Reshaping the market for extra care sheltered housing and supported living - Birmingham City Council

Birmingham City Council recognises that in future there will be reduced demand for residential care and more for extra-care housing for older age adults. This forms part of our adult social care markets and commissioning resource.


The story so far

The council is aiming to get providers thinking about developing larger scale supported living arrangements/environments on a core-and-cluster model.

The council has invested in developing good relationships with supported housing providers which have resulted in progressive conversations about meeting needs differently.

Taking its inspiration from large scale extra-care sheltered housing schemes, Upward Developments (West Midlands) Ltd have been encouraged to develop, at their own cost, a younger adults supported living development into which is incorporated a short stay/respite care ‘hotel’.

Developments

On the ground floor there are four apartments for people with learning and/or physical disabilities or complex needs and five business lets eg for a shop, charity, beautician, pharmacy or café which will bring in the local community and support local business. Additionally, the council has invested £350,000 in developing a community hub on the ground floor including a hydrotherapy pool, potential for a local children’s centre to re-locate and a centre for those living onsite and the wider community offering activities including art, music, meeting/ community rooms including for councillors’ surgeries.

Upward Care Limited (the separate care arm of Upward Developments) is looking at offering crisis/ emergency beds using a ‘tenancy at will’ approach. On the first floor are 21 one or two bed apartments plus two communal areas and a housing management suite with a ‘hotel’ reception for the care hotel. Ten of these apartments will be the ‘care hotel’ for short breaks or respite breaks and the two bedroom apartments provide scope for family members to also stay over.

These can be used by anyone, not just Birmingham residents, although the council does have a priority nominations agreement linked to their £350,000 investment.  

On the second floor are 21 one or two bed apartments plus two communal areas and a housing management suite. There is no short break element on this floor – these apartments are for temporary and long term occupation.

  • Bromford Housing have developed a ‘MyPlace’ model, which is supported living based around 14 self-contained apartments. Birmingham is their first MyPlace scheme for people with long-term conditions as an alternative to residential care.
  • Lifeways are one of several providers in the city starting to develop ‘core and cluster’ models of care on a larger scale which are linked to more than one care delivery model. In March 2017 Lifeways (in conjunction with Inclusion Housing) opened its largest scheme in the country – two blocks of 16 supported living apartments; on the same site there is also a nine bed ‘high and complex care’/autistic specialist residential suite. Birmingham City Council recognises that in future there will be reduced demand for residential care and more for extra-care housing for older age adults.

Benefits

  • Extra care sheltered housing will continue for people over 55, however commissioners are encouraging Upward Care to look at the needs of younger age adults and in doing so begin to break down artificial age barriers and offer real benefit in enabling integration in local communities. The council hope that the ‘care hotel’ development will accommodate all adults over 18 and will begin to challenge the notion that younger and older adults must be segregated from each other, with separate provision. This is the start of ‘all age’ care provision much more aligned to what real community looks like.  
  • Providers can get loans more easily as the council supports proof of concept by investing £350,000 and for the council, this means they have no further need for block contracts, thus clearly signalling a shift in need and demand to providers at time when the council is looking to its own future and the future of its own short stay/respite services for Younger Age Adults.
  • By involving three cabinet members in visits to a similar new build scheme in Solihull, and the developer undertaking local consultation in the affected wards, early support for the scheme was assured.

Challenges

For several years, younger adults’ care and support has been delivered in bespoke settings for small numbers of people. This approach has made delivery of care extremely expensive particularly as in some cases, smaller size developments were not always critical to the care and support needed. The council is challenging those perceptions but could potentially face criticism for returning to the days of long-stay institutions and ghettoisation. To counter this, the council has worked with Upward, Lifeways, Bromford and other providers in order to ensure that any new developments are an integral part of the local community and are outward facing. To signal its commitment to this approach,the council invested £350,000 in the Upward scheme.

A further challenge for bed-based schemes for younger age adults is the reluctance by the Care Quality Commission (CQC) to register any provision for more than six beds – this is potentially an issue for Lifeways and their nine bed development.

Sharing care hours – the council has always treated individuals as individuals and very often developed a care package around one person. The council has struggled with, and continues to struggle with, being clear about how ‘shared hours’ approaches can benefit the council, the citizen and the provider.

A further challenge remains about how extra-care/ housing care can meet the needs of those with dementia and significantly delay or prevent a move on to dementia nursing homes.

Social workers with reservations about larger scale models for younger adults which has traditionally seen care and support being delivered around small numbers of citizens also proved a challenge, however this was tackled through meetings between providers and professionals to discuss and allay concerns.

Impact

Time will tell on this; the council are looking for a cultural shift: away from provision being delivered to low numbers of people, away from individuals being isolated with one or two carers supporting one citizen only, away from segregation of younger and older adults and away from a ‘single service’ model.

Future developments

The council has begun conversations with developers about a more progressive approach to the needs of people with dementia. The council need to reduce the numbers moving on from extra-care housing to dementia nursing homes and feels is there is a place for a larger scale, multi –development site encompassing dementia friendly extra-care, a dementia nursing home and day opportunities/day care supporting both older adults and older adults with dementia. Precious Homes are developing a three-tiered residential and supported living service with social enterprise in Birmingham which opens in April 2017.

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