How can your area ensure appropriate move-on for people with long-term care and support needs?
Using a series of suggestions based on real examples from voluntary agencies, local authorities and housing associations, this page gives some possible answers to that question.
Homeless Link can provide contact details for the examples used. You can also download a good practice briefing MOPP Matters 4 that covers much of this information.
Introduction | Identifying Residents | Staff Knowledge | Assessments: what care/support does your client need? | Registered Care Accommodation - Social Services | Local Joint-Funded Schemes and Long-Term Supporting People Accommodation | Sheltered Housing | Extra Care | General Needs Support - Helping People Away From Institutionalisation | Footnotes
Many hostels, designed to be places of short-term residency, will identify with the fact that older people and those with long-term care and support needs often end up staying longer than they should.
We know that long stays in inappropriate temporary accommodation can create institutionalism and reduce people’s capacity for independent living, but a move-on solution for this marginalised section of the homeless population is not always apparent.
Barriers to appropriate move-on options include:
These barriers exist despite the fact that there are, for example, an equivalent number of older as young people in the homeless population.
This page provides examples of how these barriers are being overcome in different areas across the country. It is important because we must recognise that move-on is not always about the transition from temporary to general needs accommodation.
While the introduction of Supporting People (SP) and the focus on two-year maximum stays in hostels have highlighted the need for move-on, many people with long-term care and support needs are still living in unsuitable temporary accommodation. To help them move on it is vitally important to understand the numbers in an area and the individual needs of each specific client. Traditionally older homeless people and those with long-term care and support needs have been overlooked in terms of priority for move-on because they are less vocal or are long-term residents and have become institutionalised.
back to index
Skills: To help provide effective move-on for people with long-term care and support needs hostel managers should ensure that their staff have skills in the following areas:
Training: Offering training around the needs of older people to hostel staff helps ensure that expertise can be developed and made use of in move-on planning. Homeless Link and SITRA have the capacity to develop specialist training courses around the needs of older homeless people. If this is something that your organisation would be interested in please contact Sarah Gorton.
People with long-term care and support needs require access to appropriate assessments that lead to relevant services. Those with complex and multiple needs in particular require assessments that recognise their circumstances and react appropriately. Homeless agencies report that 58% of their clients have complex needs (Briheim-Crookall, Linda (2006) Multiple Needs and Support, Homeless Link) and the proportion of older people with such needs is likely to be higher.
Homeless Link defines a typical homeless person with complex/multiple needs as presenting with two or more of the following:
And where one issue is resolved, the others will still give cause for concern (Bevan, Pip (2002) Multiple Needs – Good Practice Briefing, Homeless Link ).
back to index
Clients who have ongoing care and support needs that go beyond housing related support may need registered care or a care package (either in the hostel or to support move-on). To access these services they would need to have a Community Care Assessment and be found eligible. Hostel residents can find it very difficult to access appropriate Community Care Assessments, especially if they have chaotic behaviour, a label of personality disorder, misuse substances or a combination of these things. Often this is because their needs cut across pre-defined social services teams. The complexity of people’s needs underlines the importance of a thorough assessment leading to appropriate services. Hostel managers and staff should always draw the distinction between clients who require housing-related support (Supporting People) and those that require care (see information on Fair Access to Care Services and joint-funded accommodation, below). They should then work to ensure that these clients receive appropriate assessments. The following two examples are ways in which this can be achieved:
Outsourcing CCAs can be a way to ensure that appropriate assessments are available for homeless people in your area. Staff experienced in working with homeless people can obtain the necessary information with sensitivity from people who are often alienated from statutory services. They also have a detailed knowledge of specialist provision in the area. As part of its Service Level Agreement with Nottingham City Social Services, Nottingham Hostels Liaison Group’s Mental Health Support Team (MHST) for Homeless People operates such a scheme.
