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 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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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

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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.

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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.

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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

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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?

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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

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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

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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

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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

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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!!

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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.

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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.

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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.

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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)

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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)

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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)

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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

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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.

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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?

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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?)

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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

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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

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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

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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

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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.

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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

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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

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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?

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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