From care home to having a home Deregistration: Making it work for residents

‘Deregistration’ - What are we talking about? When is a registered residential service not a care home? Language – supported housing and supported living Access to housing tenure and rights The promotion of citizenship Usually people with learning disabilities and people with mental health needs

From residential care to housing with support Change of ‘registration’ in situ/remodelling of existing service, including property remodelling ‘Decommissioning’ a residential care service (in-house or external) and reproviding with housing and support alternatives Terminating ‘placements’ and finding alternative housing with support options

Possible drivers Local authorities needing to make substantial spending cuts Care and support providers reviewing service models Drive towards ‘personalisation’ of care and support Housing provider concerns with residential care models Pressure in the care monitoring system

In whose interests? Financial motivation – local authority? Service sustainability motivation – care provider? Housing provider – desirability of care model and suitability of property? When is it in the residents’ interests?

Background Not a new idea Pre Supporting People Valuing People Local authority policies More recent cost pressures Some individuals and self advocates

Current Position Currently 30% of adults (approximately 33,000 people) with a learning disability live in accommodation that is registered for persons who require nursing or personal care with the Care Quality Commission. Feeling Settled, 2011 Think Local, Act Personal: Next Steps for Transforming Adult Social Care encourages the facilitation of a: “broad range of choice in the local care and support market, including housing options, and personalisation of the way in which care and support services are delivered wherever people live”

Deregistration - Key Players Care providers Support providers Housing providers Care Quality Commission Local authorities/commissioners NHS (sometimes) Housing benefit Families Advcoates/IMCAs

Perspective – supported living sector People with disabilities and their families have higher expectations Supported living offers people more rights and more disposable income Following NHS Campus reprovision programme the focus will shift to reproviding for out of county residential placements that are perceived as expensive and of mediocre quality Economic realities - supported living is perceived to be a less expensive option Personalisation agenda

Perspective – residential care sector Residential care more fully regulated Package can still be attractive – often marketed to families Contest cost/savings vs. supported living Argue that individualised care/support can also be delivered Residential services continue to be commissioned

Perspective - housing providers May have historic residential services Prefer to offer proper housing tenure Concerns about best use of property and future suitability for residents But: May be wary of LA motives Concerns about monitoring arrangements Future relationship with support provider

Example Choice Support have been able to achieve a significant reduction in revenue costs as a direct result of changing services from Residential Care to Supported Living. They have reduced their fees to Southwark council by £164,000 in 2010/11 following the change of registration of 11 small registered care homes in that Local Authority Feeling Settled, 2011

Tensions… Care quality and registration requirements Care management and assessment Mental capacity Housing options and tenure Housing benefit Ordinary residence Funding of care and support Best interests of residents

Considerations: CQC What is a Supported Living Service? “SLS are where people live in their own home and receive care or support to promote their independence. If there is genuine separation between the care and the accommodation, the care they receive is regulated by CQC but the accommodation is not.” CQC Guidance for Providers February 2011.

Considerations: CQC It is important that a provider is correctly registered for the regulated activity they are actually carrying on. In order for a provider of a supported living service to be correctly registered to carry on ‘personal care’, rather than ‘accommodation for persons who require nursing or personal care’, there must be a clear separation between the provision of care and the provision of accommodation. CQC Guidance for Providers February 2011.

Considerations: role of local social services authority Assessment duty and care management role remains FACS criteria May have differing approaches to ‘personalisation’ and funding via ‘resource allocation system’ May have different approaches to ‘person centred planning’

Considerations: housing Support change in registration process? Any changes required to existing housing (in situ)? Alternative housing options required? More complex ‘housing transfer’ arrangements? Nomination and voids agreements Relationship with future support/care provider

Considerations: mental capacity and tenancies If someone has capacity, they should sign their own tenancy agreement If a person lacks the mental capacity to make his or her own informed decision about whether or not to accept a tenancy offer, then an appropriate person can make the decision through the best interest process outlined in the Mental Capacity Act. Some landlords may be content to accept unsigned tenancies Someone can sign a tenancy agreement on the person’s behalf if they: Have lasting power of attorney (LPA) or enduring power of attorney (EPA); Are a deputy appointed by the Court of Protection;

Considerations: housing benefit Is there a rental liability Do the residents hold tenancy agreements? Are the tenancies ‘contrived’? Usual HB/LHA rules will apply Involve HB departments early in the process

Considerations: ‘ordinary residence’ Often a key barrier (for local authorities) The ADASS national protocol on Ordinary Residence in 2010, complements the DH Ordinary Residence: Guidance on the identification of the ordinary residence of people in need of community care services, England Level of sign up from local authorities was insufficient to go ahead with the protocol - in practice issue remains unresolved

Considerations: care/support funding LAs - new services should be at least cost- neutral and increasingly they are looking for overall and / or individual reductions in service costs. Link to self assessment and Resource Allocations systems – may be unclear Future funding security/viability Individuals need to be properly supported to maximise the welfare benefits they can claim once they become tenants

Deregistration – putting it together Local authority in South West National care provider (learning disabilities) 9 residential homes for 52 people 3 existing Registered Providers Long standing services Wide mix of residents ages/needs

Deregistration – putting it together Planning: Local authority – care management and funding position CQC – approach and timescales Housing providers – views and options Housing benefit – awareness & circumstances Individual and families Advocacy group

Deregistration – putting it together Delivery: LA – assessments LA/provider – housing assessments Advocacy group – individual plans Care and support ‘models’ Approach to ‘personalisation’ Housing providers – tenancy agreements/arrangements with care provider Agreement with CQC – care provider Agreement with HB – housing providers

Getting it right for residents 1 The needs of individuals – putting the person and carers at the centre of the process The role of local authority – assessment and care management process should be clear Finance – revenue and capital considerations considered at outset Relationship between housing and support/care provider - clarity and any agreements in place

Getting it right for residents 2 Working with CQC – at outset of process Mental capacity - any problems identified with correct approach/timescale Tenancy issues – suitable tenancy ‘models’ and link between holding a tenancy and capacity; HB issues resolved Ordinary residence – identified and addressed Staffing issues – training, culture, TUPE

Unavoidable issues Who ‘drives’ the process Housing and support/care provision Funding – Any capital funding requirements Revenue cost drivers – need to model carefully (CFCs may not always be reliable) Capacity and ‘best interest’ processes Tangible change in support provision and culture - service quality Satisfying CQC

Resources “Feeling Settled” Guide: Changing from Registered Care Home to Supported Living www.ndti.org.uk/uploads/files/Feeling_Settled_Fina l_Report_February_2011.pdf CQC Guidance Supported Living Schemes: Regulated Activities for which the provider may need to register http://www.cqc.org.uk/publications.cfm?fde_id=17 217 Housing Options: www.housingoptions.org.uk Ordinary Residence ADASS http://www.adass.org.uk/index.php?option=com_c ontent&view=article&id=287&Itemid=238

Discussion

Contact Ian Copeman The Housing and Support Partnership, Stanelaw House, Sutton Lane, Sutton, Witney, OX29 5RY. Tel: 07894 904355 Email: enquiries@housingandsupport.co.uk