Risk Factor: Will independence result in isolation?

A woman with learning disabilities wants to live independently after a period in communal living. Is there a risk of her becoming isolated?

CASE NOTES

Practitioner: Andy Paton (pictured), director of the social work team at Camphill

Field: Learning disability

Location: North Yorkshire

Client: Mary*, a 45-year-old woman with learning disabilities.

Case history: Mary moved to a Camphill community 15 years ago where she receives supported employment and accommodation. Service users are fully integrated into community life and live communally with staff in the same properties. Until recently, Mary was happy in this arrangement but now has expressed her desire to live in alternative accommodation.

Dilemma: Mary now feels that she is ready to live more independently. However, the Camphill project does not offer outreach support to those in non-communal settings.

Risk factor: After the relative security of living in a supported communal setting, independent living would expose Mary to increased risks – both from accidents in the home and from individuals who might wish to exploit her.

Outcome: Camphill developed a scheme that allows Mary to move into a new home where she lives with another service user. Both tenants settle in and receive daily outreach support from Camphill staff.

* Not her real name

All services find the need to review their aims and objectives periodically. Such reviews are an important aspect of the philosophy of Camphill, a communal living project where service users live alongside support staff, writes Mark Drinkwater.

At its Malton project, more than 30 service users live in seven houses spread across the North Yorkshire town.

“One of the special features of the whole set-up is that the staff, the co-workers, actually live together with the service users,” says Andy Paton, a qualified social worker and the director of Camphill’s social work team.

While the projects are popular with service users, Paton recognises that the Camphill approach does not suit all users indefinitely. Two years ago, the project held a conference where service users fed back what they liked and what they would like to change about the services. From this came the idea of providing separate accommodation to help service users develop more independence.

One service user was quick to embrace the idea of living more independently. “Mary* was keen on this, but still wanted the back-up support of the small community setting,” Paton says. “She was saying that the most important thing was her friends and her relationships. In terms of the accommodation she wanted to be more independent, but not isolated.”

Staff at Camphill explored the idea with Mary and looked into the implications of such a radical change to her provision. “There were evident risks around vulnerability and potential exploitation,” Paton says. “We took that very seriously. We planned with her for many months before the move. She also had some health and safety training with our health and safety officer for the various areas around the house and the kitchen.”

Several risks were identified and staff at Camphill considered how to manage the risk of strangers seeking to exploit her and her knowledge of safety in the home. In addition, Paton considered how such a fundamental change might affect her support network: “The main risk we saw was about isolation. All those other issues, around health and safety and safeguarding, were addressed as we worked on effective training.”

Paton and his colleagues looked at the practicalities of providing accommodation with arm’s-length support. Mary had chosen to share the home with a trusted friend from Camphill, who also has learning disabilities, and Paton notes the importance of compatibility between co-tenants and their ability to share household tasks. He recalls: “My memory of sharing in my student days was that it didn’t matter what you thought of Mao Tse-Tung or Marx, shared houses broke down because someone didn’t do the washing up.”

A small house in Malton was identified as suitable for Mary to rent with her friend. In the run-up to the move, a lot of planning took place between Mary and her co-tenant. This included the fine detail of how they would decorate the house, deciding how they would share the kitchen, how they would pay the bills and budgeting.

Earlier this year Mary moved into her new home – and it has worked out well. Paton says several practical considerations were critical to success of the initiative: “The potential for exploitation was something that we were aware of. Whether it was someone coming to the door trying to sell them something or them meeting someone in town who wants to come back to the house and work their way in financially, or other type of abuse.”

Fears about Mary becoming isolated have been allayed. Although she lives in a home where there is no overnight staff cover, Paton emphasises that she is not entirely without staff support: “It’s not as if they just have a couple of hours’ support a week. It’s much more than that. There is someone meeting them every day.”

Mary remains in contact with those living in the Camphill community and is still involved in the day activities she was involved with before moving. As a result, Paton says the change was incremental and not overwhelming.

Reflecting on the case, Paton highlights the positive attitude to risk that he and his colleagues took. “We didn’t want to be too risk averse,” he says. “We knew there were going to be risks but we wanted to look at where there would be positive outcomes to the possible risks.”

WEIGHING UP THE RISKS

Arguments for taking the risk

● It was what the service user wanted Mary was clear about her desire to live more independently. The service provider worked in a client-centred way to help her identify accommodation and support.

● New service was risk assessed Her provider went through a comprehensive risk assessment process in planning the new service. Through this, staff identified the risks and provided training in advance of the move.

● Outreach staff available Outreach staff will still visit Mary to ensure she receives support in her home. She will also be able to continue to participate in the Camphill community workshops to prevent isolation.

Arguments against taking the risk

● Lack of staff Staff will not be at Mary’s new home the whole time and there are several health and safety considerations. It is unknown how Mary might cope in an emergency without staff assistance.

● Potential problems overlooked This is the first time this project has developed an outreach service for people living non-communally. There is always the risk that some potential problems might have been overlooked.

● Possible exploitation Without a constant staff presence, Mary might be identified as vulnerable and a target for those who wish to exploit her physically or financially.

INDEPENDENT COMMENT

Rhys Bradley is a learning disabilities social worker at Vale of Glamorgan

There can be a reluctance to endorse any risk-taking enterprise in social care. Understandably, there is a fear of the negative consequences and the blame that may be attributed should any harm come to a service user.

However, risk taking is a part of everyday life and an overly-cautious approach could deny service users the chance to realise their aspirations and shape the lifestyles they would choose for themselves. This could be regarded as oppressive practice and contradict the duties incumbent upon us as enshrined in the UK care councils’ codes of practice.

Mary’s service provider should be applauded for being flexible and responsive to her needs in a way that is truly person-centred. While there may be risks associated with independent living, these may be outweighed by the potential benefits. Indeed, risk taking should be viewed as a positive experience which empowers service users to exercise their autonomy and self-determination.

In cases where the service user has capacity, professionals need to ensure that any risks are fully explained so that they can be supported to make an informed decision. Measures can then be taken to minimise identified risks.

➔ Email Mark Drinkwater to submit your Risk Factor case studies

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This article is published in th 1 September 2011 edition of Community Care under the headline “Independence without isolation”