Improving outcomes for service users in adult placement - Commissioning and care management

Making good placements - Care plans

Adult placement service users should have a care management care plan, which sets out how their needs and preferences will be met through adult placement. The national minimum standards require that the scheme receive a copy of the care plan, which will form the basis of the service user plan and placement agreement.

Until her father died, Josie (aged 37, with learning disabilities) lived at home where she was content but over-protected; she rarely left the house or saw people other than family members, and had few life skills. Josie’s social worker spent a lot of time with Josie, and sometimes with her sister and aunt, learning what Josie would like to do. While Josie could go to live with her sister, she yearned for friends, to learn to cook, and to go out on her own. Josie’s care plan established that a supported home-based service outside the family would meet her needs, as part of a package including a day service offering accredited basic skills training. Josie was referred to the adult placement scheme and, following further assessment, was matched with an adult placement family and soon blossomed: Josie is learning to look after her own diet and personal hygiene, becoming more confident, helping with cooking and laundry, and learning to cross roads and take the local bus to college.

The first-stage project found that adult placement service users (particularly those in longstanding placements) are unlikely to have a care management care plan, and that even where a care plan exists it seldom provides the information the scheme requires.

Discussion group issues

Discussion group participants confirmed the findings of the earlier SCIE project: only those people recently referred for adult placement are likely to have a care management care plan; schemes almost always carry out their own, detailed assessment (see Assessment) and produce their own 'care plan’. Participants agreed that schemes should insist on a full care management care plan from the purchaser before accepting a placement.

Participants also noted that some care managers have a poor grasp of what a care plan should provide, and/or do not have time to do a detailed care plan and assume the scheme will produce one. The quality and relevance of care plans was queried, and the summary of assessed needs was sometimes thought to be more useful than the actual care plan which - according to one scheme manager - might be 'just a list of funded services’.

Service users, families and sometimes adult placement carers are confused by what one scheme worker called a 'series of care plans’ (community care plan, service user plan, placement plan, person-centred plan, and potentially an individual funding/broker plan). Some participants thought the adult placement carer should receive the full care management care plan, while others suggested the summary assessment or the scheme’s own assessment was more appropriate. Several participants suggested that the array of plans might be rationalised or combined (see also Review and change).

Practice points

Line managers should:

Care managers should: