The Care Act eligiblity criteria

Care Act 2014: A Guide to Rights, Needs and Eligibility - What Your Rights Really Mean

Purpose of This Page

This page is designed to support adults who need care and support because of physical, mental, sensory, learning, or cognitive disabilities or illnesses, as well as those affected by substance misuse or brain injury.

It is also written for families and young people with SEND, offering clear guidance to help you prepare for assessments under the Care Act 2014 or other legal frameworks, and to help you understand your rights at every stage.

The aim is simple:

to give you the information, confidence, and clarity you need to navigate assessments, advocate for yourself or your child, and ensure that your needs—and your lived experience—are recognised and respected.

For that reason, I aim for those resources to be used to:

Prepare before an assessment and reflect on strengths, needs, preferences, and the assessment itself.
Support the assessment process, promote shared understanding, and ensure the experience is trauma‑informed, neurodivergence‑friendly, and accessible.
Guide meaningful conversations and help practitioners, families, and individuals co‑produce personalised, inclusive, rights-based care and support plans.
Build confidence and empowerment. Explore the principles and strategies outlined below to feel more informed, prepared, and actively involved in planning for care and support.

Supporting the person’s involvement in the assessment

Section 6.22 of the Care Act 2014 Care and Support Statutory Guidance states:

"From their very first contact with the local authority, the person must be given as much information as possible about the assessment process, as early as possible, to ensure a personalised approach to the assessment. This should include details of what can be expected during the assessment process (such as the format and timescale of assessment, complaints processes and possible access to independent advocacy) and allow them to be as involved in the process as possible".

What this means in everyday language

This part of the law protects your right to clear information from the very beginning. You should never be left guessing, confused, or unsure about what is happening.

For adults needing care and support due to physical, mental, sensory, learning, or cognitive disabilities or illnesses, substance misuse, or brain injury, and for families and young people with SEND, this means:

You must be told what the assessment will involve — not at the last minute, but early enough to prepare.
You should know the format — whether it’s in person, online, at home, or somewhere else.
You should know the timescale — how long the process will take and when to expect updates.
You must be told about your rights, including how to make a complaint if something goes wrong.
You must be informed about advocacy — someone who can support you, speak up for you, or help you understand the process.
You should be supported to take part fully, in a way that works for your communication style, neurotype, and needs.

Why this matters

Many families describe feeling lost or overwhelmed when approaching social care. Section 6.22 exists to prevent that. It ensures:

transparency,
fairness,
and a genuinely personalised approach.

When you understand the process, you can prepare, ask questions, and make sure your needs and experiences are heard.

This section of the guidance is there to make sure the assessment is not something done to you, but something you are actively involved in from the very first step.

Section 6.30 of the Care Act 2014 Care and Support Statutory Guidance also states:

"Putting the person at the heart of the assessment process is crucial to understanding the person’s needs, outcomes and wellbeing, and delivering better care and support. The local authority must involve the person being assessed in the process as they are best placed to judge their own wellbeing. In the case of an adult with care and support needs, the local authority must also involve any carer the person has (which may be more than one carer), and in all cases, the authority must also involve any other person requested".

What this means in everyday language

This part of the law makes something very clear: You have the right to be fully involved in your own assessment.

Your voice matters. You know your needs, challenges, strengths, and daily experiences better than anyone else.

You must be included. The local authority cannot assess you without involving you in a meaningful way.

Your carers must be included too. If you have one or more carers, they must also be involved because they understand your day‑to‑day support needs.

You can choose who else is involved. If you want another person to support you—such as a parent, advocate, friend, or professional—the local authority must include them.

Why this is important

be listened to,
be understood,
have your communication needs respected,
and have people you trust involved in the process.

This ensures the assessment reflects your real life—not assumptions, stereotypes, or guesswork.

Appropriate and Proportionate Assessments

Sections 6.35–6.42 of the Care Act 2014 Care and Support Statutory Guidance explain what a good assessment should look like.

These paragraphs are especially important for families and young people with SEND because they set out, in clear legal language, what local authorities must do when assessing your needs.

