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Independent Living and Social Care

Independent Living

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What is independent living?

Independent Living

Independent living is about disabled people being able to live in the community with choice and control over the support we need to be fully included. Independent living is not about doing everything for yourself.

UN Convention

The UK is signed up to the United Nations Convention on the Rights of People with Disabilities.

Article 19 of the Convention says that countries who are signed up will recognise the equal right of all disabled people to “live in the community, with choices equal to others” and shall take measures to ensure disabled people’s “full inclusion and participation in the community”.

To explain what independent living means in practice, the disabled people’s movement has identified a range of issues that need to be worked on and improved to make independent living a reality.

These “12 Pillars of Independent Living” are:

  • accessible information
  • enough money to live on
  • accessible health and social care
  • a fully accessible transport system
  • an accessible environment (places and buildings)
  • aids and equipment
  • accessible housing
  • personal assistance
  • inclusive education and training
  • equal opportunities for employment
  • independent advocacy and self-advocacy
  • peer support and counselling

2) Social care support

Social Care

One of the main ways that disabled people are supported to live in the community is through social care provided by the local Council.

3) Asking for an assessment

Social care assessment

Disabled children and adults can ask for a social care assessment to see if they are eligible for social care support from the local Council. Councils also have a duty to assess the needs of carers.

Local authorities have a duty to assess anyone who appears to have care and support needs. Your local authority should:

  • assess your needs and give you advice, whatever your financial circumstances
  • provide information about services and support options available to you in your area
  • give you a carer’s assessment if you are an unpaid/family carer
Ask for social care assessment

You can ask your council for an assessment yourself, or be referred by someone you know, or by a professional who is already involved in your care, such as a GP, community nurse, or mental health nurse.

Social care - entitlement

The assessment will help the council to then decide if you do need care and support, and whether you are eligible for funding from the council towards the costs.

Bromley Borough Logo

If you live in the London Borough of Bromley and want to ask for a social care assessment you need to contact the Adult Early Intervention Service:

Telephone

Telephone: 0208 461 7777

4) Community care assessments

Qualified social worker

The assessment will be conducted by a social worker or care manager. It must be carried out by someone with the right training and qualifications.

The assessment should be carried out in a way that ensures your involvement and that takes the right amount of time to capture all of your needs.

unpaid carer

If a friend or family member gives you support on an unpaid basis, they can also have a carer’s assessment.

You can choose to have people with you in the assessment, for example an advocate or friends or family. For information about advocacy see below.

Think about support

It is important to prepare in advance for your assessment. You should think carefully about what your support needs so you can give as much information as possible. You can ask for the questions in advance.

Sometimes as part of the assessment you will also be asked:

Doctors Certificate

For supporting information about your impairment and medical conditions and contact details for health professionals who know you.

Support Log

To fill in a support log showing how your needs are currently being met.

OT Assessment

To have an assessment by an Occupational Therapist (OT). For more information about OT assessments see below.

Observe routines

For assessors to come and observe your support routines.

Law - speaking up

The Care Act 2014 says that assessments must be appropriate and “proportionate”. You should say if you feel that an assessment is being carried out in a way that is unnecessarily intrusive.

Social services must communicate with you clearly about what the next steps are after the assessment.

5) Being eligible for social care support

Social care - entitlement

Your Council will decide if you are eligible for social care support.

To be able to get social care support:

disability symbol

Your needs for care and support must be because of disability or illness.

Because of disability or illness, you must be unable to carry out two or more daily living tasks from the list below.

Time

This includes if you can do them on your own but it takes a much longer time than if you had assistance.

Risk to wellbeing

As a result of not being able to do these there is a serious risk to your well-being.

Daily living tasks

The list of daily living tasks covers the following:

  • Eating and drinking and preparing meals
  • Keeping yourself clean
  • Toileting
  • Dressing
  • Getting around and using your home safely
  • Cleaning your home
  • Having a social network
  • Work, training, education and volunteering
  • The local community
  • Caring responsibilities

6) Financial assessments

Financial assessment

If your Council decides you are eligible for social care support, they will carry out a financial assessment to determine how much you will need to pay towards your care, if anything.

Over limit - no council money

At the moment you are expected to be a self-funder if you have savings above £23,250. This means you will have to pay for all your own social care support.

Below limit - council pays

If you have less than £14,250 in savings, you don’t need to make use of these savings to pay towards the cost of your care and support needs.

Council charging

Most Councils expect disabled people to pay something towards their social care costs. This is called charging. In London, Hammersmith and Fulham is the only Council that does not charge.

