Assessment of Need
Under the Chronically Sick and Disabled Persons Act 1970, local authorities have a statutory responsibility to arrange for the provision of equipment and adaptations to the home that will help people maintain their independence and continue living in their own homes. If you live in a residential home, you may also get help.
This assessment will not just look at your possible need of equipment, it should also look at your possible need for the whole range of community care services.
Do note that if your need is urgent, you can get help without waiting for a formal assessment.
Although, since April 1993, the local authorities are the lead community care agency, the health service retains all its functions and responsibilities. If the process of assessing your needs suggests to the local authority that you may also need the services of another agency, such as the NHS, they will inform that agency and invite them to participate in the assessment.
If it is clear that you will need help from several sources, the assessment should be a joint one.
You, and your carer, should also be involved in the needs assessment.
Once the assessment is complete, there should be a written record kept.
If you are refused services, you can ask to see a copy of this.
If you disagree with it, then you can use the local authority’s complaints procedure
If you are going to be provided with services, the local authority will usually give you and your carer a written care plan. It may also set out any arrangements for reviewing your care plan.
Suitable adapted or specialised equipment is a key factor in enabling someone to live as independently as possible.
The range of items is wide so don’t buy anything without getting expert advice and, if possible, using the equipment on a trial basis to see if it really will work for you.
Equipment provided by local authorities or by the NHS is generally considered to be on long-term loan.
Items for daily living include items to make it easier to use the toilet, to wash, to dress, use cooking facilities etc., for example, handrails next to the bath and toilet, raised toilet seats, widened doorways, a bathroom on the ground floor etc.
A social worker in your social services department may be the best person to turn to initially for advice and help. However, all personal and health care professionals may be able to give help and advice – eg an occupational therapist, a physiotherapist, a district nurse, a health visitor, a general practitioner or the HDANI Specialist Care Nurse.
Health authorities, including NHS trusts, as part of their community health services, may provide nursing equipment such as special beds, commodes, urinals, incontinence pads etc.
Some items may serve a dual purpose – for nursing care and for daily living. So some health and social service authorities have a jointly agreed procedure to determine who supplies which particular item.
In the first instance, apply for any item via your GP, district nurse, health visitor, continence adviser, occupational therapist or social worker. If you have any difficulty in getting the supplies you need, your local Community Health Council may be able to help you.
Services to help with incontinence
Many disabled people have trouble either occasionally or regularly with incontinence, which can be costly besides causing a lot of extra work.
Seek advice from a District Nurse on what help is available, how it is administered and the management of incontinence.
There are three types of provision:
- Laundry Service
- Disposal of Waste
How can you get help?
Area Health Authorities have powers to supply, free of charge, aids and equipment to help in nursing sick and disabled people at home and in residential care. These may include the loan of a commode and bed linen, the supply of incontinence pads, protective pants, inter liners, disposable draw-sheets and bedpans, nappy rolls etc.
It is up to the Area Health Authority to decide on the quantity of items, such as pads and some, indeed, decide not to supply any at all. If this happens, you may want to complain to your Community Health Council
Protective pants and pads are not available on prescription. If you cannot get an item through the Area Health Authority, you can buy it privately either from chemists (a limited range) or more generally through specialist mail order firms.
Body worn urinary appliances can be prescribed by GPs, but take the prescription to a chemist or surgical supplier providing a skilled fitting service. Appliances supplied ‘over the counter’ are unlikely to be satisfactory.
How can you obtain laundry service?
If a laundry service is available in your area it will normally be run by the local social services department and probably attached to the Personal Care Service. A laundry service may collect soiled sheets, bedding, clothes or nappies and return them laundered It should be available to those too ill or disabled to manage laundry, as well as to people who are incontinent. Ask your social service department or the Area Health Authority for details. If you find the receptionist does not know whether a laundry service exists or not ask to speak to Customer Service.
How can you dispose of waste?
The Local Authority refuse disposal service should collect soiled incontinence pads, dressings and other nursing waste which cannot be disposed of normally and which arises from the care of a sick or disabled person at home. This service can sometimes be arranged through the Area Health Authority, but is generally provided by your local authority’s Environmental Health Department.
Seating and Other Equipment
Sitting is often a major problem for people with Huntington’s disease, as the person frequently has a tendency to slip out of a conventional chair because of the twisting and arching movements regularly seen.
There are no hard and fast rules about suitable chairs for people with Huntington’s disease but there are guidelines which should be considered before deciding upon a particular chair. In some cases, different chairs may be required at different stages of the illness.
The main aim of the chair should be to promote good support and encourage the correct posture and body alignment from the earliest to the final stages of the disease.
People should always have an assessment by an occupational therapist even if they are buying it themselves.
What to consider before deciding on a chair
Firstly the height of the seat and angle of the seat to the back of the chair are two essential points to consider.
- The front of the seat should be higher than the back so that when the person is sitting the knees are higher than the hips.
- The angle caused by the difference in height will have to vary according to the individual and type of chair.
- The angle can be adjusted by using either wedge shaped cushions or a chair which is specifically designed to meet this requirement.
- The height at the front of the seat must allow the user to sit with his or her feet resting comfortably on the floor, without causing undue pressure on the back of the thighs, and be deep enough to support without putting pressure on the back of the knees.
To prevent the person adopting an abnormal sitting position, the seat should be narrow enough to support and secure the angle of the hip joint but allow for ease in getting out of the chair.
The back of the chair must be high enough to provide support for the head, neck, shoulders and back.
For the person who tends to sleep in a chair during the daytime, a recliner chair with adjustable back and strong footrest may be considered.
However, the hip angle needs to be maintained if involuntary hip extension (which causes the person to slide out of a chair) is to be avoided. The arms of the chair should project far enough forward to assist the person when getting in or out of the chair.
For comfort, support and safety reasons filled in sides are recommended. It is preferable to adjust the angle of the seat rather than tilting the chair backwards as a means of restraint. The tilting action of the chair can cause the person to become disorientated and limit their communication.
Before you purchase a chair we recommend that you seek advice from a professional person such as an occupational therapist through social services or your doctor.
Don’t buy a chair until the user is satisfied with it.
Most makers and suppliers will be happy to visit and give advice on the most suitable chair from their range.
A correctly angled seat and back can often overcome the problems encountered.
Harnesses should be avoided it at all possible. If a harness has to be used because all other methods of maintaining posture have failed and the person becomes a danger to him/herself, then the correct harness must be used. Before using a harness we strongly recommend you seek professional advice.
Under the National Health Service, wheelchairs are supplied and maintained free of charge to a disabled person whose need for such a chair is permanent.
If you need a wheelchair, contact your GP or hospital consultant first. He/she will complete the application form and send it to the Wheelchair Service Centre who will supply the wheelchair (after an occupational therapist has assessed you, if necessary).
NB: Any special equipment (irrespective of cost) purchased for people with disabilities can be VAT exempt. Please mention this at the time of purchase. You will be asked to fill in a VAT exemption form. For example, Kirton Healthcare have special forms for use when purchasing any of their equipment for people with a disability.
Other Downloadable Fact Sheets available from this website:
Thanks to the Scottish Huntington’s Association for permission to reprint this fact sheet