Jeremy Porteus Director Housing LIN Housing and Dementia APPG on Housing and Care for Older People 20 October 2014

About the Housing LIN Previously responsible for managing the DH’s £227m Extra Care Housing Fund and £80m Telecare in England grant Member of the Prime Minister’s Challenge on Dementia Group 48,000 members across housing, health and social services to help improve partnership working and integration on housing and care Essential online resources on housing and dementia for older people to support commissioners, funders and providers in market development, innovation and investment at: Publish papers to brief on latest innovative policy, research and practice developments in housing, care and support for older people 10 regional ‘learning labs’ in England & Wales supporting local information exchange, peer-to-peer shared learning and improvement activities, and exemplar study visits

Key messages on housing and dementia “I believe we need to think more about the role that housing organisations have to play in providing the infrastructure and the services that allow people with dementia to carry on leading their lives, as part of the community, in their own homes” (Alistair Burns in ‘Dementia: Finding the housing solutions’, NHF, 2013) “There is only limited emphasis on the needs of people with dementia in current housing policy, but a strong emphasis in dementia policy on supporting people with dementia to remain independent in their own homes” (‘Home Truths’, Alzheimer’s Society, 2012)

Key facts about dementia Estimated 670,000 people in England with dementia. Dementia Costs society £19bn a year, more than the costs of cancer, heart disease or stroke. 550,000 carers of people with dementia Huge variation in services across the country

Why is dementia awareness in housing so important? Two thirds of people with dementia live in the community, mostly in mainstream housing Research found that 48% of organisations surveyed do not have an older people’s strategy and only 8% had a dementia strategy in place (Orbit Charitable Trust – now Quality of Life Charitable Trust, 2014) A ‘Triple A’ approach to Living Well at Home (APPG, 2011) Accessibility: much of the UK’s current housing stock is poorly designed to meet the needs of older people and t here are significant barriers to people with dementia moving home, either to specialist housing or within mainstream housing Adaptability: the importance of information and adaptations is widely recognised to support people to ‘stay put’. Advice: Information is crucial to people with dementia, their familly and carers making informed choices about housing

The value of housing interventions for people with dementia awareness The University of Bradford study of ExtraCare Charitable Trust’s Enriched Opportunities Programme (2009) found that people experiencing mental health problems could continue to enjoy a good quality of life and reduce a health intervention ‘upstream’. Specifically, the outcomes for people with dementia were that they were: half as likely to have to move out into a care home far less likely to spend time in hospital as an in-patient more likely to have a GP visit more likely to see a community physiotherapist, occupational therapist and chiropodist more likely to have their mental health problems diagnosed

What’s happening at a national level? Prime Minister’s Dementia Challenge 3 key areas (dementia friendly communities, health and social care, and research champions group) G8 Summit (December 2013) A vision for international collaboration on dementia and a series of high level actions set out in a Declaration and Communique on treatment and cure DCLG – Contestable Policy Fund DH Care Act (suitability of accommodation), Better Care Fund (£220m for DFGs), Mental Capacity Act and safeguarding DH Dementia-friendly grants - small capital grants to support delivery of care Remodelled extra care, refurbishment of sheltered housing, facilities to provide respite care DH Extra Care Housing Fund - £227m CASSHF Phase1 & 2 – £315m capital programme (Prospectus includes HAPPI and dementia criteria)

Prime Minister’s Challenge - progress Timely diagnosis - Aim by 2015 for two-thirds of people with dementia to have a diagnosis, with appropriate post diagnosis support. Contract with GPs – The new GP contract rewards practices for having a pro-active approach to identifying the early signs of dementia. Dementia Commissioning for Quality and Innovation award: For 2013/14 this includes quality of dementia care and support for carers. £90m package to improve access to diagnosis Capital Funding - £50m funding to create dementia-friendly environments in health and social care.

