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The Republican Plan to Challenge a Harris Victory

How a right-wing takeover of an obscure, unelected board in georgia could swing the election..

Hosted by Michael Barbaro

Featuring Nick Corasaniti

Produced by Olivia Natt Asthaa Chaturvedi and Eric Krupke

Edited by Patricia Willens

With Lexie Diao and Michael Benoist

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At the Democratic National Convention, party officials are celebrating polls showing that Kamala Harris is now competitive with Donald Trump in every major swing state across the country.

But in one of those swing states, Republicans have laid the groundwork to challenge a potential Harris victory this fall, by taking over an obscure, unelected board.

Nick Corasaniti, a Times reporter who focuses on voting and elections, explains.

On today’s episode

Nick Corasaniti , a reporter covering national politics for The New York Times.

Background reading

The unelected body that shapes voting rules in Georgia has a new conservative majority, whose members question the state’s 2020 results. They now have new power to influence the results in 2024 .

Kamala Harris and Donald Trump are in close races across Arizona, Georgia, Nevada and North Carolina , crucial swing states that Mr. Trump had seemed poised to run away with.

There are a lot of ways to listen to The Daily. Here’s how.

We aim to make transcripts available the next workday after an episode’s publication. You can find them at the top of the page.

Fact-checking by Susan Lee .

The Daily is made by Rachel Quester, Lynsea Garrison, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, M.J. Davis Lin, Dan Powell, Sydney Harper, Michael Benoist, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Diana Nguyen, Marion Lozano, Corey Schreppel, Rob Szypko, Elisheba Ittoop, Mooj Zadie, Patricia Willens, Rowan Niemisto, Jody Becker, Rikki Novetsky, Nina Feldman, Will Reid, Carlos Prieto, Ben Calhoun, Susan Lee, Lexie Diao, Mary Wilson, Alex Stern, Sophia Lanman, Shannon Lin, Diane Wong, Devon Taylor, Alyssa Moxley, Olivia Natt, Daniel Ramirez and Brendan Klinkenberg.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Paula Szuchman, Lisa Tobin, Larissa Anderson, Julia Simon, Sofia Milan, Mahima Chablani, Elizabeth Davis-Moorer, Jeffrey Miranda, Maddy Masiello, Isabella Anderson, Nina Lassam and Nick Pitman.

Nick Corasaniti is a Times reporter covering national politics, with a focus on voting and elections. More about Nick Corasaniti

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BTEC Tech Award Health and Social Care Component 2 Learning Aim A Component Guide Level 1/2

Subject: Personal, social and health education

Age range: 14-16

Resource type: Other

Last updated

2 August 2020

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This is a component guide for BTEC Tech Award Health and Social Care Level 1/2 - Component 2 Health and Social Care Services and Values, Learning Aim A: understand the different types of health and social care services and barriers to accessing them. The document contains:

Assessment criteria Command word definitions Specification content (from BTEC) Verna and Sam Williams case studies (from BTEC) Assignment brief task instructions (from BTEC) Section 1 guidance - explanation of how services meet needs A.1P1/A.1M1/A.2P1 (local examples provided for Kent and can be edited for your local area) Section 2 guidance - explanation of barriers A.1P2/A.1M2/A.2P2 Section 3 guidance - analysing/assessing the suitability of services and barriers A.2M1/A.2D1 Marking guidelines (from BTEC)

The booklet contains checklists for what students need to include alongside tips and example paragraphs for guidance.

Please note that this document is intended as an overview of the work that students are required to produce for their portfolio work. This is not a booklet that would teach students the component taught content. This will support students in ensuring they have covered the required content when writing up their portfolio submission.

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BTEC Tech Award Health and Social Care Level 1/2 Component 1 and 2 portfolio guidance packs

BTEC Tech Award Level 1/2 Health and Social Care - Components 1 and 2 portfolio guidance documents. 1) Component 1 Learning aim A 2) Component 1 Learning aim B 3) Component 2 Learning aim A 4) Component 2 Learning aim B Each document supports students in creating their portfolio submissions. See individual items for full descriptions,

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Hull Adult Social Care APPP

Case Studies

These case studies have been taken from the Care and Support Statutory Guidance (Department of Health and Social Care) . They should be read in conjunction with the relevant chapter.

Preventing, Reducing or Delaying Needs

Market shaping and commissioning of adult care and support, assessment and eligibility, independent advocacy, deferred payment agreements, care and support planning, personal budgets, direct payments.

Review of Care and Support Planning

Safeguarding

Integration, cooperation and partnerships.

Transition to Adult Care and Support

Delegation of Local Authority Functions

Ordinary residence, cross border placements, case study: linkage programme.

The LinkAge programme aims to promote and enhance the lives of older people (55+ years old) through a range of activities, from walking groups to coffee mornings, through a number of older people-led ‘hubs’ across the city. The main aim is to bring those people that feel socially isolated and lonely into their local communities. In an evaluation of a new hub there was significant improvement on a friendship scale with scores moving from people feeling isolated or with a low level of social support at the beginning of the hub to very or highly socially connected at follow up.

Eileen (85) said:

“I look forward to Fridays each week and enjoy the social aspect of the club too.”

“If it wasn’t for LinkAge I don’t quite know what would have happened. It’s made life bearable, well more than bearable, it’s made it life.”

Case Study: Older man living alone

An older man lives alone with some support from his daughter who works full-time. He needs occasional personal care to remain living independently with dignity, and it is likely that these needs will increase. He has lost contact with family and friends following his wife’s death and rarely goes out without support from his daughter who is restricted to taking him out at weekends because of work commitments.

An assessment would consider all of his needs, including those currently being met by his daughter, along with the outcomes he wishes to achieve. A separate carer’s assessment offered to his daughter (or a combined assessment if both father and daughter agreed) would establish the daughter’s willingness and ability to care and continue to care and how best to promote her own wellbeing, for example by having regard to the outcomes she wishes to achieve. This joint assessment would look at issues such as the possible impact on the daughter of supporting her father while in full-time employment as well as the father’s isolation, ability to connect with others or be an active citizen.

Community groups, voluntary organisations, and buddying services could support the father to reduce the social isolation that he may be feeling and maximise opportunities to look after his own health and wellbeing and participate in local community activities. This, in turn could lessen the impact of caring on his daughter and enable her to continue to support her father effectively alongside paid employment. Such support can be identified/suggested alongside other, perhaps more formal services to meet personal care needs, and can be an effective way of promoting wellbeing. In this example, the aspects of wellbeing relating to social wellbeing and family relationships might be promoted.

Case Study: Derby City Council’s Customer Journey

Derby City Council used co-production to develop clear and easy to use customer information to support their customer journey for self-directed support. Information that has been produced includes an assessment form, support planning tools for people using services, customer leaflets and a staff handbook. A small project team held discussions and workshops to identify information that needed improving to be clearer and suggestions for improvement, e.g. a new assessment form. Staff working in adult social care assessment teams had training on how to make best use of the new suite of information.

The inclusive approach taken to re-designing the information took longer than an internally managed process, but has resulted in better information, informed people using services and bringing their own perspective and experience. The co-production approach led to the development of key principles which can be used in other areas of communication. The approach is being continued.

Case Study: Midland Heart’s Reablement Service

At 82, Beryl was diagnosed with stomach cancer and admitted to hospital. As a result of a major operation, she now has a permanent colostomy bag. After only a month Beryl was successfully discharged from hospital to her own home with a reablement package from Leicester City Council and support from the housing association, Midland Heart, to help her regain her independence.

If Beryl had not received this support, she would have been discharged to a more costly care home. The reablement service ensured that Beryl’s home was suitably adapted for her return, which allowed a speedy discharge and avoided the need for institutional care. The support service has assisted her attendance at medical appointments with her GP and monitored the impact of her medication.

Case Study: Mr A, living alone at home

Mr A is a 91 year old man who lives alone with his dog in his house. He is usually independent, is a passionate cook and enjoys socialising. He drives a car. Whilst out walking his dog he suffered a stroke, he fell, causing a fractured neck of femur. He was admitted to hospital and underwent surgery for a hip replacement which meant he had to follow hip precautions for 6 weeks.

The stroke had left him with slight left-sided weakness and problems with concentration, sequencing and attention. He was transferred to a community hospital for rehabilitation where the physiotherapists (PTs) and occupational therapists (OTs) worked on mobility, transfers, personal care following hip precautions, stair climbing and kitchen tasks. Cognitive screens were completed and the OTs targeted their input on helping improve concentration, sequencing and attention.

Mr A was discharged, independently mobile using a frame, independent transferring using equipment and stair climbing with supervision. He was discharged home with 4 calls per day from BEST plus (Bradford Enablement Support Team). Joint sessions between the PTs and OTs and BEST plus were completed to work on the following:

• practising walking safely indoors using 2 walking sticks
• increase hip strength through exercises
• to be safe and independent washing and dressing
• to be safe and independent preparing hot drinks and simple snacks and transport safely using trolley

The above goals were achieved and new goals were set in consultation with Mr A:

• to be safe and independent walking outdoors using 2 sticks
• to be safe and independent bathing using bath lift
• to be safe and independent preparing hot meals from scratch
• to be safe and independent completing shopping using Access bus
• to be safe and independent walking dog short distances using 4 wheeled walker.

After 6 weeks of continued BEST plus input in Mr A’s home, he was able to achieve all of his goals and all Social Services input was withdrawn. Aspects of Mr A’s wellbeing have been promoted including physical wellbeing, social wellbeing, and control over day-to-day life.

Example: Ensuring provision of appropriate services

Young people move from children’s to adult care and support or providing support for situations where young carers become adults

For instance, many young people with learning disabilities leave full-time education at around this age and require new forms of care and support to live independently thereafter. Ensuring that services are made available to meet those needs is better for the quality of life of the young person in question. This could include things such as employment support, training, developing friendships or advice on housing options. It is equally important to think about ways of supporting carers at this time: some parent carers need extra support to juggle caring and paid work after their child leaves full time education. Loss of paid employment can have a significant impact on the carer’s wellbeing and self-esteem as well as a significant impact on the family’s financial circumstances. Similar issues can affect young carers. Taking a whole family approach to care and support planning that sets out a ‘five-day offer’ or appropriate supported living options for a young person, and support for a carer to manage an increased caring role (that allows them to stay in paid work if they wish to do so) can help families manage the transition and save money by avoiding unwanted out-of-county placements.

Case Study: Facilitating the market

Warwickshire Council’s Market Position Statement for Older People identified a significant growth in the number of people living with dementia in the county, coupled with a declining trend in the number of people accessing traditional day services in the previous 4 to 5 years. Day services provide stimulation for the person living with dementia as well as a break for the person’s carer.

Following this the Council undertook a full review of Dementia Community Support. This included evaluating the role of services funded by the NHS and the Council and also those provided directly by the voluntary and community sector.

The Council held an engagement event to establish what customers and carers want dementia Community Support services to look like and deliver. This identified the gaps between supply and demand in more detail and at a local level. The event also gathered information from providers and voluntary and community groups about the challenges of delivering services. Providers identified commissioning models which promote strong and stable service delivery whilst still allowing flexible responses to meet individual needs as particularly useful. As a result of this activity, the Council procured a new service model for Dementia Community Support. The model will include information and advice, community services, building-based respite and specialist support.

