Adult Social Care - developing a specialist response

Where older homeless people have deteriorating health and their needs have become more complex they no longer just need housing related support but Adult Social Care needs to be engaged. This section looks at the barriers and examples of where ASC has engaged with homeless people.

Using the legislation  
 

 The Health Service and Community Care Act 1990 s47 states that the social services authority should carry out an assessment of need of any person in need of community care services, and if that person also has a need for housing within the meaning of the Housing Act they should invite the housing authority to assist in making the assessment. Despite this genuine joint assessments of housing and care needs seem to be relatively rare.

The lack of expertise in Adult Social Care on homelessness issues and the lack of understanding of how adult social care works in the homelessness sector combined with other barriers often result in poor access to services in this client group. People who have long term care and support issues are in hostels when a hostel is often not the appropriate place to be.

Safeguarding adults  

Some older people have been moved out of hostels following a Protection of Vulnerable Adults assessment by social services where they have been found to be vulnerable to bullying, exploitation or intimidation from other hostel residents. A vulnerable adult in this context is a person aged 18 years or over who may be unable to take care of themselves, or protect themselves from harm or from being exploited. This kind of step in this context needs to be used very carefully and not resorted to out of desperation about the lack of move-on options.

Sometimes older people are too vulnerable to be living in a hostel situation surrounded by younger people who are substance mis-users and where the atmosphere is chaotic and challenging. Questions need to be asked about whether it is appropriate to move the victim out of the hostel or whether there is a particular perpetrator who should be dealt with where there has been bullying or intimidation of an older resident. The client should continue to be able to make active and informed choices about where they want to live and staff should ensure that residents are not put into a position of powerlessness. Every Adult Social care department will have a safeguarding co-ordinator. Hostels should ensure they have made links with  the co-ordinator, understand the issues and know when and how to make referrals.

Common Assessment framework

The Common Assessment Framework for Adults brings together and builds on the current Single Assessment Process (SAP) which was introduced as part of the national Service framework for older people, and the Care Programme Approach (CPA) in mental health. The Single Assessment Process is increasingly being used as a framework for delivering services to other adults requiring care, not just older people. Government policy documents are promoting SAP as a model for a national Common Assessment Framework (CAF) and to deliver the benefits of a holistic needs assessment for all adults with long term conditions. CAF aims to improve outcomes for all adults with complex, longer-term health and social care needs. Its unified approach will be especially helpful to those who previously had to deal with separate health, social care and other support systems. Councils with social services responsibilities and NHS trusts, along with a range of other key local partners, including Supporting People, housing authorities, home improvement agencies and community and user led organisations are being invited to be part of phase 2 of the Common Assessment Framework development. They will be asked to test and develop a set of principles relating to the assessment and care/support planning arrangements for all adults. This encouragement of a common assessment framework may lead to a more holistic and joined up response.

Barriers to care

Specialised teams 

 ASC (Adult Social Care) tend to organise in teams according to areas of need, mental health, drugs and alcohol and elderly. Older homeless people do not fit neatly into those categories and so tend to get passed around between them with no-one taking responsibility when an assessment is requested and funding sought. Specialised teams create an incentive to defend budgets and pass on responsibility

Fair Access to Care Services 

 ASC uses the Fair Access to Care Services framework, this describes need in four bands from critical to low, with the majority of local authorities only meeting needs which are assessed as falling into critical or substantial. ASC generally do not carry out an assessment on the street. Once homeless people are in a hostel with 24 hour staffing, despite those staff not being employed to meet care needs, it is often surmised that they are no longer at critical or substantial risk so they are not prioritised by ASC. The lack of budget to meet low level needs and the lack of holistic assessment means lower level needs transform into complex needs.

Substance misuse
 

ASC tend to categorise continuing substance misuse as a lifestyle choice and people can be excluded from getting a care package due to continuing alcohol or drug use. For example incontinence due to alcohol elicits a different response to incontinence related to dementia.

The case studies are examples of local authorities that have addressed these barriers by creating innovative services within ASC