Community living for people with dementia: innovation and improvement Research in Practice for Adults June 2008 Sylvia Cox Independent Consultant

Strategic solutions? Personalisation - Empowerment Dignity &respect Self assessment Self directed care-control over support, care & facilities Personal budgets-personalise social activity &breaks Choice/control who provides personal care and when Transform commissioning and delivery across health and social care Housing and other community services

JackDawe Dementia Team Nottingham City Council Specialist home care User and carer focused care plan Person centred care not traditional home care Personal care & practical tasks involve in social activities and leisure Multi professional staff CPNs OT’s and home care staff Training and support for managers and front line staff 300 people use service City wide catchment Men's team Ethnic diversity

CGS-supported living-Glasgow Person centred supported living model- personal and social support Commissioned by Glasgow City Council Alternatives to residential/ enhanced residential care Older people and people with dementia Living alone or with carers 2 new build blocks each 29 flats 2 flats form staff base dementia design 6 people -24 hour support 19 people -2 hours plus on call 24 hour support

ALTERNATIVE HOUSING MODELS Small-scale extra care/supported housing 24 access to staff/staff on site Timing of move Family carer views & other professionals Cost pressures

Extra care housing What works interdisciplinary working - assessment, care planning timely and appropriate community health services flexibility and continuity in staff accessible opportunities for stimulating activities and social interaction staff with specific training greater use assistive technology promoting links with the wider community. Issues about getting balance right between independence and social isolation (Vallelly et al 2006)

Extra care Housing Funding Initiative-Initial Findings Recent report ( PSSRU 2008) “ most schemes prefer to admit residents with lower levels of physical and mental impairment than is common in care homes” “where people have care needs the organisation of care can act as a barrier to participation ( in activities and facilities) “ ( average size of schemes- 45 units)

Short Breaks- Creative models Away from home day care In home day care overnight- planned and unplanned Host family care Adult placement Emergency breaks (CSIP briefing paper 2008)

Short breaks (CSIP Fact sheet) Limited research evidence Limited access- esp. in- home care and affordability Insufficient choice Does not address diversity short breaks cannot be seen in isolation from other services Emerging principles Focus on outcomes Integral part of care plan Easy access to planned and unplanned Effective assessment Blurring boundaries between agencies

Community Dementia Support Service - Sheffield Care Trust Flexible breaks for person and carer Shift from specialist homes to resource centres rehab, dementia &mental health Sensitive support based on individual needs Additional specialist home care Supporting carers Part of dementia strategy

DCP-Newcastle Bradbury Centre Day Opportunities Grew out of identified needs Specialist focus but community inclusive Activities, reduce isolation-improve well being Restaurant, gym, day club activities Carers & people with dementia/mental health issues Short breaks facility for younger people/ethnic minority Garden- sensory and community Funding – multiple sources and social enterprise

Observations and thoughts Gaps in research and evaluation but useful models of best practice & person/ carer views Early diagnosis, early intervention and access to services - outcomes? Implications for mainstream services? Assessment/access/eligibility?

References Cox S (2006) Home solutions 2: Housing, care and support for people with dementia, Dementia Services Development Centre, University of Stirling DH/CSIP Fact Sheet Creative Models of Short Breaks (Respite) for people with dementia PSSRU Research Summary 47 January 2008 Evaluation of the extra care Housing Funding Initiative: Summary of Initial Findings Scott J (2005) Portland House: an extra care development for people with dementia Signpost 10(2), Vallelly, S., Evans, S., Fear, T, and Means, R. (2006) Opening doors to independence: A longitudinal study exploring the contribution of extra care housing to the care and support of people with dementia London Housing 21 (summary available at