Who qualifies for help?

Eligibility criteria

We receive a high volume of referrals for care services.  To help us prioritise those people whose independence or wellbeing is most at risk or who have the most urgent need for care, we use eligibility criteria.  We aim to make sure everyone asking for help is dealt with fairly, and that people understand how decisions are made about allocating services.

A person's eligibility for services is decided following a formal assessment of their care needs. The assessment takes account of the likely risks and consequences if they do not receive social work support or services at that point of time.  This means, if your needs are less urgent than others, you may have to wait for services.

We review people's assessed needs regularly to make sure that their changing needs, and their priority for services, is updated using the eligibility criteria.

Priority

Everyone who is assessed as needing care or support is allocated a level of priority.

There are four categories of priority:

Critical

You, or others, may be at immediate risk of serious harm or neglect or loss of independence.  There may be immediate risk of your care arrangements breaking down, or your main carer being unable to continue to support you.  In these circumstances, we will arrange services to reduce these risks within one to two weeks.

For example:

  • your carer is ill or admitted to hospital, and you have no-one available to help
  • you develop major health difficulties or have an accident, and you are unable to meet vital or most of your personal or domestic care needs
  • you are a vulnerable person who has been made homeless

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Substantial

You, or others, may be at substantial risk of significant harm or neglect or loss of independence.  There may be substantial risk of your care arrangements breaking down, or your main carer being unable to continue to support you.  In these circumstances, we will arrange services to reduce these risks imminently - within six weeks.

For example:

  • you have a severe and enduring mental illness, which could result in you harming yourself or others and you need intensive support to help you manage
  • you have significant difficulty coping with daily living routines
  • you are terminally ill or have a progressive and / or significantly deteriorating condition and are unable to do many aspects of personal care
  • you have recently been discharged from hospital after serious illness, and are unable to manage many aspects of your domestic routine causing significant risk to your independence

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Moderate

You, or others, may be at some risk of harm or neglect or loss of independence.  There may be some risk that your main carer has difficulties in continuing to support you. In these circumstances, we may arrange services to reduce these risks within the foreseeable future, such as six months, if resources or appropriate services are available.  If appropriate services are not available, we will discuss with you alternative ways to address these needs.

For example:

  • you have health problems which mean you are unable to do some aspects of your personal care or domestic routines, creating moderate risk to your independence
  • you are looked after by a carer, whose health or responsibilities are under strain and at some risk of breaking down
  • you are a vulnerable person who may potentially be at risk of harm or neglect

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Low

There is a low risk to your independence, health or wellbeing with very limited, if any, need for social work services.  In these circumstances, we may consider that you do not need services within the foreseeable future.  If appropriate services are not available or not needed, we will offer you advice and information about alternative sources of support and will offer to review your needs within twelve months.

For example:

  • you have difficulty coping with one or two aspects of your personal care or domestic routines
  • you need support and motivation to care for yourself
  • your need reminders to minimise the potential risk of harm or neglect

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These eligibility criteria will be used after your needs have been formally assessed. Although you may have multiple care needs, the social work practitioner completing your care needs assessment will reach one eligibility decision, based on these criteria.

If services must be provided as a result of a statutory order, such as that from a court or Children’s Hearing, these eligibility criteria will not apply.

For more information, please read our full eligibility criteria:

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Who is not likely to qualify for a service?

You will not qualify for social work services if:

  • you can manage your personal care and carry out household tasks safely and with confidence
  • you need help with a household service only
  • your needs can be met more appropriately by other community services or activities

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What if I disagree with the decision?

If you do not agree with our decisions about your priority for services, please discuss this with the social work practitioner who is doing your assessment with you.

If you are not satisfied with the outcome of your discussions, ask to have your case considered by the social work practitioner ’s manager.  They will review your case to make sure your needs have been fully assessed and the eligibility criteria have been applied properly.

If you are still dissatisfied, you can use our complaints procedure.

 

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