1. Prepared by for An ‘Extra Care’ Housing Template for Devon

2. An ‘extra care’ Template Devon Social Services is committed to the further development of ‘extra care’ housing Demographics demonstrate a need for additional frail elderly provision in Devon Template developed as a ‘promotional’ document to inform relevant Agencies And as an aid to providers

3. What is ‘extra care’ housing? No ‘official’ definition A form of housing designed for older people whose needs dictate a requirement for housing with care Is variously described as: ‘ Extra care ’ Frail elderly Category 2.5 / 2.5+ Plus many more … But are they all true ‘ extra care ’ ?

4. ‘Extra care’ housing – how might it look? There are several routes to ‘extra care’ housing and these include: New build developments Remodelled sheltered schemes Remodelled residential care homes Core and cluster developments Plus other hybrids ‘Extra care’ housing – one size does not fit all’

5. The essential components of ‘extra care’ housing People-centred components The services A defined need The built environment New build / remodelled schemes Design features Smart technology Avoiding an institutional feel

6. The people-centred components A 24 hour ‘on site’ care team A 24 hour ‘on site’ care team –the benefits Night cover Flexibility Continuity Methods of providing the care service The care team can be provided by Social Services (in-house or contracted out) The contract can be let by the provider to an external care agency The provider can use a Care Agency, which is within its Group Structure.

7. The people-centred components A 24 hour ‘on site’ care team Choosing the delivery method Liaison with Social Services the Supporting People team and other partners – an essential element The issues Lack of control if the contract not in the hands of the provider Staff training issues if the provider manages the care contract – outside core business When the decision is made Put together a written agreement – it has benefits for all parties

8. The people-centred components The provision of a meal Why? Nutrition Social inclusion Involving the community The service options A requirement to take a meal Independence and choice Breaking even financially –Selling the service to others Service delivery The model A 365 day per year service Service provision choices Contracting out the service Providing an in-house service The dangers Health & safety implications An institutional feel

9. The people-centred components The Scheme Manager service A complex role The manager Looks after the building Performs housing management tasks May manage the care contract May manage the catering staff Also acts as a facilitator for Residents The care staff Other Agencies Resident vs non resident A stressful role Finding suitable candidates Company culture The residents’ view

10. The people-centred components A defined need ‘ Extra care ’ tenancies should only be offered to residents who have been assessed as in need of the facilities and services offered in the scheme But needs vary – so who can benefit from ‘ extra care ’ housing? People requiring medium to high levels of care People whose care needs are not consistent People whose care needs reduce to a low level after becoming an ‘ extra care ’ resident

11. The people-centred components Medium to high levels of care Prospective residents receiving a high level of personal care at home The cost of care has become prohibitive Lack of social interaction so depression and loneliness an issue A resistance to moving into residential care A lack of residential care provision Prospective residents leaving a residential care facility Care home closing or being remodelled

12. The people-centred components Non-consistent care needs People requiring high levels of care at one time and little care at other times Predominately people with particular illnesses e.g. Parkinson ’ s Disease / MS This category can include younger people

13. The people-centred components People whose care needs reduce People whose care needs reduce to a low level after becoming an ‘ extra care ’ resident Often become ‘ extra care ’ residents due to a personal crisis Hospitalisation Bereavement Depression resulting in neglect /poor nutrition A key factor in people moving to higher levels of provision But when stabilised in an ‘ extra care ’ scheme – care needs can reduce A dilemma – can Social Services justify funding? Would problems reoccur if they returned to their own home? A case for respite care?

14. The built environment Essentially an ‘ extra care ’ housing scheme comprises: Specially designed or adapted self-contained flats Built to wheelchair standard –With a larger than normal amount of communal space These components are necessary for new build and remodelled schemes ‘ You can ’ t make a silk purse out of a sow ’ s ear ’

15. New build considerations Is your site suitable? Is the location suitable? What will it cost to develop? Remodelling considerations Are the flats capable of remodelling to suit the client group? What facilities are available and are they capable of expansion? What will the remodelling cost?

