Evaluating Extra Care Housing in East Sussex Jenny Tuck / Wolfgang Weis Strategic Commissioning Adult Social Care East Sussex County Council October 2014 South East/South West Housing LIN

Evaluations Two approaches: Independent Evaluation of all schemes - making the business case Cranbrook 2 year longitudinal evaluation - quality of life and design

Schemes in East Sussex Current Schemes5 Completed 2002 – rented 31 shared equity TOTAL New Schemes2 77 rented 26 shared equity TOTAL Pipeline Schemes4TOTAL 230+

Why commission an independent evaluation? Important to take stock: Initial commissioning objective fulfilled Is extra care delivering what it should be? Changed and challenging financial landscape in ASC and ESCC placed extra care in spotlight Does extra care stand up to financial scrutiny? Business case required for capital and revenue investment in future schemes Independent Consultant – credibility key to achieve ‘buy in ‘ from Senior Managers

Hypotheses Two hypotheses tested in Evaluation: Extra care is a preventative service model enabling people to remain in the community and not enter residential / nursing care Extra care is a more cost effective model than residential/nursing care/own home These hypotheses were confirmed by the evaluation findings.

Methodology Consultant asked to consider: - whether people in extra care were placed appropriately - indicate hypothetical alternatives if someone was not living in extra care (from care/support at home to Nursing Care) Desktop exercise by Consultant using: social care assessments, housing assessments, support plans, reviews Consultant made judgement about appropriate alternatives to extra care Discussions with scheme managers and care provider managers - where would people be living if they were not in extra care? Verification exercise by ASC Practice Managers Detailed costing by ASC Strategic Finance of alternatives (gross and net costs)

Key Findings Appropriate placement 95% of people were appropriately placed Hypothetical alternative placement 36% of people would require domiciliary care in own home/sheltered housing if not in extra care Hypothetical alternative placement 63% of people would require residential/EMI/nursing care if not living in extra care Age under 65 11% % % % Dependency Levels (rented) 33% high 27% medium 25% low 10% none 4% voids Care Need 82% overall had a care need 86% rented 61% shared equity Dementia 3% - 26% range in schemes 14% average (formal diagnosis) Couples 27% average at scheme opening 13% at time of evaluation Design Accessible environment was an incentive to families to continue care and visiting also design impacted positively on care delivery Double-ups 8 – 24% in schemes 14% average Cost benefit to ASC Care Provision in Extra Care is half the cost of the average alternative provision identified (gross costs) Balanced Community Mixed age and mixed dependency schemes worked best - a balanced community is crucial to success of schemes. Restaurant Restaurant acts as a focal point for meals, good nutrition and a springboard for social activities. It is critical to success of the model. Moved from Hospital into Extra Care 3 – 21% in schemes 13% average Health and Wellbeing * Reduction in anxiety * Positive impact on high prevalence of diabetes * Reduction of social isolation

Dependency Levels Challenging area worth investing time in Worked hard with partners to achieve and maintain a balance of levels 2003 Scheme Schemes 2012 Scheme Future Schemes 2015  33% Low: 0 - 4hrs 33 Medium: 5 – 9hrs 33% High: 10+hrs 20% Low: 2.5 – 5hrs 40% Medium: 6 – 11hrs 40% High: 12+hrs 30% Low: split between:  10% very low* 2.5hrs  20% Low: 6-9hrs 40% Medium: hrs 30% High: 15+hrs 20% Low: 5 - 9hrs 50% Med: hrs 30% High: 15+hrs HIGHER HOURS IN EACH BAND, BUT NOT AN INCREASE IN HIGH DEPENDENCY NUMBERS

Dependency Levels % in high band has not continued to rise People in high end of medium band likely to be main beneficiaries because: -able to contribute to a scheme -care needs often reduce after entry but need to be at a level ensuring benefit from the scheme and vfm -if care needs increase scheme is able to manage increase -people not yet at crisis point prevented from residential care Care does not translate into support - low care needs may mean high support needs Carers enabled to continue to care for people with high care needs

Allocations Strong commissioning – operations interface in ASC Partnership work to agree Nominations Protocol in advance of allocations starting ASC has strong influence through Nominations Protocol Invest time/resources in allocations – first let and ongoing Tight, joint operational management Keep balance of need under control Careful re. care needs reducing Allocate to scheme and on individual basis Carers – careful re care needs reducing once in scheme

Evaluating the impact of extra care housing: 2 year evaluation of Cranbrook Scheme completed January 2012; 62 flats Residents offered chance to participate in evaluation (52 were invited) Key Focus: Key feedback on design and quality of life Key information on care hour delivery

Two Key Areas: 1. Quality of Life / Health and Wellbeing Quality of Life / health and Wellbeing Question  The Percentage of interviewees who reported being ‘Very Satisfied’ or ‘Satisfied’ 6 Month Evaluation 12 Month Evaluation 18 Month Evaluation 24 Month Evaluation 1. Living in Cranbrook has improved my quality of life? 83%85%100%78% 2. Living in Cranbrook has helped me to be more independent? 74%85%92%78% 3. Living in Cranbrook allows me to have as much control as I want over my daily life? 87%90%100%89% 4. Living in Cranbrook helps me to feel safe and secure? 92%100% 5. Living in Cranbrook helps me to be involved as much as I want in my local community? 70%80% 89% 6. Living in Cranbrook helps me to do things I value and enjoy? 70%80%100%

2. Building Design Design Aspect meets Interviewees Needs Average Percentage: of interviewees who reported that the design aspects met their needs Access to flat98% Size of flat99% Layout of flat98% Number of bedrooms98% Location of flat within the scheme99% Keeping the flat clean and tidy99% Kitchen usability81% Lighting (including switches)85% Shower room and toilet facilities82% Colour differentiation94% Average Number of Interviewees across all the 4 evaluation stages 17

Cranbrook: analysis of care hours 52 flats (original cohort) 2 years Early work indicates: Took months to fill scheme (Feb – May 2012) Care hours doubled Feb – May 2012 ( ) Balance of dependency levels crucial TimelinePeopleHoursDeathsStopped Requiring Care (may have moved) May December December May

Lessons Learnt from Evaluations Wider evaluation Resourcing an evaluation –time and money Credibility of external consultant Buy in and sign off at senior level is key Underestimated commissioners time required Remember partnerships – buildings do not belong to ASC Don’t forget value of qualitative benefits 2 year evaluation Sample size reduced over time Resource intensive process for commissioners Importance of good relationship with housing and care providers Challenge of control group Valuable information on design used in new schemes

Impact of Evaluations Engagement of partners, senior managers Extra care seen as an invest to save model Importance of quality of life combined with cost effectiveness Link to evaluation of quality of life in latest scheme – 2 year project Further capital investment proposed; more schemes to be planned – increasing capacity Keep strategic engagement of partners Continual transfer of learning

Contacts and Information Commissioning contacts in ESCC Adult Social Care Wolfgang Weis Head of Strategic Commissioning (Supported Housing) Tel: Jenny Tuck Strategic Commissioning Manager (Housing Tel: Extra Care in East Sussex Evaluation Report June 2013 is available via the East Sussex County Council website The Business Case for Extra Care Housing in Adult Social Care: An Evaluation of Extra Care Housing schemes in East Sussex usingStrategyExamples usingStrategyExamples