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Extra Care Housing for People with Dementia 15th November 2005 Fred Tibble Court The Experience So F

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Extra Care Housing for People with Dementia. 15th November 2005 ... developing our 3rd (mainstream) scheme Darcy Gardens - and are planning a 4th. ... – PowerPoint PPT presentation

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Title: Extra Care Housing for People with Dementia 15th November 2005 Fred Tibble Court The Experience So F


1
Extra Care Housing for People with Dementia 15th
November 2005Fred Tibble Court The Experience
So Far
  • Jon Head Senior Service Development Manager
    Hanover HA SE Region
  • jon.head_at_hanover.org.uk
  • www.hanover.org.uk

2
Fred Tibble Court The Experience So Far
  • Background Barking and Dagenham
  • Why extra care for people with dementia?
  • Description of Fred Tibble Court (FTC)
  • TLC Care Services
  • Managing our risks
  • Entry criteria
  • Telecare
  • Evaluation by Institute of Public Care
    background, aims and some key findings
  • National Policy context
  • Conclusion

3
Fred Tibble Court The Experience So Far
Background Barking and Dagenham
  • LBBD (2001-2) reviewed alternatives to
    residential care and planned an ongoing strategy
    for service modernisation and reprovision.
  • Limited modern provision for people with dementia
    in the Borough
  • Many people needing care away from home had to go
    to neighbouring LAs
  • Decision to promote a specialist extra care
    scheme for people with dementia with following
    aim (LBBD)
  • to provide secure and appropriate accommodation
    and separately commissioned care to meet the
    needs of the Service Users who will, in the main,
    be older people living with dementia. ..to
    create independence and choice for Service Users
    enabling them to maintain their presence within
    the community.

4
Fred Tibble Court The Experience So Far
Background Barking and Dagenham (cont.)
  • Not an isolated development
  • LBBD already had an Anchor-run extra care scheme
    Colin Pond Court
  • Hanover had opened a non specialist extra care
    housing scheme - Harp House in 2002.
  • Fred Tibble Court opened in 2004
  • Hanover and LBBD are now developing our 3rd
    (mainstream) scheme Darcy Gardens - and are
    planning a 4th.

5
Fred Tibble Court The Experience So FarWhy
extra care housing for people with dementia?
  • Why Not?
  • Extra care largely evolved as a response to
    physical frailty but..
  • If extra care is to be a true alternative to
    residential care then it should also respond to
    the needs of people with dementia and their
    carers
  • Extra care offers major advantages for carers who
    wish to remain actively involved in supporting a
    person with dementia
  • Of course, Extra care already meets the needs of
    many people with dementia
  • Research undertaken in 2002 - 10 of Hanover
    Extra Care tenants had a diagnosis of dementia
    and a further 16 were believed to have dementia,
    based on behaviours and other signs

6
Fred Tibble Court The Experience So
FarDescription
  • Typology of extra care schemes catering for
    people with dementia?
  • A unit or wing - within a non specialist scheme
  • Integrated, mainstream extra care schemes
  • Specialist schemes
  • Exclusive schemes
  • Where does Fred Tibble fit?

7
Fred Tibble Court The Experience So
FarDesign/build issues
  • Outside scope of presentation but to set scene
  • 31 flat (26 x 1 bed 5 x 2 bed) scheme in
    Dagenham - opened in June 2004
  • Flats to normal extra care scheme /design
    standards
  • Built upon the site of a closed residential care
    home
  • Normal extra care communal facilities include a
    residents lounge/dining room, laundry room,
    assisted bathroom, shop/kiosk, guest room,
    hairdressing salon
  • A small professionally designed cinema
  • A secure garden area
  • Telecare
  • Particular focus on interior design

8
Fred Tibble Court The Experience So Far TLC
Care Services - www.tlccare.org.uk
  • TLC Care Services not for profit care
    provider founded in 1991 - based in NE London
  • TLC provides both care and support for residents
    to ensure as seamless a service as possible.
    Separate contracts with
  • SSD for care provision
  • Hanover for housing related support provision
  • Also a dementia inclusion worker
  • Committed to working in a holistic, person
    centred way

9
Fred Tibble Court The Experience So FarTLC
(cont.)
  • Specialising in work with
  • people with dementia
  • people of all ages who are living with
    disabilities, illness or frailty
  • carers.
  • people with learning disabilities and people with
    mental health problems
  • training and consultancy services
  • support groups for stroke survivors
  • domiciliary and respite care.
  • Also, care contract at Harp House scheme
  • Work alongside Hanovers Estate Manager (EM) and
    Assistant EM, who cover both Hanovers schemes in
    LBBD

10
Fred Tibble Court The Experience So
FarManaging our risks
  • Translating perception of need into sufficient
    applicants
  • Would assessment / case finding process be
    finely tuned enough?
  • Would the scheme be attractive enough to be
    viable?
  • bearing in mind that people would need to fall
    within a window of opportunity defined by
    level of dementia
  • If - in response to the above risk - we loosened
    entry criteria, would it then lose specialist
    focus and identity?
  • Would the scheme be sustainable in longer term,
    i.e. when residents needs increase?
  • Concerns about registration issues during the
    planning stage

11
Fred Tibble Court The Experience So Far
Managing our risks
  • How we managed risks
  • Eligibility criteria broad approach
  • Scheme design / facilities that are sufficiently
    generic to make the scheme attractive - (exit
    route/flexibility)
  • However this hasnt been tested
  • Emphasis on the housing model
  • Assured Tenancies guidance on how tenancies
    could be set up where people lacked capacity to
    sign
  • Ensure that the tenant is able to enter a valid
    tenancy agreement at the point of entry
  • Choices over care
  • Evaluation!!

12
Fred Tibble Court The Experience So FarEntry
Criteria detail
  • Applicants
  • will be mainly older people living with cognitive
    dysfunction arising from diagnosed medical
    conditions/disabilities, with possible short term
    memory loss, some disorientation, and/or
    communication difficulties, but to a degree which
    is assessed as being manageable at the point of
    entry, allowing them to become settled in their
    new environment.
  • will be people at the early stages of dementia,
    though others with similar difficulties arising
    from other diagnosed medical conditions (e.g.
    Parkinsons Disease and strokes) will also be
    eligible.
  • must be able to appreciate in general terms,
    their rights and responsibilities as a housing
    resident and as a recipient of care and support
    services.
  • will have some knowledge and awareness of their
    surroundings.

13
Fred Tibble Court The Experience So Far Entry
Criteria detail (Cont.)
  • Applicants
  • will be able to partake of supportive
    relationships within the Scheme and function
    within a daily routine
  • Will have a commitment to living as independently
    as possible, in self-contained accommodation -
    but should also need the security and peace of
    mind offered by the Scheme.
  • should be able to make choices (with appropriate
    degrees of support) about the care and support
    they receive.
  • should not have a level of physical or mental
    frailty that is likely to cause serious
    disruption or risk to other occupants.

14
Fred Tibble Court The Experience So Far
  • People with dementia or other cognitive
    impairments that are already at a more advanced
    stage will not be eligible for entry to the
    scheme.
  • Wherever possible the applicants should enter the
    Scheme at an optimum time for them and not at a
    point of crisis.

15
Fred Tibble Court The Experience So Far
  • IPC summarised the criteria as
  • having a diagnosis of dementia or other medical
    condition resulting in cognitive dysfunction
  • being at an early stage in the progression of the
    illness
  • being aware of their surroundings, and able to
    make choices
  • not being a risk to other residents and/or staff
  • ideally not being at a point of crisis
  • Also .. a balance of need and dependency
    levels, defined as
  • High Care needs - 10 hours and over p.w. (40)
  • Medium Care needs - 5 -10 hours per week (30)
  • Low Care needs of less than 5 hours per week (30)

16
Fred Tibble Court The Experience So FarOther
points in criteria
  • ExtraCare- a Housing option - fundamental
    principle of promoting independent living, and
    the value of people having their own front door
    and tenancy.
  • Preference to Local applicants
  • Both housing and care needs LA Housing
    Nomination route
  • Exceptionally, if not possible to fill void units
    using the above criteria, units could be let to
  • Frail older people who meet the eligibility
    criteria for non-specialist extra care housing
  • Older people who do meet the above criteria but
    who live outside the LBBD.
  • (Hasnt happened so far)

17
Fred Tibble Court The Experience So
FarTelecare
  • Starter pack plus infrastructure
  • Fall detector
  • Movement detectors
  • Bed sensors
  • Chair sensors
  • MIDAS / CALMS
  • EIB wiring (lighting path - bed to WC)

18
Fred Tibble Court The Experience So
FarTelecare (cont.)
  • Issues
  • Technical teething problems / test bed
  • Interference with the call system was problematic
  • A lot of devices very useful
  • Not fully deployed yet
  • Telecare - Joint Protocol
  • Telecare deployed in ways that reflect
  • needs identified in individual care and support
    plans
  • residents preferences (or views of carers /
    representatives)
  • and which promote privacy and dignity

19
Fred Tibble Court The Experience So Far
Telecare - Joint Protocol (cont.)
  • Focus at FTC - person-centred, social model
    of dementia care.
  • Face-to-face interaction and communication with
    service users at centre of service delivery.
  • Telecare is an aid to this core service, to be
    used where it can support and assist the aims set
    out in individuals care and support plans.
  • Telecare may not be needed in every instance.

20
Fred Tibble Court The Experience So
FarEvaluation by Institute of Public Care (IPC)
  • Why?
  • Asked to look at
  • Is the scheme attracting the right population?
  • Is the scheme performing to an acceptable
    standard?
  • Does the scheme deliver a reasonable quality of
    life for its residents?
  • A fourth element as a possible future stage
  • Does the scheme meet the expectations of users?

