1. Past, current and future research in Housing & Care 21 Vanessa Pritchard-Wilkes

2. Housing & Care 21… Mission: Support independence and choice for older people through the provision of quality housing, care and support Extra Care: 122 schemes 10% of market share 40,000 hours per week Home Care: 28 branches 42,000 hours of care each week Retirement Housing: 11,358 RH properties 336 courts Formed 1964 by the Royal British Legion. 1992 became Housing 21… 2014 became Housing & Care 21 Not for profit organisation whose profits are reinvested Last year, turnover of £200, 535 million

3. 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…

4. Extra Care and dementia Internal drivers: Resident expectations Tenure mix Safeguarding in model Deprivation of Liberty Capacity to sign tenancy External drivers: Rise in dementia prevalence Re-provision of residential Commissioning strategies Dementia and co-morbidities

5. Movements and Positioning of Extra Care General Housing Retirement Housing Extra CareCare Homes

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 friendly design? The environment promotes… Scheme 1Scheme 2Scheme 3 Meaningful interaction and purposeful activity between residents, their families and staff 90%70%78% Well-being 71%81%69% Encourages eating and drinking 70%83%73% Mobility 85%83%75% Continence and personal hygiene 80%74%77% Orientation 72%66%60% Calm, safety and security 80%88%89%

8. Areas for improvement Lower signage (no higher than 1.2m) Open shelves/ glass fronted cabinets Scheme 1 – light switches that contrast with the wall, – even-lighting without pools of light, – no dead ends at the end of corridors, – disguised staff areas. Scheme 2 – a more obvious entrance – improved natural light in the lounge – greater contrast in the handrails – walls/flooring without patterns (tiling in this case) in the entrance hallway.

9. Areas for improvement Scheme 3 – better signage, – a more welcoming entrance, – better use of outdoor space. Areas of the tool which we struggled with … – What is considered to be ‘contrasting’ – Is planting non-toxic and has it been chosen to offer variety throughout the year? – Have noise absorbent surfaces been used to aid noise reduction?

10. Dementia Specific Service- Cherry Tree House 10 fully-functioning apartments around communal area. Residents have their 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.

11. Future research considerations Clarity around the dementia offer, what works, what does not Is Extra Care suitable for people living with dementia? – at what point does it become unsuitable? What are the implications for people in Extra Care not living with dementia? How do we work together as sector to develop appropriate services for people living with dementia?