Adult placements and person-centred approaches

Adult placement and being person-centred

What is adult placement?

Adult placement (AP) offers people (predominantly those with a learning disability, but also older people and people with mental health problems) an alternative, highly flexible form of accommodation and person-centred support, which is provided by ordinary individuals or families (adult placement carers) in the local community. This enables individuals to share in the life of the adult placement carer.

Adult placement carers provide long- and short-term accommodation and support in their own home, with the majority of carers providing services to one, or at the most two, people at any one time.

Adult placement carers are members of adult placement schemes. These schemes receive referrals, match potential service users with carers, and monitor placements to ensure standards are met.

Regulations affecting adult placement

In August 2004, the government changed the way in which adult placement in England was regulated. Before August 2004, adult placement schemes were required to follow Department of Health guidance, and adult placement carers were registered as 'care homes providing adult placement' with the Commission for Social Care Inspection (CSCI).

From August 2004, adult placement schemes were required to register with the Commission for Social Care Inspection (CSCI). Individual carers are no longer directly regulated.

Adult placement schemes have to conform to the Adult Placement Schemes (England) Regulations 2004. In assessing whether an adult placement scheme meets the regulations, CSCI takes into account published national minimum standards. (2)

Formal definitions

The Department of Health national minimum standards use the following definition for adult placements:

• accommodation with care, or intermediate care, in the family home (habitual residence) of an adult placement carer
• accommodation with support, including support funded through Supporting People, in the family home (habitual residence) of an adult placement carer
• day services based in or outside the home of the adult placement carer
• short breaks, with or without personal care, inside or outside the carer's home
• support in the community by an adult placement carer acting as extended family ('kinship') support or 'outreach' support in the community.

It goes on to define the following terms:

• Adult placement carer A person who, under the terms of a carer agreement entered into with an adult placement scheme, provides, or intends to provide, care or support (which may include accommodation in the adult placement carer's home) for no more than three service users at any one time.
• Adult placement scheme A scheme regulated under the Care Standards Act 2000 (3) managed by a local council with social services responsibilities, or independent (profit-making or non profit-making) body-responsible for recruiting, assessing, training and supporting adult placement carers; for taking referrals, matching and placing people with adult placement carers; and for supporting and monitoring the adult placement.
• Adult placement worker An individual employed by an adult placement scheme who has the competencies, qualities and experience needed to carry out its tasks.

The adult placement model

Adult placement has its roots in fostering. Adult placement carers, like foster carers, are self-employed and are required to share their daily life with the person placed with them. Central to the aims and objectives of the scheme are the following principles:

• to live a normal life in the community.
• to share the daily life of the adult placement carer.
• to stay well and keep safe through the use of key documents and processes.

These are defined in the regulations and national minimum standards for adult placement schemes, and are referred to at the beginning of each chapter in this document. They can be also be found in full at www.dh.gov.uk.

Person-centred planning - an explanation

This is a brief summary; for a detailed discussion, go to the person-centred planning section of this guide.

The government set out its strategy for services for people with learning disabilities in a white paper 'Valuing people' (4) published in 2001. It introduces the concept of person-centred planning (PCP), as:

a process for continual listening and learning, focusing on what is important to someone now and in the future, and acting upon this in alliance with their family and friends'.

Person-centred planning provides the basis for, and promotes, 'ways of commissioning, providing and organising services rooted in listening to what people want'. It is based on principles of rights, independence, choice and inclusion.

So, person-centred planning is about helping a person work out what they want, and person-centred approaches focus on how this is delivered. Services should fit in with the needs of the individual and make changes accordingly, rather than expecting the individual to fit in with what is already there. This means looking to the wider community and not limiting resources to specialist learning disability services.

Implementing person-centred planning means change: change for the person, for the people around them; change for organisations providing services, and for the work staff do: and change in the way the service system engages with people and families'. (5)

' Valuing people' (4) identifies five key features of person-centred planning:

• the person is at the centre.
• family members and friends are full partners.
• person-centred planning reflects a person's capacities, what is important to that person, and specifies the support they require to make a valued contribution to the community.
• person-centred planning builds a shared commitment to action that will uphold a person's rights.
• person-centred planning leads to continual listening, learning and action, and helps a person to get what they want out of life.

In 'Valuing people', the government asked Local Partnership Boards in England to implement person-centred planning in a strategic and joined-up way. The recent government green paper on the future of adult social care, ' Independence, well-being and choice' (1), proposes that person-centred planning should be an integral part of future service provision for adults.