past, current and future research in housing & care 21 vanessa pritchard-wilkes
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Past, current and future research in Housing & Care 21
Vanessa Pritchard-Wilkes
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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
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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…
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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
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Movements and Positioning of Extra Care
General Housing
Retirement Housing
Extra Care Care Homes
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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
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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%
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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.
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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?
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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.
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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?