Introduction, Legal Requirements and Tools (Occupational Therapy)
Scope of this chapter
The OT procedures in tri.x should be read alongside the LCC Occupational Therapy Practice Guidance on the Intranet.
Amendment
In August 2024, text amendments were made to Section 4, The Purpose of any Assessment. These amendments were made to reflect feedback received following a full tri.x legal review of the Care Act 2014 Resource chapter ‘The Purpose of Assessment’.
The Occupational Therapy procedures support people to maximise their independence in their lived environment, covering specifics to identify needs and risks. These may be managed by equipment, adaptations, environmental changes, the development and regaining of skills, and the ability through occupational therapy and re-enabling interventions.
These procedures should be used by any Occupational Therapy practitioner that has been allocated or asked to carry out any process that establishes needs under the Care Act, including any formal assessment or reassessment of need.
Where applicable, these procedures should not be used to carry out the assessment of a child's needs under the Children Act 1989 or any other legislation, where reference should instead be made to available Children's Services procedures.
Additional practice guidance that can support the processes of establishing needs, planning and review when the person has specific or complex needs, can be accessed in the tri.x Resources.
These procedures apply equally to people who live in their own home and people who live in a care home or other setting. If a person lives in a care home and is found to have eligible needs, the Local Authority has a duty to provide bespoke or specialist disability equipment that is beyond that which must be provided by the care home.
- Any intervention must be based on an assessment of the person’s occupational performance;
- When selecting suitable equipment or adaptations, occupational therapists must also focus on the person’s needs and situation;
- It is important to consider and document the persons / family cultural needs when recommending potential equipment / adaptations;
- Goals of occupational therapy should be focused on the occupations of the person and not the equipment or adaptation (Professional Standards for Occupational Therapy Practice, Conduct and Ethics).
Under the Care Act, any method of establishing needs is known as an assessment and this is the legally recognised term. Assessment is an integral part of Adult Care and Support.
The term 'assessment' covers:
- the range of methods that can be used to establish needs, some of which are formal (for example, a face to face assessment) and some of which are not so formal (for example, a short telephone conversation); and
- the range of models and frameworks used to support or shape the process of information gathering.
Unfortunately, the word 'assessment' is all too often associated with outdated practices to gather information that do not support the ethos of the Care Act. For example:
- a process led by the assessor;
- a structured process involving the use of forms and arbitrary questions;
- an 'interview' of the person being assessed; and
- a gateway to funding and services, the nature of which is decided by the assessor.
As a mechanism to promote and support new practices around assessment that are in line with the Care Act ethos and duties, these procedures intentionally use the phrase 'Establishing Needs' alongside the legal term 'assessment'. This supports users of the procedures to think more flexibly about what an 'assessment' can, and may need to involve so that it is:
- proportionate, only being formal or lengthy when it needs to be;
- led by the person with care and support needs;
- appropriate to the person and their situation; and
- a method of supporting the person to find their own solutions to issues identified.
Under the Care Act, the main purpose of an assessment is:
- to provide a full picture of the person's needs, with a particular focus on the impact that those needs have on their wellbeing and the outcomes they want to achieve in their day-to-day life; so that
- the Local Authority can put in place appropriate, proportionate and timely arrangements for that person in order to meet their needs and promote individual wellbeing. This response might range from offering guidance and information to arranging for equipment or an adaptation to prevent, reduce, delay or meet needs.
Under the Care Act, the duty to promote individual wellbeing is intrinsically linked to the purpose of assessment. Any assessment that has not considered or promoted wellbeing has not fulfilled its legal requirements.
It is vital that you understand the principle of wellbeing in order to promote it. See: Promoting Individual Wellbeing.
A good assessment will also:
- support people to understand their strengths and capabilities within the context of their situation;
- support people to understand the support that may be available to them within the community or through other networks and services; and
- support people to consider some of the different ways that the Local Authority may be able to support them (for example, through another prevention service).
