A new report examining the quality of supported living and residential care for adults with learning disabilities has found that most just want to feel part of their local community and who they live with is more important to them than the property itself.
The 200 Lives project, which was led by Professor Chris Hatton of Public Health and Disability at Manchester Metropolitan University’s Centre for Disability Research, examined the quality and costs of supported living and residential care for 200 adults with learning disabilities aged 18-64 years (#200lives).
The aim was to use this information to get good, up-to-date evidence on the quality and costs of supported living and residential care services to people who can make good use of it, including the government, people who commission social care services, organisations who provide housing support for adults with learning disabilities, groups of people with learning disabilities, family groups, and the Care Quality Commission.
It collected information about the costs of housing support services, how housing support services operate, the health, wellbeing and lifestyles of adults with learning disabilities, and the views of family members.
This study was designed to seek the perspective of people with learning disabilities and to include people who did not have capacity to consent to take part in the research to ensure participants with a wide range of support needs.
Nearly £3 billion a year is spent by councils on supported living and residential care for adults with learning disabilities. The number of people needing such support is growing and many adults with learning disabilities living with their families would prefer to live independently. Despite the large amounts of public money being spent, the researchers said that very little is known about how good supported living/residential care services are, and how much they really cost.
Supported living can work well for people with higher support needs
It found that supported living can work well for people with higher support needs. On average, people living in residential care had significantly higher levels of support needs than people living in supported living, as reported by staff and people themselves. However there were people with the full range of support needs living in both supported living and residential care. This suggests that both service models can work well for people with higher support needs.
However, within residential care and in particular supported living, there was a wide range of variation in how services operated. For example, a wide range of institutional practice was reported within both models, with some households scoring very low and others scoring very high. In some aspects, there was evidence of greater restrictions on people’s choice and freedoms within residential care.
This is because residential care homes were more likely to include areas out of bounds to people living in them, and to use deadlocks within the home to restrict people’s access to certain areas or rooms. People in residential care homes were also much more likely to be under Deprivation of Liberty Safeguards (DoLS) than people in supported living, although services across the board rarely prohibited any activities.
Residential care is also considerably more expensive than supported living. Total cost for individuals in residential care was an order of magnitude higher than that for supported living and those people living independently due to the high accommodation costs. There was a significant positive association between total costs and the number of health conditions people had.
Importance of the local community
Who people live with is more important to them than the property itself. For many people, the company of their housemates and staff was one of their favourite things about where they lived. Equally, some people may prefer to live alone or with a partner. When people did not get along with their housemates or staff, this could be a reason for them to want to move.
People also liked being able to put their own stamp on their home. It was important to people that they were able claim space within their home and put their own stamp on where they live. This means having their own places and ‘spots’ within the house, beyond just their room.
Those who were in supported living felt more connected to their local community. These households appeared to be more integrated into their surrounding communities. This can have positives and negatives; people in supported living were more likely to know their neighbours and be more involved in their communities. However, they could be more affected by local crime, antisocial behaviour and deprivation.
In addition, living somewhere for a long time could help people to feel a sense of belonging, as they knew people in the area. People were proud of their roles within their families, friendship groups, local communities and/or romantic partnerships. For example, being part of a local church or supporting their local football team helped them to feel a sense of belonging.
No differences were found in terms of people’s social networks across supported living and residential care, and the average size of people’s social networks was quite small.
The project was funded by the National Institute for Health Research and run by Manchester Metropolitan University in partnership with National Development Team for Inclusion, London School of Economics and Changing Our Lives.