Progress to date Hospitals - Through the Dementia Commissioning for Quality and Innovation (CQUIN) goal, more people with dementia in hospitals are being identified and assessed. Training - Over 108,000 NHS staff have already received foundation level training with a further 250,000 NHS staff to receive training in dementia by March Over 100,000 social care workers have also received some form of dementia awareness training – new resources from Skills for Care Dementia friendly technology charter published this year End of life care resource for publication December 2014 Care at home resource for publication in Spring 2015

Progress to date Government funded dementia research in England has almost doubled, from £28.2 million in 2009/10 to £52.2 million in 2012/13 £20 million funding awarded in July 2012 to six projects looking at areas including living well with dementia, promoting independence and managing agitation £9.6m investment in brain scanning by MRC for a pilot study involving 8,000 volunteers NIHR funded research undertaken by Mental Health Foundation on individual budgets for people with learning disability and early onset dementia as well as work on peer-to-peer support in housing settings with Housing & Care 21

The housing offer Improving the rate of diagnosis (housing management early signs of reported behaviour, need for aids/adaptations, care or support at home) Preventing hospital admission Providing information and advice on housing Improving hospital discharge Promoting independence at home Designing dementia-friendly homes Encouraging staff to become ‘dementia friends’

Dementia-friendly Communities “City, town or village where people with dementia are understood, respected and supported, and confident they can contribute to community life. In a dementia-friendly community people will be aware of and understand dementia, and people with dementia will feel included and involved, and have choice and control over their day- to-day lives” (Draft PAS, British Standards Institute, 2014)

Key housing characteristics - dementia-friendly communities Environment and design (managing risk eg avoids spaces and places that contribute to the risk of: falls, confusion, getting into difficulties, embarrassment, any consequential stress responses that arise, and not inhibiting independence) Assistive technologies (eg to help every person with dementia have the opportunity to benefit from technology appropriate to their needs - Dementia friendly technology charter) Access to outdoor spaces (eg Is the space easily accessible and approachable?, can the space be navigated easily once inside? Are there wide pathways and even pavements?, what are the sights, smells and sounds?). (Draft PAS, British Standards Institute, 2014)

At a glance: dementia-friendly neighbourhoods 1. Small blocks laid out on an irregular (deformed) grid with minimal crossroads 2. A hierarchy of familiar types of streets, including high streets and residential side streets 3. Gently winding streets 4. Varied urban form and architecture that reflects local character 5. A mix of uses, including plenty of services, facilities and open space 6. Permeable buffer zones, such as trees and / or grass verges, between busy roads and footways 7. Buildings and facilities designed to reflect uses 8. Obvious entrances to buildings 9. Landmarks and environmental cues 10. Special / distinctive features at junctions, e.g. street furniture, trees 11. Wide, flat, smooth, plain, non-slip footways separate from cycle lanes 12. Frequent pedestrian crossings with audible and visual cues suitable for older people 13. Level changes only when unavoidable, clearly marked with handrails 14. Clear signs throughout 15. Frequent sturdy public seating in warm materials, with arm and back rests 16. Enclosed bus shelters, with seating and transparent walls or large, clear windows 17. Ground level public toilets

Your learning and improvement requirements Appraise frontline staff of latest legislation, regulations and practice relevant to dementia eg Care Act Ensure your organisation is dementia-friendly. Sign up to become a ‘Dementia Friend’ Training to better understand and manage operational risks Create opportunities for service improvement and/or service or product development Establish effective partnerships with health and adult social care

Other useful resources Building Dementia-friendly Communities: A priority for everyone (Alzheimer’s Society, 2013). Sector led Housing and Dementia Working Group (NHF/DCLG –Dementia-friendly design; Information and advice; Skills for the workforce; and Business case: early intervention University of Worcester Association of Dementia Studies (ADS), Sitra and the Housing LIN courses Housing and Dementia Research Consortia (under ADS) Focus on Dementia website – the ‘go to place’ for free specialist housing and dementia information from the Housing LIN Viewpoints, case studies, factsheets and toolkits Dementia Action Alliance (get involved locally) Thomas Pocklington Trust (research into dementia and sight loss) ‘Focus on Dementia’, dedicated pages on the Housing LIN website

Thank you c/o EAC 3rd Floor, 89 Albert Embankment London SE1 7TP tel: website: