Enhanced Sheltered Housing ?

Response from John Gatward, Group Chief Executive, Hanover Group

The comments that follow are primarily directed at the Housing LIN but we would be happy to discuss direct with John Hazelhurst - Hanover is very active in Tameside.

In advance of any other input, I think I should take issue with a number of tacit or overt assumptions in your note. I am not getting at anyone - but people need to be aware that terms are interpreted according to historical usage!

- there is the implication that 'ordinary' sheltered housing does not contain and support 'significant numbers of both older people and older people with care inputs'. It clearly does.

- There is a focus on 'enhancing care delivery', which I take to exclude physical changes to the scheme. I am not clear why there needs to be a single 'model' for this. The capacity of any individual scheme to support people with higher support needs is dependent on many factors, amongst them the physical topography, on-site facilities, local service provision&

- You refer to 'ordinary' sheltered housing as 2.0 and Extra Care Supported Housing as 2.5. I am disappointed by this. Category 2 ½ sheltered housing was a concept around in the late '80s, when it was called frail elderly housing, and was seen as midway between Category 2 sheltered housing and Part 3 residential care. Hanover developed extra care housing as 'a real alternative to residential care' or, using the old terminology (it was never actually called this), Cat 3. It is designed to higher specifications than the old Cat 2 ½ housing. Were you proposing to call the new Enhanced Sheltered Housing Cat 2 ¼? I hope not! I think we should avoid the use of outmoded classifications that carry particular historic connotations of which some will be more aware than others.

- You refer to pilots in '3 sheltered housing units with resident wardens'. Why 'resident wardens'? Hanover, and many other leading providers, have long switched to non-resident estate/scheme managers. Is there an inference that the sort of service being envisaged could be provided only by a resident warden? If so, beware the Working Time Directive - if someone is on-site (or even off-site) and on-call, which I infer is what is being suggested here, then they are considered to be on duty within the terms of the WTD and the limitations with regard to the number of hours worked per week or in a row come into play. A few years ago we had what we called '19-hour contracts' - resident wardens worked 9am-1pm, were off duty until 6pm and were then on call round to 9am, during the working week. We had to abolish these (which I was very keen to do anyway!) because of the WTD. I would strongly suggest that residency is not necessary.

Our North Regional Office would be pleased to discuss such matters with John. If what we are talking about here is essentially how health staff could collaborate with housing and support staff to provide forms of health support - medication etc - to people living in sheltered housing, Hanover would certainly be interested. We already collaborate with a couple of PCTs to provide a few flats for intermediate (step-down) care for people coming out of hospital. Two of these flats are in 'ordinary' (i.e. Cat 2) sheltered housing (in Cirencester), the others in extra care housing (in St Neots, near Cambridge). The whole issue around 'floating support' in the context of Supporting people funding is very alive within Hanover - and most other providers - at present.

John Gatward
Group Chief Executive

Response to John Hazelhurst from Judith Hawkshaw, Suffolk CC

In Suffolk the 7 DC/BCs, Suffolk CC, RSL provider colleagues and Supporting People have agreed to come together with a view to strategically looking at Sheltered services in Suffolk across the board.

Below I have made a few comments starting with definitions....

- Sheltered Housing (was cat 1 and will have alarm call system only service);

- Sheltered Housing with Support (was cat 2 and will have alarm system with peripatetic support going in from a 'floating' support service. We are aiming for the support providers also to deliver care;

- Very Sheltered Housing (sometimes known as Extra Care) (cat 2.5 with 24 hour care and support available)

- Extra Care - in Suffolk a specialist service for people with either dementia or functional mental ill health located within a VSH scheme.

Judith Hawkshaw
SuffolkSocial Services

Reply to John Hazelhurst from Philip Malyan - Durham CC

I'm currently working on a project remodelling sheltered housing and one thing of great debate is the current role of the resident warden. I must admit I'm sitting on the fence a bit here, as I'm waiting/ expecting someone to come up with exactly what you have proposed. I don't think that there is a huge issue over the quality of current services and the needs of their tenants, certainly not in Durham.

However , I'm reluctant to recommend major changes/ closures due to the possibility of a cost economic option like the one you have discussed. Also it is a great opportunity to develop sites owned by district councils and bring them into the picture more centrally. I would interested to know what response you are getting here. please let me know as I think Durham may well be going the same place as you are suggesting.

Philip Malyan
Durham County Council

Response to John Hazelhurst from Andrew Buchan - North Herts Homes

Dear John,

I am responding to the e-mail circular from the Housing LIN.

I have to say Im slightly puzzled by the research, and concerned about yet another sub-division of housing for older people.

