Range of housing types

The range of housing types that should be made available is as wide as that for people without learning disabilities. In this section the whole range has been split into various general types although it has to be stated that there is much crossover between types. There are also some suggestions about the general advantages and disadvantages of each type, although it must be stressed that different people will view advantages and disadvantages according to their own preferences. Choice is very much a personal thing.

Group homes

Group accommodation for up to four people in one house or flat can be provided with
varying levels of support for different residents, including those with the need for very high
levels of support and live-in support.

The advantages of this model are that relevant support can be made available on demand, the availability of compatible friendships, company and activity with other co-residents, yet also an ability to live one’s own life in a separate room if desired. Group homes can offer a high degree of staff contact.

The closeness of others can be a disadvantage for those of a very independent frame of mind and group treatment needs to avoided by good practice providers. Systems such as Active Support can be used to ensure maximum independence and engagement of coresidents in their home and community life.

Independent living

Independent living separates the provision of housing from the “support” people need to live. People can live in a range of houses and flats from a number of different housing providers, depending on availability and choice, and they hold their own tenancies or have ownership arrangements. Support can be offered in a range of ways and at different levels of intensity depending on individual need. Continuing the theme from group homes, the advantages of  the model are that it empowers the individual to make their own decisions about their lives, to make choices about what they do, when and where. Support can be tailored to the person and not overpower the person’s own independence. People can have a lot of control over their environment, depending on their tenancy agreement of ownership of their home.

The following are examples of how support can be delivered to people living in independent living:

  • The Keyring housing model
    Offers independent housing for several people living within the same neighbourhood. A relatively low level of support is usually needed and is provided by an individual volunteer who lives in one of the housing units. The Keyring emphasis on neighbourhood also offers the opportunity for people to support one another and offers the benefits of a ready-made community of people. This model is not available in Cardiff.
  • Intensively supported independent living.
    This model has been offered to people with autism and/or challenging behaviour who find it difficult to live within a shared setting and who might otherwise be more expensively accommodated out of county. In this model 12 to 15 units are situated near to one another, some with living space for individual support workers, although general support for the whole scheme needs also to be centrally located, along with some community facilities. Each unit is fitted with modern technological support aids and systems. Joint funding with the LHB is common for such a scheme.
  • Warden assisted group of flats and/or houses
    This form of housing is a more supportive version of Keyring, offering accommodation and support for up to fifteen people living on the same site or in the same area. As well as an independent living unit, there are also communal facilities such as a lounge and laundry. Residents usually have quite high support needs or wish to live in separate accommodation while still taking advantage
    of communal facilities and a sense of community among tenants. A live-in warden
    supervises the support that tenants require.
    The above models are sometimes referred to as ‘Core and Cluster’.
  • Supported living own tenancy
    This form of housing enables a person to live independently in their own home
    with twenty four hour support provided by a dedicated, consistent, experienced
    staff team. Services include supporting the individual to develop independent living
    skills such as: shopping, household chores, planning and preparing meals, budgeting and paying bills, cooking and cleaning; support to access the local community, help with personal care and maintaining the tenancy.

Life sharing arrangements

There are various ways in which life sharing arrangements can be made. People can offer a place in their own home or elect to move in with a person with a learning disability either on a voluntary basis or with some form of payment.

Generally the advantages of sharing one’s life with others are to have a close personal relationship with particular people to whom one is attached, to have constant, accessible support and, through the sharing person, have access into local community network.

Disadvantages are that life sharing might inhibit a sense of independence and that success will be dependent on compatibility and the quality of the relationship. This means that great care is needed in creating the match between the sharers and argues for a scheme to provide matching and monitoring services.

The following are examples of how life sharing can be arranged:

  • Shared living (formerly known as adult placement)
    Living with a well-matched “host” family or individual provides a shared life within the carers’ own family and with access to their social networks in a local community setting. Shared Lives carers can provide long or short term, full time or part time accommodation, support and care for up to two people. They are part of organised Shared Lives schemes which approve and train carers and monitor arrangements. Shared Lives carers do not employ staff and provide all the care and support themselves.
  • Supported lodging
    This is very similar to Shared Lives (adult placement) in that the individual has a tenancy, licence or lodging in someone’s home. The person can receive support through the person providing lodgings, although this is likely to be less support than might be provided in more formal Shared Lives arrangement.
  • Flat or annex in a family home
    This form of accommodation offers individually created facilities to people who wish to live separately but to have family support nearby.
  • Living with a support tenant
    An individual, a couple or a small group of people, usually with quite low support needs, live in a house or flat with a support tenant.All have their separate accommodation in the home and the support tenant, who usually has another job, gets free accommodation and a small honorarium for delivering whatever support is require.

Housing for Older People

Wherever possible the principle should be to allow people to live in their own homes with
relevant support if they wish to do so. Several of the types of accommodation mentioned above are relevant for older people and will deliver the positive outcomes they do for younger people. Where people’s personal care needs increase with age, the same opportunities for housing, residential carand nursing homes and dementia services for older people should also be available to people with learning disabilities.
One emerging model may be particularly useful in the future:

  • Extra care housing
    Extra care housing provides different types of housing such as self-contained flats or bungalows but with more extensive communal facilities and the opportunity for increasing amounts of care, including domiciliary care and nursing care, to be provided as necessary.

Intentional communities

An intentional community is a distinct community of people with varying levels of learning disabilities who live in community with non-disabled people supporting them, usually
according to a strong communal philosophy based on sharing lives and on work. Intentional communities might be based on a campus or on dispersed housing in the local community or both. They seek to integrate into their local community. They might be rural or urban, large or small according to the wishes and needs of the individuals. Their accommodation arrangements could be regarded as group homes, independent living or shared lives arrangements mentioned above.

The main advantages of an intentional community are an active social and working life
and the strong sense of friendship and company. There tends to be greater consistency in the staff team with consequent benefits to people with learning disabilities. The disadvantages are that some might prefer a quieter or a more independent lifestyle with more privacy and, in some forms, communities can be geographically isolated.

Residential care home

Specialist residential care homes for people with learning disabilities involve a fully integrated package of accommodation and care and require registration under the Care Standards Act 2000. These are becoming less as group home and independent living forms of housing are achieving significant levels of care, for people along with a high degree of autonomy.

An advantage is that residential care homes can provide extensive personal care support and facilities according to the wishes of residents, and can provide appropriately for people with higher support needs. Disadvantages are that registered residential care homes can be larger in size than other accommodation forms, with associated difficulties in maintaining an individualised approach.

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Appeals, Complaints and Comments

Appeals, Complaints and Comments

You can appeal against a decision if you disagree with it.  Examples of the sort of decision you can appeal against are:

  • a decision that you do not appear to need an assessment.
  • following a specialist or comprehensive assessment, a decision that you do not qualify for a service.
  • if you think you need more services or different services from those which are proposed or being provided.

You can complain if you think the processes have not been followed properly or because the quality of your service is poor.

There are several ways of dealing with disputes ranging from the informal to the formal, by contacting a councillor, AM or MP to a judicial review or an appeal to the European Court.

If a complaint or a dispute with social services arises, you may use the local authority's complaints procedure where the following procedures apply:

  • Anyone can make a complaint and can act on behalf of an individual. 
  • Complaints normally dealt with by an external provider may also be referred if the complainant is dissatisfied. 
  • The complaints process has three distinct stages.  You may make your initial complaint at either stage 1 or 2.

Stage 1 Local Resolution

Most problems are best sorted out by the staff who are working with you.  Contact the person in charge of your local services or contact the social services complaints officer who will speak to that person on your behalf.  You can do this face to face, by telephone in writing or by e-mail.  They will do their best to sort things out quickly.  This should be no more than two weeks.

Stage 2 Formal Consideration

If not satisfied at Stage 1 you can process your complaint to Stage 2.  Contact the social services complaints officer who will arrange for someone not involved providing your service to investigate your complaint.  You have the right to expect a response from the council within 5 weeks.  You may contact the complaints officer to make your initial complaint or after having spoken to the staff who work with you.

Stage 3 Independent Panel Hearing

if you remain unsatisfied at this stage you can ask for a review of how social services have dealt with your complaint by an independent panel. 

You may ask for more detailed information about the complaints procedure first to help you decide whether you want to make a complaint. 

Remember its your right to complain if you are not happy with the quality of the services you receive and it is social services duty to look into your complaint and try to resolve it.

