Dementia-proofing, retro-decorating & life-experience ‘homework’ – a new direction for dementia care October 24, 2011

Here at Foundations we have been running a PR campaign throughout September and October which has resulted in us achieving a significant rise in profile for the HIA sector and their role in supporting quality of life and independent living. Articles have so far featured in various media channels, including television, radio, online and hardcopy channels and requests for stories just keep coming.

 

The campaign has been based on two case studies from Merseyside and Lancashire. Reminiscence therapies have long been used by occupational therapists in their work with older people who have dementia. Sharing experiences with others, discussing old photographs and objects or taking part in reminiscence activities can boost wellbeing and productive living amongst elderly people. In Lancashire, reminiscence therapies are now being used to support people with dementia to live safely and independently in their own properties for longer through a technique called ‘retro-decorating’.

 

Take the case of Mr H. Before his wife died, Mr H loved to travel. He’d been a farmer all his life and going on holiday was something he and Mrs H had been passionate about. Three years after his wife passed away, Mr H was diagnosed with dementia. He began to experience some short term memory loss, sometimes forgetting to prepare meals or wash himself. Since retiring from farming Mr H had continued to work until his mid 70s, driving a school bus. But the dementia prevented him from being so self reliant. He was less active and started to feel frustrated, leading to depression and withdrawal.

 

Mr H’s son had been in touch with the local home improvement agency to discuss what help was available. They discovered that Mr H had kept his house just as it was prior to his wife’s death, something that gave him comfort. It was suggested that one way to encourage Mr H to become more communicative was to ‘retro-decorate’ his property. This would involve Mr H choosing vintage furniture and old objects that brought back happy memories. It might be a 1960s lamp, table and chairs or an old transistor radio and retro holiday posters that would prompt Mr H to remember positive times when he was self reliant, at the height of his career and enjoying travel with his wife.

 

Surrounding someone with furniture from their past can also help them to remember their daily routine – such as sitting down for a meal or washing themselves. It can also keep them calm, reducing the need for anti-psychotic medicine or residential care. Some reminiscence furniture has the appearance of coming from the past but is actually designed for people with dementia – such as a wardrobe with see-through panels that can help people remember where clothes are stored.

 

Hyndburn Homewise Home Improvement Agency Caseworkers had built up a picture of Mr H’s values, interests and skills by speaking to him and his family about his current situation. They encouraged the family to set Mr H a project that would combine his planning and logistical skills with his love of travel. Mr H was asked to organise a family tour of some farming shows.

 

Whilst it is still too early to say how these interventions have impacted Mr H’s life, initial signs are encouraging. He wants to socialise much more now and he attends a memory clinic once a month. He is also still living independently in his own house.

 

Over in Liverpool, home environment interventions are also being used to help individuals with dementia live safely in their own properties. Riverside Home Improvement Agency makes simple ‘dementia proofing’ adaptations such as re-organising mirrors, fitting clear-fronted cupboard doors, glare-free lighting, flood alarms and putting coloured tape up and down the stairs. These simple adjustments are having a big effect.

 

Retro-decorating and dementia proofing interventions could provide us with another resource for working with older people in their own homes and these approaches can be delivered by home improvement agencies.

 

This all fits with the growing call for a more integrated approach when it comes to dementia care, which could tackle the fact that up to 25 per cent of hospital beds are taken up by people with dementia. The recent All-Party Parliamentary Group report into dementia says that reducing this number of hospital beds by 10 per cent could save £1 billion.

 

Currently around 750,000 people in the UK have dementia. Researchers forecast that this will increase to over 1.7m by 2051 and the UK government currently spends around £8.2 billion per year on dementia care. As occupational therapists play a central role in supporting people with dementia, could they hold the key to rolling out the use of low-level home-based interventions that maintain people in their own homes and help to bring down this country’s dementia care bill?

 

We are extending this campaign into our conference which is being held on the 1^st November in Birmingham and we are pleased to have Sue Sinclair from Hyndburn presenting a workshop for delegates.

 

You will be able to find articles in Mature Times http://www.maturetimes.co.uk/Dementia-patients-to-have-homes-retro-decorated and BBC News Online http://www.bbc.co.uk/news/uk-england-lancashire-15111407 and keep checking our website news page for updates as more articles and media coverage are released.

Reuniting health and housing August 16, 2011

Divisions between health and housing are entrenched. Professionals from both sectors remain miles apart in terms of language, commissioning and measuring value. Yet the case for housing and health to converge has never been stronger. Helping older people remain in their homes reduces pressure on hospital budgets and evidence of the impact poor housing has on public health is undeniable.