We are in a completely different geographical area, so you may feel that our input is not entirely relevant. However we are in the early stages of a review of our sheltered housing schemes, but the picture we are considering is one with a mix of available services.

My observation is that most sheltered schemes include a fair proportion of people with substantial care needs, which in Hertfordshire are normally provided by a geographical block provider, with care spot purchased by social services. Extra-care involves block purchasing and the benefit of this is that schemes can gain 24-hr cover and some opportunity for motivational and re-enablement work.

The number of schemes that we have that operate as traditional sheltered housing we think are few and far between. Although we are completing the review on one, where we have an average age of over  80, but almost no statutory service input. In this case, an excellent example of independence promoted and sustained.

Im not sure where your concept between the two existing models comes in? Id welcome your views.

Andrew Buchan
Service Development Manager
North Herts Homes
01462 704174
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Response from John Hazelhurst to Anderw Buchan

Andrew

I entirely understand your reasoning. However our concern was having variance in the age/needs profile of schemes and seeking to recognise and improve the situation in those schemes with high number of older people with care. Essentially we are aiming to rationalise existing (individually commissioned) care inputs and create an environment where people can be maintained for longer and avoid unnecessary moves.

Hope this helps clarify and welcome any further comments.

John

Response from Andrew Buchan to John Hazelhurst

John  thank you for your response.

It seems that what you are looking at then, is a mixed community with some sheltered tenants who are essentially independent and some who have care hours. People probably dont move to the scheme to receive care, but may well start as ordinary sheltered tenants who can have their care needs addressed as they arise.

Have you envisaging a lower threshold of care hours? (Most Extra-care schemes seem to have a minimum number of care hours needed in order to be considered). I assume that you would then expect block contract purchase of care hours. Would you get the same benefits of economy of scale that would allow for 24-hr staffing?

What are your thoughts about physical standards? Most of the sheltered schemes that we have were built in the 70s and early 80s when it was expected that the tenants would be newly retired and fairly fit and active  they werent designed with disabilities really in mind. Many have stairs in corridors or steep ramps, no lifts and poor flat layouts. What sort of physical standards would you envisage?

Thanks
Andrew Buchan
Service Development Manager
North Herts Homes
01462 704174

Response from John Hazelhurst to Andrew Buchan

Andrew

You raise all the questions we are currently grappling with. The RSL's we are working with are agreeable to DDA assessment and an OT view on the environment within the schemes. We will discuss further having got the outcomes of these assessments.

Regarding care input, progress is alongside a reconfiguration project of homecare within the Borough. Yes, there will be lower levels of input than extra care. Initially the aim is to place all care with one care provider on current `spot' purchase basis. However I can envisage some contractual agreed levels being established over time.

I recognise this is brief but hopefully gives you a sense of what we are doing.

John

Response from Katy Sagoe, Longhurst HA, to John Hazelhurst's first message

Dear John

I received your email concerning your exploration of a model of enhanced sheltered housing and was very interested.

In my experience we already deliver something very similar in a few of our smaller schemes where all the tenants are over 85, but currently without identifying it as something distinct from our service to less vulnerable tenants. It has tended to be a natural progression and the main issues have been the scheme managers role in the increasing support required for everyday needs without tipping into personal care. We have tended to address this by supporting tenants to hold lunch clubs for instance, where the scheme manager plays a key role in ensuring a good standard of nutrition is maintained. In practice this often means the scheme manager cooks for 15 people a couple of times a week, not part of the support envisaged by SP.

These schemes also have a closer relationship with the care team as most residents are in receipt of care services, but a more flexible model, responsive to short-term needs identified by the scheme manager would be a great improvement.

Striking the balance between meeting the needs of this independent but frail group and attracting "younger" older people into sheltered housing to enable us to plan for long term viability is another issue. Identifying some accommodation as enhanced sheltered would help to address this and I feel would be extremely attractive to older people who have hung on in independent living to the limit of their personal resources.

Yours sincerely,

Katy Sagoe
Supported Housing Manager
Spire Homes
www.longhurst-group.org.uk

Response from John Hazelhurst to Katy Sagoe

Katy

Thanks for your email, the experience you offer is very helpful to us. However the intent at present is to develop the model with existing providers within existing schemes where there are significant numbers of older people with care inputs. We have identified 3 for this purpose and are in discussion with the particular RSL's.

Thus the opportunity for other providers is not currently available - it is more about improving what we have and recognising the needs profiles within certain schemes.

John

Response from Ruth Eley, Department of Heath to John Hazelhurst original message

I think you need to be really careful about developing another category of housing. Experience from other sectors (eg intermediate care) is that if you add in a new service, with its own criteria, you don't fill a gap but create another one (see below) for people to fall through.

