Adult Social Care Accommodation Strategy 2024-2034

What we provide

Care and support services are provided in a range of settings that best meet the individual’s needs. Residents are supported to maintain independence in their own home for as long as possible. Adult Social Care practitioners work with residents to identify their strengths and assets to prevent need according to the Islington Adult Social Care Building Strengths for Better Lives Framework. Adult Social Care also works with partners in health in line with Principle Five of the NHS Reducing Length of Stay programme to encourage a “Home First” approach. This approach prevents lengthy stays in hospital and the over-prescription of care which leads to greater dependence (Reference: NHS England » Principle 5: Encourage a supported ‘Home First’ approach).

However, there is a range of bespoke accommodation-based services for when needs change.  

Decisions about the package of care and setting take the individual’s best interests into consideration. However, effective and fair use of resources, and value for money must also be considered. For example, the cost of care home services can vary significantly. Services are means tested (except where the resident has been in hospital under the Mental Health Act)  or where a person receives free care and support as part of Continuing Healthcare. Residents, with their family or carers, can pay additional third-party contributions if they opt for a service that is more costly than the service being offered.

Current provision

Setting	Housing provision	Care and support provision	People	Dependency
General needs housing	Council, registered housing provider or private housing	No onsite care provision. Care and support will often be provided by family, friends or neighbours. Residents may also be in receipt of assistive technology, aids and adaptations, floating supporting, homecare, respite care or Homeshare. They have access to voluntary and community sector services for information, advice and support.	Residents aged 18+ who may have current or future Care Act eligible needs	Typically lower dependency
Older people's housing schemes (sheltered, retirement, LiveSmart)	Provided by registered housing provider - Islington hold nomination rights for around 75% of lets Self-contained Provision of concierge type service or facilities management	No onsite care provision Emergency call system Access to communal areas, but activities coordination Residents may be in receipt of assistive technology, aids and adaptations, floating support and homecare services Residents can access voluntary and community sector services for information	Residents age 55+ who may have current or future Care Act eligible needs	Typically lower dependency
Shared Lives	Carer's accommodation	Shared Lives Carer provides long-term, short-term, overnight or respite care	Residents aged 16+ with Care Act eligible needs	Typically lower dependency
Supported housing	Council or registered housing provider housing Self-contained or shared accommodation Provision of security, facilities management, and tenancy support	Tenancy sustainment Homelessness prevention support	Typically younger adults aged 18-64 who have experienced multiple disadvantage, including homelessness, substance misuse, and young people leaving care	Typically lower dependency
Supported living	Council or registered housing provider housing Self-contained or shared accommodation Provision of security, facilities management, and tenancy support	Onsite care provision (personal, domestic care) Extensive communal facilities and activities Care Call system Assistive technology Aids and adaptations	Typically younger adults aged 18-64 with learning disabilities or mental health needs. Residents may be supported until end of life	Alternatives to, or preventing higher dependency
Extra care housing	Council or registered housing provider housing Self-contained units Provision of security, facilities management, and tenancy support	Onsite care provision (personal, domestic care) Extensive communal facilities and activities Care Call system Assistive technology Aids and adaptations	Typically older people age 55+ with care needs, however there are examples of successful mixed aged extra care schemes	Alternatives to, or preventing higher dependency
Residential care	Private or shared en-suite rooms within a care facility	24-hour onsite care (personal, domestic) Communal facilities	Adults with care and support needs	Higher dependency
Nursing care	Private or shared en-suite rooms within a care facility	24-hour onsite care (personal, domestic) Communal facilities	Adults with nursing care needs	Higher dependency

Preventing, reducing and delaying care needs

Early intervention and prevention are key to Islington’s approach to enabling people to live healthy and independent lives. We recognise the importance of community networks to wellbeing and safety. Social isolation is known to negatively affect mental health and physical wellbeing and is a risk factor for early mortality (Reference: Naito et al, Jan 2023, Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies).

