For decades we have been promised a more joined up future between health and social care to better support those who are most frail or very ill. As evidenced under this pandemic, we have an amazing NHS that has shown that it is capable of delivering urgent care to the very sick and acutely ill and we have the framework for an exemplary adult social care system. However, for years our social services have been underfunded. Yet it could work if the money being spent on healthcare were spent in a different way. We are not talking about more money, as welcome as this would be, but simply how it is spent.
What I am talking about is about the ‘bit in the middle’; the bit between health and social care is where people are suffering the most. Here, they literally fall between the gap of a national healthcare system with what seems endless amounts of money and a local cash strapped social care system unable to provide such high levels of quality care to people to support them at home. Coronavirus has also shown the overwhelming demand on our public services, including acute NHS Trusts. To manage this demand in a hospital setting, many older patients were rapidly transferred to residential care homes with no or little choice because there were no safe, alternative ‘care ready’ housing choices available locally. Furthermore, many of those care homes were not set-up to take NHS patients, especially in the absence of PPE and other infection control measures.
Last month the government announced a Social Care Taskforce to implement their social care action plan and support care homes to help end transmission of coronavirus in the community. But what the pandemic has demonstrated to me is that we need to think beyond our current health and social care architecture. We also need to prepare to build bespoke and inviting settings where a recovering patient can be rehabilitated and get back to full health. This would involve specialist beds, equipment, accessible shower rooms and the like but also areas to practice ‘normal’ daily living tasks that a person might be returning to in a comfortable hotel-like setting. It would also involve a team of highly trained therapists and care staff who would to teach people to walk again, feed themselves, use walking or other aids, staff who would assist with how to take medication and even how to access help via technology, everything to enable them to recover before going home.
"the pandemic has demonstrated to me is that we need to think beyond our current health and social care architecture. We also need to prepare to build bespoke and inviting settings where a recovering patient can be rehabilitated and get back to full health"
A ‘care hotel’ could do this and could even provide a base for a dedicated on-site team of aids and adaptation specialists who assess a person’s existing home and begin to implement changes ready for them to return home to and of course to stay home without relapse. Ideally, we would tackle the cause at the root of the problem which is the state of our poor existing housing but this would mean demolishing or drastically retrofitting the majority of our existing housing stock and replacing it with something akin to a Lifetime Home standard. This is clearly not possible, so for those who want to return home from hospital or who need to vacate an expensive NHS bed, they need somewhere to recover, rehabilitate or recuperate. We already knew this but the pandemic has shone a great spotlight on the issue that now cannot be ignored.
Interestingly, and at the other end of the spectrum of care, we have seen providers of housing for older people (with care) doing their bit to provide what they have called ‘respite care’ or ‘rehabilitation beds’ for older people who are too well for hospital but who do not have appropriate accommodation to return home to. These organisations are to be commended.
While popular in parts of mainland Europe, some local authorities such as Ashford and Stockport Borough Council’s who have gone so far as to spend their own money on ‘step-down-care’ within new specialist housing schemes such as Farrow Court in Ashford, Kent, where an 8 bed wing of recuperative care is provided within a larger scheme of 83 independent apartments for over-55’s, a community resource centre and an 12 unit supported living block all on the same site. Economies of scale work well here and so too do the social and community aspects. The temporary residents who come to recuperate and recover are introduced to bustling and lively communal areas of the scheme and become familiar with the concept of how extra care can work. This model is good but 6 beds is just a drop in the ocean and 60 beds could easily be filled.
On a larger scale, Stockport’s Academy of Living Well is being designed to house dementia care and other forms of transitional care including intermediate care, respite care, step up/step down care. The intermediate care design will be based on the innovative Evermore small homes model, a household model where patients will engage with and support each other and be active participants in their care and recovery. It is centred around the concept of “The BIG Table” where everyone has a seat and it is the focal point of activity throughout the day, not just at mealtimes. Five households of 14 will provide Stockport with 70 care rooms, supporting patients to get home.
"a bespoke ‘care hotel’ would be able to manage situations where ‘patients’ or ‘recovering people’ could be isolated from infection (or with infection) in a setting well equipped to deliver NHS type care but which is the step down to an independent life at home"
As a practice we are known for exemplary designs for extra care housing, retirement living and care home operators, often commissioned by local authorities responsible for adult social care. We could take the best features from each of these and design ‘care hotels’. In my view, a bespoke ‘care hotel’ would be able to manage situations where ‘patients’ or ‘recovering people’ could be isolated from infection (or with infection) in a setting well equipped to deliver NHS type care but which is the step down to an independent life at home.
Read the recently updated Housing LIN Factsheet (no6), Design principles of Extra Care Housing (3rd edition) (opens new window). Written by PRP, it has also been updated to address health and safety considerations following Grenfell, the avoidance of overheating and, more recently, the impact of Coronavirus on the design of self-contained accommodation for older people.