By Leo Sowerby, Chief Executive of Affinity Trust
An article in the Sunday Times on 05.06.16 by Rosa Monckton has drawn my attention, as it argues that people with learning disabilities should not be moved from Residential Care into Supported Living. The article claims that this is being done purely for financial reasons, that it is unfair and inappropriate for people who are unable to live on their own and can represent huge disruption to those who have lived in the same setting for many years and cause unnecessary worry for their families and carers.
I want to put the extremely strong case for Supported Living, on behalf of the hundreds of people we support who have moved into supported living and now enjoy a much higher quality of life with more choice and control.
The article provides shocking examples of people being left to make choices or decisions for which they lack capacity and expected to carry out tasks which their disability renders them incapable of doing. These examples are, at best, examples of naive and ill-informed support, at worst, poor practice verging on abuse. In good quality Supported Living, if someone has capacity and the ability, the support staff would actively work with the individual to encourage and enable them to do or at least participate in everyday tasks. If the individual does not have the capacity or ability, then support staff would ensure such tasks were carried out for them, including by the support staff themselves. People receiving support would not have the tasks thrust upon them and be left to fend for themselves under the staff’s misguided notion that the person supported was simply exercising their right to choose.
Generally, on the debate between Residential Care and Supported Living, Affinity Trust believes that a residential service for 10 to 40 people will not be able to provide individual, personalised and tailored support which responds to each individual’s needs and preferences as well as Supported Living can (Supported Living involves, typically, supporting one to three people in their own accommodation).
However, that is not to say that everyone in Residential Care services should be made to leave. Such a move should be, demonstrably, in the individual’s best interests. If someone has lived in Residential Care for a long time and is settled with established relationships they should, of course, be allowed to remain there if they want to. If people lack the mental capacity to make such decisions then a “best interests” meeting (including family and friends) should be able to determine if it is in their best interests to remain in the Residential Care home.
The choice between Residential Care and Supported Living does not need to be determined by an individual’s intellectual or physical ability, or lack of i.e. it is not the case that Supported Living only works for people with greater levels of ability. Affinity Trust supports many people with profound and multiple needs in Supported Living. These people are not left to make choices for which they lack capacity and they are not left to fend for themselves with daily or household tasks or anything else if they are not able. Rather, whether they live with one or two other people or on their own they are supported 24 hours a day by dedicated teams of Support Workers. They experience much more choice and control over their lives than they did in a residential setting where, often, an individual’s preferences have to compete with perhaps 20 or 30 others for example meal times are likely to be at a fixed time every day with limited choice because of the need for a catering team to prepare a large number of meals every day. We understand completely that the people with disabilities and their families and carers may find a move from Residential care to Supported Living to be large and difficult change. Generally, though, if the change is managed well, the outcome is usually incredibly positive and life affirming.
Affinity Trust recognises that people need relationships and to feel that they are part of a community. Supported Living does not mean that people are not part of a community. Rather it enables people to be part of communities which are of their choosing (i.e. matches their own interest and preferences) and seeks to enable them to participate in activities which enable them to participate and be included in the communities around them rather than live in a community which is insulated or separate from the world in which other people live.
In Affinity Trust’s considerable experience, Supported Living is often not a cheaper option for local Authorities. Yes, the housing costs are borne by Housing Benefit and not by Local Authorities ‘care’ budget, but Supported Living, because it provides more individualised and personal support, typically involves each person receiving more hours of one to one support per day/week. This means that costs are usually greater than in residential services where staff hours are more typically shared by a number of people at a time e.g. in a residential services its common to find six people with profound or complex needs being supported by three staff whereas in Supported Living individual people with similar needs are likely to be supported by a single Support Worker on a one to one basis,
We are all too aware of the financial pressures experienced by Local Authorities but in Affinity Trust’s experience Local Authorities prefer Supported Living to residential Care because it provides better quality support and lifestyles. If anything, our experience is that costs are causing Local Authorities to place people in settings where there are a greater number of people rather than the lower numbers associated with Supported Living simply because of the economies of scale which arise.