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For many people who provide foster care for disabled adults, the government's new regulations, designed to raise the overall quality of care, represent an unwelcome burden. They could even prove self-defeating as carers decide to opt out. Natalie Valios reports.

You have fostered disabled children for years with no problems. They have become members of the family and you count them as your own. They call you mum and dad. They turn 18 and want to stay in the family home. The arrangement becomes an adult placement and that is when the problems begin.

Adult placements are an alternative to residential care: a flexible form of accommodation and care for vulnerable adults aged 18 or over who need support, such as older people, disabled people, and people with learning difficulties or mental health problems. Placements are provided by ordinary individuals and families in the community, giving a vulnerable adult the opportunity to share in the carer's life.

Adult placements are based on the fostering model. Carers provide a variety of services from long-term and short-term accommodation and support in the carer's home, to day care support, befriending, sitting services and support to people in their own homes.

Before implementation of the Care Standards Act 2000, two groups of adult placement carers were exempt from regulation: those who cared for somebody who had been "ordinarily resident" for more than five years, that is former foster carers; and short break carers who provided less than 28 days' care a year.

The government decided against carrying these exemptions forward into the new regulatory regime. And while Scotland and Wales opted to regulate adult placement schemes - rather than individual adult placement carers - in England the government ruled against this approach. The upshot is that all adult placement carers providing accommodation and personal care in their own home in England now have to register with the National Care Standards Commission. A separate set of 30 national minimum standards for adult placements are designed to take account of the domestic nature of provision.¹

The outlook is worse for former foster carers who have not registered with their local adult placement scheme, as they will have to register as care homes and comply with the accompanying more stringent national minimum standards.

Registration involves a one-off payment of £300 and then an annual fee of £100. Former foster carers will face two inspections a year, one announced and one unannounced. The main carer will also be expected to gain an NVQ2 in care. These conditions are causing distress to many former foster carers who question their need for a qualification to care for someone they regard as part of the family and whom they have successfully supported for many years.

The freedom of the individual in the placement to stay with other family members or friends overnight could also be curtailed as they will also have to register. As a result, foster carers are sometimes not continuing their placements after the person living with them reaches 18, says Sian Lockwood, chairperson of the National Association of Adult Placement Schemes (Naaps). "It is also affecting the viability of some long-term placements that are supported by short-breaks carers and is likely over time to have an impact on the ability of some families to continue to care for their vulnerable family member," she says.

Ironically, while the regulatory regime is designed to ensure consistent standards, these will continue to vary because some services provided by adult placement carers remain outside regulation, including home-based day care and befriending.

Naaps has 156 adult placement scheme members supporting 6,500 carers who provide services to about 10,000 vulnerable adults. It supports the need for rigorous and appropriate regulation, but this approach doesn't sit comfortably with adult placements, says Lockwood. The fear is that regulation will limit the flexibility of services offered through adult placement schemes.

"My huge anxiety is that we are losing the very carers that the government values, the good-hearted people who want to give someone accommodation and support because they want to give back to the community. They aren't going into it as a business," says Lockwood. "If we aren't careful, the only people left will be those who are geared up to do this as a business. They are only one end of what adult placements are about and the ultimate losers will be the users who are left with no options."

Gwylfa Evans, social services director at Oldham Council, is well aware of the issue because one family in his authority has been vociferous in bringing it to his attention (see panel). Evans wants consistent standards but says registering individuals will result in placements becoming institutionalised, which he is loath to see happen.

Registering the scheme rather than the individual carer would mean that the local authority would be responsible for maintaining standards in the scheme and the standards authority would inspect it to make sure it was doing the job properly.

"It would bring in good standards across the country," adds Evans.

Naaps accepts that for the time being the government has decided not to regulate adult placement schemes. In the meantime, it wants the government to reinstate the two previous exemptions - and it has backing from the National Care Standards Commission. All three are in talks, and Heather Wing, NCSC director of adult services, is confident that the government will change its mind.

Former foster carers and short-term carers should have registered by April but many have refused. Meanwhile, the NCSC is stuck between a rock and a hard place. It played no part in drafting the regulations, the act, or the minimum standards, and it empathises with the plight of these carers. But it is legally obliged to prosecute anyone who refuses to register. However, it is in no hurry to use these powers before the government's decision is known. Wing says:"We want to be reasonable. We can't abdicate our responsibility to protect vulnerable people, but some people do need to be taken out of the regulation approach."

Unless this happens, the standards brought in to protect these disabled people could be the very thing that leaves them more vulnerable.

¹ Department of Health, Care Homes for Younger Adults and Adult Placements, The Stationery Office, 2002

For more information go to www.doh.gov.uk/ncsc or www.carestandards.org.uk

Part of the family

Kathleen and Ray Navesey were approved as foster parents for Janet Huxley 21 years ago. They met Janet when their daughter Adele was in hospital having her appendix removed. Unknown to the family, Janet had lived on the hospital's children's ward since she was a baby. She has cerebral palsy and severe learning difficulties, and needs 24-hour care.

A few weeks after Adele was discharged from hospital the local paper ran an article on several disabled children who needed foster parents, including Janet. Kathleen contacted Oldham social services department to inquire about fostering Janet and after about a year she came to live with them.

When Janet became 18, the arrangement transferred to the adult placement scheme. Recently, workers from the scheme advised the family on the need to register as an adult placement carer under the Care Standards Act 2000.

Dawn Navesey, Kathleen's other birth daughter, says: "Janet is very firmly our sister. She is seen as a daughter, sister, auntie, granddaughter within our family, not as a client in an adult placement scheme.

"She is not cared for as a client but as part of a loving family. My mum is not a "carer", she is Janet's mum in all senses of the word."

Janet's opportunities to develop relationships, have a valued role in the community and be loved as an individual have been greatly enhanced by her being part of the family, says Dawn, who manages housing services for people with learning difficulties at a voluntary organisation. She believes the care standards are in conflict with the ethos behind the white paper Valuing People, which states that people with learning difficulties must have inclusion, independence, choice and the same rights as other citizens.

"I appreciate the need for standards to protect vulnerable people but I feel that individual cases like Janet's could be addressed differently in a more person-centred manner," she adds.