Assessment

Assessment

Unified Assessment is the name given to the assessment process which involves health and social care professionals working together to assess and manage care and share information. Please note that the following guideline may need reviewing in light of recent legislative changes such as the Social Service & Well Being Act but principles remain similar. 

Assessments underpin any funding decisions that are taken so it is essential that you prepare for and participate in this process. If you do not agree with decisions you have the right to appeal against a decision and free advice and assistance is available. Please contact us for information if in any doubt.

There are three main stages in the process:

Stage 1 Assessment

This is the process of collecting information from the individual, the carers and others about the individual's needs and wishes.  Assessment should be carried out according to the following:

  • Local authorities have a duty to assess individuals if they have the 'appearance of need', including people with higher-functioning autism and Asperger's syndrome.
  • They aim to empower people, by enabling them to make informed choices and maximise their independence according to their individual circumstances. 
  • The main purpose of an assessment is to identify needs and how to meet them.
  • Assessments should be carried out without reference to financial resources, availability of local services or locally preferred options.
  • Authorities have a duty to provide users and carers with a full range of information about all services and the rights of users and carers.
  • Information gained during assessment is confidential and shared only if the law says it should be.  Users or their agents have a right to access the information under certain conditions. 
  • A care co-ordinator will carry out the assessments, who would usually be the most appropriate professional.
  • Assessments should be carried out in a timely manner, in informal settings such as the home, and be proportionate to the level of need. 
  • There are specific types of need included in government guidance.  All needs should be assessed in the light of their impact on independence, daily functioning and quality of life.  The focus should always be on outcomes for service users and their carers.
  • A person-centred approach should be taken during assessment and care planning.  Person-centred planning and reviews also take place in addition to an assessment, if appropriate.
  • Carers have a right to have their views acknowledged in the assessment process both in helping to identify the individual's needs and wishes and also to express their own views of the individual's needs and wishes as well as their own needs.  The role of carers continues once the individual has left the family home.

Carers may request an assessment both of their own ability to care for an individual and of their own need for services for themselves.  Carer's must be informed of their right to an assessment.

Stage 2 Making the Service Provision Decision

The service provision decision for social services makes clear which needs are eligible for support.  The needs identified as a result of the assessment will be considered with the service user/carer and agreement sought on the most appropriate way of meeting them.  This may involve support provided within the family network, by accessing voluntary sector services, statutory services or signposting to other sources of help and support.

The procedures to be applied are as follows:

  • All risks are balanced against the independence of the individual in the light of the four key factors of independence, i.e. the individual's autonomy and freedom to make choices, health and safety, management of daily routine and involvement in other activities. This is based on the what would happen if no help were to be provided.
  • There are four categories of eligibility (critical, substantial, moderate and low) laid down in the local authority's Eligibility Criteria.  Once the risks are assessed, professionals should determine the position of the individual's needs within these bands.  If the needs are above a threshold determined by the authority they become eligible needs and must be met.  A holistic approach is taken, according to the four key factors of independence, even though the needs are identified separately.
  • At this stage there should be no reference to financial resources, locally preferred options or the local availability of services.

Stage 3  Care Planning

This is the process of arranging provision of services:

  • Care planning should address the eligible needs of the individual, the views of the individual and of the carer(s) and cost considerations.  Services should be needs led with full information on a range of services. 
  • Care planning should be responsive to the age, living circumstances, location, disability, gender, culture, faith, personal relationships and lifestyle choices of users.
  • Care planning should be flexible and adaptable to desired outcomes and expectations.
  • Care planning should identify outcomes, i.e. the desired changes aimed at improving independence and quality of life.  A recordmust be made, with timescales for achievement.
  • Care planning should involve service users, carers and professionals in reaching an agreed care plan and identify the most appropriate aervices to acheive the desired outcome.
  • Care planning services should be provided as holistically as possible to suit individual needs and maximise their potential for independence.

Where there is a genuine choice of services, the authority may choose a service based on quality and cost, taking the user's and carer's preferences into account.  Cost ceilings may be used as a guide only and if lack of finance is a reason for making a choice, it must be shown by evidence.  The authority should not impose its own preferred models of care.

Reviews or re-assessments must take place regularly and have a review date.  They should focus on the needs of users and their carers and be evaluated according to a list of factors laid down in guidance.