They explain that assessments must be:

Appropriate – meaning they must reflect your situation, communication style, neurotype, and level of need.
Proportionate – meaning they must be detailed enough to understand your real needs, but not overwhelming or burdensome.
Person‑centred – meaning the assessment must focus on you, your lived experience, and what matters most in your daily life.
Inclusive – meaning the assessor must make sure you can take part, understand the process, and express your views in a way that works for you.
Holistic – meaning the assessment must look at your whole life, including education, health, independence, relationships, safety, and wellbeing.

Because these paragraphs contain clear, authoritative wording that helps families understand their rights, I will include direct quotes from Sections 6.35–6.42 below on your page. This allows you to see exactly what the law says, in the government’s own words, so you can feel confident, informed, and prepared.

These quotes can help you:

recognise when an assessment is not being done properly,
understand what you can ask for,
challenge decisions if needed,
and feel more in control of the process.

This is your legal framework. You deserve to see it clearly and without interpretation.

6.35 The assessment must be person-centred throughout. Local authorities must find out the extent to which the person being assessed wishes to be involved in the assessment and should meet those wishes as far as is practicable do so, as the person is best placed to understand the impact of their condition(s) on their outcomes and wellbeing.

6.36 An assessment should be a collaborative process and it is therefore essential that the process is transparent and understandable so that the individual is able to:

develop an understanding of the assessment process
develop an understanding of the implications of the assessment process on their condition(s) and situation
understand their own needs, the outcomes they want to achieve and the impact of their needs on their own wellbeing to allow them to engage effectively with the assessment process
start to identify the options that are available to them to meet those outcomes and to support their independence and wellbeing
understand the basis on which decisions are reached

6.37 To support the person’s involvement, the local authority should establish the individual’s communication needs and seek to adapt the assessment process accordingly. In doing so local authorities must provide information about the assessment process in an accessible format.

6.38 To help the adult with needs for care and support, or the carer, prepare for the assessment the local authority should provide in advance, and in an accessible format, the list of questions to be covered in the assessment. This will help the individual or carer prepare for their assessment and think through what their needs are and the outcomes they want to achieve.

6.39 Some people being assessed may have severe communication needs, such as people with Profound and Multiple Learning Disabilities, Autistic Spectrum Disorder, or those who are deaf or blind. Such individuals may require the support of a specialist interpreter to help them to communicate and engage in the assessment.

6.40 Local authorities should also consider the impact of the assessment process itself on the individual’s condition(s). People may feel uncertain and worried about what an assessment involves and may find the process itself to be strenuous. Local authorities should therefore give consideration to the preferences of the individual with regards to the timing, location and medium of the assessment.

6.41 The assessment should be designed to reflect the wishes of the person being assessed, taking into account their presenting need and their circumstances. An assessment process which benefits an individual in one instance may not necessarily be as effective for another. Local authorities should recognise this and in order to maintain a person-centred approach, local authorities must ensure that assessments are flexible to each individual case.

6.42 In carrying out a proportionate assessment local authorities must have regard to:

a) The person’s wishes and preferences and desired outcomes. For example, an individual who pays for their own care may wish to receive local authority support with accessing a particular service, but may not want the same interaction with the authority as someone who wants greater support.

b) The severity and overall extent of the person’s needs. For example, an individual with more complex needs will require a more detailed assessment, potentially involving a number of professionals. A person with lower needs may require a less intensive response.

c) The potential fluctuation of a person’s needs, both adults and carers. For example, where the local authority is aware that an adult’s needs fluctuate over time, the assessment carried out at a particular moment may take into account the adult’s history to get a complete picture of the person’s needs.

6.43 Each local authority may decide to use an assessment tool to help collect information about the adult or carer and details of their wishes and feeling and their desired outcomes and needs. Where a local authority has decided that a person does not need a more detailed assessment, it should consider which elements of the assessment tool it should use and which are not necessary. When carrying out a proportionate assessment the assessor should continue to look for the appearance of further needs which may be the result of an underlying condition. Where the assessor believes that the person’s presenting needs may be as a result of or a part of wider needs then the local authority should undertake a more detailed assessment and refer the person to other services such as housing or the NHS if necessary.

