1. 'How are the challenges and opportunities of dementia shaping our housing and care offer?'

2. About Housing & Care 21… We are a not for profit organisation with a social purpose. We promote independence and choice for older people through quality housing, care and support. We are an expert provider to people aged over 65 We provide 3 distinct types of service:  Retirement housing  Extra Care  Home Care

3. Retirement Housing Home care in community Extra Care- Generic Extra Care- “Dementia Wings” Extra Care Specialist Dementia Housing&Care21 is the leading provider of Extra Care with 10% of extra care market. We have recently opened our 100 th extra care scheme EXTRA CARE Local Authority commissioned models

4. Extra Care…the model Our Extra Care Model: Local Authority commissioned Small amounts of shared ownership/ mainly rental Mixture of low, medium and high needs Mixture of approaches to dementia care Benefits: Independent living for longer- supported to have own tenancies Couples enabled to live together Integrated housing and care Preventative and positive health outcomes Wellbeing and inclusion BUT THERE ARE CHALLENGES…

5. Changing landscape: Extra Care… and dementia External Factors: Rise in dementia prevalence Re-provision of residential Commissioning strategies Dementia and co-morbidities Internal Factors: Resident expectations Leasehold v. rental Safeguarding in model Deprivation of Liberty Capacity to sign tenancy IMPACT ON EXTRA CARE MODEL

6. Research: “Dementia Wings” v. dispersal Analysis of 6 “Dementia Wings” as part of Extra Care sites Underpinning rationale is that they are L.A. led Stigmatising & labelling Prevents integration & community support Puts condition first. Person second Deprivation of Liberty issues Actually should be looking at: Person first Age-friendly apartments Use of assistive technology

7. Dementia Specific Service- Cherry Tree House 10 fully-functioning apartments around communal area. Residents have own tenancy. Dementia criteria- but service designed to reduce impact: “Dementia is only part of the person…” Positive risk taking approach Community living & support “Dementia Friendly Community” Early on-set and young dementias Model successful- prevention/ better outcomes BUT THE MODEL IS EXPENSIVE.

8. Key success factors… Design services for the individual not the condition Living independently is about enabling people to take measured risks Recognise the limitations of the EC model Fund the model sufficiently Be clear on purpose, rationale and design Strong support and understanding from local authority commissioner

9. Extra Care- Tensions in the model  Care Act- challenges & opportunities  Tenure Mix Differing expectations Clarity of offer  “Residentialisation” of Extra Care Re-provision of Residential Care Move to higher needs Challenge and opportunity  Affordability Welfare reform/ change to funding models  The dementia “challenge” How are people living with dementia supported in EC? At what point does EC become inappropriate?

10. Conclusion: Clarity around “dementia” offer, what works, what does not. Understanding opportunities and limitations of Extra Care for people with dementia e.g. in light of DoLs. Dementia is just one of the issues which affects residents Engagement with commissioners to shape model- currently trying to be all things to all people.

11. Discussion points: Is Extra Care suitable for people living with dementia? – at what point does it become unsuitable? If not, where can people with dementia live? What are the implications for people without dementia? How do we work together as sector to develop appropriate services for people living with dementia?