Service User Involvement, Engagement and Empowerment

This section looks at some of the specific issues involved in engaging and empowering the older homeless user group.

Quality Assessment Framework

Empowerment is associated with listening to the user voice, and involving users of services in the planning, delivery and evaluation of services that impact upon them. The new  Quality Assessment Framework (QAF) has a strengthened section on service user involvement. Agencies are measured on a number of issues:

• There is a commitment to empowering clients and supporting their independence.
• Clients are well informed so that they can communicate their needs and views and make informed choices.
• Clients are consulted about the services provided and are offered opportunities to be involved in their running.
• Clients are encouraged to do things for themselves rather than rely on staff
• Clients are empowered in their engagement in the wider community and the development of social networks.

Institutionalised residents

This is a good framework in which to develop service user involvement. In relation to older people there is a complex issue if when consulted their wish is to remain long term in the hostel which they have come to regard as their home. Lessons can be learned from the closure of long stay psychiatric and learning disabilities hospitals. The questions that need to be asked include:

• Is moving older people on a response to a political/funding agenda or is it genuinely in the interests of the resident because a temporary hostel is not an appropriate place to grow old in.
• How far is it convenient and a reason for inaction to take at face value the feeling expressed by older users that the hostel is their home and they don’t want to move?
• What is the evidence that moving older people on who had become institutionalised improves their quality of life?

Engaging older residents in the idea of moving has to start with their feelings about the options. If they are long-term residents and are resistant to the idea it is worth starting with what the resistance is based on.

Resistance to moving on could be based around any of these points or could be a combination of all of the factors:

• They may have pre-conceived and inaccurate ideas about the sort of accommodation they will get, or what will happen to their benefits if they are moved on.
• They may be frightened about the responsibility of budgeting for rent and bills and for looking after themselves.
• Some of them will have left their last home because they couldn’t cope with these responsibilities.
• They may be frightened of the loneliness and of being shunned by neighbours.
• They may be frightened of going in to a care home and losing their independence.
• They may be very attached to a very local familiar area and feel there are no move-on options in that area.
• They may wish to continue to live with people who share their history of an unsettled lifestyle.

These are all realistic fears and should be addressed at the residents own pace. This is time consuming work and key workers are likely to need recognition from management that case loads should be smaller if they are working on resettling older people. Some suggestions are:

• Facilitate access to independent advice and advocacy
• Start to break people out of very fixed routines in the hostel, i.e. where they sit for their meals and who they sit with, and try to introduce new elements to their regular patterns.
• Once it becomes clear that they will move out of the hostel, work to integrate them into a community outside the hostel, find a day centre where they can go for lunch and other social activities in the area.
• Take residents  to visit sheltered schemes or studio flats in the area that they are interested in, contact the warden and ask if there is an empty flat, or if someone has already been resettled from the hostel ask if they could show the resident.
• If there is a sheltered scheme they are interested in (and can expect a vacancy to come up) take them on repeated visits for lunch or tea so that it becomes familiar and they are a familiar face to other residents.
• Talk to the scheme manager about identifying one or two residents who will support and befriend new residents informally.
• If the next move is going to be to a registered care home find out what the range of possibilities is and see if they can be taken to visit different options.
• If they are going into independent accommodation talk to them in detail about what areas they would be happy with, taking into account any community facilities they already use, any friends, transport, shops, GP, day centre etc.
• Discuss any possible interest in contacting family members or old friends they have lost touch with and might like help to be put back in touch with.
• Find out if they have interests and could be linked into local activities such as strollers groups, reminiscence gropus, art groups, gardening groups and look at local befriending schemes
• Consider moving a group of residents together

Further information

 See also section on Institutionalisation.