�Regular and substantial� care � towards a definition by S9AJ32J8




Agreed 11/02/04


            Towards a definition of ‘Regular and Substantial’ care


        Usually ‘living with’, if not at least weekly, face-to-face contact
        Increased levels of contact during periods of acute distress.


        The carer is providing a level of care which is integral to the care plan
         and which directly enables the service user to remain independent in the
         community and achieve a reasonable quality of life (e.g. help with daily
         living - shopping, cooking, housework, personal hygiene/care, help to
         socialise, help to maintain the mental health condition, prompting to take
         medication, alerting professionals if there is a deterioration, etc.)

        If the carer was unable to continue to provide the support outlined in the
         care plan, the service user would be at risk and/or the care co-ordinator
         would have to provide alternative sources of care to substitute.

[N.B. These guidelines will require some interpretation and therefore some
discretion on the part of Care Co-ordinators].


   There is a distinction between ‘caring about’ someone and ‘caring for’ them.
    Most relatives care about their family, but not all are providing direct care.
    Carers’ assessments are designed to be offered to those relatives who are
    carrying a substantial level of care.

   Carers need not be ‘next of kin’, they may not even be a relative, as long as
    they meet the criteria set out above.

   Carers’ assessments should focus on those problems (health, practical,
    social, etc.) which arise directly from the process of care and are most
    appropriately dealt with the users’ care team. These are set out in the
    assessment proforma. If the carer has mental or physical health needs which
    require intervention in their own right the team should support an independent
    referral to the relevant specialist (e.g. G.P, psychiatrist).

   In general, the carers of users who are on Enhanced CPA should be

   The needs of young carers should also be given special consideration.

   Where there is more than one carer at home, a decision should be taken as
    to whether a joint assessment should be offered, or whether there is a ‘main

   Carers’ assessments will usually be undertaken by a qualified member of
    staff, however they may be undertaken by non-qualified staff (e.g. support
    workers) providing they are working under appropriate professional

   If a carer meets the criteria described above, and is offered an assessment,
    the user cannot ‘veto’ this. User’s views must be discussed and an
    explanation given by the care co-ordinator as to why the carers assessment is
    being undertaken. If the user remains dissatisfied their objections should be
    recorded in the notes.

   Carers’ assessments should be offered in private (i.e. the service user should
    not be present unless both parties wish it).

   Carers assessments should be stored in the patient’s notes, in a separate
    section, clearly marked ‘Not be shared with the patient without consent’.

   Carers who decline the offer of an assessment can review their decision at
    any point in the future.

   Carers who wish to dispute their eligibility for a formal assessment (i.e. they
    feel they meet the criteria, but the care co-ordinator does not) should
    approach the team leader (manager) for that team. If they remain
    dissatisfied, they should approach PALS for advice on how to pursue their
    concerns further.

   If carers do not the criteria described above, or decline a formal assessment,
    they should still be kept regularly informed of non-confidential information
    relating to their relatives’ care and be given information and advice about how
    families can best cope with a mentally ill relative (e.g. general information
    about illness, service structures, responsibilities of different professionals,
    how to contact services, general advice about management, etc.). This
    activity should also be recorded in the care plan.

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