Factors impacting quality in supported living: choice, independence, equality
In the last blog of this series looking at the learning from the Supported Living Improvement Coalition, Stefan Kallee, Senior Specialist for People with a learning disability and autistic people, looks at the final factors Coalition partners said affected quality in supported living
Over the last few blogs, I’ve talked about how the work of the Supported Living Improvement Coalition is being continued through networks. I also started to talk about the learning about the 4 key factors that Coalition partners said affected quality in supported living.
Working together well to address the ongoing variation in the quality of supported living is so important to make a difference for people.
In this last part of the series, I want to focus on the final 2 fundamental factors affecting the experience of people, their equality and quality of life in supported living. These are:
- Choice, independence and equality: being able to choose the care and support you want
- Relationships: support staff getting to know people
Choice, independence and equality: choosing the care and support you want
Choice came through as a core principle in Coalition partners’ description of what good supported living services look like. This means people should have the ability to choose the type of care they receive, the type of life they lead, and they should live as independently as possible. Coalition partners also talked about how people having equality and universal human rights upheld is central to good supported living.
Coalition partners highlighted some of the barriers to achieving choice, equality and independence for people in supported living services. These included choice of home, institutionalisation, communities, and human rights.
While choice was the underlying principle of good supported living, we heard that people weren’t always being given choice around their homes. People were not being consulted, and large-scale developments were being designed without consideration for people’s specific needs and choices. And because of the links between housing and care providers, people who wanted to change their care provider also risked having to move house — even if they wanted to stay where they were.
People risked becoming institutionalised within supported living services. This can prevent people from living an ordinary life. Factors that contributed to people feeling institutionalised included:
- People not being consulted on their opinions and choices about the types of accommodation being built and offered to people. This risked a lack of integration in communities.
- Multi-occupancy services managed in a similar way to more institutionalised settings, meaning people’s choices and spontaneity were restricted.
- Unnecessary signage and documentation or an overreliance on formal guidelines and checklists. This made spaces feel more like a workplace for staff than a home for people.
Other barriers were linked to the wider community. These included negative or intolerant attitudes towards supported living services and the people who use them, lack of guidance or support around opportunities for people to participate in their chosen communities, and a lack of physical access to community spaces.
We heard examples which demonstrated the links between unnecessary signage and institutionalisation. A family member told us how some accommodation have signs that we wouldn’t have in our homes, such as emergency exit plans on every window and door. This idea was reinforced by a representative of a charity provider who told us about a service where someone had put safeguarding posters which included pictures of “sad and scared-looking people over the whole house”. The house hadn’t been thought about as somebody’s home and how those images might affect them, but thought about as a workplace.
Coalition partners shared good examples of how people were supported by their families, supported living providers and the social care system more broadly to help realise their larger life choices, whilst also helping them with day-to-day support.
[My relative] used to volunteer in the kitchen at a charity café and she had started to get quite upset. So, we asked her if she still enjoyed going, and she answered, ‘Yes, yes’. But then she became even more upset. A staff member began to notice and flagged it to us, saying ‘We’re not quite sure what’s going on here; it is affecting her moods in other activities and we can only pin it to working here’. Eventually, we said OK, let’s get together and ask her: ‘Do you want to do this? This is what your schedule would look like without it.’ She answered, ‘Yes, I don’t want to do it anymore.’ So that was a big choice for her that she’s made recently. She’s much happier. She’s joined a gym instead and goes to Zumba and swimming.
Family member
The voices and experiences of people at the heart of the Coalition constantly reminded us why we were all here: to achieve better outcomes for people.
Relationships compromised by workforce issues: support staff getting to know people
The final factor I want to talk about is the importance of relationships to help people live their best lives.
Staff being able to build relationships and communicate well with the people they are supporting were described as vital. It was thought that these skills can help services build a deep understanding of people’s needs and preferences.
Issues around staff recruitment and retention were said to affect the capacity of supported living services to function — reducing the ability of staff to provide real choice and build meaningful relationships with people in supported living.
[Relationships are] what makes people feel secure, it’s what makes people feel heard, it makes sure that people are heard, because of people who know them well, it provides them with better outcomes, it provides them with better healthcare, it provides them with better everything’
Representative of a charity provider
Everyone knows what I like and what I don’t like. They know me very, very well, I would say. [That makes me feel] great and good.”
Person with lived experience of supported livingIt’s that constant having to train and learn, which is great and I think that is a fantastic part of being part of the care sector; but when you have staff that are only there for 6 weeks […] you have a workforce that don’t always have the necessary training that we would like them to have to deliver that high quality, person-centred care.”
Family member
The spirit of the Coalition has always been about working together to drive real change and improvement. If we want to achieve a shift to more preventative working, people need to get the right care and support where they live. High-quality, community-based options are critical to stop people going into or staying in hospital unnecessarily. Supported living plays a key role in this.
Have these blogs have inspired you to reflect, and think about what you can do — and what we can do together — to ensure a good quality of supported living and positive outcomes for people?
Please do share your thoughts and reflections on our online participation platform.
And look out for an episode of our podcast CQC connect coming soon. In it, we will speak more with people with lived experience and those supporting them about the factors we have discussed in this series.
