Cork Supported Accommodation Service (CSAS)

1. Cork Supported Accommodation Service (CSAS) The Challenge and Reward of Transition as experienced through the CSAS

2. Cork Supported Accommodation Service • HSE wanted an ‘under one roof’ residential service • Cheshire proposed to set up, develop and promote individualised accommodation services for people with a physical/sensory disability in the Cork City area by supporting people to have a good quality of life through promoting choice, new experiences and responding to individual need – one person at a time HAVE WE ACHIEVED THIS IN A REAL WAY?

3. Proposal for the Project • Proposals for new project to support people with physical and sensory disabilities sought by HSE in Cork • Proposal submitted by Cheshire Ireland in line with the principal of working with ‘one person at a time’ • Supports would be responsive to the individuals needs and wishes and meaningful in the life of the person • Personal care, management of their disability and social inclusion would be core components of service • Living environment, family and other supports e.g. friends and neighbours would be explored • People needing the service were identified by the HSE and following an initial assessment plans were put in place to start work.

4. Model for the Service The Social Model of Disability aims to: • Be based on the wishes and needs of the individual • Be inclusive (social and community) • Be listening, responsive and flexible to individual needs • Be suitable and of high quality • Build capacity by: • Planning, negotiation, financial planning and promoting self advocacy • Working closely with the person, family, friends, staff and key partners with regard to attitudes, values and beliefs

5. Assessment / Service Planning Process An assessment which is deep in detail is the most valuable tool for considering and capturing: • The range of needs of a person • The full supports required and what form these would take • Housing needs including work to a persons own property or sourcing other accommodation • The person’s own aspirations and desire as to how they wish to live a full and meaningful life of their own choosing which could include education, training, employment and a social life

6. Assessment / Service Planning Process • Preliminary assessments were instrumental in giving a broad outline of the needs of the people identified. • When more detailed planning carried out, including environmental and housing considerations it was clear that other issues such as health and safety and fire risks would need to be prioritized • Self medication, medication, emergency response systems, 24/7 care packages, transport and socialization (care plans) had to be put in place to meet the needs of each person with reference to personal circumstances.

7. Domains of Need

8. Domains of need contd.

9. Domains of Need contd.

10. Housing Arrangements • When first proposed the service was seen as providing individualized services to people in a variety of living situations in the Cork City Area. • A number of people have their own homes • For a number of people it was thought that accommodation would be sourced which would be in reasonably close proximity to one another to facilitate the service delivery (cluster) - this has not been met as people have very different needs and wishes with regard to their accommodation for example, close to family, away from their family, in the centre of the city, in the suburbs or in rural locations

11. Start up • The Project start up phase began in May 06 with the appointment of a temporary coordinator and the support of the Cheshire National Development Manager • The individuals (and their family where appropriate) identified by the Disability Coordinator were contacted • Meetings were arranged and the initial assessment process undertaken which would give more detailed information of their needs • Emerging needs were identified and plans put in place to meet the needs which had priority before the person could move e.g. work to their home/sourcing accommodation

12. Service Structure • Service Manager • Two senior care workers • Current staff compliment is 26 (the equivalent of 13.75 WTE including service manager) • Support from Regional Manager • Support from Cheshire national Services – HR, Training, Quality, Health and Safety, Policy Development, Clinical Need Supports, Finance

13. Challenges in Staffing the Service • Consideration needed to be given to people’s preferences regarding staff for example – a number of people would have had staff from other agencies working with them prior to engaging with Cheshire for services. They wished that these staff remain with them and the staff wanted this as well. Consultation, partnership with all involved and using networks already in place ensured that the services appropriate to the needs of the person are developed and put in place. • Flexibility of staff – service user may require 11/2 hours in the morning – 1/12 hours at 10.30 pm.

14. Challenges • Distance – some people have their own homes which are not within the City area. • Expectation that staff don’t just work with one person • Time – allocation of time to facilitate movement between homes can give rise to issues of breaks etc. • Modes of transport – walking, bus, own transport, van can be an issue • Changes for people – going out/not going at short notice – staff availability and flexibility • Not nine to five – combines various elements of living • Ensuring people’s needs are met and at the same time ensuring we are being good employers regarding time off etc.

15. Service Provision Since September 2006 15 people have taken up services, (three people have passed away RIP) 9 people currently being directly supported. 8 people in their own homes and 3 person in rented accommodation – awaiting council/co-op housing 1 person remains in a nursing home with frequent time spent in hospital – awaiting meeting with the consultant to progress. However he has received a limited service in the form of a detailed assessment for returning home, plus visitation and taking him out and meetings with other agencies, services and family regarding the planning of services.

16. Service Provision 1 person currently lives at home – appropriate alternative accommodation being sourced – social needs programme in place assisting with the transition from home to independent living. 2 Assessments underway at present.

17. Service Provision Tony’s story

18. Service provision It is anticipated that over time: • Some individual support needs will decrease with increased social supports, family supports and activities such as training, education and employment reducing the costs of their service • Some individual support needs will increase due to the nature of the condition they are experiencing thus increasing the level of support required

19. Service Provision • This service is part of the evolution of services for people with disabilities. • Moves away from what was once seen as the only way to provide residential services - the residential group home provision • Provides the context in which people can have a vision for their own future and experience this vision in a real and meaningful way - self determination

20. HAVE WE ACHIEVED OUR AIM? • In the process – some services for individuals are still being resolved • Complex needs – thoughtful approach to service provision – may take longer time to resolve issues • Lack of appropriate accommodation in Cork City for rent • Individuals/families/friends/neighbours all require consideration • Other agencies involved – partnership, building relationships, networking e.g. 7 PHNs, 3 Disability Managers, up to 10 voluntary agencies, HSE services • Independent Review in 2008

21. Clinical components • Tracheotomy care • Ventilation support • Suppositories • Medication provision • Bowel care • Catheter care

22. OUTCOMES • People moving to chosen accommodation is only part of the process • Ongoing support required – transition to new environment, developing self care skills, developing confidence, integration in chosen community, employment/training • Emerging issues for people can include past experiences and assisting people dealing with these, renewed family relationships after long absences, changing clinical needs etc. • NOT STATIC

23. CONCLUSION • Will continue to provide support as identified and required by individuals • Continue to engage with families and others • Continue to engage with other agencies and services • There are alternatives to institutional living - in Ireland Visit www.cheshire.ie for full version of Tony’s DVD