Information on Eligibility Criteria

Adult Services

• Introduction
• What are Eligibility Criteria?
• What are the four bands?
• Substantial Needs
• Moderate Needs
• Low needs
• How do we use the eligibility criteria?
• To whom do Eligibility Criteria apply?
• What if you are not eligible for services from Adult Services?
• What if you have more questions
• What if you disagree with the Adult Services decision?

We hope that the following questions will answer some of the queries you may have about eligibility criteria.

In May 2002 the Government issued new guidance to councils on how they should set their eligibility criteria for services. This is to ensure fairer access to services across the country. All Social Care and Health departments in England and Wales must apply Eligibility Criteria to help them prioritise and make sure resources go to those in greatest need.

Please do not hesitate to contact us if you have any further questions after reading this information. We will be happy to explain anything further:

What are Eligibility Criteria?

In setting its criteria for services, Tameside Adult Services must use the eligibility framework laid down by the Government. This consists of four bands (see below). It is based on the seriousness of the risk to an individual's independence if their problems and issues are not addressed.

Councils use this framework to set their eligibility criteria according to the resources that are available. Tameside has looked at the resources it has and has calculated it will meet individuals' needs which fall into the critical and substantial bands. However, if needs are identified below these thresholds, then Adult Services may be able to provide some services for those with moderate needs. These services may include adaptations, provision of equipment, rehabilitation training and counselling. Information and advice about other available services and organisations will also be given.

What are the four bands?

Critical Needs

The Government's Eligibility Framework says need will be assessed as critical when:

• Life is, or will be threatened; and/or
• Significant health problems have developed or will develop; and/or
• There is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or
• Serious abuse or neglect has occurred or will occur; and/or
• There is, or will be, an inability to carry out vital personal care or domestic routines; and/or
• Vital involvement in work, education or learning cannot or will not be sustained; and/or
• Vital support systems and relationships cannot or will not be sustained; and/or
• Vital family and other social roles and responsibilities cannot or will not be undertaken.

The following are examples of situations which may fall into the critical band. However, we must emphasise that all decisions are made according to an individual's personal circumstances.

• A person who is at critical risk of physical or mental abuse from others.
• A relative who meets most of a person's essential care needs is admitted to hospital in an emergency or has died.
• A person who is confused to a degree that without assistance and care throughout a 24 hour period would be at extreme risk.
• A deaf person who has a medical condition which is affecting his sight so that he will become severely visually impaired. He will need help with a range of daily living activities such as shopping, food preparation, paper work as well as needing rehabilitation training.

Substantial Needs

The Government's Eligibility Framework says need will be assessed as substantial when:

• There is, or will be, only partial choice and control over the immediate environment; and/or
• Abuse or neglect has occurred or will occur; and/or
• There is, or will be, an inability to carry out the majority of personal care or domestic routines; and/or
• Involvement in many aspects of work, education or learning cannot or will not be sustained; and/or
• The majority of social support systems and relationships cannot or will not be sustained; and/or
• The majority of family and other social roles and responsibilities cannot or will not be undertaken.

The following are examples of situations which may fall into the substantial band. However, we must emphasise that all decisions are made according to an individual's personal circumstances.

• A person, in hospital who is at substantial risk of falling when getting in or out of bed, or getting up from a chair
• A person, who is being discharged from hospital and is unable to use toileting facilities
• A disabled person living alone has some mobility problems and cannot carry out personal care tasks independently. She needs help with personal care, shopping, bills and other paperwork as well as needing adaptations for her home. Without this support she would steadily deteriorate and would eventually need residential care.

Moderate Needs

The Government's Eligibility Framework says need will be assessed as moderate when:

• There is, or will be, an inability to carry out several personal care or domestic routines; and/or
• Involvement in several aspects of work, education cannot or will not be sustained; and/or
• Several social support systems and relationships cannot or will not be sustained; and/or
• Several family and other social roles and responsibilities cannot or will not be undertaken

The following are examples of situations which may fall into the moderate band. However, we must emphasise that all decisions are made according to an individual's personal circumstances.

• A person is having increasing difficulty making her own meals to the extent she is not receiving an adequate diet
• A person is having difficulty attending to his personal care and unable to undertake practical tasks such as shopping and collecting his pension.
• A person who is socially isolated with a significant lack of social networks or opportunities for involvement in family and wider community life

Low needs

The Government's Eligibility Framework says need will be assessed as low when:

• There is, or will be, an inability to carry out one or two personal care or domestic routines; and/or
• Involvement in one or two aspects of work, education or learning cannot or will not be sustained; and/or
• One or two social support systems and relationships cannot or will not be sustained; and/or
• One or two family and other social roles and responsibilities cannot or will not be undertaken.

The following are examples of situations which may fall into the low band. However, we must emphasise that all decisions are made according to an individual's personal circumstances.

• A person who is unable to undertake practical tasks such as shopping, gardening or decorating
• A person who is having difficulty using a bath but is able to strip wash

How do we use the eligibility criteria?

When you contact Adult Services, we will talk with you about the difficulties you are experiencing. This information is then evaluated against the risks to your independence in four areas:

• personal health and safety
• freedom to make choices
• ability to manage daily routines
• involvement in family and wider community life.

If appropriate we will look at your involvement in work, education, or learning, social support systems and relationships and family. The degree to which your independence is at risk in these areas will be measured against the eligibility criteria set out in the four bands above.

To whom do Eligibility Criteria apply?

They apply to adults (18 and over), living in Tameside and seeking support from Adutl Services and who

• have a physical disability or
• have a learning disability
• have a hearing loss
• have a visual impairment
• have a long term illness
• have a mental health problem
• have a drug or alcohol related problem
• are carers
• are vulnerable due to environmental factors, abuse or at risk to themselves or others.

What if you are not eligible for services from Adult Services?

If Adult Services cannot provide you with services because you do not meet Tameside's eligibility criteria, there are other options and you will be provided with information about other agencies, which provide advice and support. There may be a charge for these services.

Even if you are paying for your own care, Tameside Adult Services can give you information, advice and support.  If you are paying for your own care, you are considered to be "Self funding". If you are a Self funder and not receiving any of our adult care services you are still entitled to help, information and advice about staying in your own home or moving into a care home.

Our Customer Care Officers will be pleased to advise you and can make home visits if necessary. We can provide information in a wide range fo different formats and will provide an interpreter if necessary. Additionally, highly trained Welfare Rights Officers are available and can advise you about benefits, allowances and pension entitlements.

What if you have more questions?

If you or your carer have any further questions about Eligibility Criteria or any other aspect of Adult Services, please do not hesitate to contact Adult Services.

You may also like to contact the Carers Centre for more information directly related to carers:

 50 Warrington Street, Ashton-under-Lyne OL6 7JX 
0161 342 3344  0161 342 3720  0161 342 3721 Send a Message to Tameside Carers Centre

What if you disagree with the Adult Services' decision?

If you are unhappy with the decision that Adult Services has made, please contact the Adult Assessment and Customer Care Team. Alternatively you may like to make a complaint.

Contact Information
Send us a Message	Tameside Adult Services Stalybridge Resource Centre Waterloo Road Stalybridge SK15 2AU View local map
0161 342 2400
0161 342 2460
0161 342 3602