16. Design features – the building Catering kitchen Dining room / lounge Tea kitchen Social activities area A shop Specialised bathroom Laundry facilities Buggy store Wide corridors Lift with speaking device / instructions in Braille Automatically opening front door Contrasting colours on the different floors Office / care staff accommodation Raised gardens Health & fitness facilities

17. Design features - individual flats A mix of one and two bedroom properties with: Generous space standards Ample and accessible storage space A user friendly heating system Individual meters for utilities Low level windows A specially adapted bathroom with: Adequate space standards Appropriate safety features Walk in showers

18. Design features - individual flats Bedrooms with: Sufficient space standards to accommodate a hoist or a carer on each side of the bed Kitchens with: Storage space suitable for wheelchair users Mid height cooker and fridge

19. Design features - smart technology A few thoughts: Automatically opening and closing doors and windows Sensors on cookers A ‘ smart ’ heating system Install the enabling infrastructure into buildings during the build /refurbishment stage Passive monitoring – the use of sensors An issue for debate among: Residents / Relatives Professionals

20. Design features - avoiding an ‘institutional feel’ Adding ‘ interest ’ to a building can increase costs – but can a balance be struck? Some options to consider: Avoid long corridors – include sitting / activity areas Give communal areas a cosy feel – use room dividers Enhance exterior areas e.g. include a covered garden situated within the envelope of the building Avoid institutional style seating Wheelchairs in the corridor!

21. Design features - optional extras Options could include: A day care facility with a separate entrance Respite care provision Intermediate care provision Intergenerational facilities These facilities should be designed so that the floor space can be used for flats or other facilities in the future if: The original use is no longer required Funding is withdrawn

22. Further elements in the debate The financing of ‘extra care’ housing The rural dimension Tenure

23. The financing of ‘extra care’ housing Is the scheme financially viable from both a capital and on-going revenue point of view? If not: Don’t waste any more time on it!

24. The financing of ‘extra care’ housing Capital funding – the elements: The cost of the land Grant aid Achieving cross subsidy Sourcing charitable funding Assessing the requirement for private finance Revenue funding: A block care contract Supporting People Grant On-going funding for: Luncheon club Respite care Intermediary care Other services

25. The financing of ‘extra care’ housing Can ‘extra care’ housing be cost effective? Most research indicates that: It is cost effective for the LA; but Not necessarily for the Exchequer However, there is much added value that cross the boundaries of housing, health, care and support : Reduction in hospital admissions Facilitating hospital discharge Providing a community facility Acting as a hub for Social Services and others

26. The rural dimension ‘One size doesn’t fit all’ In rural locations a 35 - 40 unit scheme may not be viable What are the options for rural communities? ‘Extra care’ housing with defined community uses For older people Intergenerational use Core and cluster developments catering for Varying age groups Mixed tenure developments Multi-agency working Using the facility as a ‘ hub ’ Providing additional income-generating opportunities

27. Tenure Offering choice is a key consideration Above national average levels of owner occupation in Devon (80%) Problems that develop with age take little account of wealth Many owner-occupiers have a clear need for ‘ extra care ’ housing But should it be funded from the public purse? Is there an opportunity here for providers?

28. Developing ‘extra care’ housing Step 1 - Inception Assessing demand Option appraisal Tenure options

29. Developing ‘extra care’ housing Step 2 - Planning Internal project team Multi disciplinary Step 1 - Inception Risk Assessment Panel Assessing demand Option appraisal Devise a Risk Assessment Criteria Timescales / milestones Tenure options A funding opportunity Design & development feasibility study Prioritise targets

30. Developing ‘extra care’ housing Step 3 - Development Partnership working Financing Extra Care housing Step 2 - Planning Tenancy Agreements Internal project team Multi discipline Nominations A local lettings policy Step 1 - Inception Risk Assessment PanelContracts Care / catering /other Assessing demand Option appraisal Devise a Risk Assessment Criteria Timescales / milestones Promoting the scheme Marketing an essential element Tenure optionsDesign & development feasibility study Prioritise targets Letting the scheme Recruitment Assisting with the move

31. So is the case for ‘extra care’ housing proven? The residents Offers choice and independence Assists in maintaining independence for longer Promotes social inclusion The policy debate Demographics The prevention / avoidance agenda Services to the community The providers’ perspective The future marketplace

32. Final thoughts… The essence of developing successful ‘extra care’ housing is: Defining the need Careful planning Detailed risk assessment Joint working between Agencies Including prospective and current residents in the process from the outset A strong and proactive project team

33. Prepared by for An ‘Extra Care’ Housing Template for Devon