The Great Supported Living Mystery

Over the past few months there has been some discussion and an under the radar focus on supported living and what it all means. The coming of the Care Act (and its market position statements), the Green Paper “No rights ignored, No voice unheard” and the general clamber to develop supported living throughout the land has stirred a debate and raised some questions, but all to often the wrong ones.

A short while ago Lucy Series (@TheSmallPlaces) in her blog A stupid question (about supported living) asked some of these questions and more. Lucy introduced us to the regulatory framework and the reality of what supported living may mean i.e. who does the washing up and who does the cooking. This seems to be as good a place to start as any, we may want to throw in “who owns the office next to my living room as well”.

The fundamental issue is that supported living whatever it may be is certainly not a thing. It is true that the Care Act has introduced a set of descriptors via the Choice of Accommodation regulations. The first time for me that we have a clear set of “things” with which to badge Supported Accommodation. Prior to this the reality is that supported living was either, a residential unit by any other name or a glorified home / domiciliary care service. Do these new descriptors help the situation? Cynically and in one sense they may well do, as the focus is on the property and the people. If you follow the guidance to its conclusion, then any building that a is designated as accommodation for adults that need care and support, or in circumstances where personal care is available if required is supported living. In reality could these tests be easily met at the direction of a commissioner, procurement officer or a landlord. Stating that it is so, rather than the reality of whether it is what’s needed or chosen by the individual.

Here for me lay a very important issue one that seems to be very rarely spoken off or acknowledged. Supported living means money for social, charitable and not for profit Landlords. There is a strong chance that I’m misunderstanding some of the statutory frameworks at play here. However if this is the case then so are landlords commissioners and housing depts the country over. You see, if you deem a property to meet a certain criteria then the rent can increase, and I mean really increase. Most supported accommodation if it meets a certain criteria can charge rent outside of the usual rent level restrictions for housing benefit payments. This means that the rent can be charged at a much higher rate and amounts as much as £300-400 a week for a single bedroom flat or even a room in a shared accommodation (non London) is not unheard off.

So how do you get to such a level of rent and what has it got to do with the adult who needs care and support, do they like luxury properties more than the rest of us? Well the answer lay in the ability to increase the rent if you meet the following criteria.

“Accommodation provided by an upper-tier county council, housing association, registered charity or not-for-profit organisation where that body or a person acting on their behalf provides the claimant with care, support or supervision.

The person ‘acting on their behalf’ seems to mean that the landlord sub-contracts the care, support or supervision to another organisation. In the days before Supporting People went live in April 2003, this was a very common arrangement.

In most cases now, the care, support or supervision provider is contracted by a local authority. Where the landlord is not the care/support/supervision provider the accommodation will not be “exempt accommodation”.

This is the case, for example, where:

  •   There is a managing agent contracted by the landlord to do the housing management and by the local authority to provide the care, support or supervision
  •   The landlord does the housing management but the local authority contracts with a different organisation to provide the care, support or supervision.By contrast, if the organisation providing the care, support or supervision leases the property from its owner and becomes the tenants’ landlord, the accommodation will be considered exempt.”

So my take on this is, if you are in need of care, support or supervision and this is provided by the Landlord or indeed the Landlord sub-contracts this function then the property is exempt and rent can be charged at whatever specified rate. This raises a very important question in that who regulates or checks on the quality of the care, support and supervision provided  or sub-contracted for by the Landlord. It does not appear to fit the CQC, unless some form of registered activity is taking place. Nor would it fit with monitoring by local social care commissioners as there is no commission or contract present. In reality Landlords rarely provide any care, support or supervision in care terms and just use the concept of supporting people in their need for housing management as the function that fulfils the exempt rent rules.

There has been a string of litigation on this issue – principally before Upper Tribunal Judge Turnball. Now, I am no legal expert but these are my naive interpretations. The litigation has principally turned on whether the landlord is providing more support – as a consequence of the disability(ies) of the tenant(s) – than would ordinarily be expected of a landlord in the exercise of their usual housing functions. In two cases the Upper Tribunal has undertaken a step by step analysis of the amount of support provided. In the Chorley BC case (2009) he held that the landlord did provide enough support to amount to exempt accommodation. In Oxford City Council (2012) (Oxford City Case 2012 (DW v Oxford City Council (HB) [2012] UKUT 52 (AAC)) he held that Renaissance Homes were not undertaking enough support and as such the accommodation was not exempt. in essence there is an easy question that Landlords and commissioners can ask;

Am I the landlord? Do I provide the care, support or supervision or does the local authority do it?

The answer will nearly always, in my experience, be the local authority and as such the property is not exempt. The Oxford case above set out a reasonably high threshold as to what care, support and supervision mean in relation to housing support and where this is above the normal expectation of a housing Landlord. Often, I would argue, landlords do not go above this threshold.

Why then is it still common practice for supported living in all its forms to be deemed exempt and have an abnormally high level of rent charged. Surely this process is not a potentially lucrative one for landlords in the category above so as  to be able to ensure a significant income based on the label of disability?

