Adult placements and person-centred approaches
Adult placement carers
Standard 8 states that the adult placement scheme selection, procedure and training programme should ensure carers have the competencies and qualities to carry out the tasks required to meet the person's needs.
It goes on to say that carers should receive training to meet Topss - now 'Skills for Care' - induction and foundation standards, and any national occupational standards for adult placement carers, linked to Learning Disability Awards Framework requirements, if the person has learning disabilities.
Annex 4 defines in detail the process that must be used. It includes:
- a pre-application meeting
- completion of an adult placement carer application form
- satisfactory completion of references and checks
- demonstration of adult placement carers' skills, knowledge and abilities to support service users
- completion of the scheme's pre-placement learning and assessment programmes, and approval by an independent approval panel.
Annex 5 of the national minimum standards sets out the 25 adult placement carer skills and knowledge statements. Annex 6 of the standards details the way in which the approval panel must operate. Regulation 16 and Schedule 3 of the 'Adult Placement Schemes (England) Regulations' set out the requirements that must be satisfied by prospective adult placement carers before they can be approved.
Motivation of adult placement carers
- schemes involved in the practice survey emphasised the importance of adult placement carers as the resource upon which adult placement depends. Issues raised during the practice survey had implications for the selection, support and training of adult placement carers (and of the adult placement workers who support them).
- most of the adult placement carers interviewed spoke of helping the person placed with them to change, grow, develop, and become more independent.
- whilst a few were aware of, and used, the language of person-centred working, it was clear that adult placement carers are most motivated by 'giving' and 'caring'.
Despite a background in care, and relatives who have been adult placement carers, R believes that pre- and post-approval training is definitely valuable in helping him support the needs of the people placed with him (especially on challenging behaviour, medication, and safety) but also to give him confidence in his attitudes and working methods.
- although all the carers interviewed were enthusiastic about their jobs, several were frustrated by changes in their roles, and felt they were not valued and were 'doing it wrong'.
- one carer said that other professionals were not interested in their views, and didn't involve them-'you're just the adult placement carer.'
- several were concerned that adult placement was becoming more user- than carer-centred: meetings with adult placement workers were now 'all about service users' rights.'
The Gs are successful, long-term carers who appear to work in a very person-centred way, and think highly of their adult placement scheme. However, they feel that the scheme now focuses more on (and cares more about) the person placed than about them. At the annual carer review, the scheme worker now has to talk to service users about their views of carers-this should be the carers' time. They attribute these changes to 'the government', 'the system' (regulatory requirements), not the scheme. They resent twice yearly National Council for Social Care / Commission for Social Care Inspection inspections despite consistently 'high marks'.
- in the practice survey, managers and staff spoke of the importance of both pre- and post-approval training for adult placement carers, and of an 'evolutionary' approach to changing the practice of traditional carers. Once again, NAAPS 'Learning the ropes' (23) was thought helpful.
- some long-standing carers believe they know best how to support the person placed with them, and do not value or attend scheme training events.
- changing working practice was particularly difficult for older, long-standing, traditional carers, who were resistant to change ('we tried it and it didn't work'), or found new requirements daunting.
- when one scheme expanded to include former small care homes, scheme workers re-assessed these carers and made judgements about whether, with training and support, they could raise their standard of caring.
The changing role of adult placement carers
The introduction of national minimum standards for adult placement has led to changes in the roles and requirements of adult placement carers. Carers now have to demonstrate that they have the skills and experience to do their work, and they are expected to participate in on-going training and learning designed to ensure that they continue to work effectively with the people placed with them. They are subject to regular support and monitoring visits and to annual reviews of their work.
For established carers these changing expectations can be hard to accept. They have been providing valued placements for many years and possess numerous skills. The challenge for the adult placement scheme is to work with carers in a way that values their experience and skill but enables them to develop and work in new ways.
Training and learning opportunities are important in helping adult placement carers to reflect upon and change their practice, although the practice survey found that this can be a difficult process with which to engage some carers.
Schemes are sometimes faced with the realisation that the carer's practice is unlikely to change. They will then have to make a judgment about whether the placement is 'good enough' and whether the benefit to the person of staying in the placement outweighs any disadvantages.
Effective adult placement carer support
Inherent in this is the notion of the service user moving towards independence, rather than staying with the carer for life. This can, potentially, change the relationship, and yet there is still an expectation that the carer will provide a safe and loving environment. This is a role that requires a significant level of flexibility, understanding and insight into the needs of the service user, as well as the ability to put all of that knowledge into action. Support from the schemes to do this effectively is essential, as is effective recruitment of carers.
Yet, there does seem to be a conflict of interest for adult placement schemes where there is little on-going support provided by the care manager. Supporting the service user might then become the priority, to the detriment of the carer.
Additionally, it is clear that where there is no social work support for the person in the placement, the carer may resent the adult placement worker's attention to the service user and feel less valued by the scheme.
This has implications for a whole range of issues, including the carers' development of their skills base, and their ability to work in a person-centred way without adequate support. It also calls into question the role of the care manager, and is, therefore, an issue for commissioners.
Person-centred planning will not be done well, or will not go beyond the planning stage, if the people who should implement it do not have the skills or resources to do so.