Past, current and future research in Housing & Care 21

Vanessa Pritchard-Wilkes

Housing & Care 21…

Mission: Support independence and choice for older people through the provision of quality housing, care and support

Extra Care: 122 schemes

10% of market share40,000 hours per week

Home Care:28 branches

42,000 hours of care each week

Retirement Housing:11,358 RH properties

336 courts

• Formed 1964 by the Royal British Legion. • 1992 became Housing 21… 2014 became Housing & Care 21• Not for profit organisation whose profits are reinvested• Last year, turnover of £200, 535 million

Extra Care…the modelOur Extra Care Model:•Local Authority commissioned•Small amounts of shared ownership/ mainly rental•Mixture of low, medium and high needs•Mixture of approaches to dementia care

Benefits:•Independent living for longer- supported to have own tenancies•Couples enabled to live together•Integrated housing and care•Preventative and positive health outcomes•Wellbeing and inclusion

BUT THERE ARE CHALLENGES…

Extra Care and dementia

Internal drivers:

Resident expectationsTenure mix

Safeguarding in modelDeprivation of Liberty

Capacity to sign tenancy

External drivers:

Rise in dementia prevalenceRe-provision of residentialCommissioning strategies

Dementia and co-morbidities

Movements and Positioning of Extra Care

General Housing

Retirement Housing

Extra Care Care Homes

Research:

“Dementia Wings” v. dispersal

•Analysis of 6 “Dementia Wings” as part of Extra Care sites•Underpinning rationale is that they are L.A. led•Stigmatising & labelling•Prevents integration & community support•Puts condition first. Person second•Deprivation of Liberty issues Actually should be looking at:•Person first•Age-friendly apartments•Use of assistive technology

Dementia friendly design?

The environment promotes…

Scheme 1 Scheme 2 Scheme 3

Meaningful interaction and purposeful activity between residents, their families and staff 90% 70% 78%

Well-being 71% 81% 69%

Encourages eating and drinking 70% 83% 73%

Mobility 85% 83% 75%

Continence and personal hygiene 80% 74% 77%

Orientation 72% 66% 60%

Calm, safety and security 80% 88% 89%

Areas for improvement• Lower signage (no higher than 1.2m)• Open shelves/ glass fronted cabinets• Scheme 1

– light switches that contrast with the wall, – even-lighting without pools of light, – no dead ends at the end of corridors, – disguised staff areas.

• Scheme 2– a more obvious entrance– improved natural light in the lounge– greater contrast in the handrails – walls/flooring without patterns (tiling in this case) in the entrance hallway.

Areas for improvement

• Scheme 3 – better signage, – a more welcoming entrance, – better use of outdoor space.

• Areas of the tool which we struggled with …– What is considered to be ‘contrasting’– Is planting non-toxic and has it been chosen to offer variety throughout the year?– Have noise absorbent surfaces been used to aid noise reduction?

Dementia Specific Service- Cherry Tree House

• 10 fully-functioning apartments around communal area.• Residents have their own tenancy.• Dementia criteria- but service designed to reduce impact:

“Dementia is only part of the person…”

• Positive risk taking approach• Community living & support• “Dementia Friendly Community”• Early on-set and young dementias

• Model successful- prevention/ better outcomes

BUT THE MODEL IS EXPENSIVE.

Future research considerations

• Clarity around the dementia offer, what works, what does not

• Is Extra Care suitable for people living with dementia? – at what point does it become unsuitable?

• What are the implications for people in Extra Care not living with dementia?

• How do we work together as sector to develop appropriate services for people living with dementia?