Support at home in England: a plain guide

A council needs assessment is a free conversation about how you live day to day and what would make that easier. The council then decides whether you meet the national eligibility criteria for care and support. If you do, it agrees a personal budget with you, and you choose how to take it, either as a managed budget or as a direct payment.

How does a council needs assessment work?

You ask the council where you live for an assessment. You can ask for yourself, and a family member, a friend or a professional can ask on your behalf. The council must carry out the assessment if it looks like you may need care and support, whatever your income or savings.

A trained assessor, often a social worker or an occupational therapist, visits you or talks to you by phone or video. The conversation covers the things the law calls your wellbeing: washing, dressing, eating, getting out, keeping in touch with people, staying safe at home, and any caring you do for someone else. You can have someone with you. You can ask for an interpreter or for the assessment in a different format.

The assessor writes down what you can do, what you struggle with and what you want to change. The council then applies the eligibility criteria. In England these are set out in the Care Act 2014 and the guidance that follows it. There are three tests. Your needs must come from a physical or mental impairment or illness. Those needs must have a significant effect on your wellbeing. And because of them, you must be unable to achieve at least two of a list of outcomes, such as eating well, keeping yourself clean, or maintaining relationships.

If you meet the criteria, the council must work out a support plan with you. If you do not, the council still has to give you information and advice about what else is available in your area. That might include community groups, equipment, or help from the voluntary sector.

A refusal is not always the end. You can ask for the decision to be reviewed, and there is a formal complaints route. The same law and guidance that shape this process also shape the wider picture of supported living in England, from the first assessment through to the housing and the checks on the people who provide care.

What is the difference between a personal budget and a direct payment?

A personal budget is the amount of money the council has worked out is needed to meet your eligible needs. It is a figure, not a payment. It is the total, and it stays visible to you.

A direct payment is one way of receiving that budget. The council pays the money to you, or to a person or organisation you choose, and you use it to buy the support in your plan. You become the employer if you hire your own staff, or you can ask a payroll service or a user led organisation to handle the paperwork.

There are other ways to take a personal budget. The council can manage it and arrange the support itself. You can choose a mix, with part managed and part paid directly to you. Some people use an individual service fund, where a care provider holds the budget and you direct how it is spent.

A direct payment is not extra money and it is not a benefit. It is your assessed budget, paid differently. You have to keep records and show what you spent. The council reviews the plan, usually at least once a year, and the amount can go up or down if your needs change.

If you would rather not handle money or staff, say so. The council cannot insist on a direct payment. It must offer you a real choice, and it must explain the options in a way you can use.

Which housing options exist for an adult who needs support at home?

There is no single answer. The right option depends on how much support you need, how much you want to live alone, and what is available where you live.

Your own tenancy. You rent a flat or house in your own name, from a council, a housing association or a private landlord. Support comes to you, arranged through your personal budget. This gives you the most control and the most responsibility.

A shared tenancy. Two or more adults rent together, each with their own room and their own agreement, and share the kitchen and living space. Support staff visit or are on site, depending on the setup. This can suit people who want company without giving up their own front door.

Shared Lives. An adult moves in with an approved individual or family and becomes part of that household. It is arranged and monitored by the council, and it can be short term, long term or a regular break. It is not a care home and it is not fostering.

A registered care home. This is for people whose needs are too high for support at home to be safe. Care homes are registered and inspected, and they offer personal care and nursing around the clock.

Extra care housing. Self contained flats on one site, with care staff available and communal facilities. You hold a tenancy, and care is delivered to your door.

Alongside the housing itself, there is equipment and technology. Grab rails, a level access shower, a stairlift, a key safe, a fall alarm, a pendant that calls a response centre. An occupational therapist can recommend these, and the council may fund them through a disabled facilities grant or through your personal budget.

What does the CQC check?

The Care Quality Commission is the regulator for health and adult social care in England. Care homes, home care agencies, Shared Lives schemes and some supported living services must register with it.

Inspectors look at five questions. Is the service safe? Is it effective? Is it caring? Is it responsive to people's needs? Is it well led? They visit, they talk to the people who use the service and to staff, and they read records. They then give a rating: outstanding, good, requires improvement or inadequate.

For supported living, the picture is split. The housing itself is not regulated as care. The care and support that is delivered to you is. That means the landlord and the care provider may be two different organisations, with two different sets of responsibilities. It is worth asking who is who before you sign anything.

Inspection reports are public. You can read them before you choose a provider, and you can use them to ask questions. If something goes wrong, you can raise it with the provider first, then with the council, and then with the CQC or the local government and social care ombudsman.

What to do first

Write down what a normal day looks like and where it breaks down. That list is the raw material for your assessment. Ask the council for the assessment in writing, and keep a copy of everything you send and receive.

Ask about the personal budget figure early, and ask how it was calculated. Ask what happens if your needs change. Ask who will provide the care and who will inspect it.

None of this is quick, and the rules are not simple. But the process is written down, and the documents are public. Reading them before you start makes the conversations shorter.

This article is general information, not medical or legal advice. Rules and local practice change. For decisions about your own care, speak to your council, a qualified adviser or a health professional.

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