1. DEMENTIA ENABLEMENT PROJECT 5th October 2018
Funded by the Life Changes Trust for a three year pilot
Presented by
Judith Leslie (Angus Care & Repair)
Maureen Cameron (Lochaber Care and Repair)
Care and Repair and the Life Changes Trust working together to improve, adapt and personalise the home environment for people living with Dementia.

2. We work to encourage early intervention and developing solutions for living ‘at home’ with dementia.
Care & Repair services have been assisting older people to remain living independently within their own homes for over 30 years.
Officers have existing relationships working with adaptations, telecare and facilitating hospital discharge and prevention of hospital admissions.
Staff skills combine home safety and security, housing repairs and adaptations, preventative works and health & social care expertise.
Staff are non medical – so the service is seen more as a home check than a person check.
A recent update (August 2018) to the Scottish Government’s “Age, Home and Community” strategy stressed continued support for the services provided by Care and Repair to older homeowners as a trusted source of advice and handyperson services.

3. Owned outright
% of older households
Social rented
Buying with mortgage
Private rent
Source: Scottish Household Survey
73% of older households do not have a regular safety inspection done to check the condition of their property, electrics, trip hazards or safety issues
Home safety assessment and modification to reduce injurious falls in community-dwelling older adults: cost-utility and equity analysis Frank Pega, Giorgi Kvizhinadze, Tony Blakely, June Atkinson, Nick Wilson concluded that a personalised assessment of injury hazards in the home followed by a systematic removal of these hazards, adding grab rails in and around the shower and the toilet, adding hand rails on both sides of stairways and improving home lighting reduced the rate of falls by 19%

4. Tai Chi £0.85 : £1.00 £1.97 : £1.00 Home assessment
Source: ISD Unintentional Injuries Dashboard
Aged 75+
Aged
Summary of return on investment with each intervention according to Public Health Scotland – Return on Investment of falls prevention.
Intervention Financial ROI Societal ROI Otago £0.95 : £ £2.20 : £1.00 FaME group exercise £0.99 : £ £2.28 : £1.00
Tai Chi £0.85 : £ £1.97 : £1.00 Home assessment
and modification £3.17 : £ £7.34 : £1.00
Number of emergency admissions resulting from falls at home
Percentage of emergency admissions resulting from falls which occurred at home

5. Older people prefer to stay in their own homes and communities until it is impossible for them to do so, rather than move into residential care. Most older people enjoy being in their home surroundings and view residential care with suspicion. (SCIE) Older people move home less often than younger people because many neither want nor need to (JRF)
All home adaptations should be considered as early as possible, to ensure the needs of people with dementia are person centred, well planned and can promote living well at home for as long as possible.
Home adaptations should address the cognitive and psychological needs of people living with dementia as well as physical support.
People living with dementia are more likely to fall if they are in a strange environment. If they have lived in their home prior to being affected by dementia their home will be a ‘known’ space.

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Lochaber, Lochalsh and Skye
398
3 areas in Scotland each with a different demographic (remote rural, rural and urban) were selected and began working with people who are living at home with dementia to improve their daily living by providing improvements, adaptations or alterations to their home.
Aberdeen
3455
Dementia trained, dedicated and skilled staff discuss and agree works with the individual (and carer) which will enhance their life in their home and then carry them out.
Angus
2526

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Vascular
Parkinsons
Alzheimers
Diagnosed with a type of dementia
Helping people living with dementia to remain safe at home, living well.
Working to encourage early intervention and developing solutions for living at home with dementia
Close working with existing services such as Dementia Link workers/Post diagnostic support, Telecare, Health and Social Care, Carers and other voluntary organisations to promote a joined up approach.
Non medical – more of a home check than a person check.
Lewy Bodies
Alzheimers & Vascular
Mixed
Fronto-temporal
Going through diagnosis
Unknown
Presenting with signs

8. Assessing potential hazards or things that may cause accidents
Telecare equip
Home Safety Check
Room to room
Assessing potential hazards or things that may cause accidents
Focussing on any particular difficulties impacting due to his/her dementia and in their time.
Grab rails
Referral on for additional services or assessment OT/benefits/
housing
Minor repairs carried out as necessary in relation to safety in the home.
Follow up check after 6 months to see how things are going
Dementia specific materials / equipment provided and fitted by same officer.
Dementia specific materials / equipment provided and fitted by same officer.
Care and Repair dedicated home safety and dementia trained officers

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Type of works / equipment
Wall Planner
Stickers
Message in a Bottle
PIR external light
Highlighting Paint
TV control
Socket covers
Night light
Easi plug
Magi Plug
Thumb turn lock Coloured rails Daylight bulbs
Clock Level Threshold Privacy lock

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14. Wherever possible we try to prevent trips and falls inside the home and out. Here the edges of the steps have been highlighted in yellow to make them stand out.
Before After

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Outcomes
People will be safer and more independent in their home and they will know where to get additional assistance when needed.
People living with dementia will receive adaptations and equipment specific to their needs.
Existing services will be informed and new services developed for design, adaptations and equipment to suit people living with dementia. These can then be adopted by others and incorporated into future dementia provision for individuals and can influence needs assessments in the future.
People living with dementia will receive additional assistance with other housing and social care enquiries.
People living with dementia and/or their carer(s) can contribute to designing a service which is provided in a timely, respectful and mutually agreed manner and suits the recipients needs. This will help retain independence, safety, security and activity in the home and the community.

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What next?
The pilot will provide evidence of dementia specific works and equipment to assist people to remain independent in their own homes.
The evaluation will demonstrate the benefit and cost effectiveness of this model of support.
The enablement service learning will be rolled out into other areas of Scotland though Care and Repair networks.
Funding for the enablement check and equipment will be secured to be included as a core service for people living with and affected by dementia.
There will be greater awareness of how housing can influence the comfort and safety of people living with dementia.

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Thank you