Modern Warehouses

I have a concern.

The first draft & Easy Read version of the #LBBill is just days from being launched. Thanks to the excellent Chris Hatton, I feel very confident that in a price war between the cost of support for someone living in the home of their choosing VS the cost of residential care/ATUs, we more than ring the victory bell. Considering the national weekly cost of a residential placement/ATU is £3300, a very good home care package will come in at much less than that figure.

However, I see a fly in the ointment and this post is a shout out to people, their families, their carers, or any professionals in the field who fancy spilling the beans. I see a potential fly in the shape of supported/independent living flats/houses that seem to be increasingly popular amongst LAs. The recent upsurge in popularity should immediately set off a warning alarm. They have to be the cheap option. Unfortunately, there are precious little figures in the public domain to see how much these types of living/support packages cost. We want to make sure that #LBBill covers all bases and don’t want to be trumped at the last minute by the Aldi’s of care packages – supported living.

My fear, from what I’ve been learning over the past few weeks is that supported living is becoming the new warehousing. Another great idea, kidnapped by the efficiency savings brigade.

For example, I have learned recently about a block of supported living flats where all the residents (about 25) are classified as “high needs”. Each person has their own one bedroom or studio flat. I fell into the trap set by the Spin and believed that as each person had their own front door, their own living accommodation, they would each get their own made to measure care package. Perhaps mistakenly, I compared them to Steven living in one of those flats and assumed that “high needs” probably meant 1:1 support 24 hours of the day. I still felt that the cost of a package like that would still be cheaper than a residential package but didn’t have any concrete figures to go on.

Then I found out, shockingly, that 1:1 support is not happening. At night times, the ratio is 2 staff to 9 residents. The support staff are not with the people in their flats but monitor from outside the flats. No face to face contact. No interaction. And it appears, although I hope I’m wrong, that a “night” begins at 7pm! So, from 7pm to 7am, the person is left on their own in their cell! flat. Under these arrangements, you can see the costs plummeting. Daytimes are not much better. No 1:1 support. If a person wants to go out, they tend to go in pairs or groups with other residents. And when the numbers for going out becomes unsafe, the rest of the residents tend to get herded into the communal room. The bottom line is that the 25 residents get nowhere near 1:1 support at any time of the day.

I was speaking to a mother last week whose middle aged DS daughter is in one of these types of supported living flats. She has been there just over 6 months. She hates it and is frightened most of the time. The mother and the woman’s sister take it in turns to spend the night with her in the flat because that is when she is most anxious. Not surprisingly, but depressingly, one thing that happened in the first month was for the woman’s medication to be increased significantly. (Incidentally, another shocking figure that Chris has turned up is the cost of out patient psychiatric appointments for people with learning disabilities in 2012/13 was £28.7million. Nice earner there and very nice for BigPharma who will reap the rewards of those consultations). Back to the mother though – she told me that she keeps asking her daughter’s social worker, what was the point of her going to live in this flat? She had a better support package at home and certainly got out more and her anxiety was much much less.

It looks to me that the latest turd in an LA’s crown is to turn the idea of supported living into a residential home in all but name. It’s a warehouse. It’s not about living.

Anyway – the shout out. We need to know the cost of living in a supported living flat like I’ve mentioned above. perhaps there are people who are getting a full, appropriate level of support. if there is – that’s great but it would helpful if you could let #LBBill group know the costs. More significantly, if you have a family member or know someone who is living in supported living under the type of regime I’ve mentioned above, it is important that we have an idea of the costs of that sort of package. I don’t know – perhaps a support package like that isn’t legal, it sure isn’t ethical but anything goes these days. I suspect these figures will be the trickiest to ascertain but are fundamental when costing the #LBBill.

Your help would be very much appreciated. If you know someone in supported living, please feel free to forward this blog post on to them and ask for their help in bringing the figures involved into the public domain. Many thanks.

23 thoughts on “Modern Warehouses”

  1. I am a social worker with experience of the good (there really is a lot of good, though still needs a lot of change) and bad of supported/independent living and related costs. Could not of course give specifics, as can unwittingly break confidentiality, but would be happy to share info generally (no naming clients, specific areas or providers without consent, but you don’t need those details) It isn’t spilling the beans, it’s enabling choice.

    1. Hi Liz. Thank you. Don’t worry – I don’t expect you to break any confidentiality. First off – is the story that I relate in the blog post common? Is it unlikely/likely that a person living in a supported living flat would have 1:1 support for themselves 24 hours per day? If so, can you give a rough idea of the cost? Would the person get a personal budget or would the LA commission an agency to provide the support? If the picture I painted above is more common, what about the costs per person for that sort of arrangement? Thanks

  2. I know you don’t expect specifics, wrote the confidentiality bit so other profs don’t misunderstand and think I’m being inappropriate. I probably worry too much, but I’m fairly new to social media. I’m preparing the answer and tomorrow I can send some real but generalised examples because I think those are most useful to you. Including a recently commissioned 24 hr 1:1 with periods of 2:1 – such a support package is possible.

  3. Mark the situation you discuss is becoming increasingly common, you are exactly right in everything you say. Many housing providers are turning away from the individual approaches to housing because they are being pulled in and working freely with commissioners to create schemes of this nature. In fact, even though CQC is a toothless animal, these schemes are even more dangerous than residential care as there is no regulation apart from the agency regulation.
    Ling recently created a situation if 4 flats.mwe worked hard with the individuals who we knew very well, about what they wanted and needed for the future. No one had family. One young man with autism and his friend decided to have their flats on the first floor. The only two up there. They watch out for each other. They always got on well. Lived together in fact, but found that tough. Two flats are just great for them.
    Downstairs in two flats with separate entrances and gardens are two ladies in their own place who just could not tolerate living with snyone else. The support is completely individualised here not overall.
    Of course Ling were taken off the contract last year to make way for new providers. We still keep in complete touch with every one of these tenants but the attempts that have been made to alter things, even move one person in, have been underhand and detrimental to the tenants. I’m happy to give examples of this and some of the underhand things that have gone on once they get their own people in!
    I’m going to inbox with some suggestions on this.

