Excellence and Choice

Improving Dementia Services in west Belfast and Re-provision of Ballyowen EMI Residential Home for a Support Housing Model for people with dementia

8 June 2015 – 31 August 2015

Contents

Page
Executive Summary / 3
Foreword / 4
1. / Introduction & Guiding Principles / 6
2. / Background & Strategic Context / 8
3. / Current Trust Service / 13
4. / Trust Proposal / 15
5. / Impact on residents and their families and staff / 17
6. / Equality Considerations / 18
7. / Summary of Consultation Proposal / 19
8. / Consultation Questions / 20
9 / Appendices / 22
10. / References / 23

Executive Summary

This paper sets out the context and rationale for the proposed development of a new supported housing scheme, to be located on the Grosvenor Road in west Belfast. The scheme will provide 30 self-contained apartments, designed to dementia specific standards,offering tenancies for thirty people with dementia and if appropriate their spouse, sibling or family carer.

To achieve this new improved service development in west Belfast, care revenue funding is required through the re-provision of Ballyowen EMI residential home, which is located in Andersonstown, also in west Belfast. This will require the Trust to go out to a public consultation on its intended service change and if approved, will see the subsequent closure of Ballyowen EMI residential home.

Ballyowen has capacity for 31 residents; however its current occupancy falls well short of that. Currently there are 18residents living there; 3 of which are there on a temporary basis as their long terms needs are assessed. Factors associated with this decline in demand are due to the age of the home, poor outdated design and an outdated institutional model of care for people with dementia.

Thisproposal for supported housing for people with dementia is inline with the strategic direction fordementia services, including the DHSS Bamford policy Living Fuller Lives, 2007 and the Northern Ireland Dementia Strategy, 2011. It is in keeping with the Trust’s strategy for improving dementia services and enabling people to live well with dementia and is also underlined as the strategic direction for special needs housing within the NIHE Supporting People Strategy 2005-2010.

In its consultation document, Excellence and Choice in Older Peoples Services, 2009, the Trust highlighted its intention to phase out statutory residential care, given the outdated environmental standards and the institutional approach to care, setting out a clear strategic direction to replace these institutions with supported housing and domiciliary care models. For supported housing, there is a growing body of evidence demonstrating improved quality of life and the avoidance or delay in the need for institutional care.

In order to maximise the opportunities that currently exist to gain significant capital and revenue funding from the Department of Social Development, a business case has already been submitted to NIHE[1] for capital and supporting people revenue funding, with a plan to commence building of the scheme no later than end of March 2016. A design team made up of architects, housing and Trust staff with specialist knowledge on dementia design, alongside service user and carer representatives who are experts by experience has been established to support the process.

To inform this paper, a pre-consultation process was undertaken with people who would be directly affected by this proposal; relatives of current residents, staff, local elected representatives and local community groups. These meetings provided the opportunity to inform the proposalsdetailed and to address issues raised.

Foreword

Belfast Trust is committed to working in partnership to deliver quality services which support and sustain people’s ability to live independently in their own homes. These partnerships include older people, their families and carers, community, voluntary and other groups, including housing and care organisations, and are already well established.Nationally and locally there is an increasing emphasis on enabling families and communities build the resilience to look after themselves – supporting carers to care and helping local communities become more dementia friendly.Locally, through engagement with older people with dementia, and their carers, Belfast Trust has identified a preference for individual choice and provision of care in people’s own homes and enabling self-care support.Belfast Trust has approximately 4,000 residents living with dementia and forecasts predict this will reach almost 4,500 by 2021.

Last year, in partnership with Helm Housing, the Trust opened Hemsworth Court, in the Shankill area of west Belfast; a purpose-built supported housing scheme for people living with dementia, replacing a residential dementia facility. The service is highly valued by those who live there and their families, for the opportunities it presents to remain independent and live fuller lives and for the specialist support deliveredbya team of well-trained competent staff, for a model of care and support that is human rights based, focussed on retaining strengths and attributeswith personalised support.

Theproposal outlined in this document is for a second supported housing scheme in west Belfast, at the Grovetree House site, Grosvenor Road.By re-providing the dementia service on the Grovetree site, the Trust proposes to close Ballyowen Residential Home, which is no longer able to adequately meet best practice standards in dementia careneeded for service users.

