Enhancing Dementia Care through Innovative Design and Community Integration

1. Developing HAPPI housing to deliver health outcomes Alex Walker NHS Central Lancashire 12th December 2012

2. What are we trying to achieve for dementia care in Central Lancashire? • Centres of excellence • Specialist design • Learning environments • A therapeutic approach • Improvement and maintenance of skills • Resilience for people with dementia and their carers • Improved quality of life • At all levels of need • A shift in culture • Breaking stigma • Changing staff approaches • Normalising dementia • Care planning based on skills not deficits

3. What are we trying to achieve for dementia care in Central Lancashire? • Access to outdoors as the norm • Seeing the whole environment as vital to the delivery of support • Recognising the importance of nature • Integration of services • Multi agency • A continuing sense of being part of the community • Meaningful engagement in normal life

4. Integrated base for: MH Trust, County Council Age Concern, Alzheimer’s Society People with Dementia and their carers Services: Memory assessment, Post diagnostic services, Training, Dementia advisers, Dementia cafés, Carers groups Enhanced day care Community Mental Health Team Design was critical Light, Space, Freedom of movement, Easy access to the outdoors, Welcoming, Domestic feel Charnley Fold Resource centre - South Ribble

5. The importance of thinking about the design of outdoor spaces in care settings Nature and being outdoors: PROVIDE sensory stimulation, pleasure, purpose, distraction, orientation, Vitamin D, exercise and movement IMPROVE appetite, blood pressure, focus, verbal expression, relaxation, engagement, sleep patterns, mood, strength, agility and balance DIMINISH apathy, agitation and aggression

6. The Pocket Park Archetypal spaces help cue people as to what to do

7. The Back Garden

8. The Backyard

9. Meaningful places enhance daily life

10. Nature is a tool to promote communication and better mental well being

11. Connect inside and outdoor use Changed windows to doors Added a porch and a raised bed Edge Space

12. Outcomes at Charnley FoldEnhanced Day centre • Focus • Maintain or improve skills • Sustain people in their own homes in the community • Approach • 12 week therapeutic programme • 97 people have attended at least 2 programmes • People were assessed across 2 programmes in relation to independent learning skills and abilities • Period of time across programmes: • 2 programmes attended – 8 months • 4 programmes attended – 16 months • 6 programmes attended – 24 months • 8 programmes attended – 30 months

13. Attendance across programmes

14. Skills maintained or improved across programmes

15. Overview on impact

16. Service to people with severe symptoms from their dementia 2 tiers of service commissioned (42 beds in total) Fusing a different care approach with good practice design principles Specialist dementia design Space Meaningful environment and activity Apartment living High quality Innovation: Massive cultural shift Therapeutic approach aimed at reducing need The Lodge - Continuing Healthcare facility

17. Impacts Reduction in level of need • 21/57 have seen their level of need reduce from Tier 1 to Tier 2 • Only 1 person has seen need increase from Tier 2 to Tier 1 (had previously stepped down from Tier 1) • 6/12 could see care reduce below Tier 2 Medicines use • 17/27 admitted to the Lodge on anti-psychotics have seen reduction in use (63%) • 10/27 stopped (37%) • 7/27 reduced (26%) • 17 people have seen reductions in prescribing of anti-depressants

18. Impact – Specialist in-patient dementia services Central Lancashire has seen the highest impact across Lancashire in reductions of admissions and length of stay for specialist dementia in-patient care

19. Impact – Interface of Residential Carewith specialist in-patient services • Interface of admissions to in patient units from residential care • 34/57 (60%) had previous admissions to residential care that had broken down (101 care placements in total) • 12/57 (21%) had lived in multiple residential settings where care had broken down (more than 2 placements) • 7/57 (12%) had multiple hospital admissions prior to the Lodge, 700 bed days excluding admissions prior to the Lodge (£200k +) • 0/57 breakdowns in care at the Lodge in 2.5 years, with no re-admissions to hospitals

20. Before...

21. Garden renovation • The Lodge: • Divide garden in half • Install fencing and trellis • Reposition raised beds • Realign and add paving • Transplant turf and plants • Install a roof on the veranda and part of the pergola • Put a gate in the fence by the area for pets

22. During

23. After Separate spaces for different needs and abilities Nature stimulates. People act.

24. After

25. Nature stimulates. People act.

26. Thinking through different cluster arrangements

27. Brookside Resource centre- West Lancashire • 111 flats of extra care housing • Wider range of health services • Memory Assessment • CMHT • Dementia Adviser • Peer supports • Prevention services • Stroke services • Falls and Therapy • Longer term rehabilitation flats for: • Stroke • Dementia care • Intermediate care

28. Wider partnership RSL District council CCG U3A Age UK Alzheimer’s Society Integrated Care organisation MH Trust Bistro provider Wider community Brookside Resource centre- West Lancashire

29. Brookside Resource centre- West Lancashire • Greater integration of services • Physical and Mental Health care • Health and Social care • Statutory and Voluntary sector supports • Housing as part of the equation • Emphasis on changing the quality and environments for support • De-stigmatisation • Community ownership • Transformational, influential and educational

30. Challenges • Different approach to risk within a housing scheme • Health & Safety – is it balanced? • The challenge of integrating • Different cultures • Working together takes time • Leadership is critical • The changing provider and commissioner landscape • CCG not PCT • Split of Health providers • Procurement v On-going service development

31. Contact details: alex.walker@centrallancashire.nhs.uk Design guide available at: www.chalfontdesign.com