April 1998 - Ref 498
Service users' perspectives on 'floating' support

Enabling people to live independently through the provision of support services supplied to people in their own homes ('floating' support) is a key element of community care. Research by Anne Douglas, Charlotte MacDonald and Mary Taylor examined the experience of such services from a user perspective. They found that:

• Floating support was judged by users to be very successful in terms of practical help, but views were mixed in relation to the provision of emotional and moral support. Both of these were valued highly when available.
• On the whole people were positive about their experiences of floating support, particularly the flexibility of the service and the quality of the relationship with their support worker.
• Many users had, prior to their current situation, experienced a period of adverse living conditions or had been in hospital and this may have influenced their view of the services which they currently enjoyed. User satisfaction should be seen in this context.
• Users appeared to have little choice in their support arrangements, which had often been set up when they were least able to make appropriate decisions.
• The current complexity of financial, legal and institutional arrangements for provision of services made informed choice by users almost impossible.
• Most of the study participants had assured tenancies. Many service users were uncertain about the relationship between their support and their tenancy and the consequences for one of ending or varying the other.
• Though providers may be tempted to see floating support as a panacea, users were clear that it would not be appropriate for everyone, especially more vulnerable people or those needing more intensive support services.
• Some service users felt isolated both within their local community and from people with similar needs.

Introduction

This study explored the experiences, choices, needs and satisfaction of users of 'floating' support from three different client groups in Scotland. In addition, the links between housing and support services were investigated from the users' point of view.

Floating support is not a term which is widely recognised in Scotland, nor is there consensus about its application. For this reason the study developed its own working definition:

• The support is designed to sustain a tenancy, across a broad range of tenancy types, by developing independent living skills.
• The user may also be receiving personal care, counselling or domestic help.
• The support may be discontinued when no longer needed.
• The service may or may not be funded through SNAP (the Special Needs Allowance Package).
• The support is tied to the individual and not the property.

The people who participated in the study fitted one or more of the following descriptions: vulnerable young people under the age of 25; people with experience of severe and/or enduring mental health problems; and people with a physical impairment, which may include a sensory impairment.

Users' experiences

The floating support arrangements experienced by participants in the study represented different combinations of circumstances including: sources of funding, tenure, extent of support, and the relationship between user and provider.

Service users' understanding of how support services were paid for was limited. Many users who were paying for support through rent or service charges were not aware that they were doing so despite the charge appearing on their rent statement. In general people were not well informed about funding or entitlements and assumed that they were receiving as much help as resources would allow.

The services provided a range of practical, emotional and moral support. The nature of the support received was similar across the three client groups, particularly in relation to practical help. Regular home visits from a support worker was the most common mode of service provision.

Links between housing and support

Landlord involvement (usually housing associations) in support arrangements varied and included provision of a support worker by the landlords as well as contracts and partnerships between landlords, and social services and health boards. Users who had a good relationship with their housing association support worker saw a positive advantage in obtaining floating support direct from their landlord, who may have a better awareness of their particular needs.

The service providers who were interviewed indicated that in no case was the support received by participants a tenancy condition, but users did not perceive arrangements to be quite so clear-cut. This perception of a link between their housing and support appeared to be strongest among the young people in the study, who had all had to accept some form of support to get their accommodation in the first instance.

Users commonly saw their housing and support as linked in a variety of ways. In a significant minority of cases, support and accommodation had been arranged together as part of a care plan or provided by the same organisation. Some users who thought that support was a tenancy condition expressed doubts about the consequences for their tenancy of ending support and vice versa.

I had to agree to get help so I could get my house and I did want help but I'm not sure what would happen if I didn't need help any more.

The difference in the ways users and providers understood the link between housing and support suggests that more could be done to inform and educate service users as they become more self-reliant.

Choice

The study found little evidence of users having a choice about the support they received. The researchers conclude that if users had a better understanding of their entitlements and the way their support was funded they would have been better able to exercise choice and control. Although information may be available to service users, the study found that it is not presented to them in a form they readily understand.

Many of the participants in the study had had their support needs assessed at a time of personal crisis. In retrospect, people felt that they had not been able at that time to participate fully in assessment and planning for their future. Regular reviews and responsive services were necessary to allow them to do this as time went on. Most of the service users in the study were not aware of formal care plans relating to their floating support. Nevertheless, the young people involved in the study were aware of their entitlement to throughcare (and aftercare) provided by the social work department.

Most people said they knew how to make a complaint if they were not happy with the service and a minority of people had done so with varying success. Significantly, a minority did not think they would have the confidence to make a complaint.

Needs

People tended to define their needs in terms of the services they received, but unmet needs also emerged including, for example:

• People with a physical impairment who found a lack of flexibility in the service provided by home helps.
• Young people who experienced peer group pressure to take over their home as a meeting place and needed a 'door keeper' as part of their housing package.
• Concern that housing support workers did not have sufficient awareness of mental illness to support people newly discharged from psychiatric hospital.
• People who felt that they did not have access to a crisis or out-of-hours service.

People in all three client groups also emphasised the importance of people in the wider community having a knowledge and understanding of their needs.

Satisfaction

The study found widespread satisfaction with services, with particular value attached to the flexibility and responsiveness of support workers. The support worker's ability to develop a positive relationship with users was crucial to users' satisfaction with the support. This was the case regardless of the organisational and funding arrangements for service provision.

Prior to their current situation, many users had experienced a period of adverse living conditions or of hospitalisation, and the researchers felt that this influenced their view of the services which they currently enjoyed.

At a practical level, floating support could be judged very successful in providing a flexible response to individuals' needs. Its success in meeting emotional needs was more varied. Independent living could bring isolation and loneliness. The need for moral support to help people lead what they regarded as a normal life, with active participation in the life of the local community, was not always met by the range of services provided.

You can feel at your worst at weekends, everything is shut and you are by yourself, it's the very time you need a worker. They should have something at weekends even if it's just a phone line.

Participants valued opportunities for social life which their situation provided but agencies were often not funded to organise social activities. The sense of social isolation expressed by users in part reflects the fact that their accommodation is not clustered together with that of other service users.

There was some evidence of users participating in the local community. However, it was often difficult to achieve as it was constrained by lack of resources and facilities for community activities.

The quality of the relationship between user and support worker was seen at its best in instances of voluntary participation by staff in social activities. At its worst, support workers had been known to have 'warned' neighbours when service users moved in. Service users considered such activity to be a breach of confidentiality, as well as harmful to relationships with their neighbours.

About the study

The research is based on discussions with the project advisory group (which included user representatives), 21 face-to-face interviews and two rounds of focus groups with users from each of the three user groups. A total of 39 service users were involved. In addition, after the user interviews were conducted managers from six service providers were interviewed to obtain factual and contextual information.

How to get further information

A full report, Living independently with support: Service users' perspectives on 'floating' support by Anne Douglas, Charlotte MacDonald and Mary Taylor, is published by The Policy Press in association with Community Care magazine and the Foundation. (ISBN 1 86134 093 1, price £13.95).

This title is now out of print.