Assessment Must Be Done by Someone Who Understands Your Needs - Expertise Matters: Legal Requirements for Assessors

Section 6.90 of the Care Act 2014 Care and Support Statutory Guidance explains:

“The Care Act strengthens this guidance in relation to assessors having specialised training to assess an adult with autism. The Act places a legal requirement on local authorities that all assessors must have the skills, knowledge and competence to carry out the assessment in question. Where an assessor does not have experience in a particular condition (such as autism, learning disabilities, mental health needs or other conditions), they must consult someone with relevant experience. This is so that the person being assessed is involved throughout the process and their needs, outcomes and the impact of needs on their wellbeing are all accurately identified.”

What this means in everyday language

This part of the law protects autistic and neurodivergent adults—and anyone with a specialist condition—from being assessed by someone who doesn’t understand their needs.

Your assessor must be properly trained.

They must understand autism, learning disabilities, mental health needs, or any other relevant condition. If they don’t have the right expertise, they must get help.

The law requires them to consult someone who has the necessary knowledge—this could be a specialist practitioner, a clinician, or someone with lived experience.

Your needs must be understood accurately. This includes sensory needs, communication differences, executive functioning, fluctuating needs, trauma history, and the impact of the environment.

You must be involved throughout the process. The assessment cannot be based on assumptions or stereotypes. It must reflect your real life and your lived experience.

Why this matters

Many autistic and neurodivergent people have had assessments where their needs were misunderstood, minimised, or overlooked. Section 6.90 exists to prevent this. It ensures that:

assessments are fair,
Your neurotype is respected,
Your communication style is understood,
and your needs are identified accurately so you can receive the right support.

This section gives you a powerful right: to be assessed by someone who truly understands your condition—or by a team who will seek the right expertise if they don’t.

I bring nearly a decade of NHS experience as a Senior Mental Health Social Worker, AMHP, dual‑diagnosis practitioner, and clinical lead within a Specialist Community Mental Health Team. Much of my work has involved supporting people with both diagnosed and suspected ADHD and/or ASD, as well as care and support assessment and planning for people with physical, mental, sensory, learning, or cognitive disabilities or illnesses, substance misuse, or brain injury, and for families and young people with SEND

To learn more about Skills, knowledge, training and experience, please visit the "About KindMindsWithKM' page or click the button below

About KindMindsWithKM

Understanding the Wellbeing Principle Care Act 2014, Section 1, especially subsections 1.1 to 1.26)

Under the Care Act 2014, unmet needs—whether they meet eligibility criteria or not—can have a significant impact on one or more aspects of a person’s wellbeing. This is especially relevant for individuals with Autism Spectrum Disorder (ASD), neurodivergence, and mental health needs, whose support requirements are often misunderstood, minimised, or under‑assessed.

Unmet social care needs (both eligible and non‑eligible) may affect any or all of the wellbeing domains described in the Act. These include areas such as emotional wellbeing, personal dignity, physical and mental health, relationships, safety, control over daily life, and participation in work, education, or community life.

The core purpose of care and support under the Care Act is to help people achieve the outcomes that matter most to them. Recognising unmet needs—accurately and without bias—is essential to ensuring individuals receive the right support, at the right time, in a way that respects their identity, neurotype, and lived experience.

Local authorities have a legal duty to promote a person’s wellbeing whenever they carry out any care and support function. This is often referred to as the wellbeing principle because it places the person’s overall wellbeing at the centre of all decisions, actions, and assessments.

The Care Act 2014 begins with a powerful message: Everything the local authority does must focus on the person, their needs, and the outcomes that matter most in their life.

This is known as the wellbeing principle, and it sits at the heart of all care and support.

Local authorities must promote a person’s wellbeing whenever they carry out any care and support function. This applies to:

adults with care and support needs
carers
Young people and families going through the transition to adulthood
people who are assessed but do not go on to receive services

Wellbeing is a broad, holistic concept. Under the Care Act, it includes (but is not limited to):

Personal dignity and respectful treatment
Physical and mental health, and emotional wellbeing
Protection from abuse and neglect
Control over day‑to‑day life, including how care is provided
Participation in work, education, training, or recreation
Social and economic wellbeing
Domestic, family, and personal relationships
Suitable living accommodation
Contribution to society

These areas reflect the full spectrum of what matters in a person’s life. There is no hierarchy within the wellbeing domains, and each aspect must be considered with equal importance when understanding a person’s needs and circumstances.

