LEARNING DISABILITY PRACTICEApril 2009 | Volume 12 | Number 332
Feature
Box 1 Service models for older people with
learning disabilities (Grant 2001)
Age
integrated
Needs are met by learning
disability services throughout the
individual's lifespan.
Specialist Needs are met by specialist
services developed for older
people with a learning disability.
Generic Older people with learning
disabilities use generic older
people services for their needs.
earlier in people with learning disabilities � at
around 50 years of age. Interestingly, there are
similarities in the documents as they both advocate
person-centred care, healthy ageing, partnerships
and fighting discrimination. However, there are
some fundamental differences in philosophies, not
least that Valuing People emphasises independence,
choice, access, empowerment and enablement.
The implication for older people with learning
disabilities is that services for them may be
provided without any clear direction, philosophy or
evidence base.
This is apparent in the recently published
three-year strategy document for people with
learning disabilities Valuing People Now (DH 2009).
This strategy builds on the 2001 white paper but,
again, makes little explicit reference to the specific
needs of older people with learning disabilities.
on a positive note, the four underlying principles
remain the same � rights, independent living,
control and inclusion � and more emphasis is
placed on meeting health needs by, for example,
improving access to health care, making training for
healthcare professionals mandatory, increasing carer
involvement and monitoring service provision.
Age-integrated model Generally, learning disability
services provide care and support from cradle to
grave. Social services tend to take responsibility
for providing day services, group homes, hostels
and ordinary community housing. NHS provision
tends to be for clients with more complex needs,
such as those with challenging behaviour, mental
health and forensic needs. The services provided by
private, voluntary and charitable organisations are
also similar to those provided by statutory services
(Northway and Jenkins 2007). one problem facing
social services is the changing health needs of
clients as they age. In the following examples, it
can be seen that health changes may result in
clients having to leave their place of residence.
Social care staff try their best to cope with a
sudden change in the health status of a client they
support. The service does not appear to be suitable
for clients to `age in place', although it is clear that
it is not only the client who may be at risk, but also
the support staff:
`The criteria were changed in the social service
homes and now we are finding that a lot of the
people with learning disabilities [and] physical
disabilities are being asked to leave. So what happens
to these individuals? They're just being shipped out
of the homes they've been in for years' (focus group
2, practice nurse).
`People were told: "This is your home for life",
without any real thoughts about possible changes
in their health. When I first arrived at one house
I had a bit of a battle with staff because a chap
who had been resettled not long before had seen
his health change dramatically. The staff didn't
want to say that they couldn't cope; they were
carrying him up and down the stairs. So I had to
say that this couldn't continue and the guy went
into a nursing home. The staff crossed me off their
Christmas card list' (focus group 3, community
learning disability nurse).
In yet another example, learning disability day
services do not seem to be equipped for people who
are ageing. There have been moves to co-ordinate
individualised services based on individual need
(Northway and Jenkins 2007), but in this instance,
it can be seen that again little account seems to be
made of individual needs or the effects of ageing:
`I think services still expect people to fit in. The
staff don't seem to accept that people are ageing
and perhaps they don't want to get up and go to
work at seven o'clock every morning' (focus group 1,
community learning disability nurse).
even when day services are developed to cater
for people with learning disabilities they may not
be suitable for a wide range of age groups. It must
be stressed here that these are nurses' views, and
clients may have different opinions:
`And you know, as [name of community nurse]
says, when you are 60-odd, 70-odd, 80-odd, you
don't really want to spend your day in a noisy day
centre with a lot of younger people' (focus group 1,
community learning disability nurse).
learning disability nurses may care for or support
people over a considerable period of time and,
therefore, age along with their clients. They may
become part of each other's lives and experience
similar emotions:
`A lot of us have been in a home for a long time,
so we've worked with some people for 10 to 15 years.
You've been a part of their getting older as we get

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