Proven practice: Shared Lives schemes for adults

The Social Care Institute for Excellence presents the latest guidance on Shared Lives schemes for adults

Shared Lives is a model of adult placements that offers personalised services. The schemes recruit, assess and support carers who offer accommodation or care and support in their family home to people who are unable to live independently. They are usually managed by local authorities or voluntary sector providers and are monitored by the Care Quality Commission, which regulates social care in England.

Users include older people, people with mental ill-health and people with disabilities, both physical and learning. Carers can support a maximum of three adults at any one time and are self-employed.

There is evidence that the Shared Lives approach is highly valued by service users and commissioners. Its focus on the individual helps councils meet the personalisation agenda to give service users more control and choice and to develop the capacity of the whole community to support its more vulnerable members.

But awareness of Shared Lives schemes varies widely and may be limited to a few practitioners in any area.

To realise its value and potential, Shared Lives needs to be better known and understood by strategic commissioners and care managers, and schemes need to become more active partners in developing local commissioning strategies.

Knowledge among care managers about the potential for Shared Lives arrangements needs to be increased. This includes expanding awareness of Shared Lives opportunities across a region rather than within a locality.

Local authorities need to improve management systems and support, to ensure that Shared Lives carers and the people they support are on the IT system to prevent them falling through the net.

Care managers need to be aware of the potential for Shared Lives as a major lever for the promotion of choice, control and person-centred planning.

Local authorities need to be aware of pressures that can influence the quality of assessment and referral and ensure that these are not allowed to damage the Shared Lives service.

Speedy placements

Pressures include demand for speedy placements, narrow eligibility criteria, and overprotection of budgets.

Local authorities should develop protocols between care management and the Shared Lives scheme to ensure effective and appropriate referral. They should make emergency placements only with Shared Lives carers who are approved and trained to take people in an emergency.

Care managers need to ensure schemes receive all the information that they need to make a good and safe match. They should provide a comprehensive care management assessment and arrange and attend regular reviews.

Care managers should ensure schemes receive a full, up-to-date care management plan as part of the referral. Care managers need to agree with the scheme manager on how changes to risk over time will be assessed and new risk management pro­cedures introduced.

Risk assessments must not be allowed to become static or rigid: care managers should ensure they are reviewed regularly, and timescales clearly recorded so all involved are aware of them.

The care manager is also responsible for ensuring regular reviews are arranged and attended to ensure information is available and shared to inform any decision making. It is essential that reviews are not just a paper exercise. The care manager should attend all reviews whenever possible, and not rely on the appointment of a different reviewing officer.

If a reviewing officer is appointed to attend the review, care managers should ensure a named person or advocate is there to support the service user, and that the review takes account of the views of the service user at all times.

Local authorities should support care managers in developing relationships with people supported through Shared Lives. Care managers tend to “dip in” to the role because workload and funding can make ongoing support impossible.

Local authorities, particularly care managers, need to work with commissioners to determine how specific and local needs can be met through the development of Shared Lives schemes, and seek to expand the service to include other user groups and develop the kinds of service provided.

Care managers should ensure that they keep commissioners updated about Shared Lives service availability and the potential for development, including comparisons of costs with other services. They should assist them in making this information available to service users.

Case study: Settled after a life defined by chaos

James was referred to the Shared Lives scheme after a lengthy hospital stay and treatment for a serious, life-threatening illness. He was going to need hospital treatment for the rest of his life.

James had had a particularly chaotic lifestyle, moving from area to area and periodically sleeping rough. He had no family or friends and was terrified at the thought of living alone.

Now in his fifties, he was dealing with physical health difficulties, longstanding mental health issues and difficulties maintaining relationships. He also had money worries and a history of misusing alcohol.

James could be volatile and would lose his temper if thwarted. There was concern that, if he reverted to his previous lifestyle, he would end up living rough again and seriously jeopardise his health.

James tried two or three placements before the right one was found. He now lives with two experienced Shared Lives carers, Val and Gary, who run a business from home and have been supporting people for nearly 20 years.

Two of their grown-up children are also approved Shared Lives carers. They provide a supportive environment and can cope with James’s volatile behaviour and help him find other ways to deal with problems.

He has become part of the family, helps with the gardening and care of the pets and sometimes cooks for everyone. He has also developed a more independent life, and goes out on his own when he is well.

Because he has settled and has somewhere stable to live, James has been able to start therapy to help him manage his emotional difficulties as well as treatment for his physical health problems. He knows there is somewhere there for him if he becomes unwell.

He regularly tells Shared Lives workers: “This is the best thing that ever happened to me.”

Practitioners’ messages

Care managers should:

● Be aware of the potential for Shared Lives as a major lever for the promotion of choice, control and person-centred planning.

● Ensure schemes receive a full, up-to-date, care management care plan as part of the referral.

● Ensure schemes receive all the information that they need to make a good, safe match, including a comprehensive care management assessment.

● Ensure that risk assessments are reviewed regularly, and timescales for review are clearly recorded so all involved are aware of this.

● Ensure that reviews take account of the views of service user and, if a different reviewing officer is appointed, the service user is supported by an advocate or named person.

● Be clear about the procedure for re-assessing needs of the service user if there is a major change in the placement.

● Involve and update commissioners about Shared Lives’ service availability and the potential for development to meet specific local need.

Further reading

At a glance 02: Improving outcomes for people in Shared Lives arrangements, Scie Guide 8: Adult placements and person-centred approaches www.scie.org.uk

Research abstracts

Authors NAAPS/Improvement and Efficiency South East

Title A business case for Shared Lives (2009)

Abstract This research focuses on the outcomes and costs of Shared Lives schemes.

Authors NAAPS/Department of Health

Title Supporting Micromarket Development: A Practical Guide for Local Authorities (2009)

Abstract A three-year project funded by the Department of Health to test the development of a range of micro care and support services has successfully shown the effectiveness of this local support agency approach. This resource forms part of the personalisation toolkit, supporting councils to transform their social care systems.

Authors Lewin M, Wilkinson H, Donaldson C

Title Good Ideas for day carers and respite carers who provide support to older people in their own homes (2009)

Reference Royal Bank of Scotland Centre for the Older Person’s Agenda, Queen Margaret University, Edinburgh.

Abstract This report provides suggestions for supporting day and respite carers who are working with housebound older people and their families.

Author Bernard S

Title A national survey of adult placement schemes in England: recruitment and retention of adult placement carers.

Reference Health and Social Care in the Community, 13(6), November 2005, pp.563-569.

Abstract This study of adult placement schemes in England provides data about the workforce, care provision, qualification levels, training and support issues, and recruitment and retention problems. The results supported a view that the current regulatory system was leading to a loss of adult placement carers. The report supported moves to shift the burden of regulation from individual carers to adult placement schemes, thereby ensuring a consistent standard of assessment, training and support in England.

This article is published in the 18 March issue of Community Care magazine under the heading Realise the potential of Shared Lives schemes