Shared Lives (Adult Placement) - Models of care and support

Shared Lives Plus is the UK charity that promotes and develops both the Shared Lives and Homeshare models and provides support to member schemes and carers. Shared Lives is better known as adult placement in Northern Ireland and is a unique type of social care regulated by RQIA. Four adult placement schemes were established by a number of legacy health and social care trusts in the 1990s. They have focused exclusively since then on supporting adults with a learning disability. They offer day support, short breaks or longer-term care arrangements in the homes of approved carers in the community. Local schemes have a successful track record in building their services over many years pioneering the drive for more person-centred and community-based care models. Schemes offer people the chance to stay in the community being looked after in a more normal environment and as an alternative to institutions and day centres. With support from the Big Lottery, Shared Lives Plus has been working with key stakeholders in Northern Ireland to expand the adult placement model to support other groups and in particular older people. This work reflects how the model has expanded in the rest of the UK to support a broader range of vulnerable adults. This expansion project is being supported with Department of Health transformation funding and is being led by the Health & Social Care Board in conjunction with the five health and social care trusts.

Current users and outcomes (Northern Ireland)

• 221 adults with a learning disability supported, 214 carers
• Schemes running in four out of five health and social care trusts
• 50 per cent of care provided is shorts breaks
• 25 per cent of adults being supported are in care arrangements that last 4+ weeks

Estimated current financial benefits per year

• £26,000 savings a year for people with learning disabilities compared to institutional care (Social Finance)
• £8,000 savings a year for people with mental health needs compared to institutional care (Social Finance)
• £2,351 savings a week on delayed discharge from hospital (Welsh example) – £413 a bed night in hospital compared to £540 a week in Shared Lives placement

Potential benefits

• Developing this model of care as an additional option available through self-directed support (SDS)
• The adult placement model is well established in Northern Ireland over 20 years providing safe person-centred care
• It offers an alternative to institutional care when family carers need to organise respite care for an older loved one
• It could be developed as a step-down support option from hospital or provide intermediate care in the community
• Provides continuity of care for older people who receive care from the same carers in the community
• Combats social isolation – older people benefit from inclusion in the carers wider family networks
• Potential to support older people in the early stages of dementia with a familiar respite option enabling their family carer to get a break
• Health trusts can avoid costly out-of-area placements in residential settings

Implementation issues

• Expanding beyond learning disability directorates within health and social care trusts
• Addressing low awareness levels about the model and its benefits
• Reviewing and updating carer payment rates to ensure consistency across Northern Ireland
• Developing a consistent regional approach sharing learning and good practice from both Northern Ireland and across the UK
• Can take 12–18 months to establish new schemes
• Embedding alongside other more traditional models of care as part of the scaling-up process

Case study: Older persons (Scotland)

Service-user

Ian was diagnosed with dementia several years ago with symptoms including macular degeneration and subsequent gradual loss of sight and short-term memory loss. His independence was reduced, and his wife struggled to care for him without a break.

Support provided

Ian was referred to his local Shared Lives scheme in Moray, Scotland. He was matched with a local Shared Lives carer taking into account his needs and preferences. Care and support have grown steadily in line with his needs from two hours weekly with the Shared Lives carer to overnight respite in the Shared Lives carer home.

Outcomes

Shared Lives carer support has enabled Ian to remain living at home and in the community. His wife can now access regular respite that enables her to continue caring for Ian.