Case Study 1: John (eligible)

John is 32 and has been referred by his mother for an assessment, who is concerned for John and his future. John is unemployed and lives with his mother and she is getting to an age where she realises that she might not be able to provide the same level of care and support for her son as she has done so far. John is able to manage his own personal care, but his mother does all the housework for both of them. John feels increasingly isolated and will not leave the house without his mother. It is important to John that he is intellectually stimulated and there is a chess club nearby which he would like to join, but John does not feel confident about this due to his anxiety in social situations.

Adult on the autistic spectrum.

John has severe difficulties socialising and co-operating with other people.

He only has transactional exchanges and cannot maintain eye contact. John knows that others feel uneasy around him, and spends a lot of his time alone. As a result, John is unable to achieve the following outcomes: Developing and maintaining family or other personal relationships and making use of necessary facilities and services in the community.

Impact on wellbeing

John is too anxious to initiate developing friendships on his own although he would like to and he feels lonely and depressed most of the time. His nervousness also affects his ability to take advantage of facilities in the community, which could help him feel less lonely. Feeling anxious and lonely has a significant impact on his wellbeing

Decision: Eligible

Next actions.

John’s local authority thinks John’s needs are eligible. Both John and the local authority agree that the most effective way of meeting John’s needs is to develop his confidence to join the chess club. John uses his personal budget to pay for a support worker to accompany him to an autism social skills group, and to the chess club and to travel with him on the bus to get there.

John’s local authority notes that John’s mother could need support too and offers her a carer’s assessment.

Case study 2: Dave (not eligible)

Dave is 32 and has been referred by his mother for an assessment, who is concerned for Dave and his future. Dave lives with his mother and she is getting to an age where she realises that she might not be able to provide the same level of care and support for her son as she has done so far.

Dave is able to manage his own personal care, but his mother does all the housework for both of them. Dave also works, but would like to get a job that is a better match for his intellectual abilities as his current job does not make the most of his numerical skills. Dave’s social contact is mainly online because he feels more comfortable communicating this way and he spends a lot of time in his room on his computer.

Dave struggles severely in social situations leading to difficulties accessing work and cooperating with other people. He only has transactional exchanges with others and cannot maintain eye contact. Dave knows that others feel uneasy around him and spends a lot of his time alone.

Dave is not in ideal employment, but has access to and is engaged in work. This has some impact on his wellbeing but not to a significant extent.

Dave prefers to socialise with people online. It emerges from conversations with Dave that he has access to those personal relationships that he considers essential. Dave is contributing to society, has contact with others, is in employment and is able to look after himself.

Decision: Not Eligible

Dave has difficulties doing some of the things that many other people would think should be a natural part of daily living and he is unable to participate in recreational activities in a conventional sense. Those aspects of his wellbeing that are affected by the needs caused by his autism are not so significantly affected that Dave’s overall wellbeing is at risk.

The local authority decides that Dave’s needs are not eligible, because they do not have a significant effect on his wellbeing despite his mother’s concerns.

The local authority records Dave’s assessment and sends him a copy. They include information about a local autism support group. Dave’s local authority notes that Dave’s mother could well need support and offers her a carer’s assessment.

Case Study – Carer: Deirdre (not eligible)

Deirdre is 58 and has been caring for her neighbour for the past 6 years. Deirdre has been coping with her caring responsibilities, which include checking in on her neighbour, doing her shopping and cleaning and helping her with the cooking every other day.

Deirdre works 20 hours a week at the local school, and she is also helping her daughter by picking up her grandchild after school. Deirdre’s son is concerned that she is taking on too much and notices that she is tired. Deirdre’s son persuades her to ask the local authority for a carer’s assessment.

Caring responsibilities

Neighbour with COPD.

Deirdre enjoys the variety that her working life and caring role provide. She would like to be able to spend more time with her grandchild in the afternoons, but recognises that there is a balance between doing this and caring for her neighbour. Deirdre’s needs impact on the following outcomes:

• carrying out caring responsibilities the carer has for a child
• engaging in recreational activities

Deirdre’s needs are impacting on a few outcomes.

Deirdre enjoys her caring responsibility for her grandchild and would like more free time. On the other hand, her caring roles are fulfilling so although Deirdre is tired at the end of the day, her local authority does not think her wellbeing is significantly affected.

The local authority decides that Deirdre is not eligible because her wellbeing is not significantly affected.

Next actions

The local authority recognises that Deirdre could do with some advice to help her manage her day so that she can find some time for herself and so she does not get tired. They advise on how she may reduce some of her tasks such as sitting down with her neighbour to order their food shopping online rather than carrying them home. They make contact with a local carers’ organisation and the local authority makes sure Deirdre is able to access it. The organisation is able to provide additional advice.

Case study – Carer: Sam (eligible)

Sam is 38 and cares for his mother who has early-stage dementia. Sam’s mother has telecare, but he still checks in on her daily, and does her shopping, cooking and laundry. Sam is a divorced father of 2 children, who live with him every other week. Sam works fulltime in an IT company and has come forward for an assessment as he is starting to feel unable to cope with his various responsibilities in the weeks when he looks after his children. Sam has made an arrangement with his employer that he can work longer hours on the weeks when the children are with their mother and fewer when he has the children.

Mother with early stage dementia.

Sam wants to spend more time with his children and for instance be able to free up an hour in the afternoon to help them with their homework, so it doesn’t have to be done in the evening when the children are tired. Sam’s needs impact on the following outcomes:

Sam’s responsibilities impact on a few important outcomes. Sam is starting to feel like he is failing as a parent and it affects the relationship he has with his children, his ex-wife, and his mother. He also worries that his ability to stay in work would be in jeopardy unless he receives support. Sam seems quite stressed and anxious.

The local authority decides that Sam’s fluctuating needs are eligible for support, because it perceives that they have a significant impact on his wellbeing. If the local authority supports Sam to maintain his current role, everyone is better off, because Sam can stay in employment, sustain his family relationships and provide security for his mother.

The local authority gives Sam a direct payment which he uses to pay for a care worker to come in for 3 days every other week to check on his mother and make her a meal. This gives Sam more time to spend with his children, doing homework with them and spending some more relaxed time with them.

The local authority directs Sam to a carers’ organisation which provides Sam with information about his rights at work and how to speak to his employers.

Case Study: Stephen who has an acquired brain injury

Stephen sustained a brain injury in a fall; he has completed 6 months in a specialist residential rehabilitation setting and the next step is an assessment of need for his continuing support.

Prior to this, the social worker telephones Stephen’s treating clinician who confirms that because of his brain injury, Stephen lacks insight into the effects this has had on him and he also has difficulty processing lots of information quickly – this is a common symptom of brain injury.

Therefore the social worker decides on an initial short meeting to determine Stephen’s needs and knows her first step will be to evaluate if Stephen has difficulty understanding and therefore being involved in the assessment process. If so, support could come from a carer, family member or friend or Mental Capacity Advocate, as she is aware lack of insight does not necessarily determine lack of capacity.

The social worker notes that Stephen is able to retain information about who she is and why she is meeting with him. He is articulate and can converse well about his plans for the future which includes detailed plans to meet up with friends and return to work again. However, a pre-assessment conversation with his mother, confirms that his friendship group has significantly diminished as his friends find it difficult to understand the differences in his behaviour since his fall and doubts whether he will be able to return to full-time employment. The social worker judges that because Stephen lacks insight into his personal relationships and future plans, he may well also have trouble estimating his true care and support needs. At this point the social worker decides that Stephen would have substantial difficulty in being fully involved in the rest of the assessment process and would therefore benefit from assistance.

Stephen is adamant that he wants to act and make decisions independently of his mother, though he is happy for her to inform the assessment process. The social worker decides that Stephen’s mother would not be an appropriate person under the Care Act to support his involvement in the needs assessment. The social worker talks to Stephen about how an independent advocate could help him make sure his views, beliefs, wishes and aspirations are taken into account in the assessment, and with his agreement, arranges for an independent advocate with specialist brain injury training to support him. The independent advocate meets Stephen but also talks to his mother to get a true picture of Stephen’s current needs and wishes and to ascertain the differences between how Stephen is now and prior to acquiring his brain injury. The social worker carries out the needs assessment with Stephen who is supported by his independent advocate, and with Stephen’s approval, input from his mother.

Case Study: Lynette, who has learning disabilities

Lynette, who has learning disabilities, lives in a care home. A support worker contacted the local authority because another resident, Fred, has come into Lynette’s room late at night shouting on several occasions and most recently was seen pushing her. A safeguarding enquiry is started and the local authority appoint an independent advocate to support Lynette as they are concerned that she cannot express herself easily. When interviewed by the social worker Lynette cannot describe what happened. The social worker and advocate agree that the advocate will help Lynette to communicate how she feels.

The advocate spends time with Lynette. She explains what is happening and communicates with Lynette about different people that she lives with, including using photos, finding out more about her feelings. Lynette appears to be generally happy around the house and when going out, but is very distressed when she sees Fred in person, or even when she sees a picture of him. The advocate makes clear to the Local Authority what Lynette has communicated.

The local authority finds that whilst there is no doubt that Fred did what was reported, he may have done so as a result of his own confusion and distress. They agree a proposal from the registered manager of the care home that alarms will be put on Fred’s door and staffing numbers increased to prevent a recurrence. The local authority agrees to review the situation after some weeks during which time the advocate stays in contact with Lynette in order to understand the impact of this decision on Lynette. The advocate finds that Lynette remains distressed by Fred’s presence. She is concerned that the measures in place are not sufficient and writes this in a report to the local authority detailing what Lynette has communicated about where she lives and about Fred. The local authority agrees to look at what further action may be needed which might include considering whether Lynette and Fred should continue to share accommodation.

The main aspect of wellbeing promoted is protection from abuse and neglect, but also personal dignity and emotional wellbeing. The local authority has also demonstrated its regard for Lynette’s views, wishes, feelings and beliefs.

Case study: Janice, who cares for her mother

Janice is 43 and cares for her mother Sheena who is 72 who has advanced Parkinson’s and increasing cognitive and communication difficulties. Janice cares for her mother in excess of 40 hours per week. Janice gave up work to care for her mother 5 years ago, and using her direct payment Sheena pays her daughter for 8 hours per week for care and support, including helping her with personal care, cooking meals and grocery shopping. Sheena preferred this to paying someone else – she prefers not to have strangers in the house and finds that others often do not understand her needs. As Janice is caring for her mother for many more hours than this, Janice has received a carers assessment and receives her own carers personal budget which she uses for breaks such as her weekly aerobics class which she finds helps her keep in touch with her friends, stay healthy, and deal with stress.

There is no-one else available to act as an appropriate individual to support Sheena in decision making. Both Sheena and Janice would be happy for Janice to take on this role. However, as Janice received a payment, she would not be regarded as an appropriate individual, though the guidance states that good practice should ensure Janice’s views are sought as Sheena has made clear that she wishes this to happen.

Case study: Jacinta, who has moderate learning disabilities

Jacinta is 26 and lives with her mother and father. She has 2 siblings aged 28 and 23 who have left the family home. Jacinta would also like to move to living more independently. Jacinta has moderate learning disabilities and finds it hard to retain information. Jacinta’s parents are very worried that she won’t be able to cope living in her own home and are against her doing so. In these circumstances Jacinta’s parents would not be ‘an appropriate person’ who could effectively represent and support her involvement.

