James is now ‘living the life he chooses’

AFG has been highly praised for its work in supporting the transition into new accommodation of one of the challenging people it cares for.

James (not his real name), who has autism, moved into single tenancy accommodation in June this year. Before that he was an inpatient in an acute inpatient assessment and treatment service for people with learning disabilities since September 2018.

James needed to be re-housed because of a significant placement breakdown at his previous accommodation. He was showing physical aggression to his fellow tenants and to support staff. This was having a real impact on the wellbeing of the supported people he lived with. This was the third placement breakdown for James.

At the inpatient unit, James became very territorial over parts of the ward – turning lights off and being aggressive with other patients who entered parts of the ward he classed as his own. James would shower six to eight times a day, a barometer of how he was feeling. Increased anxiety led to more showering.

Previously, staff on the ward had restricted James’ liquids, particularly shower gel. There were reported incidents where James snatched liquids off others. One incident resulted in James reaching into the front of a car whilst in motion to snatch a drink off the driver.

Significant planning went into James move. AFG staff attended weekly MDT meetings. A four-week transition plan was created, with AFG support staff shadowing James on the ward for two weeks. For the following two weeks a member of the STAR Unit attended the placement with James and AFG support staff.

Area Manager, Learning Disabilities (Liverpool City Region), Hannah Neary explains: “Behind the scenes we worked closely with James’ Learning Disability Nurse on his communication, diagnosis and risk. And a management team developed plans with James’ father and step mother before James moved into the property.”

James moved in June 2019. The team examined all past incidents involving James and mapped out criteria to help ensure James’ successful placement and support.

James lives in a single tenancy flat with his own space. Whilst supported by two members of staff, staff ensure that they are not intrusive on his personal space. They respect that it is James’ home. What he says goes. So, if James wants the TV off, the TV goes off. A right which, in shared property, James has never previously enjoyed.

James has a clear routine for all staff to follow. Any deviation from this routine causes James to become agitated and physically aggressive.

James is a highly intelligent and capable man. Previously James was restricted in what he could do. James had never been allowed to iron his clothes which he enjoys doing. He now irons his clothes every day for the following day – a skill which his parents are delighted he has been empowered to do.

Hannah added: “We don’t and have never restricted James’ liquids particularly shower gel. After moving in, it was agreed that each day James will be given 250ml of shower gel each day for him to manage. Previously, James was restricted on how much shower gel he was given. Shortly after moving in, James only asked for shower gel when he needed it, two to three days at a time.

“We have had no incidents of James snatching liquids from others. James now only showers twice a day as part of his routine, morning and night. We believe that with anything, if you’re restricted you become more and more obsessive about it. Just like a diet, most people who cut out a food group will fail. By not restricting any liquids, the desire to have something is eliminated.”

James has always had his meals made for him despite him being a keen chef. James now cooks all his meals independently with supervision.

“You name it James can cook it successfully. But we have had to ensure the supervision is at a distance as anything too intrusive can cause him agitation.”

James previously became agitated when staff were unaware of what he was trying to communicate. James has a large pictorial communication board within his home to enable him to effectively communicate to staff his needs, wants and wishes.

“According to Maslow’s hierarchy of needs, it’s important to ensure that each of James’ needs were being met. His family members, professional and care team are delighted with his progress.”

At a recent MDT, AFG was told that no other provider had maximised James’ potential before or looked at the bigger picture to reduce previous issues. His family reported that AFG had enabled James to ‘live the life he chooses whilst keeping him safe’.

The feedback said: ‘I feel that his transition to his new accommodation from the STAR Unit was successful. I feel the staff team have supported James incredibly well. AFG involvement in MDTs at the Star Unit was very helpful and key to the success of the transition’.