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Social care and support

If you’re elderly, disabled or have an illness, you may be able to get care and support arranged by your local Health and Social Care (HSC) Trust to help you live as normally as possible.

Sometimes the HSC Trust will pay for all of your care needs, and sometimes you’ll need to contribute to this.

You could be eligible for help including:

  • help with tasks like cleaning, shopping or making meals
  • adaptations to your home, for example a stair lift or equipment like grab rails or hand rails
  • care at a day centre to give you or the person who cares for you a break
  • day care for your child if you or they have a disability
  • 24 hour care at a residential home or nursing home, either permanently or as respite care

Eligibility

You’ll need to contact the HSC Trust covering the area where you live and ask them to carry out an assessment of your needs, known as a community care assessment. A carer, friend or relative can also ask for an assessment for you or you can ask your GP to refer you.

The HSC Trust must give you an assessment if you appear to need care and support. It doesn’t matter whether you’ll be eligible for help or not.

You cannot be refused an assessment because the HSC Trust believes you will not meet their criteria for help, because they do not have enough staff to carry out an assessment or because you can afford to pay for your own help privately. If you are refused an assessment, you can complain to the HSC Trust, see complaining about social care services.

Find contact details for your local HSC Trust

If you need help after leaving hospital, you will be assessed before you leave. There may be a charge for services you receive. If you were receiving help before you went to hospital you may simply need to have these services reinstated. You should not be discharged until the services you need have been arranged. For more information, see www.nidirect.gov.uk.

What to expect from a community care assessment

A community care assessment isn’t an exam - it’s a face to face discussion with a trained person from the HSC Trust at a time and place that suits you. They could be a social worker, an occupational therapist or someone else who will be familiar with your situation. You may also be asked to fill in a questionnaire about your needs.

You’ll be able to discuss what your needs are and how the HSC Trust can offer support. It is important you give as much information as possible so the HSC Trust can identify the support you require. You should tell them about:

  • your physical and mental health and any disabilities you have
  • tasks you need assistance with - eg, personal care such as getting in and out of bed, getting dressed, washing and cooking and practical needs such as cleaning, shopping, doing laundry or getting to or from work
  • the outcomes that matter to you - eg, you may be lonely and want to make new friends or you may want to stay in your own home rather than go into residential care
  • your circumstances - eg, whether you live alone, whether you have a carer, whether you need assistance for a short period of time, eg after discharge from hospital or whether you need longer-term help

Anyone involved in your care will be invited to attend, for example your carer. You can also ask a family member, a friend or an independent advocate to come along to the meeting and represent you.

If you have requested an assessment and you haven’t heard from the HSC Trust within 4-6 weeks, give them a call and find out what is happening. The assessment should be carried out within a reasonable period of time and you should be told if there are likely to be any delays.

In Northern Ireland, the Single Assessment Tool has been developed to assess the health and social care needs of those aged over 65. It aims to get a full picture of the person being assessed to ensure they get the best possible care. It should also mean that different agencies do not have to ask the same questions or hold repeat assessments. For more information, see www.dhsspsni.gov.uk.

Assessments should be carried out regularly to make sure they are up-to-date and the information held is still accurate. You should request a new assessment if your needs or circumstances change.

What happens after an assessment

The HSC Trust will use the information you’ve given them to work out what your needs are and what services the HSC Trust can provide to support you. The HSC Trust will decide if you’re eligible for help by comparing your needs with criteria set by the Department of Health, Social Services and Public Safety which reflect the level of risk to a person’s independence if their needs are not met.

Currently, HSC Trusts in Northern Ireland will fund services for those people whose needs are classified as critical or substantial. Needs which are classified as moderate or low will only be funded if there are sufficient resources available. 

If the HSC Trust decides that you are eligible for help, you’ll be given a care plan outlining the help you can receive. You should be given the name of a care manager who is responsible for ensuring services are provided and who you can contact if there are any difficulties. The care plan should set out:

  • what needs have been identified - eg, help with preparing meals, greater social contact
  • how these needs will be met - eg, a meals on wheels service, a place at a day centre
  • what support, if any, carers will provide
  • the results of any financial assessment
  • a plan for dealing with emergencies - eg, if your carer is taken ill suddenly
  • a date for review of the care plan

You may be told that you’re not eligible for care. You should receive a letter explaining why. It should also tell you about other organisations or charities that may be able to help you. If you disagree with the HSC Trust’s decision you can make a complaint, see complaining about social care services.

Paying for care

Your finances won’t be looked at during the needs assessment but the HSC Trust may carry out a financial assessment to decide how much, if anything, you need to contribute towards the cost of your care.

Care at home

If you have been assessed as needing a service that’s provided to you in your own home, the Trust can charge you for this service. However, HSC Trusts generally only charge for the home help scheme and the meals on wheels service. If you are aged over 75, your home help will be free, but otherwise you may be asked to pay depending on your level of savings and investments. There is a standard charge for meals on wheels which is not means tested.

