Two Experts, 49 Years combined, One clear message: The Future is Supported Living

Independence, Not Institution: Why I Am Leaning Towards Supported Living

When I first started shaping Dr MJ’s Harmony Haven, I pictured a small, high quality residential home. Four to 8 Beds, calm environment, doctor led, a safe place for autistic adults and people with learning disabilities who had been failed by the system.

Then I sat down with two people who have been in this space far longer than me: a public health specialist from Kent County council with more than 25 years of experience, and Fredrick Donovan Jude a seasoned operator who has run a care home group since 2004 and is now steadily moving towards supported living. They both told me, in slightly different words, the same thing: the future is not more residential beds. The future is people living in their own homes, with the right support wrapped around them.​

The more I listened, and the more I looked at the evidence, the more I agreed.

What the experts were really saying

From the public health side, the message was simple. Health is not just tablets and hospital beds. It is housing, control, meaningful occupation, and feeling part of a community. National plans like Building the Right Support and the NHS service model make it clear that people with a learning disability and autistic people should be living in their own homes in the community, with support, not in long term institutional settings.​

From the provider side, the care home group owner was very frank. Commissioners are increasingly favouring supported living. Councils such as Birmingham now state that supported living should be the default offer for working age adults, with care home placements expected to fall as community options expand. He has seen the writing on the wall and is slowly reshaping his whole approach around that reality.​

Underneath all of that is one core idea:

• Residential care focuses on keeping people safe in a service.

• Supported living focuses on helping people live safely in their own life.

  
  

What families actually told me

I also spoke to families of autistic adults and people with learning disabilities, some with loved ones in residential care, others in supported living.

Families with loved ones in supported living talked about feeling like part of a proper team. They were included in planning, joined regular reviews, and felt they could genuinely shape what support looked like day to day.

Families with relatives in residential homes often described the opposite. They felt less in the loop, updated after decisions rather than involved in them. One parent put it simply:“It feels like they live there and we visit, instead of all of us working together so they can live well.”

That is not about blaming staff. It is about the structure. When the organisation owns the building and provides everything, the home easily becomes “the service’s space” and family quietly slide into the role of visitors.

In supported living, where the person has their own tenancy and support is wrapped around them, families described feeling more like equals. They had keys to the flat, were part of the planning from the start, and felt heard rather than managed.

If we are serious about family centred care, that matters.

What supported living actually is

Supported living is not just “a few carers popping in”. The CQC describes supported living schemes as places where people live in accommodation that is genuinely their own, often with a tenancy or licence, and receive personal care under a separate contract that can flex with their needs.​

You keep a real separation between the house and the care. You are not living in a business. You are living in your home, with support wrapped around you.

Policy and advocacy groups describe this as a key route to a good life. Supported housing is increasingly seen as critical for helping people with a learning disability and autistic people live independently in the heart of their communities. Demand is expected to rise sharply over the next decade as more people move out of hospitals and traditional care homes.​

When you listen to people who have actually made that move, the difference is obvious. Stories from supported living schemes talk about being able to choose when to get up, who comes into your flat, what you cook, what you watch, and where you go at the weekend. For many, it is the first time those decisions have genuinely been theirs.​

The demand is massive, and supply is not keeping up

Across England, supported housing for people with higher needs is already under pressure. National estimates suggest we will need around 167,000 additional supported housing units by 2040, roughly a one third increase on current supply, just to keep up with demand. For people with learning disabilities and autism, demand is rising faster than for almost any other group, driven by better diagnosis, longer life expectancy and families reaching crisis point.​

The government’s Supported Housing Review is blunt: demand is rising at the same time as providers are struggling to sustain or expand supply, especially for people with learning disabilities and autistic people. Lack of appropriate housing is a major reason people get “stuck” in hospital or assessment and treatment units even when they are clinically ready to leave.​

So we have a problem. But it is also a clear opportunity for specialist providers who are willing to build the right kind of homes in the right places.

What Kent County Council is actually planning

This is not just a national story. Kent’s own data, where Dr MJ’s Harmony Haven will be based, makes the direction of travel very clear.