Disability related expenditure

As part of the financial assessment, Councils should take into account your disability related expenditure (DRE). disability related expenditure is any extra costs you face because of your disability. This could include:

  • laundry costs due to incontinence
  • high heating bills (if, for example, you have poor blood circulation)
  • accessible taxi fares costs
  • equipment
  • essential dietary requirements costs
  • special clothing (because of wear and tear)
  • internet costs
  • therapies

List disability related costs

You should try and make a full list of all your disability related expenditure if you are having an assessment.

Disagree decision

You have the right to appeal against the Council’s decision if you are not happy with the amount you have been asked to pay. For information about how to challenge a decision see below.

Web address

For more information, go to:

https://www.disabilityrightsuk.org/charging-community-care

To see London Borough of Bromley’s charging (or “contributions”) policy, go to:

http://www.bromley.gov.uk/downloads/file/152/contributions_policy_for_non_residential_care_services

7) Care and Support planning

Care plan

A care plan (sometimes called a care and support plan, or support plan) sets out how much funding the Council will give to pay for your social care and how your support needs will be met.

planning support

You should be fully involved in putting your support plan together. You should get a written copy of the plan.

The plan must set out:

  • what your needs are as identified by the assessment
  • which of these needs the Council are going to provide support to meet
  • how the Council is going to meet those needs
  • what your Personal Budget is – this is the amount of funding the Council is giving to pay for your support

Council arrange home support

Your support needs could be met by the Council arranging for a care agency to come into your home or they could be met by a Direct Payment.

Direct Payment

This is where the Council gives you money to arrange and pay for your support yourself. This could include employing one or more Personal Assistants.

8) Direct Payments

Social care assessment

A personal budget or direct payment will be created after an assessment by social services.

Direct payment

If the council decides that you need any kind of support, you will receive a personal budget and can choose a direct payment instead of letting them arrange services for you.

Support managing direct payment

If you aren’t able to, or don’t want to manage your own finances, it’s possible for another person to manage the direct payments on your behalf.

Council rules for direct payment

The Council should set out your obligations and responsibilities in a direct payment agreement that you may be asked to sign. This could include:

Keeping records of spending

Keeping records and accounting for how the money is spent to social services.

Legal employer

Taking on the legal role of an employer if you’re using the payment to pay for a care worker.

The Council should tell you support on offer to help manage the administration of your Direct Payment including payroll services, and support with recruiting Personal Assistants and the responsibilities of being an employer.

Inhouse or private

Some Councils contract an independent organisation to provide these services and some Councils provide these services in-house. The Care Act says that you must have a choice of organisations.

Care plan

Direct payments can only be spent on the things that are set out in your care and support plan. If you spend the money on something else, the Council can demand the money back and end your direct payment agreement.

9) Reviews

Care plan review

Everyone who gets support from social services should have their care and support plan reviewed at least once a year.

Ask for care plan review

If your needs change, you should contact social services to request a review of your support plan.

Social care assessment

If needs have changed in a way that affects the details within the current plan, the council may carry out another assessment of needs, or a financial assessment.

Reviews and reassessments are different. The Care Act says that it must be communicated to you clearly if a social worker/care manager is coming out to do a review or a reassessment.

10) How to appeal against a social care decision

Disagree decision

To appeal a social services decision you will need to follow the complaints process. There are three stages to this:

Asking care manager

Stage 1 is the informal stage where you contact the care manager or social worker to see if the problem can be sorted out.

Stage 2 is to make a formal complaint. Each council has its own information about how to make a complaint.

Ask for independent judgement

Stage 3 is to ask for an independent review.

Write to councillor

If you need help with a complaint, contact your local councillor or the Citizens Advice Bureau (CAB).

Bromley Borough Logo

If you live in London Borough of Bromley, to find out who your local councillor is, go to:

http://cds.bromley.gov.uk/mgMemberIndex.aspx?bcr=1

If you need to, you can seek legal advice or take your complaint to the relevant local government ombudsman. For England contact the Local Government Ombudsman:

http://www.lgo.org.uk/making-a-complaint/

11) Advocacy

Council advocacy

Councils must involve people in decisions made about them and their care and support. No matter how complex a person’s needs, local authorities are required to help people express their wishes and feelings, support them in weighing up their options, and assist them in making their own decisions.

Council decision barriers to involvement

Councils need to make a judgement as to whether a person has substantial difficulty in being involved and if there is not an appropriate individual to support them.

Advocate

If the person does have substantial difficulty and there is not someone to support them, then an independent advocate must be appointed to support and represent the person.

Councils have contracts with independent organisations to provide independent advocacy in cases like these.