Case study: Brian, who has advanced dementia

Brian is 84 and has advancing dementia. He lives alone in the house he owns. Brian has very limited mobility, has frequent falls and has difficulty in remembering to take medication and to eat. He has periods when he is confused and weighing up the longer term advantages and disadvantages of this care and support options, but has been judged to retain ‘capacity’ Brian says he feels very lonely. Social services are already providing some domiciliary care for which Brian is charged. The local authority is reviewing Brian’s care plan. Brian’s daughter and son in law who have had little contact with Brian over the past few years and will inherit the house are adamant that he can cope at home and does not need to go into a care home. In these circumstances, in addition to a lack of recent contact, there could be a conflict of interests and Brian’s relatives would not be ‘an appropriate person’.

Case study: Kate, who has profound and multiple learning disabilities

Kate has profound and multiple learning disabilities. She doesn’t use formal communication such as words or signs. She communicates using body language and facial expressions. In her assessment, Kate’s independent advocate supports her to show some film of her visiting a local market, enjoying the colours and sounds around her. In this way, Kate is able to show the assessor some of the things that are important to her.

Case Study: Lucille

Case study 1.

Lucille develops a need for a care home placement. She lives alone and is the sole owner of her home. Her home is valued at £165,000, and she has £15,000 in savings. Lucille meets the criteria governing eligibility for a deferred payment.

Case study 2

Lucille’s son Buster has been providing informal care and support to her, and has heard of the deferred payments scheme. When Lucille decides she may benefit from a care home placement, her son suggests they approach her local authority together for information and advice about deferred payment agreements.

Her local authority provides them both with a printed information sheet setting out further details on the authority’s deferred payment scheme, and also provides them with contact details of some national and local services who provide financial information and advice

Lucille is interested in renting her property whilst residing in a care home. The local authority has an existing housing advice service, so signposts Lucille to them for further advice on lettings. The local authority’s standard information sheet also includes information on how her rental income may be used to pay for her care and support.

Case study 3

Lucille decides to secure her deferred payment agreement with her house, which is worth £165,000. The amount of equity available will be the value of the property minus 10%, minus a further £14,250 (the lower capital limit).

£165,000 – £16,500 – £14,250 = £134,250

Therefore, her ‘equity limit’ for the total amount she could defer would consequently be £134,250, which would leave £30,750 in equity in her home.

Case study 4

Lucille identifies a care home placement that meets her care and support needs, costing £540 per week. She has an income provided by her pension of £230 per week. Lucille decides not to rent her home as she intends to sell it within the year.

Based on this provisional estimate of her care costs, Lucille would contribute £86 (230 –144) per week from her income, and her weekly deferral would be £454.

Case study 5

Lucille discusses her care home fees with the local authority. Based on the equity available in her home (£134,250, as set out in Case study 3 above), Lucille could afford her weekly deferral of £454 for around 5 years. Given an average length of stay in a care home care of 19.7 months (source: BUPA 2010, cited in Laing and Buisson 2012/13), the local authority deems her projected care costs to be sustainable.

Lucille enquires as to the cost of a room with a garden view. This would increase her weekly deferral to £525 which she could afford for around four and a half years. The local authority deems this to be sustainable, so agrees to Lucille’s requested top-up.

Case study 6:

For illustrative purposes, we have used an interest rate of 3.5%. After 6 months, Lucille receives her first statement. It confirms she has deferred a total of £13,900, including £110 in interest and £100 in administration fees.

At this point, the local authority revalues her property, and finds its value has increased to £170,000. Based on the amount deferred and her care costs, her equity would afford her just over 4 and a half more years’ care at this price.

Case study: Using discretionary powers to meet needs

Mrs Pascal, who is frail and elderly, was admitted to hospital after a fall. The hospital has established that Mrs Pascal currently has no care and support plan in place and made contact with the local authority to arrange a needs assessment. The local authority assesses that she has eligible needs which will be best met in a care home setting.

The local authority undertakes a financial assessment which finds that Mrs Pascal’s finances are above the limit for financial support from the local authority. The authority provides her with information and advice about her options. Mrs Pascal expresses extreme nervousness about seeking a placement on her own as she has struggled with managing her personal finances in recent times and does not have any family who are able to support her.

After a consultation, both Mrs Pascal and her local authority agree that support with arranging and managing a care placement would be beneficial for her wellbeing and would adequately meet her eligible needs. The authority arranges for Mrs Pascal to meet a trusted brokerage organisation which discusses her needs and arranges a contract with a care home on behalf of Mrs Pascal that she is very happy with.

Case Study: Miss S, who has fluctuating needs

Miss S has Multiple Sclerosis and requires a frame or wheelchair for mobility. Miss S suffers badly with fatigue, but for the majority of the time she feels able to cope with daily life with a small amount of care and support. However, during relapses she has been unable to sit up, walk or transfer, has lost the use of an arm or lost her vision completely. This can last for a few weeks, and happens 2 or 3 times a year; requiring 24 hour support for all daily activities.

In the past, Miss S was hospitalised during relapses as she was unable to cope at home. However, for the past 3 years, she has received a care and support package that include direct payments which allows her to save up one month’s worth of 24 hour care for when she needs it, and this is detailed in the care and support plan.

Miss S can now instantly access the extra support she needs without reassessment and has reassurance that she will be able to put plans in place to cope with any fluctuating needs. She has not been hospitalised since.

Example: Costs of direct payments 1

Andrew has chosen to meet his needs by receiving care and support from a PA. The local authority has a block contract with an agency which has been providing support to Andrew twice per week. Andrew would now like more flexibility in the times at which he receives support in order to better meet his needs by allowing him to undertake other activities and consider employment.

He therefore requests a direct payment so that he can make his own arrangements with another agency, which is happy to arrange a much more flexible and personalised service, providing Andrew with the same care worker on each occasion, and at a time that works best for him.

The cost to the local authority of the block contracted services is £13.50 per hour. However, the more flexible support costs £18 per hour (inclusive of other employment costs). The local authority therefore increases Andrew’s direct payment from £67.50 to £90 per week to allow him to continue to receive the care he requires. The solution through a direct payment delivers better outcomes for Andrew and therefore the additional cost is reasonable and seen as value for money as it may delay future needs developing.

The local authority also agrees it is more efficient for them to allow Andrew to arrange and commission the hours he wants to receive support and handle the invoicing himself.

Example: Costs of direct payments 2

Following George’s assessment of needs, the local authority work out an indicative personal budget of £135 per week, based on their block contract rate of £13.50 per hour as an indication of the potential costs to meet his needs.

During care planning, George states that he has a neighbour that has recently trained to become a personal assistant, and George indicates a preference to use a direct payment to employ the neighbour instead of an arranged service.

The local authority is satisfied that George will be able to manage the direct payment, and that he understands his responsibilities as an employer. George wants to pay the PA above the living wage and has provisionally agreed a hourly rate of £9 per hour. The local authority agrees to this as George agrees that it will meet his needs and outcomes. The final personal budget is adjusted to £110 per week which factors in the new hourly rate, plus an additional allowance for employment responsibilities (PAYE, NI, insurance etc.)

Examples: Using Individual Service Funds

Sally really enjoys dancing and night clubs and she needs support for this. Sally’s ISF arrangement with her provider has given her the flexibility to employ staff that also like to do this, and they are paid time and a half after 11:00pm. The ISF arrangement also allows Sally to convert ‘standard hours’ into ‘enhanced hours’, for example, 6 standard hours equals 4 enhanced hours. Sally can plan late nights out knowing what it ‘costs’ from her allocation of 24 standard hours support, which is calculated from her personal budget.

Brian’s ISF arrangement with his provider allows him to save up and then convert the hours of his support into money to purchase personal trainer time at a local gym. In addition to promoting wellbeing in the areas of emotional and social wellbeing and personal relationships, these arrangements also demonstrate the local authority’s regard for the importance of beginning with the assumption that an individual is best-placed to judge their own wellbeing.

Examples: Flexible use of a carer’s personal budget

Conor has been caring for his wife, who is in a wheelchair with ME and arthritis, for the last 9 years. He does all the cooking, driving and general household duties for their household. Conor received a personal budget which he requested in the form of a direct payment from his local authority for a laptop to enable him to be in more regular contact through Skype with family in the US. This now enables Conor to stay connected with family he cannot afford to fly and see. This family support helps Connor with his ongoing caring role.

Divya has 4 young children and provides care for her father who is nearing the end of his life. Her father receives a direct payment, which he used to pay a family member for a period of time to give his daughter a break from her caring role. Divya received a carers’ direct payment, which she uses for her children to attend summer play schemes so that she get some free time to meet with friends and socialise when the family member providers care to her father. This gives Divya regular breaks from caring which are important to the family unit.

Case Study: Making direct payments support accessible

Abdul is a deafblind man; to communicate he prefers to use Braille, Deafblind Manual and email. He directly employs several staff through direct payments. He receives payroll support from his local direct payments support service. Abdul suggested ways to make direct payments management accessible to him. He communicates with the support service mainly via email but they also use Typetalk.

At the end of the month, Abdul emails the support service with details of the hours that his staff have worked. The support service work out any deductions from pay (such as National Insurance and Income Tax) and email him to tell him how much he should pay the staff via cheque. They then send him pay slips to be given to staff. The envelope that the payslips are sent in has 2 staples in the corner so that he knows who the letter is from. The payslips themselves are labelled in Braille so that he knows which staff to give them to.

Each quarter, the support service tells him how much he needs to pay on behalf of his employees in National Insurance and Income Tax. The service also fills in quarterly Inland Revenue paperwork. At the end of the year, the support service sends relevant information to the council, so that they are aware of how the direct payments are being spent.

Abdul has taken on only some of the responsibilities of employing people; he has delegated some tasks to the support service. Control still remains with Abdul and confidentiality is maintained by using accessible labelling. In terms of the wellbeing principle, the local authority has promoted Abdul’s control over his day-to-day life.

Example: Reduced monitoring

Gina has a stable condition and has been successfully managing her direct payment for over 2 years. The local authority therefore decides to reduce monitoring to the lowest level due to the low perceived risk (while still complying with the required review in the Act and Regulations). Gina is now considered to have the skills and experience to manage on her own unless the local authority request otherwise or information suggested otherwise comes to the attention of the local authority.

Example: Direct payment to pay a family member for administration support

David has been using direct payments to meet his needs for some time, and has used private agencies to provide payroll and administration support, funded by a one-off annual payment as part of his personal budget allocation. David’s wife, Gill provides care for him and is increasingly becoming more hands-on in arranging multiple PAs to visit and other administrative tasks as David’s care needs have begun to fluctuate.

They jointly approach the local authority to request that Gill undertake the administration support instead of the agency as they want to take complete control of the payment and care arrangements so that they can best meet David’s fluctuating needs and ensure that appropriate care is organized.

The local authority considers that Gill would be able to manage this aspect of the payment, and jointly revises the care plan to detail the aspects of the payment, and what services Gill will undertake to the agreement of all concerned. The personal budget is also revised accordingly.

The family now has complete control of the payment, Gill is reimbursed for her time in supporting David with his direct payment and the local authority is able to make a saving in the one-off support allocation as there are no provider overheads to pay. In promoting David’s wellbeing, the local authority has demonstrated regard for the balance between promoting an individual’s wellbeing and that of people who are involved in caring for them. It has given Gill increased control in a way that David is comfortable with and supports.

Example: Direct payment paid to a family member where necessary

James has severe learning difficulties as well as various physical disabilities. He has serious trust issues and a unique way of communicating that only his family, through years of care as a child, can understand. The local authority agrees that using a direct payment to pay for care from his parents is necessary as it is the best way to meet James’s needs and outcomes.

