Risk Factor: A learning disabled adult who cannot live with others

Finding suitable supported accommodation for people with learning disabilities can be difficult, writes Mark Drinkwater. The task is even more of a challenge when an individual has problems living with other service users when options in community settings are few.

Case notes

PRACTITIONER: Sian Hoolahan (pictured), development manager.

FIELD: Learning disabilities.

LOCATION: Choice Support, London.

CLIENT: Richard*, 40.

CASE HISTORY: Richard has had difficulties living in supported housing settings. He can be aggressive towards other tenants, but has also been a victim of abuse. He makes regular allegations, usually unfounded, that he has been abused. After living with Choice Support for years, he was evicted for assaulting a tenant. Since then he has lived in residential care.

DILEMMA: Residential care was intended as a temporary arrangement because he has few rights there. However, there are few options for community housing because Richard finds it difficult to live with others.

RISK FACTOR: Richard opts to buy a property through a shared ownership scheme. The plan is to provide him with one-to-one support, but there is a risk that this arrangement is too ambitious because of Richard’s high support needs and regular allegations.

OUTCOME: Richard moves into his new home and Choice Support provides support with measures to mitigate the risks.

* Name has been changed

Commentary

Finding suitable supported accommodation for people with learning disabilities can be difficult, writes Mark Drinkwater. The task is even more of a challenge when an individual has problems living with other service users when options in community settings are few.

Sian Hoolahan is a development manager with Choice Support, a charity that specialises in supported housing for people with learning disabilities. She describes a complex case involving Richard, a vulnerable man with learning disabilities, who has had great difficulty finding suitable accommodation.

Richard was originally referred to Choice Support by his social worker and for eight years he lived in a small group home run by the charity. Hoolahan got to know him well but says that supporting him was complicated by his tendency to make unfounded allegations about staff, particularly if he was not getting what he wanted.

“When Richard is communicating something he sometimes makes an allegation about someone – such as a member of staff or someone who visits him,” she says. “He will use language that sounds like he is being abused again. But when it’s been investigated it’s generally found to be something that is not true. He’s using it as one way of ­communicating.”

Assaulted fellow resident

After Richard assaulted a fellow resident, he was evicted and went into a residential care home. This was intended to be short-term respite, but he was still there three years later.

“His father had tried hard to find a long-term solution for him,” says Hoolahan. “He doesn’t want his son to be moving around, being abused or not getting on with other residents.”

Eventually, his father’s efforts resulted in a number of options from the local authority. But, as Hoolahan explains, many were unsuitable. “These were shared accommodation or they were self-contained flats in unsuitable locations,” she says. “They were either too far away from his father, or near busy roads or the support that was being offered was unsuitable.”

Committed to support

Despite the eviction, Hoolahan remained committed to supporting Richard. She stayed in contact with him and advised him on housing alternatives. Of the few options available, the one that appealed most to Richard and his father, was shared ownership – an affordable housing scheme where individuals buy a share of the property and pay rent on the rest.

The process was not straightforward and it has taken three years for Richard to buy his home through the scheme. This was partly because Richard’s father had to take responsibility for the mortgage through an application to the Court of Protection – the court with powers to appoint deputies for people lacking capacity to make decisions.

While the purchase of the flat was going through, Hoolahan helped identify methods of funding a support package, which involved the local authority securing a spot-contract with a provider.

“His father looked at other options but decided he wanted to choose a provider with which he had already established a relationship,” says Hoolahan.

With the flat purchased and a contract in place, Hoolahan planned the support in earnest with Richard and his father. “I have recruited a staff team to provide support. We are setting up the team slightly differently and have created a personalised job description for the staff. It’s very individualised. It’s around his interests and the way that he wants to be supported,” she says.

Risk assessment

Staff realise that numerous challenges lie ahead as they learn how best to support Richard, not least how they deal with the risk of allegations. But Hoolahan is optimistic about the various measures in place to minimise risk in this innovative service.

She explains that a thorough assessment of physical risks has been made and many of these risks have been mitigated using assistive technology. For instance, opening the front door at night activates a sound recording – featuring his father’s voice – that discourages Richard from leaving the flat.

Improving the quality of life for people with learning disabilities involves more than just providing care services. As well as ­maintaining links with his family, Hoolahan says Richard’s involvement with the ­community will be key to the success of the project.

“He will be living near his father and his father will be very much involved in the service,” she says. “Also, we plan that Richard will have good connections with his local community. We think that is a good way of managing risks. If he knows the people around him, they will pick up on any differences or if he doesn’t look happy.”

Independent comment

Rhys Bradley learning disabilities social worker, Vale of Glamorgan

When it comes to supported accommodation, the issue of compatibility is paramount. When it works well, supported accommodation can give clients the chance to live among peers, and form strong bonds and enduring friendships.

Difficulties arise in the cases where a client would rather live alone or is simply unable to tolerate others. While choosing to live alone is something most of us would take for granted, this option is not always readily available for those with learning disabilities.

In Richard’s case it is clear that living with others was not an option. Shared ownership appears to have provided a good solution in the absence of other provision.

It is imperative that communication between service users and those supporting them is maximised. Service users with a propensity to make unfounded allegations can create a major dilemma, namely a need to protect support staff and others without placing restrictions on the opportunities available to the service user.

Such a scenario can be managed by ensuring risk assessments are in place for the contexts in which false allegations could occur.

WEIGHING UP THE RISKS

Arguments for taking the risk

● In group homes Richard had been both the perpetrator and victim of abuse. Shared ownership is considered the best option in the community. In this setting, risks are reduced significantly because he is not living communally.

● The provider knows Richard well. Choice Options secured a budget that enables a team of skilled individuals to be recruited to support him in his new home.

● Several social factors have been addressed to ensure the project is a success. Richard now lives near his father and staff will ensure that he integrates into his local community.

Arguments against taking the risk

● Shared ownership involves the part-purchase of a property and Richard’s father is responsible for this mortgage. This is a large financial responsibility for a family member, particularly if the project does not work out.

● Richard’s history of making unfounded allegations puts him and staff at risk. There is a risk that staff are falsely accused and the risk that Richard is not believed if abuse does occur.

● There is only one member of staff on hand to deal with emergencies. And what happens if a member of staff does not show up on shift?

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