How Local Authorities Should Promote Wellbeing

Promoting wellbeing means actively looking for ways to improve a person’s life at every stage of the process—from the first conversation, through assessment, planning, and review.

Local authorities must:

consider each person’s unique needs, goals, and wishes
avoid a “one‑size‑fits‑all” approach
Focus on what matters most to the individual
think creatively about how needs can be met
recognise that modern care can be delivered in many different ways
understand how past experiences (including trauma) may affect current behaviour
Work respectfully with people who may find it hard to engage

The Care Act moves away from the old idea of fitting people into pre‑existing services. Instead, it introduces the legal concept of meeting needs. This means:

Everyone’s needs are personal and different
Support should be tailored, not standardised
The goal is to help people achieve the outcomes that matter to them
Care can be delivered in many forms, not just traditional services

Why This Matters for adults needing care and support due to physical, mental, sensory, learning, or cognitive disabilities or illnesses, substance misuse, or brain injury, and for families and young people with SEND

Your lived experience is central
Your goals shape the assessment and support plan
Your mental health, sensory needs, and emotional wellbeing are recognised
Your independence, relationships, and participation in life are valued
The local authority must consider what you say matters most

Even if you do not meet the eligibility criteria, the wellbeing principle still applies. It must guide how the local authority treats you, informs you, and supports you.

Understanding wellbeing and identifying unmet social care needs is essential not only for adults with care and support needs, but also for carers, and—crucially—for children and young people who are eligible for a transition assessment as part of Preparing for Adulthood (PfA).

This includes children and young people with SEND, young carers, and Looked After Children, whose needs may be complex, evolving, or easily overlooked. A clear understanding of wellbeing as wll impact of unmet needs ensures that support is proactive, strengths‑based, and responsive to the barriers these young people face as they move towards adulthood.

This page gives only a brief overview of the wellbeing principle. Because wellbeing, unmet social care needs, and unmet SEND needs are such important topics—and because they have a significant impact on daily life—I’ve created dedicated pages that explore each area in more depth.

You can learn more by visiting:

Wellbeing and Quality of Life

Unmet Social Care Needs

Unmet SEND Needs

These pages offer clearer explanations, practical examples, and guidance to help you understand how unmet needs affect wellbeing and what your rights are under the Care Act 2014 and other legal frameworks.

Understanding Key Concepts in Social Care Assessments

Understanding fluctuating needs, proportionate assessment, how to interpret the Care Act eligibility criteria, and what “being unable to achieve an outcome” really means is essential when preparing for a social care assessment or care planning.

These concepts shape how needs are identified, how support is allocated, and how your rights under the Care Act 2014 are upheld. For autistic and neurodivergent people—whose needs may vary day‑to‑day, be misunderstood, or be minimised—clarity around these terms is especially important.

Below, you’ll find clear explanations of key terminology and principles using Care and support statutory guidance - GOV.UK. The aim is to support you not only in preparing for an assessment but also in understanding your rights, advocating for yourself, and ensuring your lived experience is accurately represented.

What is the national eligibility threshold for adults needing care?

Section 6.102 of the Care and Support Statutory Guidance - GOV.UK guide that

"The eligibility threshold for adults with care and support needs is set out in the Care and Support (Eligibility Criteria) Regulations 2015 (the ‘Eligibility Regulations’). The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing.

6.103 In considering whether an adult with care and support needs has eligible needs, local authorities must consider whether:

- the adult’s needs arise from or are related to a physical or mental impairment or illness

- as a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes (which are described in the guidance below)

- as a consequence of being unable to achieve these outcomes there is, or there is likely to be, a significant impact on the adult’s wellbeing

An adult’s needs are only eligible where they meet all 3 of these conditions"

Interpreting the eligibility criteria (the Care Act 2014)

The first condition -

(described by section 6.104 of the Care and support statutory guidance - GOV.UK)

The adult’s needs arise from or are related to a physical or mental impairment or illness. The first condition that local authorities must be satisfied about is that the adult’s needs for care and support are due to a physical or mental impairment or illness and that they are not caused by other circumstantial factors.

