Improving outcomes for service users in adult placement - Commissioning and care management
Making good placements - Emergency placements
National minimum standards require adult placement schemes to ensure sufficient information is available about and for the service user at the time of the placement, to protect all those in the placement, and to provide a placement agreement and meet other placement criteria within three days. The standards make clear that an emergency placement is not a fast track to a permanent placement (though with ongoing review and support some placements may successfully continue long-term).
When Sula’s adult placement carer became suddenly and seriously ill, other arrangements had to be made quickly for Sula, who has learning and physical disabilities. A review meeting including Sula, her daughter and scheme worker, agreed Sula could stay on a temporary basis with another adult placement carer with whom she had had previous 'respite’ stays. Sula settled well in her temporary home. When it became clear that the previous adult placement carer would no longer be able to work, a full review looked at all the options for Sula and decided to extend the placement on a long-term basis.
The first-stage practice survey found referrals for adult placement are frequently made on an emergency basis, making it difficult for schemes to follow good practice in matching and introductory processes, and often resulting in less successful placements.
Project discussion groups identified a variety of scheme policies on accepting emergency referrals. Some have adult placement carers approved for emergency placements, while others - Lewisham, Essex - firmly say 'no’. Some care managers also thought schemes should refuse to accept 'Friday night syndrome’ referrals. Several schemes thought too many placements were made as emergencies, under pressure, to help out the referrer or not disappoint a vulnerable person: one adult placement worker said schemes 'want to make it happen’. Participants agreed that emergency placements should be made only with carers approved and trained to do so; that schemes should resist pressure to make emergency placements without adequate information; and that schemes and care managers should be satisfied that the placement is appropriate and safe.
In the Essex Home Share Day Care scheme, staff and care managers are very clear that the scheme provides planned day care, not 'respite’. Even where a family carer is 'on their knees’, and alternative support is urgently needed, the assessor will not refer to the scheme and the scheme will not accept a referral. (If an adult placement carer is ill then the service user might be placed with another day service carer.) Home Share Day Care is considering a different, home-based service where a carer would go to the service user’s home in an emergency. In East Sussex the whole adult placement scheme is registered for the local authority short-stay (respite) voucher scheme.
Line managers should:
- Develop protocols between care managers and adult placement schemes for delivering minimum information requirements for emergency placements, and for providing follow-up information (meeting the requirements of national minimum standards).
- Recognise that a crisis in an existing placement needs care management re-assessment and social work input. Commissioners should not assume that the adult placement scheme will find an emergency placement with another adult placement carer (although sometimes this may happen); nor should they assume that difficulties within a placement require that the person be moved elsewhere
- Ensure that care managers understand and respect the difference between planned short-stay and emergency placements. Commissioning bodies should have comprehensive strategies for providing both services; adult placement schemes may be able to help as part of this overall strategy.