IPC What can Extra Care deliver and how do we know

This strand of Raising the Stakes  What evidence is there to support the beneficial outcomes that have been claimed for Extra Care Housing?  How is the industry currently measuring success?  Where ECH is delivering good outcomes, what seem the critical success factors in delivering them.

Institute of Public Care  Review undertaken on behalf of the ‘Raising the Stakes’ project group by IPC  Centre of Oxford Brookes University  Applied research and knowledge transfer  Work with central and local government, health service, private and voluntary sector  Projects cover housing, social and health care  Housing examples: - ECH Toolkit and other work for Housing LIN - Evaluation of ECH schemes for RSLs - Development of accommodation and support strategies for LAs

Activities  Literature review of evidence for achievement of good outcomes and critical success factors  Structured interviews with scheme managers to determine their experience and what monitoring tools they are currently using

Literature review  A key element of the review was the work recently published by Karen Croucher and colleagues for the Joseph Rowntree Trust  Also the ECH Toolkit and the review of housing options undertaken as part of the Wanless review  Additionally looked across the literature at evaluations of ECH and at what older people say that they want  Review still in ‘draft’ form to enable updating as new related work is published

Main questions being asked Can ECH offer:  Quality of life overall  ‘Aging in place’, including for people with specialist needs  Genuine alternatives to residential or nursing care  An environment that supports diversity

Main questions being asked Can ECH offer:  Improvements in the capacity to sustain health  Opportunities to mix with others and join in the local community  Opportunities to sustain friendships/connections  Continued involvement of family carers

Main questions being asked Additionally, where ECH was deemed to be successful, to begin to identify what made it so. For the interviews we have based this around the domains developed for the questionnaire and self assessment ie:  Customer base  Environment  Services  Ethos/lifestyle

Findings so far from literature  Is Extra Care Housing able to achieve ‘aging in place’ for its occupants? and  Does ECH provide a realistic alternative to care home admission?: - Does seem that most ECH occupants do age in place and do not need to move on into care - Where people have moved on, it is mainly to care homes with nursing or specialist EMH care homes - studies of care home residents suggest many could have moved into ECH instead

Findings so far  Seems could offer a realistic alternative to ‘standard’ residential care if sufficient schemes  Less able to support people with high level needs, particularly severe dementia  Therefore probably does not represent an alternative to specialist and care homes with nursing

Findings so far  Does ECH improve health and well being, reduce, or prevent increased need for, formal health and social care input?: - Self reported feelings of improved well being are well documented - Fewer objective measures of improved functioning - Some evidence of shorter hospital stays, fewer admissions - Some evidence of reduced need for care hours from that received in previous accommodation

Findings so far  Improved feelings of well being can relate to a cluster of factors, better housing, more social contact  There is less evidence for specific measured health gain

Findings so far  Does ECH reduce social isolation, encourage involvement and provide support to other local older people?: - Opportunity is certainly there and relatively active elders can benefit - Some evidence of isolation of those with dementia and potentially BME elders - Insufficient information as yet about value to local community.

Findings so far  Does ECH enable continued involvement of family carers? - Clear value of enabling carer and supported person to remain together - Higher proportion of families retain contact than in care homes - Less evidence available of direct impact on carer themselves

Findings so far  Does ECH offer quality of life to its occupants? - Partly a summation of the previous questions - Seems clear that for most people it does offer a good quality of life, particularly in terms of independence and security - Also seems to apply to many with dementia - Quality of life has to be seen in the context of possible losses associated with moving, aging, reduced abilities etc

Findings so far  What factors seem to lead to success in achieving these outcomes? Only so far some very broad indications from the literature: - For people with dementia – admission at earliest stage, staff training and expertise - Design – space in scheme and each unit - Support and care – continuity, positive attitude, flexibility of response to need, effective use of assistive technology

Structured interviews  So far nearly all the elements within the domains are seen as important or very important to achieving success, particularly around environment and service  The main outliers to this are ‘mix of tenure’ and ‘balanced dependency levels’ which are not seen as so important

Monitoring tools  So far it appears that there is extensive monitoring undertaken within schemes over a number of areas  This is collected both manually and electronically  However, it does not seem to be used as much as it is collected!

Next steps  Continue with the structured interviews with scheme managers  Opportunity tomorrow for some of you to contribute  Collate the findings  Information gathered wil contribute to the outputs of the wider Raising the Stakes project, such as a Steps to Success guide, and appraisal tools