Transcript Powerpoint presentation template ExtraCare

Extra Care Housing for People with Dementia
15th November 2005
Fred Tibble Court – The Experience So Far
Jon Head – Senior Service
Development Manager – Hanover HA
SE Region
[email protected]
www.hanover.org.uk
Fred Tibble Court – The Experience So Far
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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
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.”
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.
Fred Tibble Court – The Experience So Far
Why 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
Fred Tibble Court – The Experience So Far
Description
‘Typology’ of extra care schemes catering for people with
dementia?
1. A unit or ‘wing’ - within a non specialist scheme
2. Integrated, mainstream extra care schemes
3. Specialist schemes
4. Exclusive schemes
Where does Fred Tibble fit?
Fred Tibble Court – The Experience So Far
Design/build issues
Outside scope of presentation … but to set scene:
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31 flat (26 x 1 bed; 5 x 2 bed) scheme in Dagenham - opened in
June 2004
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Flats to normal extra care scheme /design standards
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Built upon the site of a closed residential care home
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Normal extra care communal facilities include a residents’
lounge/dining room, laundry room, assisted bathroom, shop/kiosk,
guest room, hairdressing salon
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A small professionally designed cinema
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A secure garden area
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Telecare
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Particular focus on interior design
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
Fred Tibble Court – The Experience So Far
TLC (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 Hanover’s Estate Manager (EM) and
Assistant EM, who cover both Hanover’s schemes in
LBBD
Fred Tibble Court – The Experience So Far
Managing 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
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 hasn’t 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!!
Fred Tibble Court – The Experience So Far
Entry 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. Parkinson’s 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.
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.
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.
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%)
Fred Tibble Court – The Experience So Far
Other 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.
(Hasn’t happened so far)
Fred Tibble Court – The Experience So Far
Telecare
‘Starter pack’ plus infrastructure
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Fall detector
Movement detectors
Bed sensors
Chair sensors
MIDAS / CALMS
EIB wiring (lighting path - bed to WC)
Fred Tibble Court – The Experience So Far
Telecare (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
Fred Tibble Court – The Experience So Far
Telecare - Joint Protocol (cont.)
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Focus at FTC - person-centred, ‘social model’ of
dementia care.
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Face-to-face interaction and communication with
service users at centre of service delivery.
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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.
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Telecare may not be needed in every instance.
Fred Tibble Court – The Experience So Far
Evaluation 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?
Fred Tibble Court – The Experience So Far
Evaluation by Institute of Public Care (IPC)
(cont.)
Findings
1. Is the scheme attracting the “right” population?
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Panel decisions have largely adhered to criteria, and
initial population does match those set out by partners
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Generally, criteria have been followed- with some
exceptions
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Initial population
• Few couples - missed target set – (Why?)
• No residents from BME groups – (Why?)
Fred Tibble Court – The Experience So Far
Evaluation 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
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
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;
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
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.
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 one’s 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
Fred Tibble Court – The Experience So Far
Background – 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
Fred Tibble Court – The Experience So Far
Conclusion- 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?
Extra Care Housing for People with Dementia
15th November 2005
Fred Tibble Court – The Experience So Far
Jon Head – Senior Service
Development Manager – Hanover HA
SE Region
[email protected]
www.hanover.org.uk