Meadow View Community Care Centre

Derbyshire County Council Adult Care Group Manager: Rob Moore Derbyshire County Council Adult Care Group Manager: Direct Care Service Transformation

Strategic Need for Service Change Growth in the number of older people Growth in the number of older people living with dementia Increase in the number of older people in acute hospital settings Increase in the number of older people experiencing delayed discharge from hospital Need to develop/enhance an integrated model of care in order to improve outcomes for older people Changing aspirations of older people in terms of housing and accommodation (consultation and engagement) Lack of specialist accommodation for people living with dementia Increase in numbers of older people in long term care Ageing stock of County Council run care homes for older people Lack of affordable care homes in certain parts of the County (market management issues)

Number of older people living in Derbyshire

Number of people over 65 living with dementia in Derbyshire

Key Performance Indicators Older People admissions to long term care (per 100,00 population): 2012/13 2013/14 2014/15 2015/16 Derbyshire 758.0 715.6 799.7 730.7 East Midlands 697.2 650.6 658.5 628.2 England 759.1 690.0 673.2 612.7 Delayed transfers of care (per 100,000 population): 2012/13 2013/14 2014/15 2015/16 Derbyshire 10.7 13.1 9.7 8.5 East Midlands 9.4 9.6 11.1 12.1 England 11.7 12.1 14.3 12.7

Strategic plan Original Strategy developed 2010 based on an unsuccessful bid for PFI credits 27 homes for older people at that time, of which only 4 met the environmental standards for modern care homes for older people Plan to replace with Extra Care Housing and Specialist Community Care Centres Revised Strategy developed 2012 based on prudential borrowing for CCC’s and partnership with HA’s for extra care Revenue funding from home closure programme Aspiration to offer older people the option of an Extra Care facility within 5 miles of their current home, and access to specialist services for dementia within 10 miles of their current home Plan was for a total 1600 Extra Care apartments across 27 sites, 4 Specialist Community Care Centres, 2 dispersed Community Care Centres and retention of 4 existing homes for older people

Revised strategic plan 2013 local elections saw a change of administration and change of strategy Plan became to keep open Council run homes for older people except 4 (plus 1 respite care facility) which have now closed Investment of £4.2 million in refurbishing the remaining homes for older people The plan to develop specialist community care centres continued: this now almost complete (Buxton and Belper developments) The plan for further extra care paused: 600 units developed to date in 8 schemes with 1 in development Commitment to retain Council owned and run care homes for older people to assist with market management

Service model Care advice and support to older people and carers within the surrounding community Improved preventative, early intervention and re-ablement / intermediate care services Early diagnosis of dementia with easier access to a broad range of services and information Opportunities to live independently with specialised care for people with dementia Increased social inclusion for older people Increase choice, control, dignity and safety Joint commissioning approach for older people underpinning Derbyshire Dementia pathway and support to carers

Meadow View The fourth CCC scheme in Derbyshire opened 12 months ago Total scheme cost £10.75m inc. land purchase, fees, furniture, etc. 32 bed residential care home owned and staffed by Derbyshire County Council 16 long stay beds for older people living with dementia 8 respite care and the potential for 8 intermediate care beds (BCF funded) 20 place per day service for older people Services transferred from Underhall Resource Centre Health and well being (advice and information) zone Cafeteria Facilities for community groups Facilities for clinics/memory assessment services

Meadow View: key features Service based on the social model of dementia care Higher staffing levels on the dementia care units Enhanced staff training (5 day dementia award and positive behaviour support) RIBA Regional winner design and client of the year Aspiring to achieve Stirling Gold Standard for dementia friendly design Dementia friendly design features: wide corridors, activity rooms at the end of corridors, lighting and colour scheme, signage and wayfinding, access to outdoor space Reduction in the use of psychoactive and sedative medication: people have a better, more fulfilled quality of life and are at lower risk from falls and other health issues (evidence from other CCC’s in Derbyshire supports this conclusion).

Dementia friendly design principles The environment promotes meaningful interaction and purposeful activity between people who live in the care home, their families and staff Uncared for and unwelcoming spaces can cause anxiety and provoke concerns about the standard of care The environment promotes wellbeing Older people need higher light levels and people with dementia may interpret shadows or dark areas on the floor as holes and try to step over them. Appropriate light levels can help promote normal patterns of waking and sleeping. Views of nature and spending time outdoors are essential to wellbeing. Dementia is a terminal illness and research indicates that people prefer to die in places and amongst people that are familiar to them.

Dementia friendly design principles The environment encourages eating and drinking Having a choice of where to eat, e.g., with others or by themselves, may encourage people to eat and drink as will the provision of nutritious drinks and snacks. The environment promotes mobility People with dementia may interpret shiny floors as being wet or slippery and changes in flooring colour as something to step over. Speckles or pebble effects in flooring could look like pieces of litter. Being able to walk independently is important and safety can be enhanced by providing handrails and small seating areas where people can rest in corridors and gardens. Interesting artworks will encourage mobility and engagement, as well as helping people to find their way around.

Dementia friendly design principles The environment promotes continence and personal hygiene Not being able to find the toilet provokes anxiety and using the same signs and door colours to denote all toilets will help people find them more easily. Having visible access to toilets from every room is essential; in communal areas and in en-suite bedrooms. The environment promotes orientation People with dementia are likely to become agitated in unfamiliar surroundings. Providing visual clues and prompts, including accent colours and artworks, personalising bedrooms and providing clocks and calendars will help with orientation. Signs using both pictures and text need to be placed at a height where they can easily be seen. Corridors and spaces need to avoid dead-ends and provide meaningful activity.

Dementia friendly design principles The environment promotes calm and security Clutter and distractions, including notices, can cause added confusion and should be avoided. Signs should be kept to the minimum and but dead-ends in corridors should be avoided. Noise can make concentration difficult and can increase anxiety. Locked doors and window restrictors can lead to frustration and anger when they cannot be opened. Dead-ends can cause frustration when people do not remember why they were going down a corridor. Transparency and views both within and outside the building can reduce frustration by giving individuals prompts and visual clues about activities. Views to the outside / sitting areas can give people an opportunity to reflect and refocus on a new activity rather than be frustrated at a dead end.

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