the evidence or examples showing this;

4. what you have already asked the council to do; and

5. what outcome you are seeking.

   
   

If you remain dissatisfied after giving the council an opportunity to deal with the complaint, you may be able to approach the Local Government and Social Care Ombudsman. The Ombudsman can consider complaints about matters including assessments, delays, safety and safeguarding, and the way adult social care decisions have been made. (LGO)

The key question

When discussing care with a local authority, it is easy for the conversation to become focused on hours, visits and budgets.

A more useful starting point is:

What are the person's eligible needs, and how is each of those needs actually being met?

But there is another question worth asking alongside this:

What does the person's life look like when the care worker is not there?

If there is no satisfactory answer to those questions, it is reasonable to ask the local authority to look at the person's care and support arrangements again. And sometimes the answer will be that someone needs more formal care.

Even when someone’s essential care needs are being met, it does not necessarily mean they are experiencing a good quality of life. They may be safe, fed and supported with personal care, but still feel isolated, have lost confidence, or no longer take part in the things that once gave their days meaning. This is where Plan with Care can help. We can provide consultancy to look at the bigger picture and identify practical ways to improve someone’s wellbeing and quality of life, or provide ongoing companionship and support to help them reconnect with the people, activities and experiences that matter to them. Contact us to find out more.