Supported Living: Putting the Person at the Centre of Housing, Care and Support

It is easy to explain supported living by talking about housing providers, care providers, commissioners and Housing Benefit. But that risks starting in the wrong place.

At the centre of every supported living arrangement is a person who needs both a suitable home and support to live their life as independently as possible. Around that person may sit their family, social worker, local authority care commissioner, care provider, housing provider and, in some cases, NHS professionals or other specialists.

The purpose of the system is not simply to place someone in a property and arrange care around them. It is to find a combination of home, care and support that works for that particular individual, while preserving as much choice, independence and security as possible.

That is why the separation between housing and care is so important.

Start with the person, not the property

Imagine a young adult with learning disabilities who is currently living with their parents. Their parents may have provided support throughout their life but recognise that, like any other adult, their son or daughter wants greater independence.

The family may also be thinking much further ahead. Parents who have spent decades caring for a vulnerable child naturally worry about what happens when they become older and can no longer provide the same level of support.

Moving into supported living can therefore be an enormous step for everyone involved.

The individual may need help with cooking, washing, medication, budgeting, attending appointments or accessing the community. They might need someone present overnight or only a few hours of support each day. They may need a specially adapted property, or they may simply need a conventional house in a suitable location with the right support around them.

This is where the wider network begins to come together.

The role of the family

Families play an extremely important role, particularly where someone has complex needs or has relied heavily on their parents or other relatives for support They often know the individual better than anyone else: what makes them anxious, what routines are important, how they communicate, what environment they are comfortable in and what their ambitions are for their life.

However, a vulnerable adult is still an adult with their own rights and preferences and supported living is about recognising that. Subject to their capacity to make particular decisions, the individual’s wishes should be central to decisions about where and how they live. Where someone lacks capacity to make a particular decision, the Mental Capacity Act framework, including the best-interests process, becomes relevant.

The family’s role is therefore important, but it sits alongside the rights, wishes and needs of the individual themselves.

For many families, a successful supported living placement can represent something extremely significant: the transition from a situation in which the family is effectively responsible for both housing and care to one where there is a sustainable professional structure around their relatives.

The care commissioner: working out what support is needed

The local authority’s adult social care team or other professional first assesses the person’s needs. The process considers not simply a diagnosis but what the individual can and cannot do, what outcomes they want to achieve and what assistance is necessary for them to live safely and as independently as possible.

From that assessment comes the care package.For one person, this might involve a relatively small number of hours of support each week. Someone with more complex needs might require substantial daily assistance or 24-hour support.

Finding the right home

Once a person’s needs are understood, the next question is what sort of home will allow that care and support to be delivered successfully.

A person with mobility difficulties may need level access, wider doorways or an adapted bathroom. Someone with sensory needs may benefit from a quieter environment and particular internal design. Another person may be physically independent but need to live close to family, public transport or familiar community facilities.

The property therefore cannot sensibly be considered in isolation from the people expected to live there. In a well-designed scheme there should be a logical pathway from individual needs to their ongoing care and housing support:

individual need → care assessment → appropriate care package → suitable accommodation → ongoing care and housing support.

For investors, understanding that chain is far more useful than simply being told that there is “demand for supported housing” in a particular area.

The care provider

The care provider turns the care plan into day-to-day support.

Its staff may help residents with personal care, medication, preparing meals, accessing education or employment, attending appointments, developing life skills or participating in the local community. The precise service depends upon the individual.

Where regulated personal care is being provided, the relevant provider will generally need to be registered with the Care Quality Commission.

The care provider will usually have regular contact with the resident, their family and the professionals involved in their care. If someone’s needs change, it may be the care provider that first identifies this and raises it with the social worker or commissioner.

Importantly, however, the care provider does not necessarily control the person’s home.

Why housing and care are separated

This is one of the fundamental ideas behind supported living.

If the same package inseparably provides both accommodation and personal care, the arrangement begins to look more like residential care. In supported living, there should instead be a genuine separation between the person’s accommodation and their personal care arrangements.

That separation provides an important protection for the resident.

