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

2. ‘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

3. 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

4. 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

5. 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?

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

7. 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”

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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.

16. 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’

17. 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

18. 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;

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. Resources
“Feeling Settled” Guide: Changing from Registered Care Home to Supported Living
l_Report_February_2011.pdf
CQC Guidance Supported Living Schemes: Regulated Activities for which the provider may need to register
Housing Options:
Ordinary Residence ADASS
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29. Discussion

30. Contact
Ian Copeman
The Housing and Support Partnership, Stanelaw House, Sutton Lane, Sutton, Witney, OX29 5RY.
Tel: