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Section 4: Sustaining the caring role
In this section you will learn about FACS 2010 and:
- the risk of sustainability within the caring role
- carers' assessment
- young people providing care.
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Section 4: Sustaining the caring role
Sustaining the caring role and acting to reduce the risks to its being sustained is a critical element of FACS.
Another essential aspect is in identifying young people providing care and ensuring that their role in caring is appropriate.
We'll now look at the risk of sustainability within the caring role.
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Section 4: Sustaining the caring role
Risk of sustainability within the caring role
If the risk to the sustainability of the caring role is critical, the council has an obligation to ensure that steps are taken to reduce the risk.
They may do this by providing
- a service to support the caring role
- care for the individual using services to give the carer a short break
- additional support to the adult using services
- support to enable the carer to continue their employment or to access leisure or recreational activities.
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Section 4: Sustainging the caring role
Level of risk to sustainability of the caring role
Select from the following links to read four descriptions of carers.
For each, think about the level of risk to sustainability of the caring role, then read our commentary on the case.
When you are ready, select 'Implications for practice' to find out more.
Mrs B
Ms D
Mrs E
Mr Ross
Critical
- major health problems have developed or will develop;
- there is, or will be, an extensive loss of autonomy for the carer in decisions about the nature of tasks they will perform and how much time they will give to their caring role;
- there is, or will be, an inability to look after their own domestic needs and other daily routines while sustaining their caring role;
- involvement in employment or other responsibilities is, or will be, at risk;
- many significant social support systems and relationships are, or will be, at risk;
Substantial
- significant health problems have developed or will develop;
- there is, or will be, some significant loss of autonomy for the carer in decisions about the nature of tasks they will perform and how much time they will give to their caring role;
- there is, or will be, an inability to look after some of their own domestic needs and other daily routines while sustaining their caring role;
- involvement in some significant aspects of employment or other responsibilities are, or will be, at risk;
- some significant social support systems and relationships are, or will be, at risk.
Moderate
- there is, or will be, some loss of autonomy for the carer in decisions about the nature of tasks they will perform and how much time they will give to their caring role;
- there is, or will be, some inability to look after their own domestic needs and other daily routines while sustaining their caring role;
- several social support systems and relationships are, or will be, at risk.
Low
- there is, or will be, some inability to carry out one or two domestic tasks while sustaining their caring role;
- one or two social support systems and relationships are, or will be, at risk.
Mrs B
Description of the carer
Mrs B is 83 years old. She lives on her own in a two-bedroom flat and has been diagnosed with vascular dementia and suffers with depression. Her daughter, VB, is her main carer. Mrs B receives direct payments for personal and domestic care which is allowing her daughter to work from her own home whilst a carer is supporting her mother.
A report from the Community Mental Health Team includes a copy of a letter from VB's employer threatening termination of VB's employment if she does not return to full-time employment in three months' time. To return to work full time VB needs a carer to supervise her mother during the day to support her with all aspects of her daily living as she is at risk of not maintaining her personal hygiene and safety due to her dementia.
Mrs B
Commentary on case
There could be substantial risk to the sustainability of the caring role because:
- there is, or will be, some significant loss of autonomy for the carer in decisions about the nature of tasks they will perform and how much time they will give to their caring role.
- there is, or will be, an inability to look after some of their own domestic needs and other daily routines while sustaining their caring role.
- involvement in some significant aspects of employment or other responsibilities is, or will be, at risk.
Ms D
Ms D, aged 18, has moderate learning disabilities. She lives with her mother and father, a younger brother and sister who are still at school. Mr D works full time and Mrs D part-time and they need both incomes to maintain their family. Ms D is transferring from children's to adult services. The assessment by adult services places her in the substantial rather than critical band of eligibility.
