Another development in the fundraising strategies is to go for larger amounts and in collaboration with other fund seekers. This joint working approach is what funders want to see and it also reflects the growing need for this service; all very well in theory but I believe that there are problems inherent in this approach, for both smaller and larger advocacy organisations and -most importantly - for service users.

Secondly. advocacy umbrella organisations, which seem to be springing up, ostensibly as a result of imposed funding criteria, are in danger of a) losing sight of and potentially alienating their service users; b) setting up a cross or neighbouring borough conflict of interest; c) risking bringing advocacy into disrepute by setting up what is tantamount to a monopoly and d) being perceived by statutory organisations and service users as knowing too much over too wide an area and putting smaller often extremely successful advocacy groups out of commission.

If an advocacy project has its 'birth' within a statutory body or 'gets into bed' with one at a later time, how can it meet the needs of service users? The answer is that it can't. it will always become a 'hostage to fortune' because it compromises itself by being a large organisation in the mistaken view that it can somehow control its service delivery sustainability in this way. a result of this is that the service is likely to become less user-focussed because of business constraints on its practice and service user disillusionment.

Bigger is most definitely not better especially when people with learning difficulties are involved.. Wasn't that why we closed the institutions?

Lets not create another one in advocacy.

Supported

Living

Information Pack 2006 –

Simon O’Corra

CONTENTS:

inclusion, while providing greater protection for vulnerable individuals.

• More effective national policy co-ordination on housing and benefits.
• Ensuring that housing benefit reforms and other housing and support funding

mechanisms facilitate access to ordinary housing options.

Adults with learning difficulties still often find themselves among the most marginalised people in the community. Despite hospital resettlement programmes and the development of community care, they remain at risk of either being trapped in the family home or ending up in residential care.

The Government is placing an unprecedented emphasis on creating a society which promotes inclusion, independence and empowerment, rather than exclusion, marginalisation and dependence. Current developments represent both risks and opportunities: risks of the 'unintended' effects of wider changes; opportunities to explore how policies on housing and benefits might be adapted or adjusted to ensure that they work for people with learning difficulties.

A strategy that creates a more supportive policy framework could be developed, building on current innovations in supported living, as identified in a number of Joseph Rowntree Foundation research projects.

Similarly, innovative supported living schemes have been developed with the following elements:

• people live in their own homes with housing and support contractually separate;
• there is zero rejection, i.e. no one is 'too disabled';
• relationships with family, friends and community are central;
• people have control over their own lives.

Only a small minority of people with learning difficulties have been able to access supported living. New initiatives have been seriously impeded, both by constraints within the 'social care' world and by the wider social framework. A wide range of barriers and structural problems exists within and beyond specialist services, which limit opportunities for people with learning difficulties to live in their own home. Addressing these barriers is central to any strategy designed to create a more positive policy framework. They are listed in the box below and taken together show that the current system effectively:

• limits rather than promotes choice;
• promotes dependency rather than independence;
• leaves people economically insecure, with minimal disposable income;
• represents an inefficient use of resources.

Despite all that has been written about people with learning difficulties leading 'an ordinary life' in their own homes, in practice this rarely happens. Because of their assumed potential vulnerability and the lack of statutory regulation of alternatives, people with learning difficulties tend to end up in residential care. Yet registration and inspection offer relatively little protection. The unhelpful link between benefits and registration leaves residents with minimal disposable income and often more dependent and socially isolated, arguably increasing their vulnerability.     

This has been compounded by a system unable to deliver the requisite volume of services. Reliance on residential care and 'special needs' funding has led to a shortfall of around 5,000 places a year. At the same time, pressure on local authority expenditure has led to tighter eligibility criteria, increasingly excluding those not priorities for community care packages (even though they may have some support needs). Similarly, lack of ring-fencing for resources formerly invested in long-stay hospitals has created financial instability in NHS specialist services.

Continuing 'perverse incentives' favouring residential care, and fragmentation of local services, together with lack of central guidance, means that few localities have genuinely comprehensive services and levels of provision across the country are extremely uneven.