 

Despite this, the housing sector continues to struggle when it comes to securing health funding. So what is it about the housing proposition that doesn’t meet with the needs of health commissioners? How can social landlords shake off the negative image they have gained amongst Primary Care Trust (PCT) professionals – being seen as an ‘irritant’, seeking small amounts of money for small initiatives? The answer is for both sectors to re-align their offerings in a cohesive ‘continuum’ of services rather than a fragmented and overlapping array. But that is easier said than done.

 

The connection between health and housing has been at the heart of several recent government reports. Last month the All Party Parliamentary Group on older people’s housing and care published a paper, Living Well at Home which called for housing, health and social care to be integrated in order to help people maintain their independence. Health budgets directly benefit from the role that safe, warm housing plays in helping people live longer in their homes. Fitting a grab rail for £100 can prevent a fall that might lead to a hip fracture, saving the state £28,665. Installing a wheelchair ramp for £400 to speed up a patient’s release from hospital frees up a hospital bed, saving at least £120 a day. Yet this type of ‘casual’ proof presented by housing organisations doesn’t impress PCT commissioners. The health sector is more evidence driven than housing and it is used to robust data sets derived from an empirical approach – something that housing just doesn’t have.

 

This is one of the insights highlighted by Andrew van Doorn at housing action charity HACT. In 2009 Andrew temporarily left the world of housing, spending 18 months on secondment in the NHS. His aim was to establish reasons why housing and health have not united and what can be done to align both sectors. Andrew reported his findings at a recent Chartered Institute of Housing (CIH) event set up to examine the challenges and opportunities around health and housing. He believes that housing professionals have typically presented a peripheral offer to health, focusing predominantly on the prevention of falls and accidents. The problem is that this offer has a relatively low capital value – insignificant in the context of huge health budgets.

 

Health commissioners can only reduce costs by initiating structural change such as ward closures, staff cuts or reductions in drug based therapies. So housing must make an offer which targets these areas on a large scale. It needs to re-focus on the ‘big ticket items’. HACT’s research also highlights the fact that the housing sector has misunderstood the drivers and motivations of health commissioners in the past. Housing professionals are used to pitching their services to local authority commissioners but health commissioners think very differently to their council counterparts. As a result housing professionals have continually put the wrong message to the wrong people at the wrong time.

 

Last year, Foundations looked further at appropriate communication methods to engage health professionals. Our research aimed to identify the most effective ways for their housing members to engage with GP commissioners – an audience that will be increasingly important following current NHS reforms. Our findings showed that to obtain GP ‘buy-in’, HIAs must take a lesson from the ‘peer influencing’ techniques used successfully by the pharmaceutical industry. Pharma companies focus on the motivators, belief systems and roles of the health workers in order to connect with them.

 

GPs often place importance on continuity of care and understanding the full patient agenda rather than simply treating a condition medically. Commonly, they value independence of decision making and are less hierarchical and ambitious than their hospital counterparts. The housing sector must use such insights to help tailor its messages and choose the right communication vehicles if it hopes to successfully engage with health budget holders.

 

Housing officers must also start to speak the language of health commissioners. This means tying in with issues set out in QUIPP (Quality, Innovation, Productivity and Prevention) – the road map to cutting £20billion from the NHS. Understanding the cultural differences between housing and health is the first step in a more persuasive approach from housing professionals. Combine this with larger scale ideas from housing organisations and the current age of austerity might just provide the best opportunity for housing and health convergence in a generation.

 

I would really like to hear about your experience of bringing housing and health together. What tips would you share with the sector on how to engage with health professionals?

 

The evidence base is strengthening July 11, 2011

This coming month sees the release of multiple reports, including Dilnot on funding Care in older age, APPG Living Well at Home Inquiry findings and Commission on Social Justice not to mention reports on dementia care. All of these reports have a focus on vulnerable and elderly people. We welcome the increased interest from politicians and the media and see this as a great opportunity to promote home improvement agencies and to raise the profile of the services offered and the innovative work that is ongoing.

There are some recurring themes emerging from the findings especially around the challenges facing older people in our most deprived communities including, for example, the cost of meeting repairs and maintenance bills. Plus the high incidence of housing poverty in private rental sector is unusually (but rightly so) being given more visibility.

The evidence is pointing towards a renewed focus on prevention, personalisation, building community capacity and a shift to independent living in the community. This is an opportunity for our sector to be at the leading edge of a potential revolution.

Over the next few years local service commissioners will be looking for new strategies to deliver integrated health, care and (dare I say it) housing. We are in a fantastic position to capitalise on the thinking many agency leaders have already kicked off with commissioning heads – whether you are in the ILC with Margaret in Sunderland, part of Wayne’s team on the Wirrall or based in the West of England and dozens of places in between.  I have just told a conference that “we” HIA s must be one of the world’s best kept secrets (second only to the final Harry Potter movie) but I am determined that must change.

