Supported Living as a Plan B?

CQC’s Right support, right care, right culture guidance means that some locations are no longer suitable to be used to provide residential care services for people with autism or a learning disability. Providers are therefore having to consider how else they might utilise these spaces. A question often posed to us is “could we use it for supported living?”

The CQC position

The regulator’s position on supported living and other comparable schemes is set out in its guidance, Housing with care: guidance on regulated activities for providers of supported living and extra care housing (October 2015).

CQC broadly defines a supported living scheme as a scheme where:

• people are provided with personal care as part of the support that they need to live in accommodation that is genuinely ‘their own’;
• accommodation is often shared, but can be a single household;
• the personal care is provided under separate contractual arrangements to those for the person’s housing;
• there is, as a result, a real separation between provision of accommodation and provision of care.

In this way, the CQC distinguishes supported living schemes from residential care, where the accommodation forms part of the CQC regulated care provision. The distinction is important because it places accommodation outside of the CQC’s regulatory regime since it does not form an integral feature of the regulated care provision.

Practical considerations

Demonstrate the local need and gain the support of local commissioners: it may be helpful to present the proposal as a ‘step down’ in the care pathway. 

• Consider the suitability of the location and environment for supported living tenants. If the CQC were not prepared to register the service, then commissioners may also consider it unsuitable. 

• Check that the proposed model is in line with CQC definitions of supported living (or your chosen comparable scheme) to ensure the model will place accommodation outside of the CQC’s regulatory regime for residential care.  The key feature is a robust separation between the provision of regulated care and the provision of accommodation. Do this by checking your proposed model against the description of the preferred scheme as contained in the CQC’s Housing with care guidance. 

• Revisit the financial metrics to confirm the business case for a supported living scheme over a residential service. What about if the scheme is limited to fewer than seven supported living tenants? 

The landlord function  

Remember, there needs to be a real separation between the provision of the care and the provision of the accommodation otherwise the service risks being deemed to be a de-facto care home (and the provider potentially committing an offence of not holding the correct registration). 

Give careful thought as to the landlord; will the property be sold or leased to a third party or a registered social landlord (in which case you need to carefully consider the legal governance)?  Will you establish a separate entity to fulfil this function?

You also need to give careful thought to the occupancy agreements that will be used and how you will ensure a real separation between provision of care and provision of accommodation. Once again, the CQC’s guidance provides a list of factors it considers relevant, which you should check your model against (page 9-10).

There are other property factors that are important to consider too, such as planning, configuration, staff and onsite facilities.

Regulation of supported housing

Finally, providers should know that the Supported Housing (Regulatory Oversight) Act 2023 came into force on 29 August 2023. The Act will require local authorities in England to review supported housing and develop strategies related to it. It also grants the Secretary of State a power to introduce national standards and make regulations for local licensing schemes. As such, supported living will very likely soon be subject to a regulatory scheme of its own.

This article first appeared in the March/April 2024 issue of Care Home Management's magazine.