Some change is inevitable. The new Government is committed to making radical changes including:

• expansion of Welfare to Work and the New Deal;
• reform of the welfare state; introduction of a minimum wage;
• establishment of the Social Exclusion Unit; extension of registration to all community care services; and the lifelong learning initiative.

These developments could provide a basis for a thorough-going reform of the system which would open up many opportunities for people with learning difficulties and other marginalised groups. The risk is that such changes will be introduced in a piecemeal way, reflecting different policy aims with widespread unintended side-effects. Like many marginal groups, people with learning difficulties will be particularly vulnerable to such effects. Reforms will need to be evaluated in terms of whether they:

• promote inclusion;
• promote self-determination;
• offer security to vulnerable people;
• make efficient use of resources.

Housing benefit as a key component of community care arrangements This could be achieved by:

• reinstating housing benefit eligibility for support clearly defined as related to 'accommodation';
• removing current caps on housing benefit so that people at risk of social exclusion can live in the most appropriate locations and accommodate any necessary support workers;
• keeping social rents low through increased capital subsidies for social housing;
• developing a stepped housing benefit taper tied to the proposed minimum wage to provide clearer incentives to work for people currently on housing benefit;
• encouraging the development of 'low support' alternatives to residential care by Social Services Departments.

The Independent Living Fund

• This could be reviewed as part of a wider strategy to promote independent living and widen the Fund's scope.
• A 'preserved rights' conversion fund: If this were introduced it would remove the current disincentives for people to move from residential care into more independent living.
• A 'mortgage benefit' As part of a wider measure to assist low-income homeowners, this would provide security for the small number of home-owning people with learning difficulties and enable others to pursue the home-ownership option.

Charging for residential care: A new charging regime would interact with wages and benefits and enable people to access paid employment.

A comprehensive framework would cover specialist services but also acknowledge the rights of people with learning difficulties as citizens.

Measures which could contribute to that framework include:

• Ensuring that people with learning difficulties have effective access to the criminal justice system;
• Implementing the clauses of the Law Commission's Mental Incapacity Bill, enabling local authorities to act where someone is considered at risk of harm (a measure which the Government recognises as having "some merit");
• Revising legislation and guidance on registered homes so as to clarify the difference between residential and domiciliary services in a way which promotes the rights of people to live in their own home without introducing loopholes for registered home providers.

Specific changes within health and social services are also needed, to complement wider changes:

• complete the hospital closure programme;
• develop comprehensive community-based services, particularly for people with complex disabilities or low support needs;
• encourage a more co-ordinated approach to service planning and delivery;
• develop a national training strategy for professionals working in supportedliving and employment.

Such is the pace of reform that new initiatives (and rumours of initiatives) are emerging almost daily. Means-testing of benefits and switching Disabled Living Allowance funds to local authorities have been floated and then apparently dropped. Yet despite all this activity, many fundamental questions remain unanswered.

There is scope for a much more comprehensive review of the system. Many of the proposals outlined above could be incorporated into the Government's new initiatives. However, what is absolutely critical is that:

• all social policy changes consider marginalised groups like people with learning difficulties and be designed to promote their access to ordinary housing;
• changes in the financing and organisation of housing, support, and benefitsare not tackled in isolation; a much more holistic approach is required at all levels.

I choose who I live with

I choose where I live

I choose who supports me

I choose how I am supported

I choose what happens in my own home

I have my own home

I make friendships and relationships with people on my terms

I am supported to be healthy and safe on my terms

I have the same rights and responsibilities as other citizens

First, staff plan opportunities for resident activity based on a weekly routine of major household tasks; the need for more occasional household tasks and upon knowledge of residents’ preferred social, leisure and other pursuits. Residents are consulted as much as possible, but for many this cannot replace the necessity for staff to adopt a pro-active policy to ensure a reasonably full day. Individualised activity plans are developed in this way for each resident every day by the staff on duty.

Second, staff plan their own division of responsibility for supporting planned resident activity at the same time.

