KEY WORDS: Supported living ❙ learning disabilities ❙ personalisation
AUTHORS: Steve Strong and Claire Hall for the National Development Team for Inclusion (NDTi)
Title: Feeling Settled Project: Guide for those involved in changing a service from residential care home to supported living where the people stay in the same place.
Aim: To provide guidance to providers, commissioners and regulators involved with changing registered accommodation and care into supported living for learning disabilities.
Methodology: The methodology was not specified, but the report draws on examples of good practice provided by individuals and 20 named agencies.
Conclusion: Personalising support for people already living in residential care requires creative thinking about how to offer realistic choices in how and where they want to live. By adopting a project management approach and identifying pathfinders and pathways, providers can increase the rights, choices and control of service users from a place of their choosing.
In recent years there has been a movement away from the use of residential care for people with learning disabilities towards supported housing services that allow individuals to live more independent lives. This shift has also made services more person-centric as supported housing often provides more personalised support to service users than residential care.
Much of the impetus for this change comes from the provisions of the Mental Capacity Act 2005, which enabled the functions of housing, accommodation and care to be split.
Before this, turning residential care into supported housing was more difficult, a situation highlighted by the charity Alternative Futures' unsuccessful 2003 appeal against the National Care Standards Commission's decision not to let it turn several care homes into supported housing.
The changes introduced by the 2005 Act have led to more innovative ways of thinking about people in residential care and their options for utilising housing and community support services in different ways.
Personalising support for people and the priorities spelt out in Valuing People Now has allowed services to tailor provision to the individual, but 30% of people with learning disabilities still live in registered accommodation.
Guidance released in 2011 by the personalisation coalition Think Local, Act Personal builds on the 2005 Act and promotes ways of overcoming difficult and potentially intractable barriers and reducing the number of people in residential care. For this to happen, individuals and their care managers should work closely with commissioners, and the provider organisation should help the person with learning disabilities and their families to build up their support plan.
At a strategic level, providers and commissioners have to unpick block contract packages and present costs for local authorities at the beginning of their journey towards individualised funding.
Summary of recommendations
The Feeling Settled report sets several good practice recommendations for how to change residential care to supported living. First, every effort should be made to ensure the service user stays at the heart of the process during all stages and that this requires careful planning.
Changing from residential care to supported living is likely to involve working with local authorities at two levels by separating out housing provision with support functions towards more flexibility and choice about providers. The provider should put detailed policies and procedures in place to support a change from residential care to supported living and guidance for each stakeholder - including housing providers, care providers, commissioners and care managers - should be drawn up in advance.
Detailed individual step-by-step pathways that set out the activity required by everyone at each step should also be provided.
Given the complexity of the process, which can take from nine months to two years, a project management approach is needed and stakeholder mapping should be undertaken to ensure that communication channels are maximised. There should be procedures in place to support decisions in relation to mental capacity and tenancy issues, which include creativity in developing local resources to explain responsibilities and rights that come with tenancies including advocacy and best interest decision-making. Clear protocols in relation to ordinary residence would need establishing.
Financial issues need to be grappled with, given that one aim is longer term savings on residential care. To ensure change is cost neutral, councils should look for opportunities to ringfence budgets and aggregate resources where some people are living together in the community. Cross-subsidising resources, for example by transferring capital assets using leases, should be avoided. Councils should exploit opportunities to help individuals gain access to other funding streams and shift costs such as housing and council tax benefits and supporting people grants to reduce direct pressure on social care budgets.
Managers should consider the impact on staff and engage them in taking up opportunities to develop new skills and person-centred approaches in the new service. Manage their employment rights through, for example, Tupe. Councils should work in partnership with the Care Quality Commission throughout (the report includes a link to specific guidance on the differences between regulated activities and registration requirements).
Attention should be given to technical issues - the report's appendices include a technical housing briefing dealing with planning, building control, design and title issues and managing the expenditure associated with transfer of existing assets.
There are many different levels at which support for people can be transformed and personalised and the government's target for everyone eligible for ongoing social care to have a personal budget by 2013 includes people living in residential care.
The Feeling Settled report presumes that local authorities will embrace collaborative working to support individuals who choose to move to another local authority area or move out of a care home into alternative accommodation. However, every year about 500 people with disabilities are caught up in disputes with local authorities about ordinary residence and this can represent the most significant barrier to progress. Working with the national protocol developed by the then Association of Directors of Social Services can help avoid such disputes.
The report challenges us not to fall into the trap of seeing personalised services as being only for people who need less support and makes it clear that it is more about the quality and suitability of the support.
It also promotes bolder thinking around individualised funding with greater transparency in relation to the potential choice in corporate services alongside new partnerships with the local community, services and resources.
For care managers
● Care managers need to be able to advise people properly on their entitlement to benefits as they become tenants and work closely with housing and obtaining any premiums in relation to disability benefits and maximising an individual's natural networks and community resources.
● Commissioners will need to take a much longer term view and strategic plans and resources need to be ring-fenced to support the change from residential to supported living including looking to social enterprise.
● Providers need to be bold in responding to the personalisation agenda and imaginative in opportunities for evolving their provision to respond to more individualised needs.
● A useful factsheet for those involved in signing tenancy agreements for people without mental capacity
● The ADSS national protocol on Ordinary Residence in 2011, complements the DH Ordinary Residence: Guidance on the identification of the ordinary residence of people in need of community care services, England
● 'Care Standards Commission faces legal challenge over deregistration', Community Care, 26 September 2002
● 'Charity loses bid to deregister homes', Community Care, 8 January 2003
About the author: Dr Trish Hafford-Letchfield is teaching fellow interprofessional learning at Middlesex University
Check out the upcoming Community Care conference Valuing People Now? Continuing the support for adults with a learning disability
7th December 2011, London