For many older people in poor health, going into residential care still means saying goodbye to their independence and privacy. But a new generation of "extra care" schemes is offering even the most vulnerable people choices and dignity in their twilight years.
Across the country, local authorities are forging partnerships with housing associations to improve the housing stock. In Bristol, however, the partners have gone one step further by creating an extra care model that gives older people the chance to avoid institutionalised care and remain independent.
The project involves Bristol social services, the city council's housing department, and Housing 21, a specialist housing provider for older people. Together they have created a complex of flats offering sheltered housing, support and care. There are special features for residents with dementia and "intermediate care" facilities for people discharged from hospital.
This is an example of the government's recognition that housing can play an important role in meeting people's health and care needs. This year, for the first time, the Department of Health has set aside funding - a small, but symbolic £29m - for housing projects for older people, acknowledging that housing can play an important role in meeting their health and care needs.
Stephen Ladyman, the junior health minister responsible for community care, has predicted that extra care housing could become "the dominant model of support for older people over the next generation".
Ministers need look no further than Bristol for a prototype. The £5.6m scheme, Hillside Court, lies on the outskirts of the city on land formerly owned by the council. Post-war prefab bungalows have been knocked down to make way for the complex, which provides 49 one- and two-bedroom flats in its three storeys.
Work is advanced and the development is due to open in June. Scheme managers have started interviewing potential tenants, who will receive support, even before they arrive, in the form of practical help to take the stress out of moving.
The partners have designed the development to be home to a mixed community of older people with a range of care and housing needs. The idea is to create a self-contained environment including a restaurant, hairdressing salon and computer suite, all of which will be open to older people from the local community.
There will also be a treatment room, to be used by a chiropodist, and an adapted bathroom where people can receive help with bathing. Again, these services will be available to older people living nearby, who will also have the chance to join activities such as reminiscence groups or craft classes.
"There should be no need for people to move off site," says Susan Holmes, regional business manager for Housing 21. "There will be staff on duty 24 hours a day. Some of the people may be vulnerable in the community. They may be suffering from mental health problems or be depressed, which is very common in old age," she says. "Here, they will be able to meet other people and have some form of social network rather than live in isolation."
Holmes admits it has not been easy planning a development to serve the wider community while catering for a broad range of care needs. Careful consideration has been given to design, drawn up following a series of meetings with the council's housing and social services departments.
Among these are the arrangement of flats in small clusters and the deliberate use of colours in corridors and flats to help residents' orientation. For those with dementia, doors, floors and tiles of flats are colour-coded and "smart" technology has been installed that is capable of turning off taps and cookers when left on inadvertently.
Outside each flat is a simple shelf with enough room for a pot or vase, aimed at helping residents find their own front doors. Windows from the kitchens look out on to hallways. Ground-floor flats, meanwhile, have French windows, allowing residents to walk into secure, landscaped gardens.
The project's roots can be traced to a decision by the council to close its own residential homes for older people. This followed a consultation exercise in 1999, which showed that the city's elderly population wanted to live independently for as long as possible.
To turn these aspirations into reality, the council decided to develop 600 "very sheltered" flats in collaboration with Housing 21 and other housing associations and charitable trusts. A partnership agreement covered issues such as risk-sharing, controls on cost and quality, means of ensuring best practice and the determination of rent and service payments. The desires and needs of residents were placed at the heart of the agreement.
In a document prepared for the Office of the Deputy Prime Minister, the council says: "Freedom of choice is a key concept of the partnership. Residents, whether tenants or owners or on a shared equity basis, can choose whether to purchase meals in the restaurant and take part in organised activities."
This is the case at Hillside Court, which has a mixture of flats for rent and for leasehold purchase. Original plans to rent out all the flats were scrapped after consultation findings indicated that ownership was an important issue for older people from black and minority ethnic groups.
Doorbells with flashing alarm signals have been installed and extra wiring has been fitted for other specialist equipment which may be needed.
Four flats have been earmarked for intermediate care. These will allow older people who have been in hospital to regain their independence before moving back into their own homes. Allocations to the remainder of the flats will be split between social services and the housing department.
David Cottam, project leader for social services, says potential tenants should be over 60 or registered as disabled with needs and a lifestyle suited to living in a community of older people. Two-bedroom flats are available to couples and older people with a grown-up child acting as a carer.
Care services, which will be commissioned by social services and provided by Housing 21, will be provided on the basis of means-tested charges.
Early results of the project have delighted Carmel Brogan, Bristol council's project manager for very sheltered housing. She says the partnership has been challenging and meetings have been time-consuming, but she believes it has been well worth it. "We could not have achieved this on our own," she says. "We have pooled local knowledge and national expertise and the result is a development to be proud of."
Making a smooth transition
In his first four weeks as Hillside Court scheme manager, Dave Armstrong met 20 potential tenants eager to move into the complex. Older people are particularly excited about the support being made available before and after moving in, he reports.
"Moving is a very stressful experience for all of us. And it doesn't get any easier when you get older," Armstrong says. "There is the palaver of telling the utilities when you are moving, sorting out bills and arranging packing. The people I have spoken to have found it very reassuring that someone can help them with this and make the move smoother."
Among the people interested in moving into Hillside Court are those who are finding their current homes too big, or are finding it difficult to manage the stairs. Others have a history of diabetes, osteo-arthritis or heart problems, and believe they may need support in the future.
The first residents are expected to move into Hillside Court in May and it will be a month before all 49 flats are occupied. Care services will start before then, however, to give those tenants used to receiving home care a chance to build a relationship with their new care assistants.
Susan Holmes, Housing 21 regional business manager says: "This is part of our holistic approach and commitment to providing support at all stages."
Weblinks
For more on Housing 21: www.housing21.org
For more on Bristol city council: www.bristol-city.gov.uk
The New Old is at: www.demos.co.uk