The Trust has delivered significant changes in the way it provides services for Older People over the last five years. These developments have focussed on strengthening the community infrastructure and services necessary to support older people to receive care in their own home, to live independently for longer with the right support at the time when they need it, for example:

  • Consulted and Implemented the Trust Strategy for Older People’s Services, 2009.
  • In line with the NI Dementia strategy, modernised memory services, strengthening post diagnostic support for people with dementia and their carers and improved access to these services through a single point of referral.
  • In 2010, consulted on, developed and implementeda third Supported Housing scheme for people with dementia in Hemsworth Court.
  • Developed and implemented a specialist outreach dementia team, supporting and delivering safe and effective specialist assessment, advice and treatments for people with dementia, experiencing behaviour disturbance, preventing unnecessary admission to hospital.
  • Currently implementing an Acute Care at Home service, which will enable a multi-disciplinary team to assess and maintain people in their own homes by arranging services and support locally.
  • Opened BCH Direct, a complementary Assessment and Admission Unit for frail older people.
  • Developed and implemented an effective, responsivereablement service to support reablement of patients and a restoration of abilities, somewhat affected as a result of a sudden illness or accident.

Belfast Trust is keen to hear your views on thiscurrent proposal for improving our Dementia services. Between June – August 2015 we are seeking the broadest possible discussion on our proposals for older people with dementia and to hear the views of older people, their carers and families, elected representatives and others; looking to the choices they want to have in Belfast when they get older are central to everything we do.

We need to ensure that the money currently and traditionally spent on residential or hospital care, is being invested in the most effective ways and securing the best outcomes for people with dementia. Your comments will help us to provide the highest possible quality care and support.

  1. Introduction & Guiding Principles

1.1The Belfast Trusts overall purpose is to improve health and well-being and reduce health inequalities – putting people’s needs at the centre of all decisions, providing services locally where possible and making the best use of all our buildings and other resources.

1.2Dementia is the term used to describe a group of conditions that affect the brain and cause a progressive decline in the ability to think, remember and learn. Dementia affects people differently and can have a significant impact on the life of the individual, their family members and carers.The estimated number of people with dementia in Belfast Trust[2]predicts an increase of 11% between 2013 and 2021, from 3893 to 4315 people, the majority of whom are over 65 (98%) and with the biggest increase in people aged over 84 (20% increase).

1.3 The Older People Services Guiding Principles, developed with Service Users, are clear.[3]

  • People who use our services should have their rights respected;
  • Ensure services are accessible;
  • People who use our services should be fully involved in the commissioning, planning, design and delivery of services;
  • Further integration of primary, secondary and independent sectors to ensure services are aligned to meet the needs of older people;
  • People using Older People’s Services should have equity of access to all Trust services;
  • Keep people as independent as possible;
  • Working in partnership with commissioners to design and deliver services with a greater role for voluntary and community sectors;
  • Giving people increased control over services through greater personalisation;
  • Providing greater support for carers;
  • Dignity and respect in every service area.

1.4 The Trust is committed to providing services which will enable more older people, including those with dementia, to live fuller and fulfilling lives, independently in their own homes for as long as possible.

Working in partnership with the Northern Ireland Housing Executive, care providers and other community and voluntary groups, the Trust will ensure that it provides a range of long-term living options and improve services for people living with dementia.

1.5 The Trust has developed strong partnerships with the Housing Executive and has successfully developed a dementia supported housing scheme on the ShankhillRoad. This is in addition to two supported living schemes within the South and EastBelfast area.

1.6 This proposal is for a second supported housing schemefor people with dementia within west Belfast, on the Grovetree site on the Grosvenor Road.

1.7This document describes the range of services we provide for older people; how we have redesigned them and our commitment to ensuring community based living is at the centre of our service delivery.

2. Background & Strategic Context

2.1The Northern Ireland Dementia Strategy[4] estimated that at present in Northern Ireland there are almost 20,000 people living with dementia; fewer than 1000 of these people are under 65. As the population of Northern Ireland ages, dementia will increasingly be a major public health and societal issue, with numbers of people with dementia rising to 23,000 by 2017 and around 60,000 by 2051. The cost to society is also likely to increase dramatically.

2.2 There are a range of national and regional policy documents which are of specific relevance to the development of high quality dementia services, all of which promote the rights of people with dementia to live in the community with choices equal to others, and which take effective and appropriate measures to facilitate full enjoyment of this right and their full inclusion and participation in the community.

2.3The Bamford Review - Living Fuller Lives 2007[5]sets out the need for improved services for older people with dementia with an emphasis on promoting independence and wellbeing. It recognises the valuable contribution that supported housing models can bring to the lives of people with dementia and their carer’s. As part of the research for the strategy, the Bamford review, which was undertaken in consultation with service users and carers’ highlighted:

  • People need access to a range of appropriate treatments, therapies and activities in keeping with their needs and the stage of their condition;
  • People with dementia should be enabled to stay at home if at all possible, facilitated by intensive support mechanisms and innovative housing responses involving assistive technologies and well integrated into local communities;
  • Increased access is needed to specialist day care and specialist dementia units;
  • Staff training on dementia is needed at all levels.

The strategy recommends that, for people with dementia who are no longer able to live independently within their own home, supported housing offers a viable alternative to residential care. A key benefit for the person is that they continue to live independently within a safe and secure environment, with personalised care and support available from a dedicated staff over a 24 hour period. The social and built environment is designed to compensate for the disability associated with dementia, to promote orientation and enhance the person’s feelings of health and well-being.

2.4The National Service Framework for Older People (England and Wales)[6]has been a major policy initiative which aims to address age discrimination within the health and social care system and sets standards to ensure that older people have access to a range of services which are designed to enable them to sustain as much independence, health and wellbeing as possible.

2.5The English National Dementia Strategy ‘Living well with Dementia’ (2009)[7] references key objectives including an emphasis on the importance of considering the potential for housing support, housing-related services and telecare to support people with dementia and their carers. The needs of people with dementia and their carers should be included in the development of housing options, as well as assistive technology and telecare.

2.6The Scottish Government’s Dementia Strategy (2013-2016)[8]highlights the eightpillar model of community support, including the importance of the environment,community connections, support for carers and personalised support to promote participation and independence. A focus on community housing for older people and a reduction in residential care is emphasised, to meet older peoples requestto live in their own home for as long as possible, rather than in hospitals and care homes. A key outcome for the strategy is dementia enabled and dementia friendly local communities that contribute to a greater awareness of dementia and reduce stigma.

2.7N.I Executive Programme for Government’s Vision ‘Active Aging Strategy’ 2014-2020,[9]highlights the following key 5 themes: Independence, Participation, Care, Self-fulfilment and Dignity.

  • Strategic Aim 1: Independence

To promote active independent living, giving older people choice and control in their lives through the co-ordinated delivery of:

  • Good warm housing in safe neighbourhoods;
  • Accessible transport;
  • Adequate income and standard of living;
  • Access to social networks and good user-friendly information; and
  • Equal access to participation in the workplace.

Within the funded programme of work underway for this theme, the strategy references the role of Northern Ireland Housing Executive the Department of Social Development in ensuring accessible homes (both private and social housing) are available for older people.

  • Strategic Aim 2: Participation:

To promote the active participation of older people in all aspects of life including:

  • Participation, which helps address isolation and loneliness and ensures that older people are properly integrated, valued and included in society.
  • Strategic Aim 3: Care

To promote equal access to high quality health and social care services, which promote and maintain physical, mental and emotional health and well-being, and support those with long-term conditions. Health and social care services should conform to best practice and be informed by continuous professional development, research, individual preference and need.

The strategy focuses on improving the services and support arrangements currently available for people with dementia, their families and their carers through advice to complement recommendations in the Northern Ireland Dementia Strategy, November 2011.[10]

2.8Transforming Your Care (HSCB 2011)[11] – A Review of Health and Social Care in Northern Ireland sets out the strategic direction for Health and Social Care services in Northern Ireland emphasising the importance of providing care and support at home. It outlines a focus on prevention, earlier interventions, integrated care and promotion of personalised care to enable more services to be provided in the community, closer to people’s homes where possible.

It identifies a need to adjust service models in order to provide service users with the services needed to remain independent for as long as possible within their own homes. This focuses on reablement to promote rehabilitation and independence rather than an unnecessary or premature reliance on hospital services. A key objective is around increasing the opportunity for people to have self-directed support and individual budgets, so they have more choice and control about services they receive.

This review of health and social care sees home as the hub of care, with a focus on developing service models to support older people to remain independent in their own homes or as close to home as possible. The supported housing model provides opportunities to achieve these key strategic goals for people with dementia.

2.9The Older Peoples Service Framework (Northern Ireland)[12] reinforces the importance of providing services that support social inclusion and maintain health and wellbeing, independence and quality of life for older people and people with dementia

2.11 The role of the joint DHSSPS/DSD Supporting People Programme in Northern Ireland is to achieve a better quality of life for vulnerable people, to live more independently through the provision of housing related support to prevent problems that can often lead to hospitalisation or institutional care.Dementia has been one of the priority areas.

2.12Belfast Trusthas developed a forward looking approach to dementia care over the last decade with a model of care designed to support older people stay in their own home or in a network where independent living is supported for as long as possible.

2.13In 2009, Belfast Trust consulted on its model of care for Older People’s Services, which was fully supported by the general public for its service proposals. A commitment was given to increasing and improving community based housing support. Since then the Trust has developed its reablement service,to support reablement of patients. The aim is to restore abilities, somewhat affected as a result of a sudden illness or accident.The Belfast Trust has alsoincreased the number of supported living options for people with dementia.