12) Carer’s assessments

unpaid carer

If you provide unpaid care and support to an adult friend or family member, you may be eligible for support from your local council.

Money or short break cover

This support could include being offered money to pay for things that make caring easier or practical support such as arranging for someone to step in when you need a short break. It could also put you in touch with local support groups so you have people to talk to.

Legal right to assessment

Councils now have a legal duty to assess any carer who requests one or who appears to need support.

If you are a “carer” and you need some support, get in touch with the council.

13) Independent Living Fund

Independent Living Fund closed

The Independent Living Fund (ILF) closed on June 30th 2015. This was a fund that provided money to pay for support costs to enable disabled people with high support needs to live in the community.

From parliament to council

The responsibilities for fully meeting the social care support needs of disabled people was passed to local Councils.

Government grant to councils for four years

To help with the extra costs this would place on Councils, central government set up the “Former ILF recipient grant” to fund English Councils for four years from 2016 – 2020.

No less money, ILF

The government’s in Wales, Northern Ireland and Scotland put arrangements in place to carry on paying disabled people what they used to get from the ILF.

The Welsh Independent Living Grant is due to end on 31st March 2020. However, in Scotland the government has set up a new Scottish Independent Living Fund.

Social care assessment

In England, it is up to each individual Council to assess the needs of each disabled person who used to receive the ILF and decide how much support they will pay for.

Web address

To see how much your local Council gets through the Former ILF-recipient grant, see Annex B of the consultation document:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499151/Former_ILF_Recipient_Grant_Consultation.pdf

London Borough of Bromley was given £2,538,787 over 4 years.

Information for former ILF recipients undergoing re-assessments can be found here:

https://www.inclusionlondon.org.uk/campaigns-and-policy/facts-and-information/independent-living-social-care-and-health/frequently-asked-questions-for-independent-living-fund-ilf-users-and-other-people-with-high-support-needs/

14) Other types of independent living support

14.1 – Disability Living Allowance (DLA)/Personal Independence Payment (PIP)

Extra costs

These are benefits paid to disabled people to help towards covering the extra costs of being disabled.

Over 16

PIP has replaced DLA for disabled adults between the ages of 16 and 64. Disabled children under the age of 16 can still claim DLA. Disabled adults who are 65 and over can claim Attendance Allowance.

Web address

For more information, see our section on DLA/PIP:

xbyxbromley.com/resourcebank/dlapip

14.2 – Continuing Healthcare (CHC)

NHS continuing health care

Continuing healthcare, or CHC, also known as “fully funded NHS care”, is free care outside of hospital that’s arranged and funded by the NHS.

It can be used to pay for support in your own home through a personal health budget.

medical health

To be eligible for CHC funding you must have a need that is related to your health or a medical condition.

Continuing Health Care assessment

CHC assessments consider your needs under the following headings:

  • behaviour
  • cognition (understanding)
  • communication
  • psychological/emotional needs
  • mobility
  • nutrition (food and drink)
  • continence
  • skin (including wounds and ulcers)
  • breathing
  • symptom control through drug therapies and medication
  • altered states of consciousness
  • other significant needs

Council refer to NHS

Increasingly following the closure of the Independent Living Fund, social services are referring disabled people for CHC assessments to see if all or some of their support needs can be met with funding from the NHS.

Council screening referrals to NHS

Some councils carry out a screening process to check someone is likely to be eligible for CHC funding before they make a referral. This prevents disabled people from going through a lengthy and intrusive assessment process only to be found they are not eligible.

Does benefit cap apply?

Some Clinical Commissioning Groups, or CCGs, who are responsible for CHC funding are setting capping policies. These policies cap the amount of support they will pay for to enable a disabled person to live in their own home when residential care would be cheaper. If you are in this position you should seek legal advice.

14.3 – Personal Health Budget

Personal health budget

A personal health budget is an amount of money to support your health and wellbeing needs, which is planned and agreed between you (or someone who represents you), and your local NHS team.

It works in a similar way to personal budgets, which allow people to manage and pay for their social care needs.

Ask for care plan review

The right to have a personal health budget only applies to adults receiving NHS continuing healthcare (NHS-funded long-term health and personal care provided outside hospital) and children in receipt of continuing care.

Personal budget care plan

If you are able to have a personal health budget, then together with your NHS team, you will develop a care plan.

Pay into bank

If you already have a personal budget for care and support from social care services and your NHS team agrees, you can also have a personal health budget and ask for both to be paid into the same account.

Personal health budget care plan review

Once you have a personal health budget, your NHS team will periodically review your care plan with you. You can also ask your NHS team to review and update your plan because your health needs have changed or you feel the current plan isn’t working for you.

