Manchester City Council's Shore Green extra care housing scheme features modern building design and assistive technology to help sufferers from dementia. These factors can allow sufferers to live more independently by reducing the impact of their dementia and memory loss. It also enables them to live for longer with their partners.
Key learnings for other councils
Staff at the city council identified the following implementation issues:
- design features are important - a new build allows their incorporation
- it is important for the community to be supportive and for the physical environment to be safe when tenants leave the site.
With hindsight, staff believe that:
- a larger scheme would have been more economically viable but would have needed a different care team structure
- better publicity and allocation decisions could help to use the bungalows more fully.
People with dementia require substantial amount of care, particularly social care. Currently, 200,000 people have dementia in the UK. The total affected is estimated to reach one million by 2021 (NEPHO, 2008).
The traditional response to accommodation for people with dementia has been a nursing or residential home with intensive support. This often involves separating couples when one of them develops dementia.
However, housing services can help people live more independently with their families and prevent or delay the use of more costly, and sometimes disabling, ‘downstream' services. This policy is endorsed by the National Dementia Strategy (2009) and the National Strategy on Housing for an Ageing Society (2008).
Who was involved?
Shore Green extra care housing scheme was developed by Irwell Valley Housing Association in collaboration with Manchester City Council. The scheme received funding from the Housing Corporation of around £675,000.
The housing element of support is funded from the Supporting People programme. The cost of the care element (provided by Creative Support, a non-profit care provider) is paid for by Manchester Adult Social Care. Care staff are onsite at all times, at a gross cost of £175,000 each year. The model is very flexible and person-centred.
The partners involved emphasise that an important aspect in the success of the scheme is the close working relationship between housing support provider and care provider. In order to avoid confusion over roles and responsibilities, partner organisations worked together to produce a scheme protocol document.
The problem and how it was tackled
A review of sheltered housing provision in Manchester was carried out. It found a need for more choice in supported housing for older people and more flexible care services, particularly for sufferers of dementia and memory loss. Reducing admissions to residential care was also identified as a priority.
Shore Green opened in 2003 and has six one-bedroom and four two-bedroom flats. It offers a specialist, flexible and responsive care service for older people with dementia and other memory loss conditions. Unique self-contained bungalows enable couples to stay together for longer or for a child to move with their parent.
The scheme is specially designed to provide a safe yet welcoming environment.
There is a communal lounge, kitchen and garden. Tenants have assured leases, pay rent and their own utility bills.
Design features assist with day-to-day living, including:
- gas monitors that cut off the gas supply if a cooker is left on
- door sensors that alert the night care worker if a tenant has opened a door
- colour coding and shelves and cubby holes with personal items at entrances to help each tenants identify their door
- glass-fronted kitchen units so tenants can see which cupboards items are kept in
- a single secure entrance and exit to ensure the safety of residents
- a visitor sleepover facility for friends and family
- continuous pathways in the garden so tenants never reach a dead end, as this can cause confusion and distress
- a distinctive high roof visible throughout the neighbourhood to help tenants find their way home after local visits.
Outcomes and impact
The scheme has taken the extra care housing model of support and extended it to those with dementia. This a client group traditionally thought to have needs that are too demanding for it.
Since it began, Shore Green has had 41 tenants. Thirty have moved on. Of these four were carers who stayed with their loved one until they died. Of the others:
- 11 (37 per cent) lived at Shore Green to the end of their life, and
- 15 (50 per cent) moved to a nursing home when Shore Green could not meet all their needs.
Incident records show that in the last 12 months collectively the 11 tenants:
- have only attended A&E five times and have only been admitted to hospital on 12 occasions - a very low level of activity for this group
- have had an average length of stay in hospital of only eight days - again low relative to the average for dementia patients.
Many of the people who move into the scheme require a reduction in care package as their independence improves.
The Care Services Efficiency Delivery network recently concluded that, given the quality of the service at Shore Green, it is good value for money. Care costs at Shore Green are £7,000 a year higher than alternative residential and or nursing costs, however, there are other factors.
Manchester City Council points out that this figure is before any savings related to A&E, hospital, ambulance or police (due to fewer incidents of ‘wandering') are taken into account.
Case study'J' has a dual diagnosis of dementia and schizophrenia. He moved to Shore Green in January 2008 from a supported housing mental health scheme, as he was unable to move to more independent living. At that time he was struggling to perform all aspects of daily living. His mental health was very unstable and he was visited by his care programme nurse (CPN) on a monthly basis.
At the last monitoring in March 2010, the staff report stated: “He is capable of maintaining his flat and preparing meals with minimal prompts from staff. He no longer requires depot injections, and his medication has been reduced. His community practice nurse now sees him every three months. He attends a cookery class, has joined a local AA group, and is involved on interview panels as a tenant representative."
At his outpatient appointment in February 2010, his consultant psychiatrist actually walked past ‘J' in the waiting room as she did not recognise him. Both his consultant and his CPN state that they can't remember the last time he was both physically and mentally so well. ‘J' himself has stated that over the last few months that he has realised how independent he has become.
Manchester City Council plans to commission a further 750 extra care housing places, including 40 additional specialist dementia places. Ultimately, the aim is to have two specialist schemes each in North, Central and South Manchester.
References and further information
Estimating the future numbers of dementia, North East Public Health Observatory (NEPHO, 2008), Association of Public Health Observatories
National Dementia Strategy, ‘Living well with dementia' (2009), Department of Health
National Strategy for Housing in an Ageing Society, Lifetime Homes, Lifetime Neighbourhoods (2008), Communities and Local Government
Pip Cotterill, Lead Commissioner, Older People's Services
Manchester City Council