Example: Direct payments for short-term residential care

Mrs. H has one week in a care home every 6 weeks. Because each week in a care home is more than 4 weeks a part, they are not added together. The cumulative total is only one week and the 4-week limit is never reached.

Peter has 3 weeks in a care home, 2 weeks at home and then another week in a care home. The 2 episodes of time in a care home are less than 4 weeks apart and so they are added together making 4 weeks in total. Peter cannot use his direct payments to purchase any more care home services within a 12-month period.

Example: Using a direct payment whilst in hospital

Peter is deafblind and is required to stay in hospital for an operation. Whilst the hospital pays for an interpreter for the medical interventions, Peter needs additional support to be able to move around the ward, and to communicate informally with staff and his family. The local authority and the NHS Trust agree that Peter’s communicator guide continues to support him in hospital, and is paid for via the direct payment, as it was when Peter was at home. Personal and medical care is provided by NHS staff but Peter’s communicator guide is on hand to provide specialist communication and guiding support to make his hospital stay is as comfortable as possible.

Example: Local authority provided service

Graham has a direct payment for the full amount of his personal budget allowance. He decides to use a local authority run day service on an infrequent basis and requests to pay for it with his direct payment so that he retains flexibility about when he attends. The local authority service is able to agree to this request and has systems already in place to take payments as self-funders often use the service. The authority advise Graham that if he wishes to use the day service on a frequent basis (i.e. once a week) it would be better to provide the service to him direct, and to reduce the direct payment amount accordingly.

Review of Care and Support Plans

Example: accepting a renewal request.

A local authority receives an email from a relative of an older person receiving care and support at home. The email provides details that the older person’s condition is deteriorating and supplies evidence of recent visits to the GP. The local authority therefore decides to review their care and support plan to ensure that it continues to meet their needs.

Example: Declining a renewal request

A local authority receives a phone call from Mr X. He is angry as he feels that he has needs that have not been identified in his care plan and requests a review of the plan. The authority has on a separate recent occasion reviewed his plan, when it came to the conclusion that no revision was necessary and informed Mr X of the decision and the reasons for it. Therefore, the local authority declines the request in this case and provides a written explanation to Mr X, informing him of an anticipated date of when it will be formally reviewing the plan together with information on its complaints procedure.

Case study: Two brothers with mild learning disabilities

Two brothers with mild learning disabilities lived in their family home, where they had remained following the death of their parents some time previously. Large amounts of rubbish had accumulated both in the garden and inside the house, with cleanliness and self-neglect also an issue. They had been targeted by fraudsters, resulting in criminal investigation and conviction of those responsible, but the brothers had refused subsequent services from adult social care and their case had been closed.

They had, however, had a good relationship with their social worker, and as concerns about their health and wellbeing continued it was decided that the social worker would maintain contact, calling in every couple of weeks to see how they were, and offer any help needed, on their terms. After almost a year, through the gradual building of trust and understanding, the brothers asked to be considered for supported housing; with the social worker’s help they improved the state of their house enough to sell it, and moved to a living environment in which practical support could be provided.

Case study: Mrs B, who has dementia and there are concerns about her daughter who has lasting power of attorney

Mrs B is an 88 year old woman with dementia who was admitted to a care home from hospital following a fall. Mrs B appointed her only daughter G, to act for her under a Lasting Power of Attorney in relation to her property and financial affairs.

Mrs B’s former home was sold and she became liable to pay the full fees of her care home. Mrs B’s daughter failed to pay the fees and arrears built up, until the home made a referral to the local authority, which in turn alerted the Office of the Public Guardian (OPG).

The OPG carried out an investigation and discovered that G was not providing her mother with any money for clothing or toiletries, which were being provided by the home from its own stocks. A visit and discussion with Mrs B revealed that she was unable to participate in any activities or outings arranged by the home, which she dearly wished to do. Her room was bare of any personal effects and she had limited stocks of underwear and nightwear.

The Police were alerted and interviewed G, who admitted using the proceeds of the mother’s house for her own benefit. The OPG applied to the Court of Protection for suspension of the power of attorney and the appointment of a deputy, who was able to seek recovery of funds and ensure Mrs B’s needs were met.

Case study: Mr A, who is socially isolated

Mr A is in his 40s, and lives in a housing association flat, with little family contact. His mental health is relatively stable, following a previous period of hospitalisation and he has visits from a mental health support worker.

He rarely goes out, but he allows people into his accommodation because of his loneliness. The police were alerted by Mr A’s neighbours to several domestic disturbances. His accommodation had been targeted by a number of local people and he had become subjected to verbal, financial and sometime physical abuse. Although Mr A initially insisted they were his friends, he did indicate he was frightened; he attended a case conference with representatives from adult social care, mental health services and the police, from which emerged a plan to strengthen his own self-protective ability as well as to deal with the present abuse.

Mr A has made different arrangements for managing his money so that he does not accumulate large sums at home. A community-based visiting service has been engaged to keep him company through visits to his home, and with time his support worker aims to help get involved in social activities that will bring more positive contacts to allay the loneliness that Mr A sees as his main challenge.

Case Study: Mrs D, who is a carer for her husband and who fears for her safety

Mrs D lives with her husband, B. B has a long term brain injury which affects his mood, behaviour and his ability to manage close family relationships. This has often led to him shouting and hitting out at his wife, who is also his main informal carer. Mrs D told a professional who was involved in supporting her that she was becoming increasingly frightened by B’s physical and verbal outbursts and at times feared for her personal safety.

Other family members were unaware of the extent of the harm and that Mrs D was exhausted and considering leaving the situation. The local authority became involved.

The situation presented significant personal risk to Mrs D but there was also a risk of fragmenting relationships if the local authority staff were not sensitive to the needs of the whole family. The practitioner, under supervision from her social work manager invested time in meeting with Mrs D to explore her preferences around managing her safety and how information about the situation would be communicated with the wider family and with B. This presented dilemmas around balancing the local authority’s duty of care towards

Mrs D with her wishes to remain in the situation with B. Placing emphasis on the latter inevitably meant that Mrs D would not be entirely free from the risk of harm but allowed the practitioner to explore help and support options which would enable Mrs D to manage and sustain her safety at a level which was acceptable to her.

The practitioner received regular supervision to allow time to reflect on the support being offered and to ensure that it was ‘person centred’. The outcome for Mrs D was that she was able to continue to care for B by working in partnership with the local authority. The practitioner offered advice about how to safely access help in an emergency and helped her to develop strategies to manage her own safety – this included staff building rapport with B, building on his strengths and desire to participate in social activities outside the family home. The effect of this was that some of the trigger points of him being at home with his wife for sustained periods during the day were reduced because he was there less.

Mrs D also had a number of pre-existing support avenues, including counselling and a good relationship with her son and her friends. The situation will be reviewed regularly with Mrs D but for the time being she feels much more able to manage.

Case Study: Miss P, for whom there are concerns she is being sexually, physically and financially abused

Miss P’s mental health social worker became concerned when she had received reports that 2 of Miss P’s associates were visiting more regularly and sometimes staying over at her flat. Miss P was being coerced into prostitution and reportedly being physically assaulted by one of the men visiting her flat. There was also concern that she was being financially exploited. Miss P’s lack of understanding of how to protect herself when livng alone was exacerbated by her mental health needs and consequent inability to set safe boundaries with the people she was associating with.

The social worker recognised that the most appropriate way to enable Miss P to manage the risk of harm was to involve Miss P’s family, which she agreed to, and other professionals to develop and coordinate a plan which would enable her to continue living independently but provide a safety net for when the risk of harm became heightened. Guided initially by Miss P’s wish for the 2 men to stay away from her, the social worker initiated a planning meeting between supportive family members and other professionals such as the police, domestic violence workers, support workers and housing officers. Although Miss P herself felt unable to attend the planning meeting, her social worker ensured that her views were included and helped guide the plan. The meeting allowed family and professionals to work in partnership, to openly share information about the risks and to plan what support Miss P needed to safely maintain her independence.

Tasks were divided between the police, family members and specialist support workers. The social worker had a role in ensuring that the plan was coordinated properly and that Miss P was fully aware of everyone’s role. Miss P’s family were crucial to the success of the plan as they had always supported her and were able to advocate for her needs.

They also had a trusting relationship with her and were able to notify the police and other professionals if they thought that the risk to Miss P was increasing. The police played an active role in monitoring and preventing criminal activity towards Miss P and ensured that they kept all of the other professionals and family up to date with what was happening. Miss P is working with a domestic violence specialist to help her develop personal strategies to keep safer and her support worker is helping her to build resilience through community support and activities.

Case study: Miss Y, for whom there are concerns she is being sexually abused along with other young people and adults

Miss Y is a young woman with a learning disability with limited support from her family and was not engaged with health and social care services. Miss Y was befriended by an individual who took her to parties where she was given drugs and alcohol and forced to have sex with different men. Sometimes she would be given money or gifts in return for having sex with the men.

Miss Y disclosed this to a social worker and it was discovered that there were a number of young people and vulnerable adults who were being sexually exploited by multiple perpetrators. Miss Y lacked mental capacity in order to be able to consent to having sex, as well as in relation to her accommodation, finances or personal safety.

The perpetrators sought out Miss Y and others because of their perceived vulnerability – whether that was because of their isolated situation and social circumstances coupled with age, disability, mental illness, or their previous history as a victim of abuse. The process to safeguard Miss Y involved a coordinated response between the police, social care, health and voluntary and community sector organisations.

This included the police investigating the perpetrators for rape, sexual assault, trafficking and drug offences. The Court of Protection and Deprivation of Liberty Safeguards were also used initially to safeguard Miss Y.

Case study: Mr P, for whom there are concerns his brother is abusing him

Mr P has mild learning disabilities. The safeguarding concern was financial and other abuse and neglect by his brother, with whom he lived. His support worker had noticed that Mr P had begun to appear agitated and anxious, that he looked increasingly unkempt and that he was often without money; then he suddenly stopped attending his day centre.

When the support worker and the safeguarding officer followed up, Mr P told them that at times he was not allowed out at all by his brother and was confined to his bedroom. He was only allowed to use the bathroom when his brother said he could, and often didn’t get enough to eat. He was also very worried because his bank card no longer worked, and he had no money, so couldn’t buy food for himself.

Mr P consented to move to temporary accommodation, and a case conference was held, which he attended with an advocate. At his request a move to a supported living flat was arranged and his belongings were retrieved from his brother’s property. His bank account had been emptied by his brother, so he has made new arrangements for his money.

The police are investigating both the financial abuse and the harm Mr P suffered at his brother’s hands. He has begun to talk about his experiences and is gradually regaining his confidence.

Case study: Mr A, for whom there are concerns he is being exploited

Mr A is 24 and has autism and a mild learning disability. He is a very friendly and sociable young man, who is prone to waving and talking to most people he comes across and who sees everyone as a potential friend. However, he struggles to read the intentions of others and is easily led astray and manipulated.

He lives next door to a pub, where he knows the staff and the regulars. He also lives close to his GP and is able to access his most frequently visited places. He does, however, like to walk into town to talk to people he meets out and about. On such occasions he has been repeatedly tricked into stealing items from a newsagent by a group of teenagers and given large amounts of money away to strangers he strikes up conversations with. Due to his previous experiences, Mr A was identified during a needs assessment as being at risk of abuse and neglect and a safeguarding enquiry was triggered.

