Supported Living Workshop Notes – 06 March 2024

Why might it be of interest?

This is one of 4 workshops Bright Futures has held on the topic of supported living, including independent living in the community, residential care, etc.  They are all slightly different so you might want to have a look at the notes from each one.

There’s a lot for parents to learn and these workshop notes are a good place to start.  There isn’t a one size fits all solutions or even approach.

There’s further information on topics relevant to supported living on the information hub under Independent Living:  https://ruils.co.uk/article-cat/independent-living/.

You can find the workshop notes under the Independent Living category but also in the Workshop Presentation Notes category.

The following notes are from the presentations made by:

Sue Robson, SEND Transitions Advisor, Bright Futures @Ruils

Karl Burgess, Transitions Lead, Adult Social Care

Liz Pepper, Head of Commisioning for LD for Richmond and Wandsworth

Jackie Mackinney, Senior Service Manager, United Response

 

What are we talking about today?

• focus – supported living for young people with LD

• Other boroughs will offer something similar but who is responsible and their process may be different
• Young people with physical disabilities or mental health needs will also access independent living through different routes
• Young people funded by the NHS on CHC may access supported living differently
• There will be a lot of shared ground but –
• We are not addressing those situations today

Independent / independence

When I use the term independent living it is relative and what I really mean is as independent as they can be within a supported setting.

What is supported living?

• Supported living and residential care can look very similar
• The key to whether it is supported living or not is how much choice and control the person has over their home and life rather than what the service looks like
• No right or wrong – whatever works for your young person

The government defines supported housing as accommodation provided alongside support, supervision or care to help people live as independently as possible in the community.

As there’s no absolute definition about what supported living is the following is a comparison with residential care.  There’s potentially a lot of differences but also similarities.  The size of the provision is not an indicator of whether the provision is residential or supported living – nor is the complexity of the needs of the young person.

There are positives and negatives for both.  What matters is what works for your young person.  Below the table there are a couple of descriptions about what is NOT supported living.

Supported Living	Residential Care
Own home or tenancy	Registered care home
Care provider and housing provider are separate organisations – one can be changed without impacting the other	Care and accommodation are provided by the same organisation and neither can be change separately
Individuals are responsible for their daily needs – personal care, food, laundry, activities – albeit very likely with support	Provider is responsible for all aspects of daily needs and wellbeing – eg personal care, food, laundry, activities
More likely to have a choice of who you live with	No choice about who you live with
Independent living skills actively encouraged and supported	As all services are provided there’s less opportunity to develop independent living skills
More flexible timetables – support should be organised such that while some is shared a person will have individual support to meet their specific needs	More likely to need to fit in with the care home timetable and therefore potential for less flexibility with choice of what and when to do activities
Choosing own food and activities	Limited choice – whatever the care home provides
More likely to be able to live with people of a similar age and / or similar support needs	Mixed ages and support needs
Close to family or in a location of own choosing	May be anywhere if a suitable care home is not local
Additional bills, eg for wifi	No additional bills
Can be a very intense experience – living with a few others in a house	May be less intense – may be a larger home, greater variety of people to mix with

One big difference is how much money, from benefits, a young person can keep.  In supported living a young person will keep all of their benefits, less the amount they contribute towards their care package.  In residential care, while still eligible for many of their benefits, the local authority can take most of the money to pay towards the residential care placement.  Government says a person in residential care that is being funded by the local authority must be left with a Personal Expenses Allowance – which is currently a little over £28.   The LA can allow a person to keep more but it doesn’t have to.

It is NOT supported living if a person lives in their own home and receives home care – maybe a visit or 2 a day from a paid carer

• Because the care is not connected to the house you live in
• For example, if you have a private tenancy but social services carers visit to help with dressing or meals.

It’s also NOT supported living if the care provided is minimal

• No definition!
• 10 minutes twice a day would probably be considered minimal

What might supported living look like?

