Dementia Support Line
Assessments of need for people with dementia in Northern Ireland
Anyone with dementia can get an assessment of need. It should identify the person’s needs and what support would meet these needs. It also helps informs decisions around paying for care.
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Assessment for care and support Northern Ireland
What is an assessment of need?
An assessment of need for a person with dementia may be called different things by different organisations. This includes a ‘community care assessment’, a ‘care needs assessment’ or a ‘social care assessment’.
Everyone has unique needs, so the type of care and support will be different from person to person. Needs also change over time. Care and support should be tailored to meet the person’s needs now and then adapted or increased in the future.
Examples of care and support could be:
- someone visiting their home to help prepare meals
- help with dressing or washing
- attending a day centre or other activities in the community.
The health and social care trust (HSCT) social services or adult services department carry out most assessments. The assessor is normally a social worker. This person may ask to involve other professionals, for example, the person’s doctor.
Criteria for eligible care needs
The assessment of need will identify if the person with dementia has one or more ‘eligible care needs’. A person must have an eligible care need for the HSCT to consider paying for their care and support.
The HSCT will compare the person’s needs with eligibility criteria set by the Department of Health. These criteria are grouped under four bands of risk – critical, substantial, moderate and low.
The HSCT will try to establish whether the person has any of the needs categorised under these risk bands. The person is eligible even if they have just one of the listed needs in the relevant band. The HSCT will use this information to decide whether the person will receive services.
The identified needs for each risk band are:
Someone may be considered in critical need of support if:
- the person’s life is or may be threatened
- the person has significant health problems, or is likely to develop them
- the person has little or no control over their immediate environment
- serious abuse or neglect has occurred or is likely to occur
- the person is unable to carry out vital personal care or domestic routines
- the person is unable to carry out work, education or learning, or is likely to become unable to
- the person is unable to maintain relationships or social responsibilities, or is likely to become unable to
- the person’s hospital discharge is delayed, causing them a risk of infection or a loss of independence.
The person with dementia only needs to meet one of the listed risks to meet the criteria of the relevant band. HSCTs must provide support for a person’s care needs if these are within the critical and substantial risk bands. In this case, the person cannot source help from elsewhere.
Someone may be considered in substantial need of support if:
the person has only partial control over their immediate environment
abuse or neglect has occurred or is likely to occur
the person is unable to carry out the majority of personal care or domestic routines
the person is unable to carry out many aspects of work, education or learning, or is likely to become unable to
the person is unable to maintain the majority of relationships or social responsibilities, or is likely to become unable to
the person is at significant risk of inappropriate admission to hospital or residential care.
The person with dementia only needs to meet one of the listed risks to meet the criteria of the relevant band. HSCTs must provide support for a person’s care needs if these are within the critical and substantial risk bands. In this case, the person cannot source help from elsewhere.
Someone may be considered in moderate need of support if:
the person is unable to carry out several personal care or domestic routines
the person is unable to carry out several aspects of work, education or learning, or is likely to become unable to
the person is unable to maintain several relationships or social responsibilities, or is likely to become unable to.
The person with dementia only needs to meet one of the listed risks to meet the criteria of the relevant band. The HSCT can choose to meet a person’s needs in the moderate and low risk bands, but legally they do not have to.
Someone may be considered in low need of support if:
the person is unable to carry out one or two personal care or domestic routines
the person is unable to carry out one or two aspects of work, education or learning, or is likely to become unable to
the person is unable to maintain one or two relationships or social responsibilities, or is likely to become unable to.
The person with dementia only needs to meet one of the listed risks to meet the criteria of the relevant band. The HSCT can choose to meet a person’s needs in the moderate and low risk bands, but legally they do not have to.
What to expect at the assessment of need
An assessment of need will usually involve professionals asking the person questions, as part of a discussion. The assessor will use a Single assessment tool to carry out these assessments. This is to avoid or reduce repeat assessments. It will also mean the same questions aren’t asked by different professionals.
The assessment may be completed in one visit or, if there are more complex needs, spread over several weeks.
These questions will help the local HSCT to find out about:
- the person’s physical health
- their mental health and emotional wellbeing
- their awareness and ability to make their own decisions
- how they manage their medicines
- their communication
- their walking and movement
- their personal care and how they manage daily tasks
- their living arrangements
- their relationships with friends and family and whether they provide care to anyone else
- whether they work or are in education or training
- their finances and leisure activities
- their quality of life, their goals, wishes and preferences for their future
- whether there is a carer.
Where the assessment of need takes place
A face-to-face assessment of need usually takes place in the person’s home. This can help the assessor understand what care and support the person needs. If the assessment is arranged elsewhere, it should be somewhere convenient for the person and you.