The council found that, although Mr A was not currently experiencing abuse or neglect, he remained highly vulnerable to abuse due to his being well-known in his area as someone as easy to manipulate.

To assure his safety in the future, a safeguarding plan was agreed between Mr A and a social worker. This focused on developing his social skills and understanding of relationships and boundaries and the social worker worked with Mr A to consider various support options such as having a buddy or circle of support.

The social worker put Mr A in touch with an autism social group which provided sessions on skills for staying safe. As the group was based in town, Mr A’s plan also included a support worker to accompany him. After the first 5 sessions Mr A was able to attend himself but continued to meet with his support worker on a monthly basis as part of the risk management strategy set out in his safeguarding plan.

Case study: Mr M, for whom there are concerns he is self-neglecting

Recent research has identified ways of working that can have positive outcomes for those who self-neglect.

Mr M, in his 70s, lives in an upper-floor council flat, and had hoarded over many years: his own possessions, items inherited from his family home, and materials he had collected from skips and building sites in case they came in useful. The material was piled from floor to ceiling in every room, and Mr M lived in a burrow tunnelled through the middle, with no lighting or heating, apart from a gas stove. Finally, after years of hiding in privacy, Mr M had realised that work being carried out on the building would lead to his living conditions being discovered. Mr M himself recounted how hard it had been for him to invite access to his home, how ashamed and scared he was, and how important his hoard was to him, having learnt as a child of the war never to waste anything.

Through working closely together, Mr M, his support worker and experienced contractors have been able gradually to remove from his flat a very large volume of hoarded material and bring improvements to his home environment. It has taken time and patience, courage and faith, and a strong relationship based on trust. The worker has not judged Mr M, and has worked at his pace, positively affirming his progress. Both Mr M and his support worker acknowledge his low self-esteem, and have connected with his doctor and mental health services. The worker has recognised the need to replace what Mr M is giving up, and has encouraged activities that reflect his interests. Mr M has valued the worker’s honesty, kindness and sensitivity, his ability to listen and the respect and reciprocity within their relationship.

Example: Partnership working in relation to domestic abuse

A SAB has worked with the domestic abuse board to develop a Multi-Agency Risk Assessment Conference (MARAC) e-learning package and to commission training in line with the domestic abuse training standards, such as: domestic abuse basic awareness; domestic abuse enhanced awareness; Domestic Abuse, Stalking and Harassment (DASH) and; MARAC awareness.

Case study: Ms W, who has made complaints about being the victim of anti-social behaviour

At the age of 72 years, Ms W, although registered disabled, was an active member in her community often seen helping at community events and visiting the local shops and swimming pool. Ms W had a fall in her home which left her lacking in confidence and fearful that she would fall again. As the winter approached, Ms W spent more time alone at home only venturing to the corner shop to buy groceries. As time passed her house came in disrepair and unhygienic as local youths began throw rubbish, including dog faeces into her front garden.

Within a 5 month period Ms W made 7 complaints to the police about anti-social behaviour in her local area, and on 2 occasions was the victim of criminal damage to the front of her house, where her wheelchair accessibility ramp has been painted by graffiti. The police made a referral to social services. As a result, Ms W was placed on a waiting list for a support service.

Four weeks after she was last seen Ms W committed suicide. A Serious Case Review (SCR) was convened according to the local policy that stated ‘the purpose of an SCR is not to reinvestigate or to apportion blame, but to establish whether there are lessons to be learnt from the circumstances of the case about the way in which local professionals and agencies work together to safeguard vulnerable adults. The published report and recommendations which followed demonstrated the lessons from this case. The resultant action plan included:

• strengthened relationships and information sharing between police officers, health and the local authority
• clear lines of reporting and joint working arrangements with the community safety partnerships
• a robust multi-agency training plan
• a targeted community programme to address anti-social behaviour
• the development of a ‘people’s panel’ as a sub group to the Safeguarding Adults Board which includes people who access services, carers and voluntary groups
• the development of a ‘stay safe’ programme involving local shops where adults at risk of abuse may report their concerns to a trusted member if their community

Example: Leaflets for carers

Camden has developed a leaflet for carers about the harm they may experience when caring for a relative or friend and the harm they may cause. This was developed in partnership with carers’ organisations and carers themselves, and remains a partnership owned publication.

Case study: A care home resident who is unhappy with the standards of care

A resident at a local care home told the district nurse that staff members spoke disrespectfully to her and that there were episodes of her waiting a long time for the call bell to be answered when wanting to use the commode. The resident wished to leave the home as she was very unhappy with the treatment she was receiving, and was regularly distressed and tearful.

The resident was reluctant for a formal safeguarding enquiry to take place, but did agree that the issues could be discussed with the manager. The district nurse negotiated some actions with the manager to promote good practice and address the issues that had been raised. When the district nurse reviewed the situation; the manager at the care home had dealt with the issues appropriately and devised an action plan. The resident stated that she was now happy at the care home – staff ‘couldn’t be more helpful’ – and she no longer wanted to move.

Case study: Promoting the integration of housing, health and social care across Leicestershire

District Councils in Leicestershire have taken a strategic approach to working with county wide providers on priority issues, including housing, health and wellbeing. A District Chief Executive leads across the 7 District Councils working with a network of senior managers in each individual council. This has built the influence and credibility of District Councils with health and social care leaders who now have an increasing understanding of the vital role housing and housing based services play in the delivery of better outcomes for vulnerable people. The Housing Offer to Health in Leicestershire is built into the County`s Better Care Fund priorities and work is underway across health, social care and housing in the following key areas:

Housing’s Hospital to Home discharge pathway: looking to place housing options expertise within the day-day discharge assessment and planning work of both acute and mental health providers so that the planning and decisions around an individual’s hospital discharge includes early consideration, and actioning of appropriate and supportive housing options. * establishing an integrated service to provide practical support to people in their own homes across all tenures so that aids, equipment, adaptations, handy person services and energy efficiency interventions are available and delivered quickly. Through this we hope to reduce the time taken to provide practical help to individual people with care and support needs, reduce process costs for services paid for through the public purse and support vulnerable people to access the low level practical support that helps them remain independently at home.

Establishing a locality based approach to prevention and housing based support which includes Local Area Co-ordination, Timebanking and delivery of low level support services to vulnerable older people through a mixture of community volunteers and multi-skilled workers.

The district councils are therefore promoting wellbeing in the area of suitability of accommodation at population level, providing a basis for promoting individual wellbeing via transfers of care and universal preventative services.

Case study: Promoting the integration and social care with regards to carers support in Torbay and Southern Devon Health and Care NHS Trust

Torbay, a ‘Care Trust’ or organisation responsible for health and social takes a ‘whole system’ approach to the identification and support of carers. They worked with clinicians in primary care and the acute trust to develop an evidence base to show the positive impact early support and access to services has on carers’ health and wellbeing. This led to recognition that carer support is the joint responsibility of primary and acute health services and social care as well as an understanding that carers can be a ‘reluctant audience’ and may not identify themselves until in crisis.

Torbay has used joint CQUINs (commissioning for quality and innovation payments) to drive change. They developed a model founded on having Carers Support Workers at key points in the carer’s journey in all GP practices, in the Acute Hospital Discharge team and in specialist community teams such as Mental Health and Substance Misuse. These workers provide easy access to support, advice to other practitioners, and signpost carers through the system. They also target key staff groups for development; for example the 2013/14 focus has been on training and encouraging district and community nurses to identify and signpost carers to support. This has significantly increased referrals as well as raised awareness.

A pathway exercise was undertaken with staff and carers to map the carer’s journey through the whole system and the points at which engagement did, or could, happen. This has led to changes such as Carer Contact Cards, which includes key information on where carers can get support, in all discharge folders and a new Carers Policy for Torbay Hospital.

Providing simple, easy to access services for all carers such as Signpost’s information service, a Torbay carers’ register and carer education programmes, that are not subject to eligibility criteria and has brought carers into support much earlier therefore reducing crises.

Case study: Putting health back into housing

The Gloucestershire Affordable Housing Landlords’ Forum (GAHLF), comprising of the 7 leading local housing providers in the county, have set out an ‘offer’ to the Health and Wellbeing Board that demonstrates how each is working to improve the quality of life of their residents, the neighbourhoods and wider communities, by investing in new homes, supporting independent living, developing the community and supporting older and vulnerable people.

£12 million is being invested, by Stroud District Council, over 5 years, to improve the quality of housing stock and reduce fuel poverty for tenants. Stroud has been upgrading the heating supply in properties not currently served by mains gas. Many properties have electric storage heating which does not give the same level of control and is more expensive than gas or renewable energy. Dryleaze Court is a Supported Housing unit where 5 properties have had mains gas installed this year. At the same time, the team has also installed uPVC privacy panels, replaced porches with insulated cavity brick walls and fitted new double-glazed windows. The works have improved tenants’ quality of life, helping them to live more comfortably and reduce their fuel bills. All in all, over the 3 years ending March 2013, GAHLF has improved over 14,900 homes, with an estimated savings to the NHS of around £1.4 million per annum.

• Putting Health Back into Housing
• Case Study – Commissioning Advice Services in Portsmouth

Transition to Adult Care and Support

Case study: when a transition assessment is of ‘significant benefit’.

Isabelle is 15 years old with complex needs. She attends a residential school on a 38-week basis funded by education and social services. Care and support is currently required on the weekends and in holidays. Isabelle’s parents have approached the local authority requesting a transition assessment around the time of her 16th birthday. Initially the local authority’s reaction is that this is too soon to be of significant benefit. Since the support from school can continue until she is 19, they feel transition will be straightforward as adult services simply need to begin funding the package which is already in place.

However, when they talk in more detail to the school and the parents they realise that when Isabelle leaves school at 19 it will not be appropriate for her to live with her parents and she will require substantial supported living support and a college placement. Due to the nature of Isabelle’s needs, she will need a lengthy transition in order to get used to new staff, a new environment and a new educational setting. The college has also indicated that that they will need up to a year to plan for her start.

It is therefore of significant benefit for the transition assessment to take place around the age of 16, looking at both the funding for support from age 18 – 19 and the longer-term options. Once the assessment has identified the support Isabelle will be entitled to on leaving school, the planning process can begin and suitable support can be put in place by the time she leaves school.

If a transition assessment were to take place later, the local authority would be at risk of not promoting wellbeing in the areas of family relationships (because Isabelle could temporarily need to live with her parents while solutions are found at the last minute, which would not be appropriate) and control over day-to-day life (because Isabelle would very likely not have the same range of choices if planning and preparation were to be truncated).

Case study: Person centred transition planning, involving multiple agencies

To ensure that Matthew was fully involved in the transition process, 4 planning sessions were held with his Transition Officer and facilitated by an outside agency that had expertise in person-centred planning. Matthew’s aspirations were to live independently in his own home and to have paid employment in an office.

It was vital to Matthew’s preparation for adulthood that he was given information about what support he would be eligible for after 18 in order to plan for sustainable employment and to ensure the appropriate support would be available to enable Matthew to live independently. This involved considering:

• whether he would still have a Personal Budget
• support with travel training
• job coaching
• support to live independently, developing appropriate housing options locally

Matthew and his family worked with the local authority and the housing association to identify a suitable home for him. The housing association then bought the house for Matthew and another young man to live in, with a carer. This whole process took over 3 years. Early, person-centred planning has been crucial to Matthew achieving his goals. Without adequate transition planning, the local authority would not have been able to promote Matthew’s wellbeing in terms of participation in work, suitability of accommodation, or control over day-to-day life.