The information gathered will help the Local Authority to:
- make a determination about eligibility (where eligibility is a factor in meeting assessed needs); and
- understand the kind of equipment, aids and adaptations that could be explored when planning how to meet needs.
Across the country and even within each Local Authority there are a range of models and frameworks used to support or shape the process of information gathering to establish needs. The Care Act recognises that different approaches are used but all must fulfil the same legal requirements.
See: Legal Requirements of a Needs Assessment, part of the Care Act 2014
The Care Act does not require that a specific tool (or any tool at all) is used to support or shape the assessment process, but it does acknowledge that a good tool can be helpful. However, any tool should:
- facilitate and ensure the person's involvement;
- support the information gathering process;
- be flexible and adaptable; and
- be appropriate and proportionate to the situation and needs of the person being assessed.
See below for details of the tools that are available for you to use as required.
The process of establishing needs involves having a skilled conversation about:
- wellbeing and outcomes;
- needs; and
- risk.
You should consult with the person and/or others when arranging the assessment to understand the specific communication needs that the person has, so that any assessment tool you use will ensure their involvement in the conversation.
If you do not feel that the assessment tools available to you will be appropriate, you should speak to your manager about how they can be adapted.
Sometimes you may need to supplement the available tools with more bespoke tools to support the specific communication needs of the person. For example, you may need to use photographs or pictures. This is entirely appropriate under the Care Act as it will ensure the involvement of the person and will also support you to meet the duty to provide information in an accessible way.
Remember: see the tri.x Resources to access additional practice guidance that can support the processes of establishing needs, planning and review when the person has specific or complex needs.
All health and care professionals should be aware of frailty and identify where people would benefit from assessment and planning that minimises the impact of frailty on people’s wellbeing.
Triggers are:
- Are you older than 85 years?
- Are you male?
- In general, do you have any health problems that require you to limit your activities?
- Do you need someone to help you regularly?
- In general, do you have any health problems that require you to stay at home?
- In case of need, can you count on someone close to you?
- Do you regularly use a cane, a walker, or a wheelchair to move about?
A person hitting three or more of the seven triggers should be referred to their primary care team to request a full frailty assessment is undertaken. This referral should be made using the Lincolnshire Frailty Pathway Letter, which is available via Mosaic.
For more information about the Lincolnshire Frailty Pathway, including resources and a practice toolkit see: Lincolnshire Frailty Pathway.
Lincolnshire Adult Care has adopted the PRISMA-7 Frailty Screening tool, embedded within its needs assessments to help practitioners identify when someone is experiencing frailty.
PRISMA-7 is an internationally recognised basic seven question screening tool to identify people likely to be categorised as frail, who would benefit from a full frailty assessment, undertaken by either the person’s primary care or neighbourhood working team.
The following are other tools available to you that may enhance any assessment conversations and accessibility.
tri.x has developed a range of person centred tools that can support a person or family member to think about:
- what matters most to them, now and in the future;
- wellbeing;
- needs and what a good day/bad day looks like; and
- what is working/not working about a Care and Support Plan and any services or support they receive.
See: Resources for Person Centred and Strength Based Conversations.
Think Local Act Personal have also produced an online tool to support everything from preparing a person for an assessment, to having a skilled conversation and developing a Care and Support Plan through to review. See Personalised Care & Support Planning.
Supporting Outcomes-Focused Practice is a supplementary RiPfa website, available without normal subscription. It can support you to develop your skills, knowledge and practice in working with outcomes.
Strength Based Conversations and Assessment practice are underpinned by Adult Care’s Quality Practice Assurance Standards. Adherence to them should be evident in all practice. The Quality Practice Assurance Standards relating specifically to strengths-based conversations and assessment are Standard 1 – ‘Strengths based practice and engaging with people’ and Standard 4 – ‘Maximising Independence’.
Last Updated: August 12, 2024
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