  4. Your expression modern warehousing so describes the situation. Yesterday we were struggling at work to explain in a term what we meant by this approach. Permission to yes it please Mark. It says it all in two words.

  5. My son is middle aged and lives in supported living, in a housing association flat.

    A major issue here that LA’s can manipulate support ratings from high down to substantial for example; then down to moderate eg no, ‘nothing’, support. Individual needs ratings can depend on LA culture, it’s Political orientation, and priority pressures including last minute budget balancing. I may be wrong, but the shires can appear harshest in their rating reductions and cuts.

    Without family my son would never go to cinema, or theatre and certainly would never go on a day trip far less a holiday. All are ‘wants not needs’. Without us he would not have seen a doctor or a hospital in years. ‘Nothing’ support still for all correspondence, benefit checking….. form filling etc etc. He cant read and has unintelligible speech.

    His support packages vary (usually down) from year to year, and it is a constant battle for safe far less happy support.

    Then: without a family, who monitors the support package? Who monitors the care agency support if the LA does not? Who challenges when things go dangerously wrong? Brokers cannot. PA’s cannot for LA’s won’t pay for it….. Paid advocates are on short intervention only LA contracts, and even if they were experienced enough for a lengthy challenge….they are hamstrung.

    But of course they (who?) can always got to the Ombudsman………………….

  6. I think Marks expression just sums this up. Yesterday we just thought if all the words we could to describe how this is just not supported living but I think if you imagine it as modern warehousing it actually us so correct and very frightening really for the future.

  7. Mark for the last 20 years Martin’s and my only aim has been for him tolive in his own home with 24 hour care for his epilepsy. Now you confirm what I feared. I am having problems simply dealing with this. How do we continue fighting for something that is doomed to fail (and to fail at Martin’s cost – not mine)

  8. Hi Mark
    If you do get some answers on costings can you put them on your blog as I would be interested to know.

    1. Of course. I’m planning on doing a follow up. Have to say though, that at the moment, the figures people are being sent to me, make no sense to me at all. The variations in figures from £700 p/w to £4k p/w for exactly the same service baffles me

  9. You will never get the true figures as you can’t compare everyone is treated on an individual basis. Anyway who checks that they are getting the support that the local authority pays for, the user is not going to be able to tellyou what actually happens. Anyway I understand the care providers at the place you mention are leaving fareŵell party tomorrow and I wonder who will replace them.

  10. Hi mark, I’m writing this on the fly so apologies for this being a bit brief… The HSCIC publish data every year on local authority expenditure and costs:

    There is a set of supplementary tables (the spreadsheet) that has a column on how much is spent on people with learning disabilities and supported living (and other options).

    Also, one of the issues that concerns me about the scenario you describe is whether this really is supported living or actually an unregistered care home (which would be a criminal offence). It’s a bit long and complicated, but basically, to qualify as supported living there must be a) a ‘real’ tenancy, not a sham tenancy agreement, and b) the care mustn’t be provided ‘together with’ the accommodation. This has in the past been interpreted to mean that the person must have a real choice over how they’re supported and who supports them (ie. the landlord can’t dictate that they have to use a care provider who’s linked to the landlord), but I can’t see how you could do that on these 2 for the price of 9 arrangements. It might be worth looking into. I reckon the H&SA might have some thoughts, and the CQC also has guidance on when supported living really is supported living (and when it’s actually a care home). Sorry I can’t link to stuff, got to run, if you’re interested I’ll try and find it for you.

    1. Hi Lucy.
      Thanks. Alicia from H&SA sent me those figures as well today. I think in at least one of the cases, the council would be hard pushed to say that what they provide isn’t care with the accommodation – there is nothing person centred or individual about the care at all. I’ll try and get my head round all the figures and the stories people are sending me and will do a follow up to this post next week.

  11. Not closed down just filled it with more from out of borough placements. I can tell you that you do not want to believe about all the support they get. There seem to be fantastic daily programmes pinned to the wall but I am not sure how much actually happens. From what I can make out they spend a lot of time watching day time tv.

  12. Our son lives on his own with 24/7 support and 28 hrs of 2:1 support. He has been in his own tenancy for many years. SS want him to move to a “new model” where he will share some support. I guess the “new model” will be similar to what you describe. They haven’t got any “new models” available at the moment. If and when they do get somewhere he won’t be going unless it really is in his best interests.

    We have been trying since January to get a DP for our son since January, but are getting nowhere because I am in dispute with them.

    I can’t say any more as this is in the public domain.

  13. Thank you for this interesting post. My sibling lives in a shared house with one other both have LD. Both of them are meant to have 24h 1:1 support. However we have just learnt that this is not being provided all the time. Due to the increased nature of support needed by the housemate. My sibling is being left unattended some of the time so that the house mate can receive 2:1. This is now happening so much that my sibling went missing a few weeks ago thankfully was found safely. Alarm bells ring even in a community house. I feel it comes down to management having the balls to say “this person needs THIS amount of support and we passionately believe that they should have it. It’s about the management of the living area shouting out for what is really needed for their clients and not accepting anything less regulars less of money!

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