Third, when supporting participation, staff provide increasing degrees of help in relation to each step of an activity until the person is able to engage successfully in it - progressing if necessary from explicit verbal instruction to gestural or physical prompting and on to demonstration or physical guidance.

Fourth, staff give the majority of their attention to residents when they are constructively occupied.

Fifth, staff monitor the extent and relevance of opportunities provided to individuals each day.

As the literature in Part Two of this review has demonstrated: In general terms, Active Support may be seen as a confirmation that the needs of people with more severe learning disabilities call for specialist understanding and skills. This may seem an obvious conclusion but such specialism has not been a strongly articulated requirement within the ordinary life initiative with which we have been familiar in the last twenty years. Nor does it feature as a key element in more recent advocacy of Supported Living. However, Active Support and Supported Living are not mutually incompatible. For example, Active Support provides a practical means for realising the Supported Living principle that staffing should be related to resident needs for support. Moreover, it is likely that systematic approaches other than Active Support will be required if staff are to develop the competency to realize other aims of Supported Living, such as greater community involvement and development of social relationships. Attention to service operation and management and to further structural reform needs to proceed together.

Supported Living can be seen as a financial solution (Mid-1990s) increased demand for more supported living tenancies a consequence of reduced capacity of local authorities to deliver adequate housing – e.g. having sold off much of their housing to the Housing Association, a response to financial demands on Social Services – e.g. the loss of ‘economies of scale’ in the budgets of Social Services and Health following the closures of hospitals and reduction in large, congregated residential care options.                             

Housing Benefit – identified as a new subsidy route as demand increased and supply faltered.

Under the National Assistance Act 1948 Social Services have responsibility for providing residential accommodation to people who are "ordinary resident" in the authority's area. Section 21 deals with placement in the authorities own homes, Section 26 with purchasing service in the independent sector). Section 24 says a person who is placed in residential care, "shall be deemed to be ordinarily resident in the area in which he was ordinarily resident immediately before the residential accommodation was provided". So a person can live in residential care in another area but remain the responsibility of the authority where they lived immediately before entering residential care. So generally the placing authority is and remains responsible for residential care placements. Local Authority Circular LAC (93) 7 reinforces this saying :

"the placing authority will normally retain for that person the same

responsibility that it has for someone living in its own area."

SOME POSITIVE AND NEGATIVE EXPERIENCES OF SUPPORTED LIVING

INTRODUCTION:

Information was collected on 63 adults in supported living residences, 55 adults in small group homes, and 152 adults in large group homes. Results indicated that (a) there were no statistically significant differences in service costs once these had been adjusted to take account of participant characteristics; (b) compared with participants living in small group homes, those in supported living residences had greater choice, participated in more community-based activities, experienced fewer scheduled activities, were more likely to have had their home vandalized, and were considered at greater risk of exploitation;  (c) compared with participants living in large group homes, those in small group homes had larger social networks, more people in their social networks who were not staff, not family, and did not have mental retardation. These residents were considered at less risk of abuse.

(Emerson, Eric, Robertson, Janet, Gregory, Nicky, Hatton, Chris, Kessissoglou, Sophia, Hallam, Angela, Järbrink, Krister,

Knapp, Martin, Netten, Ann, Noonan Walsh, Patricia)

SOME POSITIVE EXPERIENCES OF SUPPORTED LIVING

SOME NEGATIVE EXPERIENCES OF SUPPORTED LIVING–

If local authority or the support provider do end up as being responsible for both housing and support, this might create difficulties in relation to registration. The main focus of concern is that very vulnerable persons who have severe mental impairment and/or extreme frailty and are now living in "deregistered" care homes or similar residential care settings "unregistered" from inception. Such persons may be unable to even operate a telephone or access any help line; past experience suggests they can easily be coerced into silence or compliance.