Local authorities must consider at this stage if the adult has a condition as a result of either physical, mental, sensory, learning or cognitive disabilities or illnesses, substance misuse or brain injury. The authority should base its judgment on the assessment of the adult, and a formal diagnosis of the condition should not be required.

The Care Act 2014 does not list specific diagnoses. Instead, it focuses on how a person’s condition—whether sensory, learning, cognitive, physical, or mental health‑related—affects their ability to achieve key outcomes and maintain wellbeing. For that reason, Sensory, learning or cognitive disabilities or illnesses may likely include a range of neurodevelopmental differences like:

Autism Spectrum Disorder (ASD)
Attention Deficit Hyperactivity Disorder (ADHD)
Dysgraphia - physical difficulties with handwriting,
Dyspraxia - difficulties with movement and coordination
Dyscalculia – difficulties with numbers and arithmetic
Tics and Tourette’s Syndrome (TS) – uncontrollable movements or noises. Motor or vocal tics
Pathological demand avoidance (PDA) – difficulties carrying out perceived demands,
Sensory processing disorder (SPD) – under- or over-sensitivity to certain stimuli
Intellectual or learning disabilities
Fetal Alcohol Spectrum Disorder (FASD)
Language and communication disorders
Other developmental co-ordination disorder
Other developmental language disorder

Neurodevelopmental difficulties can influence many aspects of a child or young person’s growth, learning, and daily functioning. These differences are not “problems” within the child—they reflect variations in how the brain develops and processes information.

However, without the right support, they can create barriers in everyday life.

Children and young people may experience challenges across areas such as:

Independence Skills – managing daily routines, self‑care, transitions, and practical tasks.
Motor Skills – coordination, balance, handwriting, fine and gross motor movements.
Social Communication Skills – understanding social cues, expressive and receptive language, interaction with peers.
Play and Flexibility – imaginative play, adapting to change, coping with uncertainty or unexpected events.
Sensory Processing and Regulation – managing sensory input, emotional regulation, and responses to overwhelm.
Academic and Learning – processing information, retaining knowledge, completing tasks, or accessing the curriculum.
Attention, Memory, Organisation and Planning – executive functioning skills needed for learning, problem‑solving, and daily life.
Emotional Wellbeing and Mental Health – anxiety, low mood, overwhelm, or difficulties coping with stress.
Attachment and Relationships – forming secure relationships, feeling safe with adults, and navigating peer relationships.

Understanding these areas helps families, professionals, and young people themselves recognise needs early, advocate effectively, and access the right support at the right time.

Importantly:

Local authorities must base their judgment on the assessment itself, the person’s lived experience, and the evidence available.
Neurodivergent conditions are highly underdiagnosed, as Royal College of General Practitioners advise recently in Neurodevelopmental conditions and neurodiversity that it is thought 15-20% of the population are neurodivergent.
NHS Data published in the Neurodevelopmental data hub - NHS England Digital says that:
- In September 2025, there were 227,813 patients with an open referral for suspected autism. Of these, 205,182 (90.1%) had a referral that had been open at least 13 weeks.
- In November 2025 it is estimated that 2,506,000 people in England have ADHD, including those without a diagnosis. Of these, an estimated 744,000 are children and young people (aged 5-24).
- In September 2025, there were up to 700,123 people who may be waiting for an ADHD assessment.
Masking, fluctuating needs, or coping strategies must not lead to under‑assessment. The focus is on the impact of the impairment or illness, not how well the person appears to manage on a particular day.
The cause must not be dismissed as “circumstantial.” For example, difficulties caused by trauma, burnout, executive functioning challenges, or sensory overload are still considered valid needs under the Care Act 2014.

Understanding Fluctuating Needs

(section 6.58 of the Care Act 2014 Care and Support Guidance)

Many people — especially those with mental health conditions, neurodivergence, chronic illness, or trauma histories — experience fluctuating needs.

The Care Act requires local authorities to:

Look beyond how the person appears on the day of the assessment
Consider how needs change over time
Review the person’s history to understand patterns
Recognise both short‑term and long‑term fluctuations
Plan support that reflects the person’s real‑life experience, not a single moment in time

Proportionate Assessment

As explained above, the Care Act requires assessments to be proportionate, meaning they must reflect the person’s level of need and complexity.

