Quality statement 9: Housing

Quality statement

Adults with a learning disability and behaviour that challenges are supported to choose where and how they live. [new 2019]

Rationale

People with a learning disability and behaviour that challenges face barriers to choosing where they live and who they live with, such as lack of available support and housing arrangements to live independently. They may want to live alone with support, with a small number of people in shared housing or with their family. Supporting people with a learning disability to make decisions about how they want to live and to be part of their community will enable them to have more control and independence and improve their quality of life.

Quality measures

Structure

Evidence that a range of different housing and care options are available that meet the needs of adults with a learning disability and behaviour that challenges.

Data source: Local data collection, for example, from land registries and Care Quality Commission registrations.

Process

a) Proportion of adults with a learning disability and behaviour that challenges who are supported to communicate their housing preferences and any specific support needs or risks.

Numerator – the number in the denominator who are supported to communicate their housing preferences and any specific support needs or risks.

Denominator – the number of adults with a learning disability and behaviour that challenges.

Data source: Local data collection, for example local audit of patient records.

b) Proportion of adults with a learning disability and behaviour that challenges who live somewhere that meets their needs.

Numerator – the number in the denominator who live somewhere that meets their needs.

Denominator – the number of adults with a learning disability and behaviour that challenges.

Data source: Local data collection, for example local audit of patient records.

Outcome

Proportion of adults with a learning disability and behaviour that challenges who feel satisfied with the level of involvement in decision making about housing.

Numerator – the number in the denominator who feel satisfied with the level of involvement in decision making about housing.

Denominator – the number of adults with a learning disability and behaviour that challenges.

Data source: Local data collection, for example using surveys, focus groups and other methods of gathering the views of people using services, such as those used in the Challenging Behaviour Foundation and Mencap's valuing the views of children with a learning disability.

What the quality statement means for different audiences

Service providers (such as social care providers, community mental health teams, community support providers, community learning disability teams, residential services, supported living services and housing providers) provide a range of different housing and care options that meet the needs of adults with a learning disability and behaviour that challenges. They ensure that practitioners working with adults with a learning disability and behaviour that challenges have the time and resources to discuss individual housing preferences and support needs with the person, and their family or carers if needed. They ensure that practitioners have training in how to communicate with people with a learning disability, and support and include them in the discussion.

Health and social care practitioners (such as social workers, community learning disability nurses and lead practitioners) support adults with a learning disability and behaviour that challenges to communicate their individual housing preferences and support needs, with their families or carers if needed, and support them to live where they choose.

Commissioners (such as local authorities, clinical commissioning groups, NHS England and lead commissioners) ensure that they monitor whether services working with adults with a learning disability and behaviour that challenges support them to communicate their individual housing preferences and support needs. They discuss housing with housing providers to ensure that adults with a learning disability and behaviour that challenges are being considered in housing plans.

Adults with a learning disability and behaviour that challenges are helped to choose where and how they live, and given the support they need to live as they would like to.

Source guidance

Learning disabilities and behaviour that challenges: service design and delivery (2018) NICE guideline NG93, recommendations 1.2.5 and 1.5.4

Definitions of terms used in this quality statement

Adults

People aged 18 years or older.

Supported to choose where and how they live

Support that takes into account their preferences, and any specific support needs or risks, including the effect of environmental factors, that:

  • is person-centred, reflecting their individual needs and choices, and maximising their control

  • helps them take an active part in all aspects of daily life that they choose, based on what they can do and what they want to do

  • takes into account the severity of their learning disability, their developmental stage, any communication difficulties or physical or mental health problems, and their life history

  • respects their cultural, religious and sexual identity

  • helps them before problems occur or as soon as they emerge, not just when crisis has been reached

  • encourages people to speak out if they have any worries

  • promotes continuity of relationships.

[NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, recommendations 1.2.5 and 1.5.4]

Carer

Someone who provides informal care and support to a child, young person or adult with a learning disability. It does not cover staff who are paid to provide care or support.

[NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, terms used in this guideline]

Behaviour that challenges

Behaviour of such an intensity, frequency or duration as to threaten the quality of life and/or physical safety of the person, or others around them. It also includes behaviour that is likely to severely limit, or result in the person being denied, access to and use of ordinary community facilities.

[Adapted from NICE's guideline on learning disabilities and behaviour that challenges: service design and delivery, terms used in this guideline]

Equality and diversity considerations

People with a learning disability may have difficulties communicating because of disability or sensory impairment. Those with severe or profound learning disability may have particularly complex needs. Practitioners working with people with a learning disability may need to call on additional support to help them communicate with the person. This could include involving speech and language therapists or working with family members to find ways of improving communication. They may also use augmentative and alternative communication approaches such as manual signs, pictures, objects and communication aids to help people to communicate well.