If the person with dementia is offered a self-assessment questionnaire or telephone assessment, they can ask to have the assessment in person. Assessments should not take place over the phone or via letter as the person’s needs must be properly assessed.
You or the person should explain why they need a face-to-face assessment. If this is still not offered, they can make a complaint about the lack of support they are receiving in having their needs assessed. See our information on Complaints.
Tips for getting the most out of your assessment
These tips can help the person with dementia get the best results from the assessment. Use these prompts to make notes or comments on relevant details about your situation, and make sure to share these in the assessment:
Create a daily diary for a few weeks. Include tasks the person needs help with.
Make a list of any medicines the person is taking. Include what conditions they are for.
Collect any letters from the GP or other professionals. This is called ‘supporting evidence’, such as a GP letter suggesting ramps if the person has problems with walking.
Are there carers or relatives that the person would like at the assessment? Check if they are available to attend.
Does the person follow any cultural or religious practices? They may have dietary requirements, such as being a vegetarian, or may regularly visit a place of worship.
What support do they get from family and carers? Even if these people carry on giving care and support, the assessment should cover what would happen if they could no longer do this. It’s also important to mention if anyone is finding it difficult to provide care or meet the person’s needs.
Is there any equipment or assistive technology that would help? This could be an automated pill dispenser or smart home systems. See more information on using technology to help with everyday life.
Is there any care and support given by professionals that would help? This could include care and support from a care organisation, support groups or day centres.
What care and support might they need in the future as their dementia progresses? This can include support from other people, as well as equipment and assistive technology.
During the assessment of need
Be honest. Some people feel uncomfortable talking to professionals about their problems. The assessor will be used to discussing things like incontinence and changes in behaviour. Being open will help the person with dementia get the best results from their assessment.
Tell the assessor if there are things the person wants to do. For example:
— be more active
— stay living at home for as long as possible
— attend groups and events to engage with other people
— get help with activities such as shopping or going for walks.
What to expect at the assessment of need
An assessment of need will usually involve professionals asking the person questions, as part of a discussion. The assessor will use a Single assessment tool to carry out these assessments. This is to avoid or reduce repeat assessments. It will also mean the same questions aren’t asked by different professionals.
The assessment may be completed in one visit or, if there are more complex needs, spread over several weeks.
These questions will help the local HSCT to find out about:
the person’s physical health
their mental health and emotional wellbeing
their awareness and ability to make their own decisions
how they manage their medicines
their communication
their walking and movement
their personal care and how they manage daily tasks
their living arrangements
their relationships with friends and family and whether they provide care to anyone else
whether they work or are in education or training
their finances and leisure activities
their quality of life, their goals, wishes and preferences for their future
whether there is a carer.
Where the assessment of need takes place
A face-to-face assessment of need usually takes place in the person’s home. This can help the assessor understand what care and support the person needs. If the assessment is arranged elsewhere, it should be somewhere convenient for the person and you.
If the person with dementia is offered a self-assessment questionnaire or telephone assessment, they can ask to have the assessment in person. Assessments should not take place over the phone or via letter as the person’s needs must be properly assessed.
You or the person should explain why they need a face-to-face assessment. If this is still not offered, they can make a complaint about the lack of support they are receiving in having their needs assessed. See our information on Complaints.
Tips for getting the best assessment outcome for you
The tips below can help the person with dementia get more from the assessment. Use the suggestions to make notes or comments on relevant details. Make sure to share these in the assessment.
Create a daily diary for a few weeks. Include tasks the person needs help with.
Make a list of any medicines the person is taking. Include what conditions they are for.
Collect any letters from the GP or other professionals. This is called ‘supporting evidence’, such as a GP letter suggesting ramps if the person has problems with walking.
Are there carers or relatives that the person would like at the assessment? Check if they are available to attend.
Does the person follow any cultural or religious practices? They may have dietary requirements, such as being a vegetarian, or may regularly visit a place of worship.
What support do they get from family and carers? Even if these people carry on giving care and support, the assessment should cover what would happen if they could no longer do this. It’s also important to mention if anyone is finding it difficult to provide care or meet the person’s needs.
Is there any equipment or assistive technology that would help? This could be an automated pill dispenser or smart home systems. For more information see our guidance on Using technology to help with everyday life.
Is there any care and support given by professionals that would help? This could include care and support from a care organisation, support groups or day centres.
What care and support might they need in the future as their dementia progresses? This can include support from other people, as well as equipment and assistive technology.
During the assessment of need
- Be honest. Some people feel uncomfortable talking to professionals about their problems. The assessor will be used to discussing things like incontinence and changes in behaviour. Being open will help the person with dementia get the best results from their assessment.
- Tell the assessor if there are things the person wants to do. For example:
- be more active
- stay living at home for as long as possible
- attend groups and events to engage with other people
- get help with activities such as shopping or going for walks.