I suppose the other question is why should I worry about this, what harm does it do and surely its better to have this and give people access to a tenancy and home of their own. Well yes, if this were the reality. But the bigger question we have to ask is, is this the reality?

This process of high rent leads to fundamental floors in supporting adults with care and support needs to be able to live as valued, included, contributing members of society;

1) By defining the building we continue to define the segregation. There is a perverse incentive on housing associations, registered charities or not-for-profit organisations to look at collective ghettoised approaches to housing delivery and development. A block of supported living flats or the old group home scenarios of shared properties attract cash and maybe for some the ability to sustain their organisation. This hardly bodes well for the development of independent accommodation or more importantly a system of access to general rented or owner occupier housing for people who may also have care and support needs.

2) Economic independence is unachievable. If you live in a property that attracts /demands such a high level of rent you are in fact removing the opportunity for people to strive for employment and economic independence. The second you can no longer claim HB due to employment you can no longer pay the significant rent. A vicious circle that seems to be addressed by social care and healths inability to support people to employment anyway rather than the thorny question being answered because full employment has been achieved.

3) You just can’t get out! you may say the answer to 2 above is to move on out. If you can work then you probably don’t need to live in a supported living “unit”. This would seem to be a great resolution to 2 if it were not for a few factors. Firstly employment does not mean you no longer have care and support needs. Secondly this is a tenancy, probably assured, so you try to find a social landlord who will provide you with general needs housing. the usual responses are, they have a disability they need care and you should provide it social services or the most damning, they are suitably housed and therefore not a priority. Should social care find an alternative it will still be supported living with the same issues. Should you take up a private tenancy you will lose the vast majority of security you had and potentially live in a world of short-term lets. Finally if you leave a suitably housed position you will be accused of making yourself intentionally homeless. This is all assuming the stress hasn’t led to a stay in an ATU, in which case your stuffed and will probably go back to square one and residential care or even worst a “step down unit” (whatever that is).

4) Its your bloody home, why should you move, why don’t you lot move the care and support on to somewhere else and stop calling it supported living and charge a fair rent.

All of these issues are valid and real for so many people everyday. Our attempts to deliver supported living although well-meaning, in reality, have achieved very little nationally other than to restrict people in exactly the same way as they were in residential care.

The early drivers for supported living were clearly designed to enable people to start to live in housing that we called mainstream and start those steps towards real community and citizenship. Then, for some reason, it went wrong and became the bastion of models and service delivery and specs designed at the behest of everyone but the tenant. Clearly it also served as a function to remove hotel costs from residential placements and seek alternate funding streams for the rent. All well-intentioned and efficient but alas became the exact thing it tried to replace..

The REACH standards I would contest are unrecognisable in the majority of supported living provisions across the country.

  • I choose who I live with
    I choose where I live
    I have my own home
    I choose how I am supported
    I choose who supports me
    I get good support
    I choose my friends and relationships
    I choose how to be healthy and safe
    I choose how to take part in my community
    I have the same rights and responsibilities as other citizens
    I get help to make changes in my life

I can’t find any Reach standards that suggest;

  • I choose to have an office inside my home
  • I choose to live with strangers who come and go at the behest of others I don’t know
  • I choose to pay a rent so high because I need something different to everyone else
  • I choose to move from my home because you say I have done so well I need to move on
  • I choose to do all the stuff I did on residential care, pool my food money, shop together, eat together, go to the day service together.
  • I choose to go to bed when people tell me
  • I choose to have staff that I have not appointed or indeed have them walk my home at night because they support someone else in this shared home.

Of course I am being a tad critical but this is the reality for so many people, not you or me but so many who by virtue of needing care and support give up their rights to real homes as payment. The honest picture is that where residential homes are de-registered they remain residential homes. Where shared supported living grows, institutional regimes can still grow. You see, the thing everyone forgets about supported living is that it has nothing to do with buildings or contracts or the need for Landlords to gain an exorbitant financial income on the back of people with disabilities. It does however have everything to do with a sense of thinking, a sense of creativity and a sense of what living in a home means to you and me. Supported living has to be a way of living, a way in which people can at least have a fair stab at being included in society and show that our communities are a poorer place without their skills and contributions.

The building in reality can be achieved in many ways and ways that do not include a complicated interpretation of landlord, commissioner, social care and healths needs before that of the individual. At what point did we decide that just because people have care and support needs they no longer have the need to live in mainstream social or owner occupier housing. Clearly there needs to be variety in accommodation but a variety that fits around a person, their choice and the care and support needs they have. Not a choice that is delivered via de-registration, or vacancy lists. If we are to ever support people in the way that the Care Act and Green Paper want us too then we need to have a very honest debate about the way in which we currently allocate people housing based on who can meet someones needs and in what building. If we don’t the costs will continue to increase, the outcomes will never be achieved and our community will forever remain segregated.

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