No ‘one size fits all’ look

Shared house with other young people

• Own bedroom but sharing kitchen, dining room, lounge, bathrooms
• A bit like a family home
• Young people may do quite a lot together – eating, going out

Shared house with other young people

• Own bedroom but sharing kitchen, dining room, lounge, bathrooms
• Young people sharing the space but living more separately
• May share some activities or occasional meals

 Flat (or flatlet) in a house

• Own bedroom, may have own bathroom but share kitchen
• May not be any other communal spaces
• Young people living pretty much separately from each other

Flat with warden

• Own flat, ie own front door
• May not be any communal spaces
• A warden onsite daily or 24/7 but likely still receiving additional care package

Flat in the community

• Own flat
• In a block of other flats but not specifically for disabled people
• No on-site care staff
• Care provided on a ‘floating’ basis

Community Living

Such as L’Arche or Camphill

3-6 young people is a good size of home

But could be more or less depending on needs of the young person

Care Packages

• the care package can be a few hours a week right up to 24/7
• it can be shared care, ie where one carer supports more than one person in the home
• it can be 121 care
• 221 care where needed
• it can be a mix of 121 and shared care

Housing Benefit:  in general will cover most of the cost of the rent for our young people.  It can include additional charges but there’s always a small amount that is not covered so the young people will have to pay that themselves.

HB recognises the additional costs associated with the needs of a person needing supported living.

HB is a means tested benefit so if your young person works and has an income this will be taken into account – there may be a ‘grace’ amount before it affects their HB (I don’t actually know – does anyone?).

If not, or in addition, there will be a taper, ie for example, for every £1 they earn they will lose 45p of their HB – or something like that.

Our young people are eligible for HB if they are living in supported living.  They are not if they are in a private tenancy or with minimal support – that would be covered by the housing element of Universal Credit.

The size of the property must be appropriate.  For example, 3 young people who need a sleep-in carer would be OK in a 4 bed house but not a 6 bed house – either the additional rooms would have to be filled or they would have to meet the additional cost themselves.

Shall I stay or shall I go?

Supported living isn’t something you choose today and your young person is in a new home next week.

It’s something to think about and plan for and accept that there is no set timeline as to when it might happen even when you have decided to actively go for it.

• No right or wrong time
• No right or wrong placement
• Not better to parent commission or go with LA offer

A few things to consider:

Supported living

• Young person is and feels more independent
• Likely to encourage independence and socialisation
• Protected from potential issues at parents’ home, eg parent falling ill
• You have your days and weeks back!
  • When at school you have a good part of each day
  • Maybe from 8am to 5pm
  • Once education is finished the young person’s day or week is likely to be more varied – maybe more time spent at home
• You have to be able to let go
  • Accept that you are not as involved or as in control as you are when your yp lives at home
  • The initial separation may be difficult
• Your young person may not live near you
• You can become a parent again rather than a parent AND a carer

Staying at home

• You may all be happy with the arrangement
• You have the same control and involvement that you have always had
• A young person may not like having carers in the home
  • It may make them feel babied
  • eg having a babysitter when you go out in the evening – may not be safe to leave your yp alone but they probably don’t see it that way
• You may find yourself in a caring role more than you were when they were at school if their activities outside of the home take up fewer hours or they don’t have something on every day
• It can feel intrusive to have a carer in your home

Liz Pepper, Head of Commissioning for LD and Karl Burgess, Transitions Lead

The LA has to make sure they have enough resources:  residential care, supported living, other support in the community and are aware that they have too much of some (residential) and not enough of others (supported living).  They have begun work on new supported living schemes and redesigning some residential provision to become supported living – but these changes don’t come overnight.  The LA has a lot of services but those appropriate for young people are full.

They are also working towards new supported living housing regulations bringing everything up to the standard – this is a work in progress.  Some current properties are tired and in need of investment.

The LA has a framework for providers.  This is a list of providers that the LA has already quality assured.  The LA has ensured they can provide good quality care and landlords can provide good quality accommodation.  The Richmond ROSE Framework – residential, outreach, supported living, emergency – is the LA’s approach to recommissioning accommodation-based care and support services for adults with a learning disability and/or autism. It will run until 2027 – read more here:  https://www.richmond.gov.uk/services/adult_social_care/learning_disability/commissioning_learning_disability_services/rose_framework.

How provision is organised

Block purchase:  The LA has agreements in place with providers with provision that already exists – of different types (residential, supported living, self contained flats, flats in the community) and has been ring fenced for Richmond and Wandsworth residents.  The LA pays landlords and care providers to reserve the accommodation for Richmond and Wandsworth.

