Case studies for comissioners
Mrs S is in her mid-60s. She lives alone in a large dilapidated house and has had sporadic contact with Bristol Care & Repair, the local home improvement agency, for a few years. She has significant mental-health difficulties and has been diagnosed with paranoid schizophrenia, but declines any engagement with mental-health services.
Mrs S does not think there is anything wrong with her.
As her house failed to meet the government’s Decent Homes standard, her case was being handled by the home improvement agency’s housing options service, with a view to finding suitable alternative accommodation. Despite several suitable flats being identified, Mrs S seemed reluctant to move. The housing options caseworker wasn’t sure Mrs S wanted to leave her home, where she had lived for the past 40 years, and it was proving difficult to determine if she had the capacity to consent to leave. It also transpired that Mrs S still owned the house with her ex-husband but she was reluctant to disclose any contact details for him.
In addition to dilapidation, there was also significant clutter in the house. Enforcement action had been considered but not pursued. The house was again assessed by an agency technical officer who felt it would be possible to convert the basement of the house into a self contained unit and repair the roof and the front door, within the limits of a minor works grant.
At this stage, the home improvement agency’s specialist mental-health caseworker was asked to take over the case. The caseworker had significant experience of working with clients with mental-health problems, having had a professional background in health.
Clients with mental-health problems often need more time spent with them to build rapport and trust. The specialist mental-health caseworker carries a smaller caseload in order to spend more time with clients and to develop and provide training and support to peers.
Mrs S has now agreed to having work done. The caseworker sees Mrs S approximately once a week and is trying to organise some help with the house clearance. She will maintain contact with Mrs S once the work has been completed.
Older adults with a moderate learning disability are increasingly likely to be living in owner-occupied homes. Most will not have been formally diagnosed as having a learning disability - they may just be seen as 'difficult cases'.
For some people with a learning disability, the everyday practicalities of living in an owner-occupied home can be difficult. This is especially true if they lived for much of their lives with parents or family carers who moved into residential care or died, leaving them in the family home to cope on their own with little or no outside help.
Physical deterioration of the home can be rapid. The person simply may not notice a problem, or if they do, they may not know what to do about it. Understandably, they may worry about being swindled by builders or simply not have the money for repairs.
Home improvement agency crisis support services are one way of enabling older people with moderate learning disabilities to live independently in mainstream housing. Such a service is now well established at Orbit Care & Repair Coventry.
The help that these schemes offer is rooted in mainstream home improvement agency repair and adaptation work. The difference is in the intensive nature of the casework, both in dealing with a crisis and subsequently building the person's capacity to manage their own affairs to prevent future problems. Resolving challenging and complex situations that may have built up over many years can be protracted but the outcomes can transform people's lives.
Miss J is 76 and lives in what was previously her parents’ home. She has a moderate learning disability.
Her house was filling up with dirty clothing and starting to smell. A neighbour complained to Environmental Health. It turned out that Miss J's washing machine had broken down and, as she felt unable to organise a repair or replacement machine, she coped by buying more and more clothes from charity shops.
A long-standing leak from the washing machine had resulted in damage to the floorboards. The local home improvement agency’s Crisis Support Worker raised charitable funds to pay for repairs and a new washing machine. This was installed by their handyman, who also carried out a number of other small repairs. Miss J now trusts the handyman and is able to contact him without fear if odd jobs need to be done. This is both preventing deterioration of the property and has reduced the conflict with neighbours.
Mrs W, 74, lives in Coventry. She has health problems and is a carer for her two daughters, who both have learning disabilities. Her elder daughter needs 24-hour care.
Mrs W has been supported by the local home improvement agency for some years. The organisation helped her sort out her debt problems and dealt with major repair work needed on her home. They helped her apply for a Disabled Facilities Grant to put in a downstairs bathroom and bedroom. They also organised replacement of rotting floorboards and bought her some new furniture.