Asking care manager

To find out about getting a Personal Health Budget, speak to your social worker or care manager.

Bromley Borough Logo

If you live in Bromley, you can also contact the Bromley Continuing Healthcare team direct on:

Telephone: 01689 866 178

14.4 – Disabled Facilities Grants (DFG)

Disabled facilities grant

You could get a grant from your council if you’re disabled and need to make changes to your home, for example to:

  • widen doors and install ramps
  • improve access to rooms and facilities e.g. fit stairlifts or a downstairs bathroom
  • adapt heating or lighting controls to make them easier to use

How much money

How much you get depends on your:

  • household income
  • household savings over £6,000

Depending on your income, you may need to pay towards the cost of the work to the property.

In England you can get up to £30,000.

To be eligible for a DFG, you or someone living in your property must be disabled. Either you or the person you’re applying for must:

  • own the property or be a tenant
  • intend to live in the property during the grant period (which is currently 5 years)

You can also apply for a grant if you’re a landlord and have a disabled tenant.

Apply to council

To apply for a DFG, you need to contact your local council.

Bromley Borough Logo

If you live in Bromley, you need to contact the Adult Early Intervention Team for an OT assessment:

Telephone: 020 8461 7777

Web address

If you live elsewhere, to find out who to contact go to:

https://www.gov.uk/apply-disabled-facilities-grant

You need to apply separately for any planning permission or building regulations approval. For more information about planning permission, see:

https://www.gov.uk/planning-permission-england-wales

For more information, go to:

https://www.gov.uk/disabled-facilities-grants/how-to-claim

14.5 – Aids and equipment

aids and adaptations

Equipment that can help you to live more independently can include things like:

  • two-handled cups, tap turners and kettle tippers for the kitchen
  • grab rails and raised toilet seats in the bathroom
  • bed raisers and hoists in the bedroom

Which equipment

You can buy your own equipment, but a social worker or occupational therapist can help make decisions about the equipment that would be most helpful. Decisions about the kind of equipment you may need will often be the result of an assessment of your care and support needs.

No charge if assessed need

If a local authority needs assessment has concluded that you need this equipment, it should be provided free of charge.

Minor adaptations costing £1,000 or less – which includes the cost of buying and fitting the adaptation – are also provided free of charge.

money-handover

Councils can make a charge for minor adaptations that cost more than £1,000 to provide.

Adjustable bed

Larger, more expensive items may be classed as adaptations and will be the responsibility of the housing department and provided through Disabled Facilities Grants.

Accessible building

Independent Living Centres (sometimes called Disabled Living Centres) can give you advice about disability aids and equipment and have products on display that you can try out. To find your nearest Independent Living Centres go to: http://www.nhs.uk/Service-Search/Support-for-independent-living/LocationSearch/386

Bromley Borough Logo

Bromley’s local Independent Living Centre is Lewis House in Beckenham. It is open Monday to Friday 10am – 5pm. Please note that you need to make an appointment via the website: www.xbyxbromley.com

or call 020 8650 2102

Web address

The links section below lists websites where you can buy new or used daily livings aids and equipment.

No VAT

If you have a long-term illness or you’re disabled, you don’t have to pay VAT on equipment designed to help with daily living.

The supplier needs to be registered for VAT and you have to sign a form declaring that you have a long-term illness or you’re disabled.

NHS equipment

The NHS can provide equipment, such as walking sticks, walking frames and wheelchairs to aid mobility.

These are provided on long-term loans and you can arrange this through your GP, hospital consultant or physiotherapist. There is no charge for this equipment, but there may be a returnable deposit.

Wheelchair assessment

NHS wheelchair services offer assessments to determine what type of wheelchair or mobility equipment you may be entitled to on the NHS.

In most cases, you’ll be referred to the service by a hospital, doctor, consultant or occupational therapists.

Wheelchair all ages

In general, wheelchair services are available to people of all ages who have a long-term need for mobility help.

However, the specific criteria for whether you’re eligible are decided locally and will vary depending on where you live.

To contact Bromley Wheelchair service, email: bromh.wheelchairservice@nhs.net

Web address

For more information about equipment, go to: https://www.scope.org.uk/support/disabled-people/equipment

OT Assessment

Occupational Therapy

You can get occupational therapy free through the NHS or social services, depending on your situation.

You can:

  • speak to your GP practice about a referral
  • contact your local social services to ask if you can get occupational therapy
  • pay privately for occupational therapy services
Web address

To find an occupational therapist in your area, you can go through the Royal College of Occupational Therapists website: https://www.rcotss-ip.org.uk/find