If they are unhappy with their care provider, it should be possible, subject to the commissioning arrangements, to change the care provider without automatically losing their home. Equally, a change in someone’s care requirements should not in itself terminate their right to occupy their home.

The property is therefore not simply somewhere that the care provider puts a service user.

It is the vulnerable person’s home.

That may sound like a subtle distinction, but it goes to the heart of supported living.

The housing provider has a different relationship with the resident

The housing provider is concerned primarily with the home.

It will typically be responsible for the resident’s tenancy or occupancy arrangements, collecting rent, managing repairs and maintenance and dealing with the other responsibilities that come with being a landlord.

Depending on the particular supported housing model, it may also provide housing-related support. That distinction can be important for Housing Benefit purposes because the rules around exempt and specified accommodation look closely at who provides care, support or supervision and on whose behalf it is provided.

Separation of personal care and housing should therefore not be confused with the housing provider having no involvement in the resident’s support.

The housing provider and care provider have different responsibilities, but they need to communicate effectively.

If a boiler fails, that is fundamentally a housing issue. If a resident’s care needs increase, that is principally a care issue. If someone’s behaviour is placing their tenancy at risk, however, both sides may need to work together with the individual, their family and the commissioner to find a solution.

How everyone interacts

The best way to think about supported living is as a network around the vulnerable person rather than a series of commercial contracts.

The vulnerable person is at the centre. Their needs, wishes, safety, independence and quality of life are the reason the arrangement exists.

Their family can provide continuity, knowledge and advocacy and may remain closely involved in important decisions and the person’s life.

The social worker and care commissioner assess needs, determine what eligible care and support is required and arrange or fund services in accordance with the applicable framework.

The care provider delivers the day-to-day care package and sees first-hand whether it continues to meet the person’s needs.

The housing provider provides and manages the home and deals with the resident as a tenant or occupier rather than simply as a recipient of care.

The Housing Benefit team performs another distinct function. It determines the individual’s entitlement to Housing Benefit and the treatment of the accommodation under the relevant rules. Housing Benefit approval should not therefore be confused with the commissioning of someone’s care.

These parties have separate responsibilities, but successful supported living depends upon them communicating effectively.

What happens when someone’s circumstances change?

If a person’s mobility deteriorates their family or care workers may notice the change first. The care provider should then raise it with the social worker, who will pass the information to the commissioner who might reassess the person’s care package. An occupational therapist might recommend physical adaptations and the housing provider may then need to consider whether those adaptations can be made to the property.

The objective should be to enable the person to remain in their home whenever possible.

Alternatively, imagine that the care provider is performing poorly. The family, resident or commissioner may raise concerns and ultimately another provider could be appointed. As the care and housing providers are separate entities, the resident should be able to remain in their home whilst the care provider is replaced.And this continuity can be particularly valuable for people for whom unexpected change is difficult or distressing.

Why this matters to a supported housing investor

For Housemartin investors, understanding this network provides important context for assessing the long-term use of a property.

A long lease to a housing provider is important, but it is only one part of the picture. Ultimately, the property needs to remain somewhere that vulnerable people actually need and want to live.

Evidence that a local authority has assessed individuals as requiring care, that appropriate care packages are funded, that a credible care provider is involved, that families and professionals support the placement and that the property has been selected or adapted around genuine needs can all help demonstrate the rationale behind a scheme.

But none of those factors creates a guarantee.

Care packages can change. Residents can move. Families can change their views. Commissioners can alter strategies. Care providers can be replaced. Housing Benefit decisions can be reviewed and housing providers themselves can encounter financial or operational difficulties.

That is why the relationships between all the parties matter.

A home first

There is a tendency when looking at specialised supported housing as an investment to focus on leases, rents, and yields. All of those things matter, but at the heart of any supported living arrangement is a vulnerable person who needs somewhere suitable to live, who deserves to be safe, secure and able to live as independent a life as possible. The aim of supported living is to create a structure in which different organisations can work together around this goal, where there are properties to match the individual requirements of those that need support.

If you would like to help those that need support by providing them a home that matches their needs, join Housemartin today.