It is noted that the Care Standards Inspectorate for Wales have been asked to monitor the effectiveness of regulations and minimum standards. It is less clear how this will be achieved, in practice, given: (a) the inherent difficulty of measuring quality of care actually delivered (b) that service users possessing severe mental impairment may be simply unable to make reliable, informed, judgments on this subject and (c) statutory constraints, under the DCR framework, limiting theInspectorate’s right of access to individual care settings/service users.

These circumstances do not detract from the basic need for robust, independent, inspection(s) of individual care homes/settings; they merely illustrate that the inspectorial process, in a DCR context, may be doubly difficult in practice. Moreover, it cannot be assumed that all failures in service provision or abusive situations are easily identifiable and/or will emerge of their own volition. A care provider faces a major dilemma in one of its Supported Living Units (for two people) when one of the tenants decides he doesn’t want the care provider to provide his care anymore. This raises major issues concerning the staffing and management of the as at any given time a person may be in the unit who is not accountable to the care provider at all and may not even have a CRB check, thus placing not only his/her client at risk but also the other tenant and the care providing organisation.

A Supported Living Unit has four people with profound and challenging needs including making extraordinary noise during the night thereby compromising their community acceptance by neighbours. These people have only sleeping night staff thereby making impossible the successful support of the tenants during the night and the integration of the tenants into their local community.

There is a real danger that the Task and Finish Group’s mapping exercise, whilst not unimportant, will be a palliative which does not effectively address serious, underlying, deficiencies in the prevailing (or perceived) protective framework(s) applicable to service users with severe/profound mental impairment. These persons are among the most vulnerable in society and should be afforded a level of protection no less than that provided to similar individuals under the Residential Care Home framework.

Klein (1994) identifies the principles underpinning supported living: Individualisation - understanding and responding to how an individual wants to live.

The HYPERLINK "http://www.ndt.org.uk/"National Development Team’s Supported Living programme identified a number of principles upon which supported living arrangements should be based. The UK experience is relatively new, but a number of barriers to the development of supported living have already been identified, as well as lessons learned about the common features associated with emerging supported living services in the North West of England. Work on the comparative costs of supported living with other forms of service has mainly been from the USA, although UK data is now becoming available.

Readiness - because arrangements are individually designed, there are no criteria or barriers to entry into services, so everybody is 'ready' as and when the service response is worked out and organized Person centred planning - is the underpinning of supported living services. Person centred planning places the person and others who know and care at the centre of planning activity. As a result of this, the supports required are determined, and professional advice is sought when and if necessary to achieve the individual’s objectives

• Ensuring that the supports a person has are in line with culture and lifestyle
• Focusing on a ‘can do’ attitude - taking a constructional approach, providing supports for things an individual cannot do, and creating opportunities for learning and developing competence for those things a person can do
• Using ordinary language - home, moving house, flatmates; avoiding the use of agency jargon. Ordinary everyday language, it is suggested, helps in the process of focusing on people and not services
• Ownership and control - the home a person lives in is theirs, possessions in the home are theirs, housemates sublet from the individual and staff supporting the person are chosen by the person.

An exploration of some of the issues associated with the early years of supported living in the UK can be found in an NDT publication, ‘A foot in the door’ by Ken Simons. Although not an evaluation of supported living per se, Simons identifies some of the common characteristics that appear to be in place to that have helped people to develop supported living arrangements in their areas. He identifies as a common concern of policy makers and purchasers the question of the comparative costs of supported living as opposed to more traditional forms of group home or hospital based services. Where some work is done to clarify these issues, Simons suggests that it is more likely that purchasers will support the development of supported living services. He is able to draw attention to some of the evidence on costs, but points out that ‘supported living has yet to be implemented on a large enough scale to allow overall assessment’. One of the issues is the nature of the needs of the people in supported living services. In Liverpool for example, Simons suggests that the costs of supported living services may be higher than residential care, but that is due to the fact that supported living has been developed for those people with the most complex needs. Given that the fundamental principles of supported living are to develop individual supports for people using a range of resources, human, technological and financial, it is to be expected that the range of costs associated with supported living services will be much greater than the range of costs for traditional group services.

