Supported Living / Residential Care – Overview

Why might it be of interest?
When your young person is ready to leave home there are different living options likely to be available. There’s no right or wrong just what will work best for your young person.

But to make the right decision one of the things you need to know is about the difference between supported living and residential care. They can look very similar – it is really all about the right service for the young person – but there are clear differences which might make a difference to your young person.

Supported Living and Residential Care

There are both good and bad supported living services and residential care services.

There is no right or wrong option – only what will work best for your young person.

While there are clear differences between the two it’s not so much about what the service looks like – as there is potential for quite a lot of overlap – but how much choice and control the person has over their home and life.

The degree or complexity of a young person’s disability and care needs are not the determining factors for which type of living placement would be best for them.

Supported living is the term in general use where people have their ‘own homes’ via a tenancy or home ownership or shared ownership and have personal and housing related support provided by an outside organisation.  Housing/accommodation and care packages are provided by separate organisations and one can be changed without impacting the other.

Supported living is not a prescriptive model of service design and can look very different for different people. For one person it may be a few hours support a week to live alone in a rented flat, for another it may be round the clock support to live in a home they own, and for others it may be a shared house with friends and support to meet individual needs.

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.  The accommodation and care are provided by the same provider and neither can be changed separately.  Residents will have their own rooms, and probably own bathrooms; meals will be provided; as will personal care needed; activities will be arranged for the residents.  However, residents may not have any choice about who they live with and may have limited choice over what they do and when.

One big difference between the two options is in how much of the benefits a person is entitled to that they can keep.  In supported living a person keeps all of their benefits – they are, after all, responsible for their own bills (although housing benefit will cover some bills).  In residential care a person is likely to only have about £25 of their benefits for their personal use as they are not responsible for their food bills or other household bills.

One potential benefit of supported living is that parents can commission the housing and care services themselves.  There is undoubtedly a lot of work involved – most of which would be done by the local authority if they were arranging the care and housing – but it does give parents more input and control over their young person’s supported living placement.

Further comparisons

Supported Living

• Smaller homes, often between 3-6 people; can be bigger
• Usually own tenancy and therefore security of tenure
• Own room and shared common areas – living room, kitchen, etc
• Usually the look and feel of a family home
• Supported by staff to live as independently as they can
  • Will include personal care and a high level of care where needed
  • But young people will be encouraged and supported to do as much as they can for themselves
• Encouraged to take part in household routines and domestic tasks
  • Never forced or necessary chores left undone if the young person doesn’t want to engage or can’t manage the task
• Support and housing provided separately
  • Could be by the same organisation but will be separate departments
  • Therefore the housing provider or care provider can be changed independently of each other, ie a person could stay in their home and have a different care provider; or move but retain the same care provider
• Home of their own with whatever level of support they need to live well
• More flexible timetables
  • Less dependent on other people’s timetables or when an activity is scheduled in the home
• Likely to engage in activities of interest outside of the home
• Part of their local community – just like their neighbours
• Close to family – or in a location of their choosing
• Could be intense for some young people, akin to living in a family home
  • May be difficult to get away from someone they don’t get on with
• More likely to be living with people of a similar age
• But young people with greater and lesser needs can live successfully together in supported living
• Potentially more choice about who they live with
• Receive full welfare benefits that they are entitled to
• Responsible for their own bills (where not covered by housing benefit) and food bills
• Choosing their menus and buying their own food

Residential Care

• Larger homes, 10-40 people, although there are smaller homes with 4-8 residents
• Own room and probably own bathroom with communal areas – but not like a family home – more like a hotel
• Won’t be involved in the domestic routines of the home – staff will do this
  • Meals, laundry, cleaning provided by staff
• Likely to be offered activities arranged for all the residents in the home
  • Probably fewer individual activities offered by the home
  • Activities scheduled so no choice about when to do an activity
• Personal care, accommodation, meals all provided as part of the package by one provider
• Staff on hand for care needs, less likely to be encouraging independent living
  • this more likely to be down to the family
• Meals likely to be set menus and at set times of day
• A suitable residential care home could be anywhere – not necessarily near family and friends
• There will always be 24/7 care on hand
• Young people can still access their community but there may be less flexibility around how and when this can happen
• Potentially a less intense experience which may work for some young people
  • ie there are more people in the home to spend time with, larger choice of potential friends
  • likely to be a mix of ages and needs
• No security of tenure
• Little choice about who they live with
• Limited amount of benefits available – currently about £25 per week for personal use (personal belongings, clothes, holidays)
• No additional bills – cost of the package includes housing, care, food, utilities, wifi, TV licence, etc

What can 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.

Comprehensive assessments and open dialogue with all the relevant parties is essential and reduces the risk of things that can go wrong.

A comprehensive assessment should include the young person (where possible); parents and other family members; school/college – and especially if residential; reports from other relevant settings/people.  Current care plans, EHCPs, professional reports can all help a care provider understand your young person’s needs and what they want from their living placement.