The support she received from children's services has included attending college twice a week and escorts to activities for the other three days a week. Her college course is ending and her parents' are very concerned that their employment is threatened. Ms D has been assessed as needing continuing care because she is not safe on her own in the house, on transport or crossing the road. Mr and Mrs D said the reduction in services is threatening their jobs and ability to care for their daughter. Transition planning is still in progress.
Ms D
There is moderate to substantial risk to sustainability of the caring role because:
- Mr and Mrs D will experience some loss of autonomy in decisions about the nature of tasks they will perform and how much time they will give to their caring role.
- involvement in some significant aspects of employment is, or will be, at risk.
- they will have less time to look after their own domestic needs and other daily routines while sustaining their caring role.
- transition planning will address Ms D's needs and there is an opportunity to review what activities will enable Ms D to achieve the outcomes she wants and the support she needs to do this without obliging her parents to give up work.
Mrs E
Description of the carer
Mrs E is concerned about the amount of support she is expected to provide for her sister-in-law, Mrs L, after she was discharged from hospital following injuries from being in a fight. Mrs E says that it is putting too much pressure on her, her two children and her relationship with her husband, who works long hours. Mrs E has a part time job during school hours and she has had to take unpaid leave to look after her sister-in-law. Mr and Mrs E are the only supports Mrs L has. Mrs L's husband left her and their two children three years ago when she was unable to control her alcohol misuse. The maternal grandparents now care for the children and all other family members have been exhausted by Mrs L's previous crises.
Mrs E is prepared to help Mrs L out by making sure she had food in the house and keeping a spare key for her when she gets locked out, but no more. Health and the alcohol support team are involved, and both state Mrs L is expected to make a full recovery and the support she needs is expected to reduce to the previous level.
Mrs E
Commentary on case
There are low to moderate risks to sustainability of the caring role because:
- there is some inability to carry out one or two domestic tasks because of Mrs E's caring role.
- Mrs E's ability to care for her two children and her relationship with her husband is affected.
- this is expected to be a temporary change in circumstances.
- the alcohol support team are monitoring Mrs L's progress and will now include review with Mrs E, her caring role and whether they should arrange extra time-limited support.
- Mrs E has been able to ask for support and to self refer.
Mr Ross
Description of the carer
Mr R, aged 85 cares for his 87-year-old wife. Their adult children live too far away to provide day-to-day support. Mrs R has Alzheimer's disease and her symptoms are becoming more severe. Carers have been coming in three times a day, and this is supplemented by overnight care once every four months to give Mr R a break. Their daughter stays over the weekend once a month. Mrs R was found by the police in distress wandering the streets during the night. On investigation Mr R was found to have had a mild heart attack and needed hospital care.
Mr Ross
Commentary on case
This is critical for Mr R as his wife's carer because:
- Mr R's life may be threatened.
- there has been an extensive loss of his autonomy in decisions about the nature of the tasks he will perform and how much time he will give to his caring role.
- he is currently unable to look after his own domestic needs and other daily routines whilst sustaining his caring role.
- significant social support systems and relationships are at risk because his family are unable to provide day to day care because they live too far away, have family and employment commitments.
It is likely that a FACS assessment for Mrs R will put her needs in the substantial or critical category.
Implications for practice
Risk of sustainability within the caring role
When assessing the risks to the sustainability of the caring role, staff will need to work with adult carers, and parents of disabled children and young people, to apply the following definitions:
Critical risk to sustainability of the caring role arises when:
- The carer's life may be threatened.
- Major health problems have developed or will develop.
- There is, or will be, an extensive loss of autonomy for the carer in decisions about the tasks they will perform and how much time they will give to their caring role.
- There is, or will be, an inability to look after their own domestic needs and other daily routines while sustaining their caring role.
- Involvement in employment or other responsibilities is, or will be, at risk.
- Many significant social support systems and relationships are, or will be, at risk.
Substantial risk to sustainability of the caring role arises when:
- Significant health problems have developed or will develop.
- There is, or will be, some significant loss of autonomy for the carer in decisions about the nature of tasks they will perform and how much time they will give to their caring role.