If the HSC Trust decides to charge you for a service provided in your home, it must carry out a financial assessment.

The financial assessment will take into account:

  • your income, for example a private or state pension
  • savings
  • investments including any property you own
  • your expenses, eg paying bills or rent
  • benefits or other financial support you get, but when services are to be provided in the home, the Trust should not take into account any disability-related benefits such as Attendance Allowance or Disability Living Allowance

Charges for services must be “reasonable” and if you think they are excessive you can complain, see complaining about social care services.

Residential care

There are two main types of residential care: care homes which provide accommodation and help with personal care such as washing and dressing (residential homes) and those which provide these services and also offer nursing care (nursing homes).

You may have to pay something towards your residential care or nursing home fees. How much you’ll have to spend depends on your personal and financial circumstances. You’ll most likely have a financial assessment to determine this.

The financial assessment will take into account:

  • your income, for example a private or state pension
  • savings
  • investments including any property you own
  • whether you get benefits or other financial support - eg, Pension Credit, Attendance Allowance
  • your expenses - eg, paying bills or rent

The current rules in Northern Ireland state that if you have more than £23,250 in capital (ie savings or investments), you’ll have to pay for the full cost of your care. If you have less than £14,250, the HSC Trust will fund your care in full. For those with capital between these limits, the HSC Trust will part-fund care on a sliding scale. The rules on what counts as capital are complicated. The full guide to how charges for residential accommodation are assessed can be found at www.dhsspsni.gov.uk.

When the HSC Trust is contributing to the costs of residential care, any benefits you are entitled to will be put towards the cost of care and you will be left with only “spending money”, currently £24.90 per week. If you are funding your own care in full you will still be able to get your state pension and other benefits such as Attendance Allowance and can use these to help pay your fees.

If you choose to live in a residential or nursing home which is more expensive than the HSC Trust usually pays for a person with your assessed needs, you will have to find a way to pay the difference. You cannot pay the extra amount yourself as you will have been financially assessed to pay what you can afford, but you can ask a friend or relative to pay the extra amount – a third party contribution.

For more details on paying residential care fees, see www.nidirect.gov.uk.

Nursing care

If you live in a nursing home and have

  • been assessed as needing nursing care; and
  • been financially assessed as being responsible for the full cost of your care

you may be eligible to receive a contribution from the HSC Trust (currently £100 per week) towards the cost of your nursing home fees. This payment will be made directly to the nursing home who should then offer you either a reduction in your fees or a refund.

For more information, see www.nidirect.gov.uk .

Respite care

If you are assessed as needing respite care (stays in residential care lasting less than 8 weeks) a financial assessment may be carried out to decide whether or not you need to contribute to the cost. The financial assessment will be carried out based on the same criteria as used for permanent moves to residential care.

Fees charged for respite care must be reasonable and if you think they are not you can complain to the HSC Trust, see complaining about social care services.

For more information on respite care, see www.nidirect.gov.uk.

Arranging and paying for your own care

If you’re eligible for help from the HSC Trust, you’ll have the option of arranging and paying for your own care. The HSC Trust will give you money to do this, known as direct payments. You cannot use direct payments to pay for permanent residential care or to pay for a relative or friend to provide you with a service unless the Trust agrees.

The amount of direct payments you get should cover the cost of buying services you're eligible for. This includes any extra costs you have to pay in order to get the service. For example, if you employ your own carer, you will have to pay recruitment costs, holiday and sick pay and insurance.

You may have to make a contribution towards the cost of services. The HSC Trust will work this out in the same way it works out how much you have to pay towards services it arranges itself. They will either deduct your contribution before paying you the direct payment or pay the direct payment in full and you will have to pay your contribution back.

You’ll have responsibilities if you arrange your own care, so you should think carefully before you make a decision. You’ll have to do things like:

  • choosing the best organisations, people or services to provide your care
  • keeping records and accounting for how the money is spent
  • taking on the legal role of an employer if you're using the payment to pay for a care worker

For more information about employing a professional carer, see www.nidirect.gov.uk.

For more information about direct payments, see www.nidirect.gov.uk.

Complaining about social care services

You should complain to the HSC Trust if you’re unhappy with a decision it has made about your social care and support. For example, you could complain if you weren’t happy with how your needs assessment was carried out or with the decision as to whether you are eligible for help. All HSC Trusts should have a complaints procedure you can follow – ask them for a copy.

If you’re unhappy about the quality of the services provided, you should speak to your Care Manager or the manager of the residential or nursing home. If you feel your complaint is not being listened to, you should complain to the HSC Trust.

If you are unhappy with the HSC Trust’s response to your complaint, you can refer your complaint to the Northern Ireland Ombudsman.

You might find it helpful to contact a specialist adviser, for example at your nearest Citizens Advice, who can help you with your complaint. You can also get confidential information and advice, as well as help to make a complaint, from the Patient and Client Council.

Further help

If you need further help or advice, there are a number of organisations you can contact.

These include:

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