Living Well with Dementia – a national strategy
4 February 2009
Yesterday (3 February 2009) the Department of Health published the long awaited National Dementia Strategy and has put Telecare at the centre of future care services. However, the Department is adopting a wait and see attitude towards working up a specific strategy around Telecare. This presents a great opportunity for Telecare to help shape this emerging policy.
Of specific relevance to the industry is: Housing and Telecare for people with dementia (page 55)
Objective 10: 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, assistive technology and Telecare. As evidence emerges, commissioners should consider the provision of options to prolong independent living and delay reliance on more intensive services.
How this can be delivered
- Monitoring the development of models of housing, including extra care housing, to meet the needs of people with dementia and their carers.
- Staff working within housing and housing-related services to develop skills needed to provide the best quality care and support for people with dementia in the roles and settings where they work.
- A watching brief over the emerging evidence base on assistive technology and Telecare to support the needs of people with dementia and their carers to enable implementation once effectiveness is proven.
The case for change
There has been little research conducted into the role of supported housing in dementia care. Nevertheless, those studies which have been conducted demonstrate that, on the whole, people with dementia can benefit from the support offered in sheltered and extra care housing. They are not always offered this opportunity. A study in 1995 found that sheltered housing can offer a positive environment to people with dementia, provided that appropriate opportunities for social interaction are available. The role of housing staff was identified as critical in the integration of tenants with dementia.
More recently the importance of flexible care packages in meeting the needs of people with dementia in extra care housing has been demonstrated.45 Many areas are now offering this sort of flexible, responsive care package through floating support services. Many residents with dementia in sheltered or extra care housing have complex health and care needs. The Housing Corporation/Housing 21 study found that these needs could be met where health, social care and housing worked together to provide a whole system strategy, although the researchers acknowledged that this remains a key challenge in supported housing.
The evidence base on design principles is sparse, but there is consensus on key principles and a number of good practice checklists are available. There is a more substantial evidence base to show the opportunities offered by assistive technology and Telecare to enable people with dementia to remain independent for longer, and in particular to help the management of risk. But the data on newer approaches are still sparse and inconclusive. An evaluation of one scheme demonstrated cost effectiveness and reports of improved quality of life. 46 Large-scale DH field trials of such technology are currently under way.
This is an evolving field, but one that is of potentially high and central importance in enabling people with dementia to live well with their condition. There is much that is being done currently that is positive in terms of housing options and assistive technologies that are part of mainstream care for people with dementia, and that contribute to their independence and safety. However, with respect to more recent innovations, this is not an area where the strategy is able at this time to make specific recommendations. Instead, central, regional and local teams should keep in touch with initiatives in the areas of housing and Telecare and make appropriate commissioning decisions as data become available, for example from the Department’s large-scale field trials of Telecare and assistive technology.
To read the full report visit:
(TSA contributed to the consultation exercise relating to the Strategy on behalf of members)