1. Very Sheltered Housing An Alternative to Residential Care

2. Background Demographic change Community care Promoting independence Rising user expectation Joined up services Improving practice Social inclusion

3. The Development Process Identify basic goals & objectives Define service Identify providers/purchasing method Monitor service is achieving objectives

4. The Other Peter Principle If you don’t know where you’re going, you’ll probably end up somewhere else.

5. Objectives Independence & wellbeing Choice & quality Person-centred, integrated service Meeting older people’s aspirations Community links Value for money

6. Causes of Dependence Physical, psychological & emotional conditions within individual Externally imposed conditions – inappropriate environment, poverty, lack of power, influence, status etc

7. Promoting Independence Minimise physical causes of dependence Address psychological/emotional causes of dependence Remove external factors creating dependence “An environment that does not encourage full use of potential may cause irreversible deterioration”

8. Choice - The Older Person’s View Remain in own home with domiciliary care, adaptations etc – preferred option Residential care – accepted very reluctantly as last resort

9. Triggers for Residential Care Frailty plus- Fear/crisis – recent illness, falls, bereavement, burglary, unsuitable home environment, burden on carers

10. Own Home versus Residential Care AdvantagesDisadvantages Residential care Safety & security 24 hour care on site Company available Environment designed for disability All costs covered by fee Little personal space/privacy Communal lifestyle Less choice/control Institutional Only pocket money under own control Own home + dom. care Privacy & personal space Own front door Own lifestyle More choice & control Physical care provided Control of own income Lack of safety/security Isolation/loneliness Unsuitable environment Care not continuously available Worry about bills

11. What Older People Want Their own home Privacy/own lifestyle Choice & control Maintain health/ability Control own income Social involvement Appropriate environment Safety/security Care services Help in emergencies To be valued

12. Strategy for Older People’s Services Development of services to support people in their existing home for as long as possible Development of specialist accommodation for those who can no longer cope in current home

13. Implementation of Strategy Closure of Soc.Services residential homes Reinvestment of resources in - Very sheltered housing Joint resource centres Specialist dementia care

14. The Very Sheltered Model Self contained, purpose designed flats Secure tenure 24 hour care team on site Social club & restaurant Rehab. & prevention Personal development Social & community involvement Personal choice and control

15. The Financial Model Accommodation Care/support Living expenses – food, fuel, clothes etc Rent/service charge(eligible for HB) Soc.Services payment Tenant contribution(AA) Supporting People Tenant (pension,IS etc)

16. Purchasing Arrangements Mixed fit and frail schemes Flat rate weekly fee at 2 levels paid by Soc.Services Block purchase for 28 frail tenants(+ additional spot purchase) Joint allocation process

17. Service Provider Relationships Develop trust & understanding of constraints/opportunities Establish shared values, principles, outcome measures Share experience & knowledge of good practice Joint problem solving Joint commitment to continuous improvement

18. Monitoring Arrangements Service reviews – interviews with tenants/staff, system checks Individual reviews – annual assessment Weekly tracking of users/payments Regular general liaison Occasional workshops with provider staff

19. New Challenges for the Very Sheltered Model Care Standards Commission Rent restructuring & capital grant provision Supporting People Fairer Charging