I am 91 years old and seriously disabled. I live in a Housing Association’s Independent Living/Sheltered Housing scheme where I rent a two bedroomed flat. During this Coronavirus "lock down" I have had time to reflect on the housing and care needs of older and disabled people living around me and made a number of observations about living in sheltered housing. These have led me to come up with some suggestions based on my experience of being a resident in a flat within a sheltered housing scheme for the past nine years.
Sheltered accommodation has now been my home for nearly ten years and, over this time, I have observed a change in age and frailty of the incoming residents. Independent Living is actually a misnomer as the majority of residents already have health problems and many have no relatives to help and support them. They now tend to be older and have more health issues than when I came into my flat in 2011.
I have also noticed that some new residents where I live even appear to already have early onset dementia which possibly was kept hidden on entry to the supported housing. I am worried that where residents have developed dementia they have no real support and often end up being a danger to themselves and to the other residents. I feel that there needs to be a stricter assessment of residents prior to coming into sheltered accommodation. People should be allocated extra care housing locally or even placed in residential care where it is more appropriate for their specific care needs.
In the future, delivery of support and care in schemes such as mine should be more comprehensive, adaptable and compassionate. Personal contact and friendship between residents should be encouraged as this is essential to prevent isolation and loneliness. My experience is that many people in independent living schemes are isolated and lonely. They come from many different backgrounds and might have little in common. I know that many have no family at all, and no-one in the local area to support them. There also seems to be very little done to help new residents settle in; for instance, by introducing them to their neighbours and to people with whom they might have something in common. I believe this lack of introductions might be management policy in sheltered housing for reasons of personal privacy but I feel strongly that this leads to increased isolation.
Once the current pandemic is over, there needs to be greater encouragement from staff to help residents to integrate and form friendships. Social mixing should not only be encouraged but should be actively facilitated safely. Although I am aware that some effort is made to lay on activities, these tend to be very limited in scope (e.g. bingo and coffee mornings) and are often organised by residents rather than by staff. Also in my ‘scheme’ there is no communal dining area where residents can purchase and eat meals every day. I feel this is essential as many residents do not have the motivation, or are unable to cook adequately for themselves, or would sometimes just like some company.
In my view, in most sheltered housing there is very limited contact from the support staff whose involvement with residents is often just a once a day phone call to check that they are 'ok', and answering calls from the emergency pull cords which are available in all the flats. Housing support workers are not allowed to assist with any personal care or health needs; these are services organised by the local authority where a resident has a care plan or they have to organise their own help privately. So, when residents develop any health or care needs, these have to be supported by outside agencies, like a domiciliary care agency, GP practice or NHS community health provider. This usually entails visits by a variety of care workers from many different companies which results in a lack of continuity of care and overall supervision. I have also noticed that these visits tend to be rather short and leave the resident alone and unsupported for most of the time. I therefore think that supported living schemes should provide on-site or in-reach day care facilities for those residents with more care needs than the once a day call from support workers. These additional facilities could be an add-on to the basic care package but would ensure that there was some consistency in staffing and how and when these care services were provided. This might enable residents to continue living safely in their own flats for longer before they needed residential or nursing care.
Where the care needs change for residents in sheltered housing, there should be prompt reassessment of their needs as soon as they display any signs of not being able to cope with independent living, and movement to a higher level of care needs to happen without delay. Residents coming into sheltered accommodation need to understand and agree on entry that they will be asked to move out quickly if their health needs change.
Ideally, all care facilities should accommodate relatively small numbers of people to enable the residents to feel some sense of familiarity and community. The three levels of care; sheltered housing, residential and nursing care could perhaps best be provided on a single site, like a care ‘village’. This would allow easy transfer of care from one level of care to another. People with varying stages of dementia could then be better accommodated, with access to appropriately trained staff to meet their needs. It would also avoid a distressing move away from loved ones, close friends and neighbours.
On the subject of staffing, of course all care facilities need to be adequately staffed with appropriately trained staff. Caring is a complicated and difficult job and it needs to be properly recognised and remunerated. Staff need sufficient time allowed in their working hours to get to know their residents and to develop relationships and trust. Consistent staffing is needed and Homes should not rely on 'cheap labour' or locums. Good medical support from GPs is needed in all homes, ideally from a single named surgery with regular and frequent visits. Also, consistent and regular support from other care professionals is required, e.g. pharmacists, podiatrists, physiotherapists etc.
I hope that after this Coronavirus crisis is over, there will be a thorough review of social care and that the government will make, and fully fund, some radical changes to ensure that high quality, efficiently managed care services are made available to all people who need them, including for those whose home is Independent Living/Sheltered Housing. Everyone requiring support should be given the best possible care irrespective of their financial circumstances so that they are able to live decent and dignified lives.
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