Cork Supported Accommodation
Service (CSAS)
The Challenge and Reward of Transition as
experienced through the CSAS
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?
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.
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
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
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.
Domains of Need
Nutrition
Health
Mobility
Social
Inclusion
Home
PERSON
Valued
Social Roles
And
Images
Value
Reputation
Respect
Work
Finance
Autonomy
Domains of need contd.
Respect for
And
Exercise
Of Rights
Security
And
Learning
Safeguards Growth
And
Experiences
Transport
Relationships
Person
Adaptive
Devices
Avocational/
Leisure
Identity
Communication
And
Culture Meaning/
Spirituality
Domains of Need contd.
‘Model’
Overall model
And
Theory
The
‘What’
Program
Content
‘WHO’
Person and
Their needs
The
‘How’
Program
Process
‘By Whom’
Human
Resource
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
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
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
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.
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.
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.
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.
Service Provision
Tony’s story
Service provision
It is anticipated that over time:
1. 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
2. Some individual support needs will increase due to the
nature of the condition they are experiencing thus
increasing the level of support required
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
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
Clinical components
•
•
•
•
•
•
Tracheotomy care
Ventilation support
Suppositories
Medication provision
Bowel care
Catheter care
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
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