Service A,GAP, Service B
criteria 1, GAP, criteria 1
criteria 2, GAP, criteria 2
criteria 3, GAP, criteria 3
etc

If you add in Service C to close the gap, this is what happens:

Service A,GAP, Service C, GAP, service B
criteria 1, GAP, criteria 1, Gap, criteria 1
criteria 2, GAP, criteria 2, Gap, criteria 2
etc

The 3 services must have different criteria, otherwise they would be the same service. Criteria are designed to exclude people, so the approach should be to develop aims and objectives for services that focus on outcomes, rather than expect individuals to have to fit in to particular criteria. The three objectives you describe seem extremely sensible  why do you need to invent a new category of housing? Why can't you apply these objectives to existing stock (maybe try a pilot scheme first?) and use
resources more flexibly to achieve the outcomes for people?

Hope that's helpful!

Ruth Eley
Head, Health and Social Care Change Agent Team
Department of Health,
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Response from John Hazelhurst to Ruth Eley

I do understand your point and how you may have got this impression. Firstly we are not creating another category of housing with its own criteria. Enhanced Sheltered Housing is simply a convenient descriptor for what we are doing. Our intention is to recognise that certain sheltered schemes have a higher balance of older people with care needs and endeavour to create the right environment to maintain those people. Additionally to focus further admission to (notionally) a third of the scheme for older people of similar profile.

Regarding criteria, the allocation referred to will be undertaken through Tameside MBC Social Care and Health allocation panel for Extra Care Housing (there are 3 schemes in the Borough). Allocation to available places in Enhanced Sheltered, will be applying only the lower criteria of the three levels within extra care criteria. Hope this makes sense!

This will help alleviate pressure on the valuable extra care resource where there can be up to 4 presentations for each arising place. A note of caution for us is ensuring that this does not deflect placement in extra care schemes towards the more dependent end of the continuum.

I hope this clarifies the issue and reassure you that we are not wanting to add further complexity to supported housing.

Your further views would be appreciated.

John Hazelhurst

Response from Gavin White  Richmondshire District Council

Having read your info, I thought I would write to tell you that in Richmondshire, we have 11 Sheltered housing schemes, with an ever increasing number of tenants in receipt of home care etc. We have also since 1994 in partnership with colleagues in North Yorkshire County Council, developed our own version of enhanced sheltered housing. All of our cat 2 schemes have a dedicated member of staff, employed by NYCC who provides additional care related services to our tenants, even ones who are not listed as in need of home care.

This has worked successfully from an initial 2 schemes in 1994, to all schemes now.

As the housing provider, we changed our lettings policy to enable a fast track approach for service users identified by Social Services to be given additional points via our enhanced care assessment panel which can be convened as and when necessary.

This service has been independently reviewed on 2 occasions, in 1998 by Health, and earlier this year by Age Concern. Both reports indicate the positive affect the service has had on service users, and in preventing early admissions to residential care, and in some cases enabling earlier discharge from hospital.

Gavin White
Head of Supported Housing
Richmondshire District Council
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Dear Colleague

I am carrying out a project on a consultancy basis for Westcountry Housing Association in the SW region looking at in-principle options for re-modelling existing sheltered schemes as enhanced sheltered i.e improved physical environment and care arrangements. In some but not all cases this may lead to a gradual progression towards full extra care as dependency increases amongst residents . The schemes may also act as a hub providing enhanced services to the local community such as outreach, health related services or facilities .

I would like to produce a template which is broadly applicable to a range of existing sheltered schemes but which can be of use in assessing and enhancing specific schemes (particularly those where there is a high level of care needs already amongst residents who are ageing in place, becoming frailer) . This would aim to cover strategic fit and demand, buildings and facilities, staffing arrangements, community services and care delivery arrangements.

The aim is to provide a service for older people which meets with local strategic priorities including preventing uneccessary admissions to residential care, enables existing residents with care needs to remain at home for as long as possible and meets local community needs for services if possible. We have been exploring development of new build extra care but are clear that in some contexts, enhancenment of existing services as part of a continuum of care and support is the way forward.

I would be keen to share any information or to learn from similiar experience that members of the Housing LIN may have in respect of

" Assessing and developing plans for enhancing existing sheltered schemes.
" Any existing models or templates that members may have developed or used to guide practice .
"Any other experiences around related initiatives, good practice and lessons learnt.

I hope that this explains our objectives and would appreciate any contact or dialogue with LIN members.

Mark Bannan
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07738 096046