1. Developing HAPPI housing to deliver health outcomes Alex Walker NHS Central Lancashire 12 th December 2012

2. What are we trying to achieve for dementia care in Central Lancashire? Centres of excellence –Specialist design –Learning environments A therapeutic approach –Improvement and maintenance of skills –Resilience for people with dementia and their carers –Improved quality of life –At all levels of need A shift in culture –Breaking stigma –Changing staff approaches –Normalising dementia –Care planning based on skills not deficits

3. What are we trying to achieve for dementia care in Central Lancashire? Access to outdoors as the norm –Seeing the whole environment as vital to the delivery of support –Recognising the importance of nature Integration of services –Multi agency A continuing sense of being part of the community Meaningful engagement in normal life

4. Charnley Fold Resource centre - South Ribble Integrated base for: –MH Trust, County Council –Age Concern, Alzheimer’s Society –People with Dementia and their carers Services: –Memory assessment, Post diagnostic services, Training, Dementia advisers, Dementia cafés, Carers groups –Enhanced day care –Community Mental Health Team Design was critical –Light, Space, Freedom of movement, Easy access to the outdoors, Welcoming, Domestic feel

5. Nature and being outdoors: PROVIDE sensory stimulation, pleasure, purpose, distraction, orientation, Vitamin D, exercise and movement IMPROVE appetite, blood pressure, focus, verbal expression, relaxation, engagement, sleep patterns, mood, strength, agility and balance DIMINISH apathy, agitation and aggression The importance of thinking about the design of outdoor spaces in care settings

6. The Pocket Park Archetypal spaces help cue people as to what to do

7. The Back Garden

8. The Backyard

9. Meaningful places enhance daily life

10. Nature is a tool to promote communication and better mental well being

11. Edge Space Connect inside and outdoor use Added a porch and a raised bed Changed windows to doors

12. Focus o Maintain or improve skills o Sustain people in their own homes in the community Approach o 12 week therapeutic programme o 97 people have attended at least 2 programmes o People were assessed across 2 programmes in relation to independent learning skills and abilities o Period of time across programmes: o 2 programmes attended – 8 months o 4 programmes attended – 16 months o 6 programmes attended – 24 months o 8 programmes attended – 30 months Outcomes at Charnley Fold Enhanced Day centre

13. Attendance across programmes No of programmes attended No of service users 140 233 312 416 52 68 710 816

14. Skills maintained or improved across programmes No of programmes attended No of service users 1 283 349 437 523 617 712 85

15. Overview on impact Number of Programmes 2345678 Number of people attending in total 97645236342616 Number of people maintaining or improving skills 8349372317125 Percentage of people maintaining or improving skills 86%77%71%64%50%46%31% Length of time skills maintained or improved (months) 8121620242730

16. The Lodge - Continuing Healthcare facility Service to people with severe symptoms from their dementia 2 tiers of service commissioned (42 beds in total) Fusing a different care approach with good practice design principles –Specialist dementia design –Space –Meaningful environment and activity –Apartment living –High quality Innovation: –Massive cultural shift –Therapeutic approach aimed at reducing need

17. Impacts Reduction in level of need 21/57 have seen their level of need reduce from Tier 1 to Tier 2 Only 1 person has seen need increase from Tier 2 to Tier 1 (had previously stepped down from Tier 1) 6/12 could see care reduce below Tier 2 Medicines use 17/27 admitted to the Lodge on anti-psychotics have seen reduction in use (63%) 10/27 stopped (37%) 7/27 reduced (26%) 17 people have seen reductions in prescribing of anti-depressants

18. Impact – Specialist in-patient dementia services Central Lancashire has seen the highest impact across Lancashire in reductions of admissions and length of stay for specialist dementia in-patient care

19. Impact – Interface of Residential Care with specialist in-patient services Interface of admissions to in patient units from residential care 34/57 (60%) had previous admissions to residential care that had broken down (101 care placements in total) 12/57 (21%) had lived in multiple residential settings where care had broken down (more than 2 placements) 7/57 (12%) had multiple hospital admissions prior to the Lodge, 700 bed days excluding admissions prior to the Lodge (£200k +) 0/57 breakdowns in care at the Lodge in 2.5 years, with no re-admissions to hospitals

20. Before...

21. Garden renovation The Lodge: Divide garden in half Install fencing and trellis Reposition raised beds Realign and add paving Transplant turf and plants Install a roof on the veranda and part of the pergola Put a gate in the fence by the area for pets

22. During

23. After Separate spaces for different needs and abilities Nature stimulates. People act.

24. After

25. Nature stimulates. People act.

26. Thinking through different cluster arrangements

27. Brookside Resource centre - West Lancashire 111 flats of extra care housing Wider range of health services –Memory Assessment –CMHT –Dementia Adviser –Peer supports –Prevention services –Stroke services –Falls and Therapy –Longer term rehabilitation flats for: Stroke Dementia care Intermediate care

28. Brookside Resource centre - West Lancashire Wider partnership –RSL –District council –CCG –U3A –Age UK –Alzheimer’s Society –Integrated Care organisation –MH Trust –Bistro provider –Wider community

29. Brookside Resource centre - West Lancashire Greater integration of services –Physical and Mental Health care –Health and Social care –Statutory and Voluntary sector supports –Housing as part of the equation Emphasis on changing the quality and environments for support –De-stigmatisation Community ownership Transformational, influential and educational

30. Challenges Different approach to risk within a housing scheme –Health & Safety – is it balanced? The challenge of integrating –Different cultures –Working together takes time –Leadership is critical The changing provider and commissioner landscape –CCG not PCT –Split of Health providers Procurement v On-going service development

31. Contact details: alex.walker@centrallancashire.nhs.uk Design guide available at: www.chalfontdesign.com