02. Who decides what sort of care I need?

The first step to getting help is to contact your local council's social services department and tell them your situation.

If you have a disability, your council must 'assess' you (find out what sort of help and support you need). The law defines people with a disability as:

• people who are blind, deaf or dumb;
• other people who are seriously or permanently handicapped by an illness, injury or congenital deformity, or who are suffering from a mental disorder as defined under the Mental Health Act; and
• people who are partially sighted or hard of hearing.

Even if you don't fit the legal definition of disability, you still have the right to an assessment if your council thinks you may need community care services (for example, things like someone to help you get up and get dressed).

You can also ask for an assessment for someone else, if they need help (for example, a relative or neighbour).

What does an assessment look at?

If your assessment shows that you need certain services, your council must usually provide them. These services include:

• practical help at home;
• equipment to help with a disability;
• help with adapting your home;
• getting meals at home or somewhere else;
• being given (or given help to get) a phone or any special equipment you need to use one;
• help to use educational and recreational facilities at home and outside (for instance at a Day Centre), including help with getting to and from those facilities; and
• holidays.

Your assessment should also cover any health services you need. If you live in an area where a Care Trust has been set up to deliver both health and social care services, it will carry out your assessment. If you're only concerned about help to do with your health, contact your GP. Your doctor can contact other people who provide healthcare providers if they need to, to work out what you need. Different areas have different rules about what you can get. But you may able to get, for example, visits from community health providers at home (such as a district nurse, health visitor, physiotherapist or chiropodist).

Do I have to be on low income to be assessed?

You should be able to have an assessment, no matter how much money you have. If the council refuses to assess you because it thinks you could afford to buy care for yourself, you should get expert advice (see 'Further help').

Can I get help if I look after someone?

If someone relies on you for care on a regular basis, you can ask to be assessed under the Carers Acts 1995 and 2000. This type of assessment will be carried out by social services, and is meant to support carers by making sure that:

• the person being cared for gets the right services; and
• the carer has a choice over the type of caring tasks they undertake.

If you care for someone, and you need support or advice, contact Carers UK (see 'Further help' ) or the government website www.carers.gov.uk.

How is the assessment done?

Each council has its own way of working out what help you might be able to get. You can find out what your council's policy is in its long-term care charter called 'Better care, higher standards'. You should be able to get this from the social services department. You may also find it in your GP's surgery, Citizens Advice Bureau or library.

You (and anyone who cares for you) should be fully involved in the assessment and you should get the chance to say what you feel you need.

If you need an interpreter to help you, the council should provide one.

The aim of an assessment is to:

• find out what sort of support you need;
• decide about the services that might help; and
• look at your finances, including whether you might be able to claim any benefits.

You may be asked questions about:

• the tasks you can and can't do;
• the tasks you find difficult some of the time;
• whether you have to follow a special diet; and
• if you have special needs (because of your religious or ethnic group, for example).

Who does the assessment?

The assessment will often be done in your home, but it could also be done at a day centre or your GP's surgery. The person assessing you will generally be from social services or possibly from the NHS or a Care Trust. Other people might take part, too. For example, an occupational therapist might give advice on making your home easier for you to live in (such as fitting stair or grab rails, bath seats or special taps).

The local housing authority may also be asked for its views on certain issues, such as whether you need to move to sheltered housing.

The person who assesses you should keep notes of:

• what is said;
• the things they have found you need; and
• whether there is anything you and they disagree about.

You should normally get a written record of the assessment, which may be in the form of a care plan (see below). Even if you are not going to get help, you should get a statement to that effect along with the reasons why.

You usually have a right to see any other personal information which social services departments hold about you. You can also ask them to change anything you think is wrong.

What happens after my assessment?

Part of the assessment process is to decide what help you qualify for. Once that has been decided, a care plan should be drawn up for you.

Councils are allowed to 'ration' their services by limiting who can get them. They often do this by deciding that only those people who need a service most can have it. Recent government guidance says that councils' policies on who can get care should take into account the extent to which people are at risk. But if you don't 'qualify', they don't have to give you the help. For example, you might need help with household cleaning but you don't qualify because the council says it will, in general, only give that kind of help to people who also need help with washing and dressing themselves.

If you find yourself in this position, you can challenge the decision (see 'What can I do if I have a problem with getting the care I need?'). And even if you are not eligible for help, councils should still provide you with information and advice.

What is a care plan?

A care plan is a record that should set out your needs, what services you will get, any changes to be made and a date when the plan will be reviewed. The council may give you some services itself. It may also arrange for you to get some services from other organisations, such as voluntary groups or private care agencies. If you have a carer, your plan should also show what help your carer has agreed to give you.

Your care plan should be looked at from time to time, normally within three months of the help being provided and then at least every year. But if your circumstances change at any point, you can ask to be assessed again. And if the council wants to take away or reduce what you get, it must reassess you first. It cannot take away services solely because it has budget problems, nor if that would leave you at 'severe physical risk'.

Once your care plan has been drawn up, you should start getting that care within a reasonable time. Social services may put you on a waiting list (as long as it is not unreasonably long), but if they do, they should make arrangements to make sure you do not suffer while you are waiting for the services you've been promised. If you consider the waiting list too long you can challenge the decision (see What can I do if I have a problem with getting the care I need?).

The council should in general favour care plans that promote independence of disabled people. This support should however be provided in the most cost effective way they can. So, for example, the council may want to move you into a care home because they believe it would better meet your needs and because it would cost significantly less than giving you the care you need in your own home.

You have the right to say you don't want to move into a care home. But if you choose to stay in your own home, you may not get all the help you need. For example, if the council would have to pay £140 a week towards the cost of a place in a care home, they might argue that they should give you care at home only worth approximately that amount, even if that wouldn't be enough for your needs. If you are unhappy with what the council has decided for you, you can challenge their decision (see 'What can I do if I have a problem with getting the care I need?').

Your assessment might say that you need of short-term 'intermediate care' at home or in a care home. This may include both health and social services. Intermediate care is a special service that can be provided for a limited time (usually no more than 6 weeks) so that you don't have to go into hospital or to stay there when you don't really need to.