Case Study: Delegation of local authority care and support functions

A local authority has agreed a contract with a local user led organisation (ULO), to carry out specialist needs assessments and care and support planning for people with learning disabilities. The expertise provided by the ULO allows for better interaction with the people undergoing assessments and a better understanding of their needs, resulting in more accurate and person-centred needs assessments.

The ULO’s specialist knowledge of local facilities, befriending groups and employment schemes allows them to broker more personalised care and support planning which allows the person’s needs to be met in a number of imaginative ways which support local people with learning disabilities to live independently, improves their wellbeing – and often with less costly care packages.

As part of the delegation, the local authority builds a good working relationship with the ULO, as it needs to monitor how the needs of the adults to whom they have a responsibility are being met. The local authority realises that the ULO has had some difficulty in advising its clients on employment laws for people who are employing personal assistants with their direct payments. The local authority has much experience of providing this type of advice to people with disabilities, and provides support to the ULO to help with this aspect of function.

Through the delegation, the local authority has been able to build its knowledge of specialist resources in its area that it did not previously know about, and has been able to learn about new practices in carrying out assessments and planning care and support packages more imaginatively and efficiently – learning which it is able to apply to other groups of people with care and support needs.

The more personalised assessment and care planning has resulted in fewer reviews of care plans. More people with learning disabilities in the area are supported to live independently for longer which results in better outcomes for them while simultaneously reducing costs to the local authority. The local authority has thus been able to use effective delegation as a way of promoting the wellbeing of its local population.

Case study: Persons of no settled residence

David is 20 years old and has a physical disability together with mild learning disabilities. Until 4 months ago, he lived with his family in local authority A. However, his family relationship broke down and his parents asked him to leave their home for good. They have since changed the locks on their house.

He sought help from local authority A and was placed in a care home for young people with disabilities located in local authority A. This placement was made on a short-term basis until a more permanent solution for David could be found in a supported living type accommodation with his own tenancy. However, David chose to leave the care home after a few weeks and stayed with friends in local authority B for a short period. However, he has recently presented at local authority B seeking accommodation on the basis that he is a destitute adult who is in need of care and attention. Local authority B provides David with care home accommodation but falls into dispute with local authority A over his place of ordinary residence.

Local authority B contends that David remains ordinarily resident in local authority A, given his previous residence there and his recent discharge from their care. Local authority A argues that David has acquired a new ordinary residence in local authority B.

As David is being provided with a type of accommodation by local authority B, as specified by the regulations, S39 (1) (a) applies. Therefore, he is deemed to continue to be ordinarily resident in the area in which he was ordinarily resident immediately before the care home accommodation was provided for him. The day before David presented at local authority B he was staying with friends in that local authority area. His friends made it clear that this was a short-term temporary arrangement, to prevent him becoming homeless upon leaving the care home in local authority A. He had not built up any community ties within the area of local authority B; nor had he chosen to reside in local authority B voluntarily and for settled purposes. Therefore, under the [Shah] test, David has not acquired an ordinary residence in local authority B.

However, nor does it appear that David has retained his ordinary residence in local authority A where he lived with his parents. He left the care home in local authority A intentionally and has no settled residence to which he can return. As David appears not to have been ordinarily resident in either local authority A or local authority B immediately before he presented at local authority B and was provided with accommodation, it is decided that he is a person of no settled residence. Section 18 of the Care Act 2014 makes clear that local authorities have a duty to meet the needs of someone, if they are present in its area but of no settled residence. Local authority B is therefore the authority responsible for David’s eligible care and support needs and can therefore treat David as if he were ordinarily resident in their area and provide him with accommodation.

Case Study: Frances, who is disabled and lives alone

Frances is a 78 year old lady with severe arthritis who lives alone in south London. Frances slips whilst walking down her stairs and breaks a wrist and leg. Frances is admitted to a local general hospital. At the hospital, Francis is visited by Ray, a local authority social services member, who conducts a needs assessment. During the assessment, Ray asks Frances about her support network – does she have any friends and/or family nearby? Frances says her best friend passed away last year. She has one son but he lives outside Edinburgh with his young family.

When Ray re-visits Frances, he informs her that she is eligible for care and support. He also says, that whilst a number of options exist, it is Ray’s opinion, that Frances’s severe arthritis now means she is unable to live independently and that a care home may be the best way forward. Frances agrees. She expresses relief that she will not have to return home alone but is anxious at moving to an unfamiliar setting.

Ray asks Frances whether she has considered moving to be nearer her son. Frances says yes, but has previously dismissed the idea because she didn’t want to get in the way. Ray asks whether a move to a care home near her son might be attractive. The local authority would take care of the arrangements and her son and his family could visit more easily. Frances is keen to take this further. Ray asks Frances’s permission to contact her son. Frances agrees.

Ray contacts Frances’s son, Ian. Ian says he wishes he could visit Frances more often but with 2 young children and a busy job it is hard to do so. Ian phones every few days and says he knows Frances has been feeling down since her friend passed away. Ian’s house is too small to accommodate Frances and is empty all day so no-one would be available to support Frances. Ray explains the possibility of a cross-border placement for Frances into a care home close to Ian. Ian says he would find this very attractive. Frances has always enjoyed her visits to Scotland before, especially seeing her grandchildren. Ian agrees to talk to Frances about the possibility.

Ray hears from Frances the next day – she and her son would like to go forward with a cross-border placement. Ray researches possible care homes close to Ian, taking Frances’s preferences into account and selects 3 possibilities which Frances, in conference with Ian, pick from. The preferred home is in a suburban area similar to that in which Frances currently lives and close to a church – Frances is a regular church-goer. Ray contacts the care home provider and confirms availability and fees and informs the provider that this would be a cross-border placement.

Ray phones his opposite number, Rhian, in the Edinburgh local authority where the care home is based. Ray informs Rhian that it appears likely a cross-border placement will take place. Rhian says she knows the care home in question and the standard of care is good based on inspectorate findings. Ray thanks her and follows up in writing with the provisional date when the placement will occur and details of the care provider identified. Over the next week, arrangements for the placement are firmed up. Ray draws up an agreement as to how Frances’s care will be managed on a day-to-day basis with assistance from Rhian’s authority. Rhian has agreed that her local authority will take on several roles including providing assistance and information so that the local authority can fulfil its responsibilities. Rhian’s team agree to help to carry out regular care reviews by gathering and reporting information back to Ray’s local authority as ultimate decision-maker. Rhian also agrees that her local authority will provide support in an emergency situation.

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Sam’s Story

Case study downloads.

• Meet Sam (PPT)
• Sam’s Story (Single Slide) (PPT)
• Sam’s Story (DOCX)
• Teaching Notes (In Progress)

Applicable Courses

• Health Promotion and Active Living
• Social Determinants of Health
• Human Anatomy and Physiology
• Human Pathophysiology/Altered Physiology
• Health Research
• Mental Health and Disabilities

Sam was born in 2017, and adopted by Nancy and Paul when he was two. He is a typical toddler: good-natured and very inquisitive. Typically, before the finalization of an adoption, children are required to undergo a routine examination by a physician. However, the required examination is not meant to be a complete health screening, and many conditions are not even checked.

Patient History

There was little information available about Sam’s biological parents. However, it was known that they died in an automobile accident when Sam’s father suffered a massive heart attack, just before Sam turned 2. In the past two weeks since Sam was adopted, he has done very well adjusting to his new environment. Moreover, he has had all the proper immunizations for his age.

Sam’s adoptive parents have noticed some greasy/oily stools in his diapers. In addition, they are concerned about his wheezing when breathing. Nancy calls her family physician and gets a referral for Sam to see a pediatrician.

Initial visit

The initial visit with the pediatrician consisted of a physical examination, blood work, and a chest x-ray.

Follow-up visit

The weather was very hot and humid, which made it almost unbearable to be outside. Sam’s parents parked their car and brought Sam into the air-conditioned comfort of the Medical Centre pediatric clinic. Sam appears to be breathing easier once he is in the cool air.

They were immediately seen by the pediatrician, and Nancy expressed her concern over the colour of Sam’s sputum. She was upset that she had forgotten to tell the pediatrician the other day about this fact. The sputum Sam has been coughing up was green and viscid.

While talking with Nancy and Paul about Sam’s sputum, the pediatrician looked over at Sam and noticed a white ‘frosting’ on his face, an indication of salty build-up on the drying edge of sweat. The pediatrician asked Nancy and Paul if they had noticed this salty-build-up before.

“That must be why his skin tastes a bit salty when I kiss him on the cheek,” Nancy replied.

The pediatrician then went over the blood count and chest x-ray results with Nancy and Paul.

After describing the chest x-ray results to them, the pediatrician had a hypothesis about Sam’s condition. To test her hypothesis, the pediatrician ordered a sweat chloride test.

Sam was diagnosed with cystic fibrosis. Nancy and Paul would have to make many adjustments to care for Sam. He would require chest physical therapy, exercise, medications, digestive support, and psychosocial care.

Sam will most likely face significant challenges: frequent hospitalizations, complications such as CF-related diabetes, depression, anxiety, and time-consuming treatment plans that can take 2-3 hours each day.

Case Key Words

• Chest Physio
• Cystic Fibrosis
• Immunizations

Multi-Course Case Studies in Health Sciences Copyright © 2021 by Laura Banks; Brenda Barth; Robert Balogh; Adam Cole; Mika Nonoyama; Elita Partosoedarso; and Otto Sanchez is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Locating available, affordable housing in Silicon Valley is never easy, but people with mental health disabilities, particularly those on social security or limited incomes, face even greater barriers (see “ Loss of Board and Care Facilities is at Crisis Level “). On this page, you will find listings of emergency and mental health supportive housing agencies, resources for finding affordable single and family housing, homeless resources, and other housing related services and legal resources (resident/tenant rights). Please call the NAMI Helpline at (408) 453-0400 for additional assistance.

• Long-Term GROUP Housing
• Short-Term Residential Treatment
• AFFORDABLE Housing
• Emergency Homeless PREVENTION Resources
• Local HOMELESS Housing Assistance
• Housing LEGAL Assistance
• Housing Rights Information

Click on the text bars below to read more about each topic:

Mental Health Long-Term Group Housing Types

• Licensed Adult Residential Facilities   (or Board & Care) homes are licensed by the state to provide long-term room and board (including meals and laundry services), 24- supervision of residents, assistance with medical and psychiatric needs and appointments, and dispensation of medications to residents. To determine if a facility is licensed (and to view complaints or violations), visit the state Community Care Licensing Facility Search site at http://ccld.ca.gov/PG3581.htm , or contact Community Care Licensing at (408) 324-2112.
• Unlicensed Adult Residential Group homes provide long-term shared or unshared rooms and access to home areas. They include “ room and board ” homes, which may offer services such as meals, laundry, transportation for appointments, shopping or social events, etc., and “ independent living ” homes, which may not provide meals or other daily living services. Note: these homes are NOT licensed and do not provide 24-hour supervision, medication management, medical or psychiatric assistance/transportation . Residents must be able to manage their medications and daily living activities on their own. If an unlicensed home is providing medications or medical care, you can make a complaint to Community Care Licensing at (408) 324-2112. Most unlicensed group homes are affordable to people on SSI or SSDI (although can be of poor quality). In these homes, you have the same rights given to all tenants in California. (See the “Housing Legal Aid” and “Housing Rights Resources” sections at the bottom of this page for information on how to report or get help with unsafe or illegal housing conditions or practices.)

