An evaluation of the two-year pilot Prepared by for Douro Court ‘Extra Care’ Centre, Ivybridge

The Douro Court Evaluation - Background - Commissioned to undertake evaluation in July 2002 An unusual model: Part ‘extra care’ part sheltered 20 ‘extra care’ units 11 sheltered units The Vision: To develop Douro Court into an ‘extra care’ centre, serving both the scheme and the community

The Douro Court Evaluation - Overview - The pilot was a success but as with any new venture there were some challenges to overcome The pilot generated a great deal of publicity Maybe a little too much: but It was much enjoyed by the residents

The Douro Court Evaluation - Our approach - Multi-faceted and people focused including: Face-to-face interviews with service users and professionals from housing, health and social services A focus group with residents Attendance at a Douro Court project group meeting A block of time observing the day to day operation the scheme Visiting another ‘extra care’ scheme in the County Drawing upon Ridgeway’s past experience

Setting up the pilot - Essential Elements - The built environment Douro Court was built to Category 2.5 standard Additional features included a commercial kitchen / assisted bathroom The management of change via Intensive resident involvement A committed multi-agency team Commitment of the Agencies involved via Enabling a 24 hour care team to be put in place Through front funding of the project The generation of additional income

Douro Court - More than an ‘extra care’ scheme - Additional services include: A day care centre A luncheon club + A respite care facility – making best use of existing facilities Assistance with: bathing, shopping, housework and escorted outings via a ‘costed menu’ A transport facility – an innovative joint venture between the Education Dept & Devon Social Services

The outcomes of the evaluation An overview – just a flavour of the outcomes Of prime importance are: The perception of all the people involved The less tangible – the ‘soft’ outcomes

Key points from the evaluation Ethos Managing change Flexibility Managing care needs The perceived benefits of living at Douro Court Dependency / prevention Prevention - the challenges The challenges Areas for improvement Proposals for additional facilities

The Ethos Centred on the ability of those involved to: ‘Challenge’ and question service delivery – constructive criticism Strive to achieve ‘continuous improvement’ – questioning service delivery and facilities Side step bureaucracy and so achieve the aims of the project – joint working was the key

Managing change Older people find change stressful – how was this challenge met? Real involvement by residents in planning and executing the pilot Pros Involvement in the decision making processes via the project group Cons The decisions may not agree with the views of the staff

Flexibility An essential factor in ‘extra care’ housing – how was this achieved at Douro Court? A block care contract enhanced flexibility It enabled care plans to be varied on a daily basis according to individual needs Multi-disciplinary working appeared to make the amendment of individual care plans less bureaucratic

Managing care needs A major challenge because of the growth in dependency levels – how was this overcome? 3 ‘pop-ins’ per day are delivered as part of the care package Additional ‘pop-ins’ are charged to residents at 15 minutes per 5 ‘pop-ins’ Sheltered residents receive one week of free care - when need dictates When applicable residents are encouraged to apply for Attendance Allowance and spend it on additional services ‘This system provides choice and has a positive influence in avoiding the ‘dependency culture’

Living at Douro Court - Perceived Benefits - Confidence is boosted because help is at hand Mobility improves Residents take an active part in the life of the community Self esteem is boosted Re-enabling by staff creates independence Staff notice sudden and / or gradual deterioration in health and take timely action

Dependency / Prevention Seen by some as a central part of the ‘vision for Douro Court’, yet as an ‘unintended consequence’ by others At Douro Court residents benefit from: The provision of appropriate care Social inclusion Meeting others who use the scheme but do not live there Community users benefit from: Care services Day care facilities Social events

Prevention – the evidence (1) The flexible nature of the care allows many residents to be cared for in their own home, e.g. those with influenza or pneumonia Hospital discharge is facilitated because of the 24 hour on site care team Additional care can be provided to allow residents to die at home

Prevention – the evidence (2) The creation of a community resource which minimises / prevents crisis Easing the strain for carers in the community No formal analysis as yet but: Since the pilot commenced no residents have moved into residential care

The Challenges Managing the care contract – a steep learning curve Identifying staff roles and responsibilities Medication Charging residents

Areas for Improvement (1) The restaurant and day centre were seen to be institutional in appearance The size of the day care facility is seen as inadequate Lack of quiet areas where private conversations can take place Inadequate private communal facilities for the residents The delivery of the meals service

Areas for improvement (2) Introduction of a ‘buddy service’ for newcomers to the facilities Staff facilities – creation of a private office for confidential meetings Development of a more extensive training programme for staff

Proposals for Additional Services (1) Provide an information service for residents and other users Broaden the remit of the day centre to include rehab Open the Luncheon Club to a wider range of clients Introduce preventative work by District Nurses so as to identify the early onset of problems Provide a resource for GPs

Proposals for Additional Services (2) Use Douro Court as an outreach facility for providing care into the community Create an intergenerational resource

In Conclusion… There was a steep learning curve for all the parties concerned and challenges were overcome via: Close multi-agency team working Close monitoring of the service True resident involvement in the decision making processes The ability to question service delivery and solve issues A proactive approach to developing additional services that assisted in making the scheme financially viable

Working together…