A Vulnerable Adults Panel can help determine what care packages might be needed for people who don't meet single service eligibility (i.e. mental health, older people, etc) but often have high, complex or multiple needs. Individual clients’ cases are referred to the panel for assessment on a regular basis. The intention of the panel is to avoid delays and disputes over funding responsibility. The London Borough of Lambeth operates such a panel.
back to index
There is also a need to ensure that more generalised housing and support needs assessments take account of older people and those with long-term care and support needs. When they replaced an old hostel Blackburn with Darwen Borough Council arranged for all long-term residents to be jointly assessed by the council’s housing needs team and social services department. The assessment outcomes were fed back to a resettlement group including representatives from housing needs, housing strategy, social services, Supporting People and the RSL responsible for both the old and new projects. A resettlement plan (housing and support) was then drawn up with each individual and agreed by all key agencies. The Resettlement Group was a sub group of and reported to the Hostel Reprovision Board, which had high-level representation from social services, the RSL and the council, making it much easier to take the work forward.
Once an assessment has taken place there will be a need for accommodation, support and care services to be arranged for the client. The remainder of this page looks at how you can ensure that your area has appropriate and accessible provision
back to index
Some clients will have needs that entitle them to Registered Care accommodation and it is worth considering this as a possible move-on option. Traditional registered care homes are often unsuitable for previously homeless people and the evidence (Crane M and Warnes A (2002) Resettling Older people – A Longitudinal Study of Outcomes, SISA) shows that those who are moved to generic residential care homes are the least likely to be settled and content. It is also unusual for traditional Registered Care accommodation to promote move-on, but for this client group, whose needs may stabilise and improve, this service is key. There is a scarcity of specialist Registered Care accommodation for older homeless people and those with long-term care and support needs, but examples do exist:
back to index
Commissioners and providers should be clear about whether housing related-support projects they commission/provide are short or long-term and place clients accordingly. People with long-term care and support needs should not reside long-term in short-term projects. This means that appropriate long-term provision for a variety of needs must be accessible and smaller areas should therefore consider cross-authority agreements for certain specialist services.
Some clients living in long-term Supporting People accommodation will also have care needs, which cannot be offered under the Supporting People grant. One option is for areas to provide domiciliary care packages for those individuals that meet FACS criteria. However, a more appropriate option could be to commission innovative joint-funded projects to provide an appropriate residential placement for this client group allowing greater flexibility around those able to access care services in a supported environment. The following are examples of how this could occur:
back to index
Please see the separate section on sheltered housing in this part of the handbook.
Extra care is a housing based alternative to registered care homes. Each resident has his or her own tenancy, but also access to flexible care and support on site. Extra care is a model that could potentially work well for older people with a history of homelessness and complex needs. The combination of independence, their own front door, access to communal facilities and the availability of health and social care on site is the sort of model that small numbers of this client group need.
back to index
It is important to recognise that some long-term hostel residents may show signs of institutionalisation but not have long-term care or support needs that prevent them managing their own independent (or sheltered) tenancy. In order to initiate move-on these clients will need high levels of emotional support and encouragement followed by specialised and perhaps ongoing floating support after the move. For a move to be successful new community links need to be formed at an early stage. To achieve this the hostel can work with social services, Age Concern and other partners to create positive social and support networks, including floating support as required, meaning that clients integrate quickly and thoroughly into their new area. Job Centre Plus could be invited to work in the hostel to engage with residents aiming to establish meaningful occupation (example: Westminster)
(1)Councils were required to implement Fair Access to Care Services by April 2003. This guidance provides councils with a national framework for setting their eligibility criteria for adult social care based on individuals' needs and associated risks to independence. It includes four eligibility bands - critical, substantial, moderate and low. Councils were asked to decide, based on the resources available to them, which bands would be eligible for care services. FACS does not require councils to meet certain levels of need or provide similar services to people in similar needs. When placing individuals in FACS bands councils should not only identify immediate needs but also needs that would worsen for the lack of timely help. Reviews of individual service users' circumstances should be carried out by appropriate council professionals on a regular and routine basis.
back to top | Next section on the private rented sector | See also: sheltered housing
Social care prevention agenda
A Note on the social care prevention agenda: There is increasing evidence of a gap between care services provided by local authorities under Fair Access to Care Services FACS (1) and the support provided via Supporting People. This gap exists because many local authorities do not provide care services to those in low or moderate FACS categories (see Community Care, 11 January 2007, p.6). Hostel staff should be aware of this issue when considering referral and move-on options. The prevention agenda in local authorities should be explicitly extended to include residents of hostels and supported housing.