Spot purchase:  providers are not on the framework or part of a block contract but the LA pays for a place in an existing provision not of the LAs own commissioning.

Floating support / outreach:  this is flexible support offered to more able young people who are likely to only need a few hours support a week and provided flexibly.  For example, one week it might just be a check in to see how a person is doing and finding out what help they need today; another week the person may need support for an appointment or someone to go through their mail and help them deal with it.

Checking quality:  Parents are welcome to form their own parent group at a property and this group or individual parents can feed into the LA via commissioning, adult social care or Quality Assurance.  The LA has a legal duty to assess and review the quality of their services.  Parent feedback is important but the LA also meets regularly with providers, social workers and GP teams.  The Quality Assurance team checks provisions as does the CQC.

Developments:  Commissioning works closely with housing colleagues and adult social care.  Where the LA has approved building projects it will ask for an allocation of housing for LA use.

Seven flats intended for semi-independent young people is still planned in Church Road – now expected in 2025.  This arrangement has worked well in Wandsworth and is a good step between shared housing and a flat in the community.

Housing providers:  Registered housing providers, such as Golden Lane Housing, are much favoured by the LA as they can claim the housing benefit back from central government.  With other types of housing provider, eg a charity, the LA pays the housing benefit.  The LA does rent evaluations and agrees a reasonable amount for housing benefit.  London is a challenging market for private investment and the figures may not add up.

Tenants in supported living have a tenancy agreement and it is this agreement that lays out the maintenance arrangements, ie who is responsible for what – landlord or care provider.

Jackie MacKinney, Senior Service Manager, United Response

United Response (UR) offer:

• residential services
• supported living services (block funded and parent commissioned)
• outreach – supporting individuals in their own home and in the community, including travel training, support at appointments, help with paperwork, etc. Clients can drop in for support and they have an on call service
• short breaks – UR run the 5 bed respite house in Powder Mill Lane
• a housing team
• activity hub (in Teddington)
• work with other local organisations such as People Hive

Referrals:  When UR gets a referral they have to consider if they can do it which will involve an assessment.  UR can work with different funding packages – invoicing the council directly, direct payments, self funders.  Assessment of individuals is ongoing to ensure they are meeting needs.  Where relevant to develop the person so they may be able to become more independent, possibly moving into another service or even going to another provider if that’s what is best for the individual.

UR are used to working with a person’s mental capacity and when they encounter a difficult scenario, for example a client likes a drink, they will try to work with the person to ensure they are safe.  They can direct the client to support services or URs own community health team.  They can use the tenancy agreement to remind clients of their responsibilities in the house.  The aim being to support change rather than to control the client.  Working with social services, family and other local teams is important to UR.

Housing:  UR work closely with housing providers.  Where UR is the managing agent they will collect the rent on behalf of the landlord and will have agreements in place laying out who is responsible for what.  For example, the managing agent may be responsible for decoration but the landlord is responsible for putting in a new kitchen.

As a managing agent they are monitored but they also monitor the houses they work with.  They have a duty to report issues.  For example, they had a house where the bathroom was unusable so they reported the issue to the landlord but also the CQC and Quality Assurance.  The same applies with reviews and repairs – they have a responsibility to report issues or if reviews are not taking place.

Care:  If a parent is not sure about what care their young person is or should be receiving they should speak to the care provider and work through any problems together.  The care provider can’t help if they don’t know there’s a problem.  They may be able to offer further staff training or suggesting that more support is needed for a young person.

UR have recently started using an electronic recording system called Nourish which staff log information and activity of a young person.  The care provider is likely to notice things about a young person that might indicated more support is needed.  For example, if a young person is looking unkempt or there’s a stack of bills to be paid.  They will provide additional support regardless but will also request additional hours from the LA.  It’s not necessarily easy to get support hours increased but UR will keep asking and recording evidence.

The young person’s social worker gives the care provider a rough idea of the number of hours of support.  UR will look at the practicality and will provide evidence if there is a greater need for support.

United Response meet quarterly with Quality Assurance.  They have to evidence everything they do and it is also a good way to highlight concerns.  They also have to work within the CQC guidance.

Where UR work locally:  UR don’t work in Hounslow but they have some services in Kingston, Ealing, Welwyn as well as Richmond.  They would look at out of borough settings – considering the location, the size of the package, are UR on the local authority’s framework, etc