The care needs assessment and financial means test 

Our dementia specialist Admiral Nurses explain what the care needs assessment is, what will happen, and why a person with dementia will also need a means test to decide what financial support they might be eligible for.

What is a care needs assessment?

A care needs assessment (sometimes just called a needs assessment, or in Northern Ireland, an assessment of need) is a free assessment by Social Services that looks at the support a person with a physical or mental health condition or disability needs to manage their everyday life.

Having a needs assessment will identify what equipment, care and other support a person with dementia might need to help them with daily living activities. This could include:

• living aids and equipment such as mobility aids or a personal fall alarm
• adaptations to the home to make it safer and more manageable, for example a stairlift or walk-in shower
• support from a paid home carer
• access to day centres and lunch clubs
• moving into a care home

Following a needs assessment, the person with dementia will usually have a financial assessment to establish what financial aid they might receive to fully or part-fund the cost of their care and support. However, the process may differ depending on which UK country you are in and the type of care required. You should be told about next steps after the needs assessment.

How do I get a needs assessment?

Needs assessments are free and anyone can request one. You will need to apply for an assessment via the local council’s Social Services Team.  You can usually apply for a needs assessment by phone or online.

If you would like to apply for a needs assessment for someone else, you can do so with their consent. If the person lacks the mental capacity to request an assessment or give their permission and you think it is in their best interests, you can still request one on their behalf.

What happens in a needs assessment?

Needs assessments are carried out by a social care professional such as a social worker. They will usually visit the person at home, although sometimes an assessment is offered by phone or online (self-assessment). If you think a face-to-face assessment is more appropriate, you can request this.

During the assessment, the assessor will ask questions to find out about:

• the person’s overall health
• daily tasks that the person can and cannot do or are struggling with, such as getting dressed, preparing and eating meals, washing and other personal care, moving around the home safely and getting out and about – these are known as ‘outcomes’
• any cultural, social or religious needs that might affect what support they need
• their current living arrangements
• their relationships
• what support they feel they would like/need

It is important to be very specific about the person’s needs. Even small things that you might think are less important – for example, difficulty putting their shoes on – will help the assessor build a picture of what support the person needs.

If possible, the person with dementia should have someone with them during the assessment. They can help them communicate how they are managing their daily life and may have noticed things that the person themself has not.

How to prepare for a needs assessment

Before the assessment, spend some time thinking about your needs or the needs of the person you care for. Social Services should provide information in advance about what the assessment will involve and the areas they will ask about.

Think about what sort of practical help the person needs, for example how they manage:

• preparing meals, eating and drinking
• personal care, including washing, dressing and using the toilet
• looking after their healthcare, such as taking medication as prescribed
• moving around the home safely, including any falls
• looking after the home and garden, for example washing up, laundry, cleaning, emptying bins, mowing the lawn
• getting out and about
• work, if they are in employment or self-employed

Also think about the person’s cultural, religious and social needs, for example:

• Do they need support with going to a place of worship?
• Do they need help with following a religious diet?
• Are they able to visit family and friends, go to the shops, or take part in leisure activities like going to the theatre, out for a meal, or attending clubs and support groups?
• Do they have any caring responsibilities of their own, for example for a spouse or child?

Be as specific as you can, and do not downplay the person’s needs – base your answers on what happens on a bad day, not a good one.

Independent Age has a useful checklist to help you prepare for the assessment.

Getting the results of a needs assessment

Following the needs assessment, the assessor will consider:

• whether the person has care and support needs because of their condition or disability
• whether they are unable to achieve two or more ‘outcomes’
• whether this is having a significant impact on their physical or mental health and wellbeing

If the person meets all three criteria, the assessor will produce a care plan for the support they need. This could include things like mobility equipment, home adaptations, meals on wheels, care at home, access to day centres and lunch clubs, or a move into a care home.

At this stage, you will not be told whether the local council or, in Northern Ireland, the Health and Social Care (HSC) Trust, will fund any or all this support.

If the assessment concludes that the person does not have eligible care needs, the council should still provide information about other support they might be able to access in the community.

If you disagree with the results of the assessment or how it was carried out, you have the right to complain. In the first instance, you should contact the local council, following the complaints procedure on its website. If you are unsatisfied with the outcome, you can escalate the complaint to the Local Government and Social Care Ombudsman in England; the Public Services Ombudsman in Wales; the Scottish Public Services Ombudsman in Scotland; or the Northern Ireland Public Services Ombudsman in Northern Ireland.

What is a financial assessment or ‘means test’?

If the needs assessment concludes that the person has care and support needs, they will usually then have a financial assessment to look at what, if anything, the local council or HSC Trust will pay towards their care. It is often called a ‘means test’.

How do I get a means test?

Following the results of the care needs assessment, the person with dementia will be sent a form to complete about their finances. They will need to provide proof of:

• income
• savings and investments
• property they own
• any expenses relating to their disability

Many councils require the form to be completed within 14 days.

How to prepare for a means test

Because the person with dementia will need to provide evidence of their financial circumstances, it is important to start collecting these documents as soon as possible.

Each council has its own list of what evidence it needs, which will be provided with the form, but it typically includes:

• bank, building society and savings account statements, often going back six months
• share certificates
• Premium Bond certificates
• awards letters or statements for any benefits the person receives
• proof of employment-related income, eg payslips
• proof of any other income, for example from renting out property
• pension statements
• statements for household bills, eg mortgage, rental agreement, Council Tax, service charges, ground rent
• evidence of disability-related expenses, eg receipts for mobility equipment, garden maintenance, fall alarm subscription charges
• evidence of the value of the person’s property (only if they are moving into a care home)

How to fill in the financial assessment means test form

Each local council has its own means test form. Make sure you read any instructions before completing it and gather all the evidence that is required.

The means test looks at the finances the person with dementia holds in their own name, and not the finances of their spouse or another person who cares for them. If the person holds joint accounts, only 50% of the funds in these accounts should be counted.

The person with dementia can have help with filling in the form, for example from a family member, friend or independent advocate, but they must sign it themselves. If they do not have the mental capacity to sign it and they have nominated a power of attorney, their attorney can sign on their behalf.

Once the form is completed and the evidence gathered, you will need to submit it to the council by email or post.

Getting the results of a means test

Following the means test, the local council will write to the person with dementia to tell them how much they will have to pay towards their care. Most people will need to pay at least some of the costs, on a sliding scale depending on their income and savings. People who have savings above a certain level will not receive any financial support from their council. The council will tell you what the threshold is.

If the local council will contribute to the cost of care, this is known as a ‘personal budget’. The person can use this in one of three ways:

• the money is paid into the person’s bank account and they can choose their care provider themselves and pay them directly, known as a ‘direct payment’
• the council chooses and pays for the person’s care
• the person chooses their own care provider, and the council pays the provider directly