Kent’s Accommodation with Care and Support Market Position Statement projects that, because people with a learning disability account for 66 per cent of all current care home placements, the council would technically need around 140 additional learning disability residential placements by 2028 if it simply carried on with business as usual.​

However, the same document sets out a very different ambition. Kent wants to reduce overall reliance on care homes over the medium term by investing in community services and developing supported living as the preferred alternative for people with lower level or moderate needs. The council describes this as “an active market with an overall oversupply in Kent” and states that future demand for care home placements “will be for people with a greater level of need”.​

The language could not be clearer:

• Kent expects fewer residential placements “that provide support for lower level needs, as people choose alternative services, such as Supported Living”.

• It expects more residential placements only “for people with a greater level of need and people with a forensic history”.​

At the same time, Kent estimates that, on top of existing stock, it will need a further 1,287 units of accommodation with care or support by 2026, across all tenure types, and another 561 units by 2031 if 2026 demand is met. That is nearly 1,900 additional units of housing with support needed in Kent alone over roughly a decade.​

The council’s wider accommodation strategy backs this up with a vision “to enable people to remain in a home of their own for as long as possible where this is what they wish” and a commitment to “work with the market to develop and make available a range of alternative options, including increasing the use and availability of supported living options”.​

Alongside this, Kent and Medway’s integrated commissioning framework for learning disability and autism services is built around reducing reliance on institutional care and supporting people to live in their local communities, close to family and networks, with personalised support.​

If you are planning to build a specialist service for autistic adults and people with learning disabilities in Kent, the message from the local authority is loud and clear:

Supported living is what they want more of. Traditional residential is what they intend to use more selectively.​

Why traditional residential can feel outdated

CQC’s Right Support, Right Care, Right Culture guidance sets the bar. Services for autistic people and people with a learning disability should promote choice, dignity and independence, and good access to local communities, not simply safety behind a front door.​

Yet a significant number of services inspected against this standard are still rated Requires Improvement or Inadequate, often because of institutional routines, limited community access, and people having little real say over their day to day lives.​

Supported living services have expanded quickly over the last few years as commissioners try to shift away from institutional models, but quality has not always kept pace, and some schemes risk drifting into “mini institutions” if they are not truly person centred. That is exactly why we need models that combine strong values, robust clinical oversight and genuine co production with families.​

Against this backdrop, designing a purely residential model in 2026, for a group of people who are explicitly meant to be supported in the community, begins to look out of step with both policy and lived experience.​

Outcomes speak louder than ideology

Evaluations of people moving from institutional care into bespoke supported housing show improvements in feeling safe and calm, being understood, communicating needs, getting out and about, feeling part of the community, and having more control over daily life.​

The 200 Lives study comparing supported living and residential care found that people in supported living often felt more connected to their communities, knew their neighbours and had more say over their environment, not just their bedroom. Crucially, the study showed that supported living can work well for people with higher support needs too, as long as the support is properly designed.​

From a system point of view, specialist supported housing is usually cheaper over the long term than hospital or long stay care homes and delivers better wellbeing outcomes. That is why national bodies, local authorities and NHS systems keep coming back to the same solution: the right support, in ordinary homes, in ordinary streets.​

Where does a doctor led model fit into all this?

This is where Harmony Haven still has something different to offer.

Most supported living is social care led. Staff do an incredible job, but medical oversight is often limited. People bounce between GP, A&E and community teams, and health issues get missed or written off as “behaviour” until they reach crisis point.​

A doctor led supported living model can sit right in that gap:

• Regular health reviews, on site or virtual, by someone who understands acute medicine and neurodiversity

• Early spotting of physical illness rather than assuming “challenging behaviour”

• Joint work with GPs, community teams and families so that health plans, behaviour support plans and care plans actually line up

• Trauma informed, autism friendly environments that still feel like home, not a ward

In other words, the independence and dignity of supported living, with a safety net that understands the very real health inequalities autistic adults and people with learning disabilities face.​

What this means for Harmony Haven

Being honest, this has meant letting go of parts of my original vision.

The picture in my head used to be a single, beautiful residential home in Kent. Now, the picture is more like a small cluster of supported living flats or houses, each person with their own front door, their own rhythm, their own tenancy, and tailored support.

The common thread is still there: medical expertise, trauma informed practice, and families treated as genuine partners, not visitors.

Residential care will always have a place for some people, especially those with very high nursing needs. But for many autistic adults and people with learning disabilities, the more honest question is not “Which care home is best?” but “How can we help you live in your own home, with the right support around you?”

After those conversations it is hard to avoid the conclusion that if we are serious about independence, choice, better health, and working with families as equals, supported living should not be our Plan B.

It should be where we start.

#SupportedbySkillSurroundedbyHeart