State Licensed Adult Residential Facilities Search

  California Department of Social Services (DSS) Community Care Licensing Facility Search:

Use the California DSS Community Care Licensing Facility Search to determine if an Adult Residential Facility (aka “board & care home”) has a current state license. Inspections, complaints and violations data are listed for each facility. Instructions:

• Click on this link:   https://www.cdss.ca.gov/inforesources/community-care-licensing/facility-search-welcome
• Select: “Adult Residential and Daycare”
• Type a Zip Code or City, and press the “Search” button.
• The next page displays the first page of facilities in that location, in alphabetical order.
• *Important Note : Many of the Adult Residential Facilities will only accept persons with developmental disabilities (such as Downs Syndrome, intellectual disabilities, fetal alcohol syndrome, fragile X syncrome, cerebral palsy, autism spectrum). If you contact a facility because you are seeking housing for someone with a mental illness, be sure to ask if the facility accepts persons with “mental health disabilities” 
• Click on “view” to display the Facility Detail page, which contains information such as license Status (upper right corner), and tabs with Complaints, Inspections and Citations

* Note :  If a facility houses seniors only, they may be licensed as “Elderly Assisted Living” homes. Make that selection in step #3 above; then make sure “Assisted Living” is selected on the Search page (step 4).

Useful Group Housing Documents

• Board and Care Home FAQs
• Checklist for Evaluation of Board and Care Facility  – Use this checklist as a guide to evaluate the board and care facility.
• Consumer’s Guide to Licensed Board and Care Homes – NAMI San Diego

Useful Residents Rights Documents

• Your Rights in Residential Care Homes – Disability Rights California
• Residents’ Rights in Board and Care Homes – JULY 2012
• Residents’ Rights in Unlicensed Room & Board Homes – May 2014
• Residents’ Rights Community Living Coalition presentation – July 2015
• City of San Jose Rental Rights and Referrals Program – Rental Ordinance Mediation Arbitration
• Disability Rights California “Protecting Yourself Against Unsafe Living Conditions & Evictions”

Mental Health Short-Term Residential Treatment Types

• Clients on Medi-cal – are referred by County Behavioral Health Services via Adult Residential Services (if transitioning from psychiatric inpatient hospitals, or by case managers at County outpatient clinics or County contract FSP (Full Service Partnership) agencies.  For assistance in obtaining County services, including help qualifying for Medi-Cal, contact the Mental Health Call Center at 800-704-0900
• Private Insurance Clients – Some insurance providers will cover a stay in a transitional living home.  Contact your insurance provider customer service number. You can also contact La Selva Project in Palo Alto (650-617-1759), which is currently the only transitional living facility in the County that takes private insurance. You may also want to conduct an internet search for transitional homes out of the area.
• Private Pay Clients – transitional living homes that take private pay are can be very expensive, and most are located out of this County.   The two transitional living facilities in the area are: 1) La Selva Project in Palo Alto (650-617-1759), and 2) Nueva Vista in Morgan Hill. (408-465-8280).  You may also want to conduct an internet search for transitional homes out of the area. To determine if a facility is licensed (and to view complaints or violations), visit the Californai state Community Care Licensing Facility Search site, and select “Social Rehabilitation Facilities”, or contact Community Care Licensing at (408) 324-2148.

Sober Living Homes (also know as SLE’s) provide long-term shared rooms and access to home areas for persons in recovery from substance abuse (including those with dual diagnoses). These are properties where all residents have agreed to remain alcohol and drug-free. Some require that residents work, go to school or volunteer during the day. Some have limits to how long a resident can stay. For people with mental illness, these homes require good independent living skills, but can also be more pleasant than “board and care homes” and more affordable than private or low-income housing.

To locate Sober Living Homes in your area, try a search engine such as Google or these internet search sites:

• http://www.yelp.com : (search for “Sober Living” near “San Jose” or other local city.
• If you have Medi-Cal or no insurance, you can contact Santa Clara County Behavioral Health Drug & Alcohol Treatment Services  ( 1-800-704-0900 ) for information and referrals.

* Note: these homes are NOT licensed and do not provide 24-hour supervision, medication management, medical or psychiatric assistance/transportation. Residents must be able to manage their medications and daily living activities on their own.

Affordable Housing Definition: Housing is defined as affordable if it costs no more than 30% of one’s income. Most local low-income housing developments are built for families and individuals with incomes of 60% or less than the area median income (AMI). The County of Santa Clara has one of the highest annual AMIs in the country, at $168,500 for a family of four in 2022, which means affordable housing rents are correspondingly high.  Affordable housing properties have rent and income rules: tenants must have incomes under a certain limit, and rents cannot be more than a certain percentage of that income. Each property has different rent and income rules, and most in the Bay Area have long or closed wait lists. It takes patience and persistence to secure an affordable housing unit. This type of housing may or may not be appropriate for someone living with mental illness. Rents are usually greater than SSI or SSDI payments, so renters may need an additional source of income. They must also be able to live independently and follow tenant rules. Occasionally, affordable housing units are reserved for special needs households, such as elderly or disabled tenants, and can be more accommodating to persons with a serious mental illness.  Note: Silicon Valley Independent Living Center assists people with disabilities (including mental illness) search for affordable housing.

Affordable Housing Types

HUD Section 8 – Under “Section 8”, the U.S. Department of Housing and Urban Development (HUD) authorizes payment of rental housing assistance to low-income households and/or disabled individuals in the United States. In Santa Clara County the Housing Authority of Santa Clara County  (HASCC) administers HUD programs. The main form of HUD housing assistance is via Housing Choice (or Section 8) vouchers, which gives vouchers to eligible recipients to cover rent or mortgage payments.

Subsidized housin g – Multi-family apartments or single-family homes that are built or leased through public-private programs, and funded by state, county and city programs.

Supportive Housing – Some vulnerable citizens, such as those with disabilities are eligible for special housing combined with supplemental services such as case management or mental health outpatient treatment.  The California Mental Health Services Act of 2004 (MHSA), for instance, provides funding for supportive housing for persons with disabling mental illnesses. Note that only people receiving County-based mental health services (via Medi-Cal) are eligible for direct MHSA funded services.  To obtain County mental health services, contact the Behavioral Health Call Center at 800-704-0900

Private Rental Housing – Single-resident occupancy units, boarding houses and other living arrangements can offer rents that are affordable to low-income residents.  (Unfortunately, private rental housing that is both low cost and livable is scarce in the current local housing market.)

Disability Group Housing – (AKA Board & Care Homes) Extremely low-income housing may also be occupied by people whose only income comes from monthly supplemental security income (SSI/SSDI), Social Security or disability checks.  See top of this page for information on group housing (licensed or unlicensed) for people with mental health disabilities.

Transitional Housing – These programs offer temporary housing for people who want to live on their own, but who do not have the financial resources or ability to do so. They usually provide supportive services to prepare them for independent living. Some programs assist people transitioning from an emergency shelter. Transitional housing usually offers more privacy than homeless shelters; may be no cost or low-cost and may cater to people with mental illness.  Information on transitional housing can be obtained in most regions by calling 2-1-1 .  Transitional housing options for people with mental illness include:

• Clients on Medi-Cal – are referred by County Behavioral Health Services via Adult Residential Services (if transitioning from psychiatric inpatient hospitals, or by case managers at County outpatient clinics or County contract FSP (Full Service Partnership) agencies.  For assistance in obtaining County services, including help qualifying for Medi-Cal, contact the Mental Health Call Center at 800-704-0900
• Private Pay Clients – transitional living homes that take private pay can be very expensive and are likely to be located out of this County.  The two transitional living facilities in the area are: 1) La Selva Project in Palo Alto (650-617-1759), and 2) Nueva Vista in Morgan Hill. (408-465-8280). You may also want to conduct an internet search for transitional homes out of the area.
• Sober Living Facilities (also known as SLE’s ) are properties where all residents have agreed to remain alcohol and drug-free. Some require that residents work, go to school or volunteer during the day, Some have limits on how long a resident can stay. For people with mental illness, these homes require good independent living skills, but can also be more pleasant than “board and care homes” and more affordable than private or low-income housing. Search for such facilities using an internet search engine or site such as Yelp.

Local Affordable Housing Resources:

Silicon Valley Independent Living Center (SVILC) Main Branch – Telephone: 408-894-9041   Address: 2202 N. First St, San Jose, CA, 95131  Email: [email protected] . South County Branch – Telephone: 408-843-9100   Address: 7881 Church Street Suite C, Gilroy, CA, 95020  Email: [email protected] . SVILC supports people with disabilities, including those with mental health challenges. They provide group workshops and a chance to work with a Housing Specialist on the following:

• Information and referrals to other community housing resources
• Developing housing search strategies
• Information about Section 8 and other subsidized and low income housing
• Understanding your housing rights as a person with a disability
• Applying for emergency financial assistance for rent, security deposit, utilities, and other critical family needs – RESTRICTIONS APPLY

SVILC Housing Resources List  – Comprehensive list of local housing-related resources

The United Effort Organization – Provides comprehensive and integrated services to find affordable housing, public assistance programs, resources and mentors. Has an excellent search tool to find affordable housing that is regularly updated.

Santa Clara County 211 Housing Resources page     Or call 211 – United Way of Silicon Valley’s 211 online information and resources database has a Housing resources page with relevant links.

Rental Housing Search Websites

One Degree – One Degree is a free non-profit committed to helping low-income families access the resources they need. They have a searchable database. Access to resources through free One Degree App (Apple store or Google Play) and by texting. Text 844-833-1334 with what you’re looking for – a word or phrase, like “food stamps” or “housing.”

Charities Housing – Develop and manage low-income housing. Have a searchable database of available housing. Telephone: 408-550-8300

Mid-Peninsula Housing – Develop and manage low-income housing. Have a searchable database of available housing. Telephone: 650-356-2900

Housing Authority of Santa Clara County  (HASCC) – Telephone: 408-275-8770. Address: 505 West Julian St., San Jose 95110.  Provides information regarding rental subsidies and affordable housing for low-income families, seniors and persons with disabilities living in Santa Clara County, through the federal rental housing assistance program (Housing Choice Voucher, also known as Section 8). HASCC also provides HUD housing development subsidies to qualified home builders.  Section 8 Vouchers may be “person-based” or “project-based”.   Note: Most of these housing choice voucher program wait lists are either closed, or people must be referred by specific County agencies.  However, HASCC owns and controls more than 2,600 affordable housing units, referred to as the agency’s housing portfolio. Use SCCHA’s Applicant Portal  to sign up for these housing interest lists.

City of San Jose Housing Department   – Telephone : 408-535-3860  Serves lower- and moderate-income families by increasing, preserving, and improving housing that is affordable and livable. Provides some subsidized housing.

Community Housing Developers – Telephone: 408-279-7657    Provides information about shared housing, senior housing, family housing and about the “below market program” for the cities of Los Altos and Santa Clara.

These agencies provide financial and other assistance to people who have a place to live but are at risk of becoming homeless due to rent increases, loss of income, psychiatric and medical emergencies, etc. The assistance is usually for a limited time and eligibility is subject to each agency’s guidelines, which are usually based on address and income. Hint: Some agencies receive their funding on a monthly basis, so you are more likely to be accepted if you arrive early in the month. If you are refused, try applying again at the start of the following month.