Local authorities must consider:

The person’s wishes, preferences, and desired outcomes
The severity and extent of their needs
Whether multiple professionals are needed
Whether the person’s needs fluctuate
How the person’s history helps build a full picture

A proportionate assessment is not a “quick assessment” — it is the right level of assessment for the person’s situation and must include whether the person’s needs fluctuate.

Why Understanding Fluctuating Needs and Proportionate Assessment Matters?

This protects people whose needs may be misunderstood or underestimated because they mask, cope temporarily, or have variable conditions. For autistic people, neurodivergent people, and those with mental health needs, these principles are essential. They ensure that:

Needs are not dismissed because they fluctuate
Masking or coping does not lead to under‑assessment
Support is personalised and strengths‑based
Long‑term goals and independence are prioritised
Transition into adulthood is planned, not left to chance

This Understanding Fluctuating Needs and Proportionate Assessment provides young people and adults with the legal foundation they need to receive fair, accessible, and meaningful support.

Understanding this definition matters because many people:

Mask their difficulties to appear “fine”
Push through tasks at great emotional or physical cost
Have fluctuating or invisible needs that change day to day
Are dismissed as coping when they are actually struggling
Experience burnout, shutdowns, overwhelm, or executive dysfunction
Face barriers that are not physical, but still deeply affect daily life

This part of the law clarifies that support is not limited to people with visible or physical disabilities. It recognises that invisible barriers — sensory overload, anxiety, trauma responses, executive functioning challenges, cognitive fatigue, and more — can make everyday tasks difficult, unsafe, or distressing.

Invisible Disabilities Are Recognised by Law and:

You do not need a visible disability.
You do not need a formal diagnosis.
You do not need to be in crisis.
Your lived experience is valid, and the law requires local authorities to take it seriously.

The Care Act explicitly recognises:

Mental health conditions
Neurodevelopmental conditions (including autism and ADHD)
Cognitive and sensory differences
Trauma‑related needs
Fluctuating or episodic conditions

The second condition - As a result of the adult’s needs, the adult is unable to achieve 2 or more of the outcomes set out in the regulations

6.105 The second condition that authorities must consider is whether the adult is ‘unable’ to achieve 2 or more of the outcomes set out in the regulations. Authorities must also be aware that the regulations provide that ‘being unable’ to achieve an outcome includes any of the following circumstances, where the adult:

is unable to achieve the outcome without assistance. This would include where an adult would be unable to do so even when assistance is provided. It also includes where the adult may need prompting for example, some adults may be physically able to wash but need reminding of the importance of personal hygiene
is able to achieve the outcome without assistance but doing so causes the adult significant pain, distress or anxiety. For example, an older person with severe arthritis may be able to prepare a meal, but doing so will leave them in severe pain and unable to eat the meal
is able to achieve the outcome without assistance, but doing so endangers or is likely to endanger the health or safety of the adult, or of others – for example, if the health or safety of another member of the family, including any child, could be endangered when an adult attempts to complete a task or an activity without relevant support
is able to achieve the outcome without assistance but takes significantly longer than would normally be expected. For example, an adult with a physical disability is able to dress themselves in the morning, but it takes them a long time to do this, leaves them exhausted and prevents them from achieving other outcomes

The third condition - As a consequence there is, or there is likely to be, a significant impact on the adult’s wellbeing

6.107 The third condition that must be met is that local authorities must consider whether the adult’s needs and their inability to achieve the outcomes above cause or risk causing a significant impact on their wellbeing. The meaning of wellbeing is set out in Section 1 of the Care Act and more detail is described in chapter 1 of this guidance and include:

a) personal dignity (including treatment of the individual with respect)

b) physical and mental health and emotional wellbeing

c) protection from abuse and neglect

d) control by the individual over day-to-day life (including over care and support provided and the way it is provided)

e) participation in work, education, training or recreation

f) social and economic wellbeing

g) domestic, family and personal relationships

h) suitability of living accommodation

i) the individual’s contribution to society

Importantly:

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