In the US, work by Smith, quoted in Simons, has suggested that three factors account for the affordability of supported living services there:

i.the flexible approach to using resources leads to greater efficiencies;

ii. there is effective use of lower cost non professional resources, and

iii. it is not based on ‘clinical treatment’ models with their associated high costs.

Emerson E & Hatton C (1994); Moving Out: Relocation from Hospital to Community, London, HMSO

Hatton C (1996); ‘A Home of Your Own, Commentary,’ in Tizard Learning Disability Review, Vol 1,3, pp26-27

Kinsella P (1993); Supported Living, A New Paradigm, National Development Team, Manchester

O’Brien J and Lovett H (1992); finding a way toward everyday lives: the contribution of person centred planning, Harrisberg, Pennsylvania office of mental retardation.

Oliver C, (1992); ‘Changing the social relations of research production?’, Disability Handicap and Society, Vol 7, No2 pp101-114.

Simons K (1997); A Foot in the door, The early years of supported living for people with learning difficulties in the UK, National Development team, Manchester.

Smull, M and Burke Harrison, S (1992); Supporting People with Severe Reputations in the Community, Virginia National Association of State Mental Retardation Program Directors.

Ward L, &Kinsella P (1993); "Supporting Roles", in Community Care, 22.7.93 pp24-25.

Wertheimer A, (1997); Great Expectations; Experiences of supported living, National Development Team, Manchester John Northfield October 1998.

TRANSITION FROM RESIDENTIAL TO SUPPORTED LIVING

Although the 1948 Act refers to "residential accommodation", with the growth of Supported Housing, registered group homes and more diverse ways of providing care and support it has been accepted in some court decisions that the 1948 Act applies equally to these more modern arrangements so that the placing authority remains responsible whether or not the placement is in a registered care home. The Social Services Ordinary Residence guidance LAC93(7), however, deals primarily with residential care arranged out of area. It does not deal with Supported Housing and domiciliary care outside of the LA area.

Three common problems occur:

1. Can a Social Services Department (SSD) as part of their care management responsibilities arrange accommodation and support outside their area? In terms of ordinary residence, the person is now a resident of the authority covering their new home and would have to cover the cost of another's care package. If allowed there is a perverse incentive for a SSD to seek accommodation in an adjacent authority's area.

These examples show the potentially damaging limitation on individual rights and choice which people with learning disabilities experience. Many people, understanding the potential risks, decide not to make a move, live with a partner, change home or service provider. The idea of consumer choice is unfulfilled.

When the Care Standards Bill was introduced into Parliament, one of its key aims was to ensure the adequate protection of vulnerable adults receiving care services or one kind or another.

During the Care Standards Tribunal, in the important text case of ‘Alternative Futures ltd v National Care Standards Commission’ (2003), it was advanced that where tensions arise between the will of Parliament and proposals, such as Supporting People initiatives by the Office of the Deputy Prime Minister, the will of the legislature should prevail. This perspective is directly relevant to resolution of the problems contributing to establishment of the Supported Housing Task & Finish Group. These largely revolve around the protection of very frail, elderly, persons or those with severe learning (and possible physical) disabilities living in "deregistered" care homes and/or similar care settings which may have been "unregistered" since inception. It is far from clear whether the spirit, if not letter, of Parliament’s intentions have been translated consistently into practice. This has resulted in many vulnerable residents being excluded from the RCH regulatory framework and deprived of its protective mantle.

The main provisions of the Care Standards Act established regulatory regimes for care homes and for domiciliary care agencies. As things currently stand, this means that a ‘supported living’ care package which is found not to fall within the statutory definition for a care home is not registered and therefore not regulated, as a whole, by the provisions of the Act. At Best, it is likely that the provider of the personal care service will be registered as a domiciliary care home of domiciliary care agency, but there is no requirement for inspections at, and of, the premises in which accommodation is provided under the regulatory system applying to such agencies.