Homelessness Prevention System

(408) 926-8885  The Homelessness Prevention System is administered by a network of 19 non-profit organizations located throughout Santa Clara County. HPS provides assistance to low-income families or individuals who are at risk of losing their housing, including temporary financial assistance, legal support, and case management and other services. All are welcome to apply regardless of citizenship or immigration status. Guidelines for eligibility: resident of Santa Clara County, low income, at risk of losing housing within approximately 14 days, at high risk of homelessness. Call or email [email protected] for eligibility screening or call one of the participating agencies shown on the HPS website.

Emergency Assistance Network United Way Silicon Valley, eight partner agencies, and seven law enforcement agencies have joined to create a safety net of essential services for all Santa Clara County residents. The goal is to stabilize individuals and families during times of trouble and help them return to self-sufficiency. Which partner agency assists people depends upon their zip code . Emergency Assistance (EAN) agencies offer the following assistance to help families and individuals recover from emergency situations (such as the sudden inability to pay rent or utilities):

• Rent and Mortgage Assistance
• Food Assistance
• Utility Assistance
• Medical and Transportation Aid

To find the EAN agency for your zip code, you can call 211, or do an online search via the Santa Clara County 211 web site :

• Go to the 211 Santa Clara County Housing page
• Click on the kind of “Housing Expense Assistance” you need
• Enter your zip code to find the agency that can assist you.

St Vincent De Paul (SVPD)   All requests for emergency services are referred to local parish based “conferences.”  You will be asked to provide your name and phone number.  Depending on the service requested, the staff will ask for documentation such as ID, income verification, rental agreements, utility bills, etc. Staff will also refer you to other non-profit organizations and county and state agencies depending on your situation. Santa Clara County Council has 24 Conferences, which provide services such as food pantries, rental and utility assistance, clothing distribution, employment assistance, mentoring, and the traditional “home visit.” Visit the SVPD website for a list of conference locations by zip code.

Silicon Valley Independent Living Center (SVILC) Main Branch – Telephone: 408-894-9041   Address: 25 N 14th St, Suite 1000, San Jose, CA, 95112.  South County Branch – Telephone: 408-843-9100   Address: 7881 Church Street Suite C, Gilroy, CA, 95020 SVILC provides emergency financial assistance for rent, security deposit, utilities, and other critical family needs – RESTRICTIONS APPLY

Domestic Violence Emergency Housing Assistance

Next Door Solutions to Domestic Violence    24/7 Hotline: (408) 279-2962 Address: 234 E Gish Road, Suite 200, San Jose, CA 95112. Confidential counseling and emergency shelter placement for women and children    IF YOU ARE IN IMMEDIATE DANGER: CALL 911

YWCA Support Services For victims of domestic violence, sexual assault, and human trafficking, offers crisis intervention, emergency shelter, legal services and community support. Telephone: 800-572-2782   Address: 375 S. Third Avenue, San Jose, CA 95112

Mental Health Crisis Housing

Momentum Crisis Stabilization Unit –  Telephone (408) 207-0560 , ext. 1, or ring doorbell at 101 Jose Figueres Avenue, San Jose. Individuals in crisis can stay up to 24 hours as a voluntary alternative to a locked treatment setting. Medi-Cal or no insurance, 18+.

Office of Supportive Housing (OSH) Telephone: 408-278-6400  Main Address: 150 W Tasman Dr, San Jose 95134 The Santa Clara County Office of Supportive Housing’s (OSH) mission is help end and prevent homelessness by increasing the supply of affordable and supportive housing that is available to extremely low income and special needs households (including those with mental illness).

OSH oversees the  Continuum of Care (COC) program , a group of County and other local housing agencies dedicated to ensuring County-wide implementation of efforts to end and prevent homelessness in Santa Clara County. CoC created and manages “ Coordinated Entry ” : a community-wide intake and assessment process to match people experiencing homelessness to existing community resources that are best fit for their situation. Santa Clara County has been using coordinated assessment for a few years for permanent supportive housing and rapid rehousing programs. They are also in the process of expanding coordinated assessment to shelter and transitional housing programs as well. In the County’s coordinated assessment system, all homeless people complete a standard assessment tool (the Vulnerability Index-Service Prioritization Decision Assessment Tool or VI-SPDAT) that considers the household’s situation and identifies the best type of housing intervention. A “community queue” of eligible people is generated from the standard assessment, which is then used to fill spaces in the County’s permanent housing programs, including permanent supportive housing and rapid rehousing. Currently, persons eligible for Coordinated Assessment services must meet the definition of “ chronically homeless ”: living on the streets or in a shelter for at least a year. Note: Chronically homeless individuals with mental illness often score as “high need” on the VI-SPDAT. 

Access points are locations where people who are homeless can complete the coordinated assessment intake (VI-SPDAT). These locations include homeless shelters and other community agencies that provide housing information and homeless services. See the List of County Participating Agencies

Local Homeless Services

Homeless Services Brochure – Excellent pamphlet produced by the City of San Jose’s listing local housing and homeless services, including emergency shelters, drop in service centers, rental and other financial assistance, food and clothing resources, help specific to women/families, youth, senior and veteran, and referrals for medical/mental health/recovery, legal, employment services.

Homeless Shelter Directory for San Jose  – Listings of homeless shelters and services for the needy in San Jose and surrounding cities.

Here4You County Shelter Hotline The Here4You call center hotline is designed to centralize referrals for clients needing shelter in Santa Clara County. Call (408) 385-2400 9am to 7pm.

HomeFirst Homeless Outreach Services Homeless Helpline: 408-510-7600  

Address: 2011 Little Orchard Street, San Jose, CA 95121.  Email : [email protected] – Call or come in if you are homeless and needing help, or if you are concerned about a homeless person(s).  HomeFirst provides adult homeless services and shelter with beds for homeless adults and families.  The phone number has 24-hour voicemail.

San Jose City Homeless Concerns . Report a concern for homeless persons or encampments in San Jose, or persons living in vehicles. City Housing Department staff will outreach.

LifeMoves Opportunities Services Center Telephone : 650-853-8672   Address: 33 Encina Ave, Palo Alto, CA 94301 . Services for adults and families, including rent & utility assistance, case management and housing referrals, medical and mental health outpatient treatment.

LifeMoves Julian Street Inn (for homeless with mental illness)  (LifeMoves was formally known as InnVision) Telephone: 408-271-0820    Address: 546 W. Julian Street, San Jose, CA 95110. Homeless shelter for seriously mentally ill persons for up to 90 days with rehabilitation, counseling, and housing referrals services.  Must be referred by a local mental health authority, such as Santa Clara County Behavioral Health Services (800-704-0900)

Bill Wilson Center    Telephone: 408-925-0231   Address: 693 S Second St, San Jose. Call for hours. Drop-in center for homeless youth ages 14-24. Services at the Drop-In Center include overnight respite and basic necessities such as food, personal care items and access to phone, computers and email. Showers and washer and dryer facilities are also available free of charge. Bill Wilson also operates a short-term shelter for young adults ages 18-24.

Useful Housing/Homeless Assistance Resources:

• Cold Weather Safety (Warming Centers) – Scroll down to “Find a Warming Center”
• Hot Weather Safety (Cooling Centers) – Scroll down to “Find a Cooling Center”
• Dignity on Wheels (shower and laundry services for homeless – click for schedule)

Law Foundation of Silicon Valley – Housing Project   Telephone: 408-280-2424   Phone intake hours: Monday 9-11:30AM. No walk-ins. Free legal advice and representation on housing-related matters to low-income individuals in Santa Clara County. The Housing project can assist with:

• Defending eviction lawsuit
• Housing discrimination issues like reasonable accommodation requests for individuals with disabilities
• Enforcing the San Jose Tenant Protection Ordinance
• Enforcing the Santa Clara County Eviction Moratorium
• Legal outreach and support for renter organizing/campaigns
• Help with Housing Authority hearings
• Section 8 and other low-income housing issues like terminations and eligibility determinations
• Legal advice and information to tenants regarding notices for repairs/bad conditions

They cannot assist with:

• Evicting anyone from a household
• Providing financial assistance for renters
• Criminal cases
• Personal injury lawsuits

Law Foundation of Silicon Valley – Health/M ental Health Program Telephone: 408-280-2420  Address: 4 N Second St, Suite 1300, San Jose, CA  95113. Phone intake: M-F 1PM-4PM. Walk-in: Tuesday and Thursday, 1PM-3PM. Health/Mental Program provides free legal services to any individual who lives in Santa Clara County and who identifies as having a mental health or a developmental disability, or are homeless. The Health Program cannot handle criminal cases, but can assist with:

Medi-Cal, Medicare, CalWORKS, CalFresh (food stamps), CAPI, General Assistance (GA)

Reasonable accommodation to access benefits programs

Investigation of allegations of abuse or denial of rights at mental health facilities

Advocacy for access to county mental health services

Advocacy for access to mental health treatment in the county jails

Assistance with name and gender marker to align with gender identity through Pro Bono Clinic

Investigate sweeps of individuals’ property

Limited counsel & advice for debtor’s rights issues/creditor harassments

California Department of Fair Employment and Housing Telephone: (general information and complaints) 800-884-1684    TTY: 800-700-2320   Email: [email protected] . The mission of the Department of Fair Employment and Housing is to protect the people of California from unlawful discrimination in employment, housing and public accommodations, and from the perpetration of acts of hate violence.

Residents’ Rights Resources In case of serious issues and/or violations (listed below) in unlicensed or licensed board and care/room and board homes, a person’s case manager, if they have one available, should be the first contact. If contact with the case manager is not possible or effective, the person should contact one or more of the agencies listed below, depending on the issue.

Abuse or Violation of Residents’ Rights

• Disability Rights California 1-800-776-5746
• Community Care Licensing 1-844-538-8766   For licensed facilities only
• Adult Protective Services 1-800-414-2002 or 408-975-4900    For dependent elders and adults
• Long Term Care Ombudsman 408-944-0567 (through Catholic Charities)    Advocates for people living in nursing homes and residential care facilities

Financial Abuse

• FAST (Financial Abuse Specialist Team) 408-975-4900 or 1-800-414-2002    For dependent elders and adults

Landlord/Tenant Issues  (unlicensed residences)

• Project Sentinel 408-720-9888    For unlicensed facilities only

Unsafe building, bedbugs, cockroaches, vermin

• Code Enforcement 408-535-7770 (San Jose)
• Disability Rights California 1-800-776-5746

Useful Housing Rights Documents

• Rights in Adult Residential Facilities (Licensed Board & Care Homes) – Disability Rights California

Attachments

• news_icon_blue (1kB)
• news_icon_gold (1kB)
• Housing Puzzle (18 kB)
• EAN CONTACT ZIP CODE distribution 2014-15 (3 MB)
• Rental Housing Search Websites+HSP info (37 kB)
• Unlicensed Housing (3 kB)
• CLC Reviewed Housing List (24 kB)
• Sober home (21 kB)
• Unlicensed Sober Living Homes (33 kB)
• _Web Licensed ARF_20211118 (246 kB)
• Unlicensed MI Group Homes 2022_02_09 (166 kB)
• https://www.facebook.com/namisantaclaracountyk
• https://www.twitter.com/NAMISantaClara
• https://www.linkedin.com/company/nami-santa-clara-county/
• [email protected]