Special report on care for older people with dementia

Is admission to residential care inevitable for older people with dementia?

This question is posed by housing provider Housing 21 in new research exploring whether people with dementia can live in extra care housing, without ever needing to go into residential care.

Housing 21 describes extra care as “very sheltered housing.” This means residents live in their own homes with varying social care support.

Melinda Phillips, chief executive at Housing 21, recently previewed the research, which will be published in full in April.

It finds that suffering from dementia is not the reason why many people enter residential care. Instead it says this is due to the way services are organised, citing a lack of integration between health and social care, the structure of long-term care funding and the treatment of challenging behaviour.

The health and social care white paper, published last month, outlines a world where services are fitted around people, not people around services, and social care and health are fully integrated. But this care nirvana is clearly not happening yet.

Good liaison between NHS and social care services affects whether people with dementia get the support to stay living at home, according to Phillips.

“When people in local authorities have good integration with health, people will live in extra care much longer,” says Phillips.

She says the way care is funded is to blame because the cash limits local authorities place on home care means that people with dementia cannot get the intensive support needed to stay out of residential care or hospital.

Sally Hughes, policy officer at mental health charity Mind, says that older people tend to be slotted into existing services.

“Residential care is the overwhelming form of provision for older people, it’s what’s available,” she says.

“A place in a residential home is seen as a quick fix by local authorities. Sorting out a package of home care for an older person with dementia who has high needs is difficult, time-consuming and expensive.”

Mind has campaigned to improve access to mental health services for older people and is concerned about the lack of options on offer. Many people over 65 are referred to older people’s services and do not get access to specialist mental health support, says Hughes.

 “Challenging behaviour” –  including older people pressing alarm buttons repeatedly or wandering frequently – is not well handled by service providers and is often a trigger for a move to residential care, said Phillips

Small adaptations can help people stay in their homes if they are prone to falls and wandering, but are not often pursued, she says.

Phillips stressed the importance of telecare, where technology such as alarms and devices enables help to be summoned at the touch of a button, in helping older people to live independently.

As a provider of extra care it is perhaps not surprising that Housing 21 promotes it as an option. “Quite simply, Housing 21 provides extra care because it is what older people want,” says a spokesperson.

“Alongside other provision, extra care is an option that should be offered to older people. Given the right support, it is a realistic option for people with dementia.”

The Housing 21 research, Opening doors to independence: older people with dementia in extra care, aims to evaluate the contribution extra care can make to the long term care and support of older people and will explore its limitations. It is a three year study following 103 Housing 21 residents, including 36 people with dementia.