Of course it’s all about local politics and the ongoing JSNA process to shape and determine local priorities – but let’s not ignore the experiences of home improvement agencies which stand us in very good stead to argue the case for preventative interventions especially where elderly and vulnerable are concerned since the overwhelming majority continue to tell us that home is where they want to remain living.

I think it’s really important we continue to focus on the development of caseworker skills to meet the ever- increasing demands which are likely to be placed on their knowledge and skills set. We start from an enviable position of strength because we are a trusted intermediary.

The increased concentration on defining what kind of care should be funded, and the emphasis on the twin objectives of preventing older people from going into care homes and improving the quality of such homes should run in tandem, and we will strive to ensure these objectives continue to gain momentum in the public eye. 

The picture emerging through these various reports is helping to strengthen our vision for the sector:

• Health, housing and social care needs should ideally be assessed as a whole and in a way where the effort going into that process is proportionate to the amount of financial investment needed.
• There is a need for better  information about  housing options so that individuals and their families  can plan better and prepare for old age (that’s why we are committed to our joint working with First Stop)
• The length of time, and in some cases costs absorbed, for people to access funding for small routine adaptations needs looking at
• I am sure we will see more investment in telecare and telehealth technologies – it’s interesting to see the interest being shown in it by Microsoft’s UK operation. It’s not surprising that a lot of this development work has started in Health – but you may have noticed some ‘tub thumping’ recently to also get a more joined up approach to the commissioning of telecare so that the medical and non-medical aspects also get taken into account.

 A number of comments from conference delegates this week around the growing amount of evidence and I am challenging my people to look at how we can make some of that more readily available to you our customers.

Questions are also being asked about the ability of the private sector to meet some of the funding gaps that will soon emerge as a result of local authorities having to absorb the cessation of private sector renewal money from DCLG. There are some encouraging signs. The Home Improvement Trust are gearing up for increased demand through their partnership model with local authorities and financial product providers are also addressing many of the concerns expressed previously about the equity release product offer to make it more accessible and relevant for HIA client groups. More on that soon.

Somehow I think these are issues we shall return to with a vengeance at our annual conference in November. We have just settled on the date for that (November 1) and will be making changes to the format this year to acknowledge the difficult circumstances in which many organisations are operating.

HIA s and HandyPerson providers are making a tremendous contribution to their communities and I was very privileged to be part of the celebration at the House of Lords recently when the annual HIA award winners were celebrated. Well done to everyone who took part.  I want next year’s Awards to be an even bolder testament to the collective impact of Home Improvement Agencies and Handy persons. Good luck!

The Director’s first blog May 29, 2011

Welcome to what I hope will be a regular blog contribution from me in a new format (made possible because our techies have made some necessary changes to the web site!)

Last  week saw the culmination of a series of one day regional conferences which First Stop have been leading on the importance of impartial information and advice on housing and care options for vulnerable and older people. Its a subject very dear to the hearts of most HIA s  so we were delighted to be asked to underline and reinforce the importance of both their  message and the criticality of collaborative working whatever shape and form that takes in your community, town or city. Foundations and First Stop will re-examine areas where there are opportunities to plug service deficiencies with a service offer that we hope can combine the best of the old with the new.

Moreover,  there is no getting away from the fact that budget cuts dictate our management skills have to reach new levels of creativity. And as you wrestle with those challenges do keep in mind, as it was famously once said “we are all in this together” -  in this context “we” must surely mean all of those service providers and commissioners that have a stake in the ground wherever HIA s are active.    

We all know one size doesn’t fit everyone and changing an operating  model that has served us well for years isn’t easy. Change is uncomfortable but sometimes it is also inevitable and as leaders we are called to make those judgements and, where necessary,  make the case for changes  with our colleagues to build their commitment . There will also be times when  you also have to just go and do it;  not unlike when you embark on a “get fit” new year resolution.  But also be clear where you want to be by the end of the year because if you have that clarity of purpose  there is just a chance you might get there or close to it.

The Home Improvement Agency and Handy person sector has got some real stars in our midst and June 23 is the opportunity to truly celebrate what they have achieved at our annual Awards and Recognition event being held once again at the Houses of Parliament. The  quality and quantity of the citations submitted this year has been phenomenal and thats given the judges a really hard time as they start to make their choices. We hope to be making those final decisions in the next few days.

I hope there are plenty of positives for you in the week ahead.

Best wishes,

Andy