- There is, or will be, an inability to look after some of their own domestic needs and other daily routines while sustaining their caring role.
- Involvement in some significant aspects of employment or other responsibilities is, or will be, at risk.
- Some significant social support systems and relationships are, or will be, at risk.
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Section 4: Sustaining the caring role
The Carer's Assessment
The purpose of the carers' assessment is to consider:
- the sustainability of the caring role.
- the resources and support carers are eligible for.
- whether carers want to access resources directly or with assistance.
- the carer's own needs, including family, education, training, leisure and work.
Clcik on the links below to read more about the carer's assessment
The why
Demographic and social trends are leading to increased demand for social care that highlights the importance of support from carers, family, friends, neighbours and the local community.
The carer's right to assessment is given a higher profile in FACS 2010 as part of the wider policy of early intervention to prevent difficulties escalating into a crisis and requiring the provision of more intensive services.
The how
Assessment of individuals' circumstances to identify the range and sustainability of current support, including that from carers.
Part of the individual's assessment will identify:
- all eligible social care needs, and whether and how they are currently being met.
- the support that carers and the individual's social networks are providing.
- whether carers and others providing support can continue to do so in the future.
- implications if the individual's need for care increases or fluctuates.
- the carer's own needs.
- whether carers should be consulted about the individual's assessment to ensure a realistic evaluation of the extent and sustainability of support carers they can provide.
Information
Carers must be given information to help them make decisions about their caring role whether or not the carer wants a carers' assessment.
Carers' assessment
When working with adult carers, and parents of disabled children and young people, staff will need to:
- implement the council's FACS policies and procedures for responding to requests for, and when carrying out, carers' assessments.
- explain the council's policies on assessing risks to the caring role.
- work in partnership with carers during their assessment ensuring, if they wish, they contribute through self-assessment.
- identify and assess the sustainability of the support that carers or others in individual's network are able and willing to give in the immediate and longer term.
- identify how the caring role impacts on the carer's employment, education, training or leisure, employment opportunities and well-being.
- provide, or signpost, relevant, timely, up-to-date information and advice about universal and community resources that support the caring role and the carer's own needs and well-being, and about feedback and complaints systems.
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Section 4: Sustaining the caring role
Young people providing care
The aim of the assessment will be to evaluate the appropriateness of the caring role for the young carer and its effects on their own health, education, development and well-being.
This assessment will seek to establish how the child or young person's caring role is impacting on the five outcomes all children and young people should be able to achieve (from the Green Paper Every Child Matters). These are set out on the right:
The Every Child Matters (ECM) outcomes that are most important to children and young people:
- be healthy
- stay safe
- enjoy and achieve
- make a positive contribution
- achieve economic well-being.
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Section 4: Sustaining the caring role
The agency responsible for undertaking the assessment of a young person providing care is the service (children's services, adult services, primary care trust) which identifies that there is a young carer in the family.
Where children or young people are providing or contributing to the person's care, assessment needs to be carried out in partnership with Children's Services.
Adults' and children's Services will identify the support that is necessary to enable the child or young person to achieve the best outcomes the impact on the young person of their caring responsibilities will determine whether he or she should be assessed under the Framework for the Assessment of Children in Need and their Families or under the Carers and Disabled Children Act 2000.
Select Implications for practice in order to find out more
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Section 4: Sustaining the caring role
Implications for practice: Young Carers
When working with young people providing care, staff will need to:
- identify whether anyone under the age of 18 is providing care for the individual.
- work with children's services to
- protect carers under 18 from providing inappropriate levels of care.
- put in place support to promote young carers' opportunities to achieve positive outcomes.
- ensure support for individuals and their families that:
- does not rely on an inappropriate level of care from a child or young person.
- enables young carers to remain and thrive within their family.
- provide timely information, advice and support for young carers in ways appropriate to their age and understanding.
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