A serious practical inconsistency of coverage exists which has not been resolved by the Group. It should not be overlooked that, more latterly, the Audit Commission’s Supporting People Inspection Co-ordinator has been reported as expressing concern about "deregistered care…….for people with learning difficulties or severe mental health problems and frail older people"; emphasised the need to acknowledge that some people would never be able to achieve independent living; and has called for "an open and honest debate over what’s appropriate".

Section 42 of the Care Standards Act allows the Assembly to develop tailored regulatory regimes for care settings which do not fall within the definitions of care home or domiciliary care agency. This has been used to develop a specific regime for adult placement schemes which are used, for example, to provide placements for adults with learning disabilities with families in the family home. The reason given in the Main Report for the conclusion that it is not possible, legally, to use section 42 to deal with supported living environment as follows:-

"….There is no statutory power under Section 31 of the Care Standards Act

2000 which would allow a regulatory regime to be set up which permits the

inspection of the quality of the accommodation and/or the provision of

personal care in a person’s own home, without obtaining that person’s

consent. Any unwarranted intrusion into a person’s home would be likely to

breach Article 8 of the Human Rights Act 1998"

When the Care Standards Bill was introduced into Parliament, one of its key aims was to ensure the adequate protection of vulnerable adults receiving care services or one kind or another.

During the Care Standards Tribunal, in the important text case of ‘Alternative Futures ltd v National Care Standards Commission’ (2003), it was advanced that where tensions arise between the will of Parliament and proposals, such as Supporting People initiatives by the Office of the Deputy Prime Minister, the will of the legislature should prevail. This perspective is directly relevant to resolution of the problems contributing to establishment of the Supported Housing Task & Finish Group. These largely revolve around the protection of very frail, elderly, persons or those with severe learning (and possible physical) disabilities living in "deregistered" care homes and/or similar care settings which may have been "unregistered" since inception. It is far from clear whether the spirit, if not letter, of Parliament’s intentions have been translated consistently into practice. This has resulted in many vulnerable residents being excluded from the RCH regulatory framework and deprived of its protective mantle

by Jay Klein, excerpted from Not Just Another "Rung" on the Continuum, TASH Newsletter, 1994.

Individualization. Webster's dictionary defines "individual" as a particular being or thing as distinguished from a class, species or collection, as single human being as contrasted with a social group or institution, as a single organism, as distinguished from a group, and as an indivisible entity. Therefore, if we say supportive living is '"individual," it must be something that is for one person without exception. This does not mean that everyone has to live alone. What it does mean is that if people want to live with someone else, they choose with whom they live. The magic number becomes one. When people get to be adults in our society they choose to live with others who are close friends, are relatives, or with whom they are romantically involved. Usually living with a close friend lasts longer than living with a relative. Unfortunately, in our country we have only a 50 percent chance of continuing to live with the first person we are romantically involved with. It makes sense that people with disabilities also prefer to have these same choices instead of being congregated or segregated based on their disability. Some people with disabilities need intensive assistance to carry out their everyday tasks. In these situations, people may choose to live with someone who can assist them or may have their assistance provided on a regular schedule or on an on-all basis.

People already in a residential care setting that is changing to become a supported living environment have two choices either stay where they are often with people they don’t like or move out of an environment which they know as their home. They often have no choice about their home environment changing the way it operates if a care provider says that that is what it (the organisation) wants to do. Not very individualized.

Everybody is ready There are no criteria to receive the support being described. Since what occurs is individually designed, there are no prerequisites. We must give up trying to make people ready by simulating how it is to live in a home and begin supporting people to have that home. If people cannot do something, then we can find someone to do it for them rather than requiring them to learn to do it before they will be ready. There is nothing magical about any program, or building. What can be magical is what the program, building, and the people who "hang out" there offer. Our challenge in supportive living is to create this "magic" in the person's home.

How can anyone say that everyone is ready? How individualized is that? How can anyone possibly know that every person with learning difficulties is ready? People are often shunted into supported living by organisations for financial reasons which in effect means that organisations and not individuals are ready. There is no argument that good supported living should be individually designed but the individual choice about whether supported living is right for a person is often the decision of support organisations and commissioners. There is an assumption here that Supported Living is the choice, the only choice, but it is not always the person with a learning difficulties’ choice.

