There is a big debate underway on the relative merits of supported living versus residential care for adults with Learning Disabilities.  Views tend to be completely polarised which is why it makes it an interesting topic for debate.

 

Government legislation has directed Local Authorities towards placing people with Learning Disabilities in supported living arrangements. Those in existing residential and out-of-county residential placements are also often being forced into supported living provisions in their home Local Authority.  The background to this is that a disproportionate number of people with Learning Disabilities live in registered services as opposed to supported living, compared to other groups in society, and part of the current shift is to redress this imbalance.

However, the current situation debates a straight comparison between the two services, with the presumption that the delivery of residential care is flawed whilst the delivery of supported living is excellent.  In reality, it’s not that clear cut; there are good and bad residential services and good and bad supported living services.

 

Definition of Services

Supported living is the term given by Local Authorities to offer people their ‘own homes’ via a tenancy or home ownership or shared ownership and have personal and housing related support provided by an outside organisation.

Residential care is when someone lives in a registered care home which is managed and run by a care provider who is responsible for all aspects of their daily needs and wellbeing.

 

Things that go wrong

Poor residential or supported living placements and services tend to come about as a result of the following:

• Poor assessment of an individual’s needs that make either the service or the level of support being given wrong which delivers negative outcomes.
• These situations may be historic, deliberate or arise from incompetence
• Placement choice may be driven by funding considerations (funding panels or commissioners) or poor care managers (social workers)
• The wrong mix of individuals can put even a good service into crisis
• The wrong support staff for a particular individual
• Lack of sufficient or appropriate training for staff
• Poorly motivated staff or just a poor care culture
• Poorly managed staff
• Warehousing individuals instead of supporting them to lead more fulfilled lives
• Inability of services to evolve with individuals
• Putting the organisation or shareholders before the individual

In either a residential environment or supported living any of these factors can lead to individuals living miserable and unfulfilled lives.

 

Funding & Financial Safeguards

A key difference between the two types of services is how an individual’s funding package is put together and who is responsible for ultimately spending that money.

Supported Living:

• Individuals have a legal right to access a range of benefits
• They have access to other sources of funding, including Direct Payments, Supporting People Monies, Independent Living Fund, etc.
• They can choose to spend their benefits package on whatever services they like
• Spending is monitored and if money is spent inappropriately, action is taken
• This also allows people to make choices about the balance between what they spend their money on

Residential Care:

• Funding goes to the provider who is responsible for delivering the individualised services
• The type and level of these services are pre-determined and are legally binding
• Contracts and outcomes are monitored to ensure service quality
• Continuing funding of placement is outcome based
• Individuals are entitled to limited benefits

 

Our Perspective

The debate can also be subjective.

Ten years ago, as parents of a child with complex needs we had a very low opinion of all care services in the UK.  We didn’t have a view on residential care versus supported living; we just couldn’t find a good service at the time for our daughter.  In the end we set up our own registered residential service, Home From Home Care.  We approached the task with logic and without the baggage or prejudices of a pre-existing operation / service.  Our aspirations were what any parent would want – fulfilled days, great environments and a really good and effective staff team where our children are treated with respect.

Ten years on we still think the standard of care in the UK is often poor an already compromised sector is now under increasing pressure from the budget cuts – so the question remains not supported living versus residential care but, “how do we raise the standards of care in the UK to better support the vulnerable in society in today’s economic climate?”

 

Who this debate is about

Whilst we don’t doubt that supported living is the right thing for many people with a Learning Disability, it tends to be more appropriate for those with lower levels of support needs.  Even if a service gets a few things wrong (as above), if they more or less get the majority of support right, the placement will succeed to an extent.

We now want to focus the debate on individuals at the other end of the spectrum, those with the higher complex needs.  In their case, it’s just too simplistic to apply the same mechanisms and criteria (rent book, tenancy etc.) to measure ‘successful outcomes’ because different things are happening in the lives of these individuals:

1. Their mental capacity may be limited
2. The margin for error in the support they receive is incredibly small
3. Situations escalate to extremes

Over the coming months we will be posting our opinions on this topic with particular regard to how the government policy of moving towards supported living might not be the best approach for those with complex needs.

 

Comment on this topic

 

Other ‘Spotlight Topics’

Autism & Transition

Duty of Care vs Choice

Residential Colleges

Support vs Care