1. Findings from recent evaluations: a specialist extra care scheme on the Wirral, and a community-based specialist end of life care service for people with dementia. Plus the latest from the Housing and Dementia Research Consortium (HDRC). Rachael Dutton, Research Manger, Housing 21 West Midlands Housing LIN January 2011

2. Presentation Overview About Housing 21 Evaluation of Cherry Tree Dementia Voice Nurse Service HDRC

3. Major national not-for-profit provider of services for older people ~ 120,000 hours of care weekly ~ 17,500 homes in management Improving people's lives by promoting independence and choice for older people through good quality care, support and housing Housing 21

4. Cherry Tree Specialist dementia extra care Wirral Owned and managed by Rodney Housing Association Care provided by Housing 21 Sheltered accommodation redesigned as extra care 3 years ago.

5. Cherry Tree 10 flats Small and homely communal spaces including a kitchen, living room, dining room and garden Pampering room 14 staff including one manager and one senior support officer.

6. Cherry Tree Objectives Enable Service Users to remain in their own homes Promote independent living Facilitate choice and risk taking Afford Privacy Promote rights Encourage fulfilment Afford dignity Provide individual care Ensure continuity of care Strive to achieve continuous improvements Act as a good employer

7. Evaluation Methods Questionnaires with relatives, staff and tenants (administered face to face by an independent experienced dementia worker). Case studies of two tenants, compiled using accounts from their relatives. An observational visit to Cherry Tree by specialist dementia staff member from another H21 service area. H21 RO - Interviews with staff, shadowed care manager, and analysed relevant information from care plans, support plans and risk assessments.

8. Cherry Tree 17 tenants lived at CT over last 3 years ¾ female 10 current tenants Aged 80 - 92, all with moderate to advanced dementia Average length of stay 1.7 years Currently 9 people on waiting list.

9. Findings from Cherry Tree Evaluation Overall Delivering against the aims and objectives in the original Statement of Purpose, especially independence and risk A range of additional strengths were identified: – the culture and philosophy –a relaxed and informal the leadership style – an environment of warmth and psychological security –quality end of life care being provided –holidays with small groups of tenants and carers –open and transparent partnerships with social services –being part of the local community –equality and diversity is understood.

10. Findings from Cherry Tree Evaluation Tenants’ Views 5 tenants were assisted by an independent dementia worker to complete a questionnaire. 2 were unable to give answers due to severity of their dementia. 2 were not available Very high satisfaction with: - safety, staff, having choice and control, their flat Satisfaction with: - care and support, garden, family and friend relationships, the food, building, activities.

11. Findings from Cherry Tree Evaluation Relatives’ Views Best things about Cherry Tree for their relative: - feeling happy - being included and fulfilled - having a consistent and committed care team. Best things about Cherry Tree for themselves: - privacy - reassurance - the quality of the staff team - the opportunity to visit at anytime. Improvements needed: - lift.

12. Findings from Cherry Tree Evaluation Relatives’ Comments ‘… an excellent scheme that respects the wishes of the tenants and their family. The staff recognise the contribution that family can make and appear keen to involve us in decisions about the nature of the care provided. Mum has been able to maintain a level of independence that would not have been possible in other circumstances. We are confident that staff have mum’s best interests at heart and are genuine in their levels of concern about her welfare’ ‘‘It is lovely to see her now so clean and happy she sings and dances and really enjoys life’

13. Findings from Cherry Tree Evaluation Staff Views Very positive - care and support provided, staffing, training, communication, knowledge of tenants and their relatives Very high ratings given to -Atmosphere at Cherry Tree -relationships with tenants and other staff, -support from the court manager, -responsiveness to tenants -their own well being and job satisfaction “When I see the tenants laughing and happy I know I have done my job good”

14. The average unit cost for the current tenancy at Cherry Tree (including rent and service charges) is £356 per week. This compares very favourably with the average unit cost for housing association general extra care housing estimated at £418 per week, and with local authority residential care estimated at £893 per week[1].[1] [1] Unit Costs of Health and Social Care (2009), Personal Social Services Research Unit, University of Kent. Findings from Cherry Tree Evaluation Costs

15. Findings from Cherry Tree Evaluation Opportunities / Gaps Ratio of female to male tenants, both past and present There are opportunities for better outcome monitoring in relation to the progression of tenants and the benefits of cognitive stimulation therapy Increased support recommended for staff when dealing with aggressive or psychotic tenants Accessibility of the lift.

16. Cherry Tree – Home for Life Input from Dementia Voice Nurse Service Specialist community-based end of life nurse – fill gaps in expertise, services and co-ordination – meet multiple complex needs – provide support, clinical advice, education and training – act as advocate and consistent link for clients (and professional staff) to facilitate access to services. Aims

17. DVN and Cherry Tree Cherry Tree is supporting one tenant through end of life care Determination of the family not to see their mum in residential care ‘The experience of her short stay in the EMI unit had confirmed our long held view that this is not the best setting in which to care for the majority of older people, whatever their disabilities’ (tenant’s daughter) DVN assessment / guidance / training / support and specialist equipment The tenant moved to Cherry Tree in November 2009 and is still being supported by staff.

18. DVN Service - Successful Outcomes Evaluation of DVN findings show big impact on the quality of care and circumstances for people with dementia and their families Evidence of significant improvements for service users in terms of wellbeing and quality of care positive impact on family members caring for e.g. enabling provision of right kind of care and support, waylaying fears and anxieties, enabling informed decisions positive impact on staff caring for person with dementia Awarded International Nurse of the Year; runner up Guardian’s Public Servant of the Year.

19. HDRC Housing and Dementia Research Consortium Established in 2008 by four leading providers of housing with care Membership of 100 organisations and individuals Aim is to develop robust evidence on dementia care in a housing with care setting

20. HDRC – New Publication

22. www.housing21.co.uk