13th & 14th September 2006

EXTRA CARE HOUSING AND DEMENTIA

COMMISSIONING FOR QUALITY

AN OVERVIEW OF THE ISSUESSue Garwood

Why this Conference ? • Simplistic messages

• Salmon sheet – applies to all Extra Care

• Green sheet – dementia specific – no claim to comprehensiveness

• Other presentations

• Workshops to explore issues in greater depth

Partnerships and Finance

• Identifying additional stakeholders – OPMHTs and local Alzheimer’s Society, potential users

• Capital – Any specialist sources?

• Revenue – Attitude of your local Supporting People Administering Authority

Range of Provision?

• Range of provision – housing only or residential and other services

• For each additional provision:– Source of capital– Source of revenue– Who will manage service?– Registration implications– Conformity to other regulations e.g HC

Provisions Shaping Design

• Facilities for staff

• Facilities for other staff and organisations?

• Amount of parking

• Number and type of communal areas

• Progressive privacy

Target Groups Shaping Design• Scale of scheme• Number, size and specification of

individual units• Lighting, field of vision, aiding orientation,

homely feel etc• Security features and walkways• If separate dementia wing, design to

minimise risk of ostracismJon and Sylvia to cover

Assistive Technology and Telecare

• Infrastructure – future proofing• What will be applied universally? e.g.

pendant and alarm• Which applications individually

decided? e.g. flat or building exit detector; falls or gas detector

• Developing guidelines and protocols See “Telecare and Ethics” Factsheet:

http://www.cat.csip.org.uk/_library/Telecare/Factsheet-Telecare-Ethics19July2005.doc

Tenure

• For rent

• For sale

• Shared ownership

• Mixed tenure

Jane’s examples span a range

Legal Aspects

• Issues include:– Capacity in relation to signing tenancies

– Capacity in relation to complying with agreement or refusing care

– Validity of tenancies and security of tenure

– Registration issues

Belinda to cover

Which Model?• Dementia specialist or dedicated?• Dementia friendly? If so, integrated or

separate dementia “wing”? If a wing:– For all who have dementia or only some?– If all, will you move those in main scheme

when they develop dementia? If so at what point?

– If only some, eligibility criteria for wing?– Will wing differ in terms of design, AT and

staffing – if so how?– Can it be seen as equivalent to an 80s EMI

unit in terms of target group?

Some Pros and ConsIn favour of separation –

•Can concentrate staffing resources in wing•Can tailor design and assistive technology•Other residents may be more tolerant

Against separation –•Risk of ghetto•Where integration more mutual assistance•Criteria for entry and issue of blurring over time•If targeted at higher needs, risk of resemblance to residential care – does this matter? Does it still offer something better?Desperate need for research into costs and benefits of different models

Point of Entry and Eligibility Criteria

•Should Extra Care completely replace residential care?•Is there a point beyond which Extra Care is no longer suitable for someone with dementia to move to?•Have you developed jointly agreed eligibility criteria which suit the built environment and level of services likely to be available?

Assessments and individual preparation

• Who? Assessor(s) needs to understand dementia, eligibility criteria and the scheme’s services and limitations

• Needs and risk assessment. Diagnosis?

• Focus on personal history

• Importance of individual engagement and preparation

• Enduring/Lasting Power of Attorney

On site service design• What management structure – integrated

housing and care management or separate?

• Who provides care? Supporting People services? Relationship between them.

• Staffing levels

• Person centred provision

• Group work

Staff training

• Understanding dementia very important

• Joint training if separate housing and care staff

Beth to cover

Home for life – guarantee or aspiration?

• Reality for many, not for all• Dependent on many factors

– Risk to individual and others– Staffing levels, flexibility and experience– Availability of peripatetic specialist services

• Get ownership and support from specialist services during scheme development

• Think in advance about moving-on criteria and processes

Final Thoughts• Proper preparation and partnership

working fundamental

• Make sure that the following are properly aligned and compatible:– Scheme features - the physical environment,

service specification and policies– Scheme eligibility criteria/target groups– Individual assessment and allocation of units

Contact Details

Sue Garwood – Extra Care SpecialistPhone: 01763 838 179Mobile: 07962 186 308E-mail: Sue@suegarwood.co.ukWeb: http://www.suegarwood.co.uk