21
Fred Tibble Court The Experience So
FarEvaluation by Institute of Public Care
(IPC)(cont.)
  • Findings
  • Is the scheme attracting the right population?
  • Panel decisions have largely adhered to criteria,
    and initial population does match those set out
    by partners
  • Generally, criteria have been followed- with some
    exceptions
  • Initial population
  • Few couples - missed target set (Why?)
  • No residents from BME groups (Why?)

22
Fred Tibble Court The Experience So
FarEvaluation by Institute of Public Care
(IPC)(cont.)
  • Is the scheme attracting the right population?
  • In FTC, compared with a larger population of
    service users in the community identified as
    having some degree of dementia, there is
  • Under representation of those living with
    families pre entry (Why?)
  • Overrepresentation of those living alone (Why?)
  • Under representation of men (Why?)
  • Also, more entrants were at crisis point than
    criteria allowed for - but often they still
    settled in
  • Although FTC did achieve the right mix, a high
    level of unmet need in the community remains
    incl. people with high needs
  • Who might have been able to use extra care if
    places available
  • and a significant minority of whom then moved
    to institutional care instead

23
Fred Tibble Court The Experience So Far
Evaluation by Institute of Public Care
(IPC)(cont.)
  • Is the scheme performing to an acceptable
    standard?
  • Does the scheme deliver a reasonable quality of
    life for its residents?
  • standards and the quality of life indicators were
    developed from a literature review of standards
    and best practice documents with focus on
  • Assessment and Allocation
  • Moving In
  • Care and Support
  • The Building
  • Communication and Involvement
  • Staffing
  • Partnership Working
  • Residents, their relatives and staff were
    interviewed to assess FTC against the standards
    developed

24
Fred Tibble Court The Experience So Far
Evaluation by Institute of Public Care
(IPC)(cont.)
  • Conclusions
  • Residents have a reasonable quality of life
  • Most residents feel safe, respected and supported
    by staff.
  • Families experience is generally positive.
  • HHA and TLC emphasise the need for person centred
    care.
  • The scheme is designed to give opportunities for
    social interaction.
  • FTC reaches an acceptable standard across a range
    of measures building design, use of assistive
    technology, support to managers and staff, a
    rehabilitative focus

25
Fred Tibble Court The Experience So Far
Evaluation by Institute of Public Care
(IPC)(cont.)
  • Issues to address
  • Almost 1/3 of resident expressed feelings of
    loneliness felt that staff do not spend enough
    time talking to them.
  • Need to increase resident involvement in care
    planning
  • Maintaining high care standards
  • Impact of staff shortages
  • Develop appropriate ways of involving residents
    in the running of the scheme.
  • Maintain and develop involvement with the wider
    community

26
Fred Tibble Court The Experience So Far
Evaluation by Institute of Public Care
(IPC)(cont.)
  • Issues to address (cont.)
  • Assessment
  • More focus on strengths, and need to better
    evidence the involvement of the older person
    and/or their carer.
  • Strengthen review process
  • Telecare need more information to residents
    about what is available.
  • Success of partnership between managers relies on
    personalities involved - needs to build upon a
    more structured approach.

27
Fred Tibble Court The Experience So Far
Background national policy
  • DoH Extra Care Definitions quick recap how
    does FTC fare?
  • Living at home not in a home
  • Having ones own front door
  • Provision of culturally sensitive services
  • Flexible care delivery based on individual need
  • Opportunity to preserve or rebuild independent
    living skills
  • Accessible buildings with smart technology that
    make independent living possible for people with
    physical or cognitive disabilities including
    dementia

28
Fred Tibble Court The Experience So
FarBackground national policy
  • Extra Care Definitions quick recap (cont.)
  • a real community .. mixed tenures and mixed
    abilities permeable to the wider community
    benefits from the variety of provision available
    to all citizens.
  • An ethos of independence /rehabilitation
  • Tenancy or equity stakes give security of tenure
  • Couples may stay together
  • Relatives and friends may continue to contribute
    to care.
  • DoH view on dementia specific schemes

29
Fred Tibble Court The Experience So
FarConclusion- Critical Factors for Hanover
  • Define entry criteria to ensure it is a truly
    housing-based service (tenancies / capacity
    issues)
  • When planning, critical to address the pros and
    cons of various models and reach an informed view
  • Balance specialist focus and flexibility design
    and services
  • Realistic level of care and support - specialist
    provider
  • Exit strategies
  • Review and evaluate
  • Good residential / nursing home care can offer a
    viable alternative for people who cannot (or can
    no longer) enjoy/ benefit from living within a
    housing model
  • But huge potential for extra care
  • Will we do it again?

30
Extra Care Housing for People with Dementia 15th
November 2005Fred Tibble Court The Experience
So Far
  • Jon Head Senior Service Development Manager
    Hanover HA SE Region
  • jon.head_at_hanover.org.uk
  • www.hanover.org.uk
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