Organising and reviewing care and support

What are care and support plans?

If a person with dementia has eligible needs, they will get a care and support plan. If a carer is eligible, they will also get a support plan. These outline the person’s care and support needs, and how they can be met. For example, a person with dementia may need prompting and support at mealtimes. The support plan may say that a care worker should visit them in their home to help them at mealtimes.

A carer’s support plan outlines things that are specifically for the carer, for example manual lifting and handling training (which could help you to use a hoist), or having a temporary break from caring. A carer’s assessment may also lead to changes in the care plan of the person they care for.

Sometimes a carer’s need is best met by giving services to the person they care for. An example is replacement (respite) care, such as a paid carer coming to spend time with the person, which allows the carer to take a break. Although it is there to help the carer, it is given to the person with dementia as part of their care plan.

If someone is eligible to have their care needs met by the local authority, their care plan will also mention their ‘personal budget’, and how much they have to spend on meeting their needs. 

How are care and support arranged?

The main ways that care and support can be arranged are:

• The local authority gives the support directly.
• The local authority arranges for a care provider, such as a homecare agency, to give the care.
• The local authority makes a direct payment to the person or their carer to buy their own care and support.

You may have care and support arranged as a combination of these options. How the care will be arranged is usually discussed in the assessment, and should be in the care plan.

The local authority must give you information about where to get care and support locally, even if they are not paying for the care. The information can include advice from professionals such as an occupational therapist or a social worker.

You can also get information from local care agencies and charities. Some of these run a brokerage scheme to help people find the support they want.

The Care Quality Commission lists all registered homecare agencies in each area of the country (see Useful resources). Some services, such as community nursing, are arranged through the GP, either directly or after discussion with social services (adult services).

Personal budgets and direct payments

What is a personal budget?

A personal budget is the amount of money that the local authority calculates will meet someone’s needs. The local authority will use the financial assessment to decide how much the person will contribute to their personal budget themselves. You or the person you care for may choose to be given a ‘direct payment’ from the local authority so you can arrange services yourselves.

What is a direct payment?

Direct payments can offer more choice and flexibility when choosing services to meet care needs. Managing direct payments can sometimes be complicated, so the local authority must be satisfied that the person is willing and able to manage a direct payment, either alone or with help.

If necessary, the local authority must help the person managing the direct payment to find local support services. These support services may come from voluntary or charitable organisations.

For people with dementia, a family carer can manage the direct payment – this option offers the same choice and flexibility. A personal budget might also be managed through an Individual Service Fund, a user-controlled trust or a suitable person.

What is a brokerage service?

Brokerage is a service that helps you to set up your care and support by direct payment. To do this you might need help from a broker. They will help you to take part in and understand the care planning process, for example, to plan and organise tailored support.

Professional brokers charge fees, but a broker can be anyone that you or the person with dementia trusts. Some voluntary organisations might also have a brokerage service.

Reviews and complaints

Your circumstances change, so the services you get should be reviewed from time to time. Local authorities do this through review meetings to see whether the needs of the person with dementia or yours as the carer have changed.

There are different ways to get a review:

• A planned review is where the date of the review was set out in the initial care plan.
• An unplanned review is normally the result of a change in circumstances, such as a fall meaning the person is less able to do things, or hospital admission.
• A requested review is where the person, their carer or a professional (for example their GP) asks for a review. This may be due to a change in care needs, or where it is felt that different support is needed.

If you have been given a personal budget by the local authority, a review should be considered within six to eight weeks. This will not be as detailed as the original assessment.

The point is to make sure that the support is meeting the care needs and to check that there is no unmet need. It should also make sure that if there are problems, they are dealt with quickly.

How do I make a complaint about assessment for care?

It is best to try to resolve any complaints about the assessment process with the person you have contact with, such as the social worker. There may have been a breakdown in communication, or a misunderstanding.

However, if this is not successful, local authorities have complaints procedures that you can follow. The local authority will explain how to use this. The complaints procedure might be useful if:

• there are problems arranging an assessment
• there is an unreasonably long wait for an assessment
• the required services are not provided, or are unsatisfactory
• there is a dispute about the amount of personal budget that is allocated
• where someone is told that they are not eligible and they feel that they are.

Contact the local authority to find out what the complaints procedure is. If the local authority complaints procedure does not resolve the issue, you can take your complaint to the Local Government and Social Care Ombudsman. It may be helpful to talk to a local advice agency first – for example, Citizens Advice (see Useful resources).