What if the ideal living situation is the existing residential one? Person Centred Planning has already been working successfully at times with people in residential settings. Once again an assumption that what exists already must be ditched for what is often an unknown situation increasingly risky both in terms of future tenure and of all types of abuse.

It is somewhat naïve to assume that many people in a person’s local community are willing to be involved and to be involved without recompense. Our culture has lost its traditional values of community support and with much less registration and inspection who will ensure people’s safety when literally anyone can become involvedwith a person with learning difficulties. An abusers charter perhaps.

Person Centred Planning and Valuing People are at the core of such flexibility. Why do people have to change to Supported Living as well because an organisations deems it to be a good idea, especially when assessments have not been carried out so that a shift to supported living is not led by a person’s known needs. Such assessments should be undertaken by an independent body with no financial or other axe to grind.

Combining natural supports, learning, and technology. Whenever possible, supports which are natural to the place, time, delivery, and person are sought. The designing of individual supports takes into consideration opportunities for individuals to learn to provide their own support, for it to be more natural, and to use technology which may give the person more control.

None of the above is the preserve of Supported Living. It is important to separate out what are true and specific benefits of Supported Living and what are more general issues that can be addressed by a multitude of support provision methods in line with people’s right to a choice in such matters as housing and support.

A good residential and/or other setting can provide all of these things. These are not benefits specific to only supported living. They are good practices in whatever setting.

Just because we call something a home does not automatically make it so. In fact if someone doesn’t want Supported Living they can often be thrown out of what is regarded by them as their home.

Ownership and control. Lastly, and most importantly, the home is the person's and that person controls the support that is received Home ownership does not mean that most individuals with disabilities who do not have many financial resources will hold the mortgage to a home. It does mean, however, that they sign the lease, things in the home belong to them, and the place is their home. In addition, roommates sub-let from the person, support people are hired by the person, and support people respond to the need for assistance when, where, and how it is needed.

With all due respect to many people ownership and control are irrelevancies and in some cases make for a frightening departure into more responsibility for people who for years have had responsibility taken away from them. Many people with Complex and Multiple Disabilities are being shunted into Supported Living and who makes sure that they understand what they are signing for and the implications of being an employer. What in effect often happens is the support organisation has yet more power and control over people’s lives, so why change the things that happen now unless it benefits the organisation which can become management agents and/or brokers often without consultation with people with learning difficulties.

In summary, supportive living is not a model, the answer, or somenew magic. It is, however, a way of viewing people and assisting them in ways that enable these individuals to receive the support they need and to live in a home they want. When asked about what model they were using in North Dakota for 598 people who receive funding under a category called supportive living, Russ Pitsley said, "We have 598 models. "In order for us to promote this shift toward supportive living, we must remember where we came from, recognize some of our recent responses, and make that paradigm shift everyone is talking about. This will require us to do things much differently than we did in the past. We cannot add another "rung" on the continuum. We will need to focus our efforts on assisting people to receive the supports they need to live beside us in places they can call their homes.

Why cant we make the paradigm shift in attitude and working practices without putting people through yet another change, sometimes as severe as forcing them out of their own home or in the case of the Sheffield case forcing them out of a residential setting only to have them forced back into it as Supported Living guarantees are eroded. Who really benefits from Supported Living the most? Quite naturally it is the Commissioners and Support Agencies who save money and transfer responsibility to yet another Government Department that is itself suffering from financial constraints. As with Care in the Community it is people with learning difficulties who are the pawns in the machinations of funding.

The author, Jay Klein is affiliated with The Institute on Disability, University of New Hampshire.

Imagine That! is a quarterly newsletter about supported living published by Allen, Shea & Associates, 1040 Main Street, Suite 200 B, Napa, CA 94559, (707) 258-1326 under contract with the California Department of Development Services HD390061.

APPENDIX 1 – INTERNET LINKS