• Our estates house vibrant communities which are enhanced by community groups, forums, events, and opportunities for participation. The Estates’ caretakers, maintenance, and repairs teams are a valuable resource as they have daily contact with residents. Trained in Islington’s CARE values, they can identify residents who are vulnerable and signpost to social activities and services.   
• Several housing providers offer housing in Islington for people aged 55 and over (Sheltered and LiveSmart). The council holds 100% nomination rights  to 13 of these schemes and 50% nominations rights to 15 schemes. There is a facilities manager onsite and residents can access an emergency call system. These schemes promote social interaction and mutual support networks. These schemes have been shown to prevent or delay the need for more institutional forms of care and help to reduce falls and hospital admissions (Reference: Demos, 2017, The Social Value of Sheltered Housing). There are a total of 673 units available to older people in Islington. Demand in Islington is high. In June 2024 there were 207 residents on the waiting list and wait times were 9 months for the most urgent cases and up to 12 months. 
• Adult Social Care can nominate fifteen residents with Learning disabilities per annum to general needs housing. These are on a single tenancy-based option only. 
• The Access Islington Hubs and Family Hubs are one-stop-shops, offering early intervention and prevention services for residents. These hubs deliver advice and support around work, money, food, home, family, wellbeing, and safety. They provide holistic support, providing access to timely housing support when needed.  
• The council also supports a vibrant and diverse voluntary and community sector through grant funding and commissioning. 

Providing care and support for residents in their own home

There are a range of options to help people to remain safe and independent in their own homes, prevent the need for more institutional forms of care and to step down to greater independence.  

• The Community Equipment service provides equipment such as walking aids, specialist beds, hoists, and bathing equipment. 
• The Assistive Technology Service provides residents with personal alarms and sensors that can be activated to alert a 24-hour support centre. Innovations in Assistive Technology are opening up new opportunities to maximise independence, increase safety, reduce social isolation, and prevent crisis. 
• The council offers grants via the Disabilities Facilities Grant fund, for disabled homeowners and private or housing association tenants, to make home adaptations, helping improve accessibility and safety around the home, restore dignity and improve home comfort. Council tenants can access adaptations via the council. 
• The council commissions a range of mental health and wellbeing community services that support people to remain well, and to live as independently as possible in their own homes, including reablement provision, floating support, housing support on estates, day opportunities and community groups, one to one support, volunteering and peer support opportunities. 
• Islington commissions over 1,200 packages of care provided to residents living in their own home. 
• Respite services are offered to provide carers with a break from their caring responsibilities and help to sustain the caring relationship in the long term. Islington Council provides a 10-bed respite service which is accessed by around 50 residents with learning disabilities over the year. We also commission one residential care bed to provide respite to carers of residents aged 65 and over. 
• Islington residents can also access Homeshare schemes. Homeshare services bring together older people and others who need support to stay in their homes (the householders), with young people and others (the home sharers), who provide companionship and ten hours per week of low-level practical support in return for an affordable place to live. Currently, only a handful of Islington residents access the Homeshare scheme. On average a match lasting nine months can avoid costs to statutory services of over £20,000.  
• Islington’s Resident Support Scheme provides support to residents facing severe financial hardship. One off payments can be offered to help with housing costs such as rent shortfall or rent deposits, or meet the costs of purchasing essential household items. This is valuable assistance to those who are stepping down from higher support settings into general needs housing. 

Accommodation-based care services 

As at the start of 2024, we provide or commission the following accommodation services in-borough to residents with a range of support needs. 

Shared Lives 

The Shared Lives scheme matches individuals with care needs with carers who share their home, family, and community life, to give care and support to the individual either long term, or for respite - for day visits or overnight. In October 2023, the Islington scheme was supporting 30 residents aged 16+ all of whom have Learning Disabilities. Four also had mental health needs. 

Supported housing 

Islington commissions 231 units of supported housing for people with complex and multiple needs. Some services have 24-hour support on site, whereas others have fewer staff hours or a visiting support offer. One service is female only. Services meet a range of needs within these services, including mental health and substance misuse. The services play an important role in the prevention of homelessness. 

Supported living 

Islington commissions a number of supported living schemes in borough that have capacity for 137 residents with learning disabilities, 139 residents with complex mental health needs and 40 residents with mental health requiring lower level of support.  

Extra Care 

The Mildmay Extra Care scheme provides housing and care to up to 87 adults aged 55+ with a range of support needs including frailty, social support, learning disabilities and mental health needs.  

Nursing and residential care

We commission 150 beds largely for adults aged 65 and over with nursing needs and dementia or mental health needs. 

We provide and commission 24-hour residential care in a number of care homes including;  

• 78 beds for residents aged 65 and over with frailty and/or dementia 
• 19 beds for people with a primary support reason of learning disabilities  
• 24 beds for people who require specialist care for a primary support reason of mental health needs  
• 15 residential care beds for older men with alcohol misuse and mental health care and support needs.