Services may only be withdrawn if certain conditions are followed, i.e. if a full re-assessment has taken place to show that the individual no longer has eligible needs or if they can be met some other way.  There can be no assumption of alternative support from carers.  The withdrawal of services may go against the user's natural rights.

Users and carers may play an important role in monitoring services and may request support in doing so.  Should a service break down, the original need for the service still applies and it is the authority's duty to provide for it.

There is no charge for an assessment or for giving advice and information.  A person may have to pay for community care services depending on how much service they get and how much money they have.  See the section on financial matters for more information.  If eligible, they will receive free nursing care in their home or in a care home, although there may have to be a contribution towards other aspects of care such as personal care, food and accommodation costs.

Person Centred Approaches to Assessments and Care Planning

The Service Principles and Unified Assessment Guidance state clearly that social services and health should always take a person centred approach to assessment and care planning.  (It should be noted that a person centred approach is not the same as person centred planning.)

 

Also see Carers' assessment

Direct Payments

Direct Payments

What are Direct Payments?

Direct Payments are cash payments to an individual from a local authority that are an alternative to directly arranged community care services. Rather than the local authority social services department providing or arranging the community care services it has assessed you as needing, you receive money to enable you to arrange your own services, allowing you more choice and control over the way your care and support needs are met.

Direct Payments can be made to people who are eligible to receive support from Social Services, allowing them to arrange their own care by directly employing a personal assistant or contracting with an independent agency.

The payments are available to disabled adults and children, and can be made to people with physical or sensory impairments, learning difficulties or mental ill health. They are also available to non-disabled people who have caring responsibilities, allowing them to continue with their role of looking after a disabled adult or child. Older people who need support to continue living in their own home may also be eligible to receive Direct Payments.

Direct Payments give people the power to make their own care or support arrangements, putting the service user in control and offering much greater flexibility by allowing individuals to make arrangements that suit their lifestyles.

Direct Payments can now also be made to ‘suitable people’ assessed by the local authority as being able to receive a Direct Payment on behalf of someone without the capacity to agree to receive a payment. A ‘suitable person’ will usually automatically be someone who has the power to make welfare and health decisions granted by a Lasting Power of Attorney, or having been appointed by the Court of Protection. Such a person has to agree to become a ‘suitable person’.

Otherwise, the local authority can agree that someone else can become a ‘suitable person’ who is best placed to promote the interests, wishes, and beliefs of the person without capacity. There is a process of assessment to be followed in all cases.

The ‘suitable person’ will be required to sign the local authority’s ‘Terms and Conditions' agreement in order to receive a Direct Payment.

You may be given conflicting information on what and how direct payments are  to be used. Seek advice if you feel that you are being treated unfairly since many families have different experiences and decisions that you feel are unfair may be open to challenge! 

Information for Service Users

Information for Service Users

The Information Sub-group of the Cardiff and Vale Unified Assessment Project has produced 4 leaflets:

  1. Unified Assessment – Helping you achieve a better quality of life. This is for all the agencies involved, i.e. Cardiff Council and the Vale of Glamorgan Council, Health boards, the Trust and other partners. It is aimed at anyone wanting to know about UA - not just service users. It is introducing people to Unified Assessment.
  2. Your assessment This is a joint Cardiff & Vale of Glamorgan local authority leaflet. It does not include Health or any other partner. It is for people about to undergo an assessment for social care needs.
  3. Looking after your social care information This is also a joint Cardiff & Vale local authority leaflet for people about to undergo an assessment. It  may also be used whenever the local authorities collect information (especially when seeking permission to share information) and service users have not already had a copy or have lost their copy and forgotten what it said.
  4. Community Care Services – A guide to social services for adults This is also a joint Cardiff & Vale local authority leaflet. It is for people undergoing an assessment or review.

To obtain copies of the above leaflets, please contact the Cardiff Learning Disability Team or Vale Community Support Team
Copies of these leaflets can also be downloaded from the Councils’ websites:

Where a Unified Assessment has identified an area of need that is eligible for services and which meets the Fair Access to Care Services eligibility criteria, the Local Authority will identify and propose a care package that is suitable and appropriate to meet that assessed need. However, if the service user does not want the package offered but wants another package instead, the Local Authority is not obliged to provide that other package

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