Joanne is 49 years old and is severely disabled through cerebral palsy. Until four years ago she had never lived independently. She met her husband, Andrew, at Beechwood residential care home, where they lived until the home was finally closed in July 2001. Andrew is blind and before moving to Beechwood had found independent living too difficult.
Now Joanne and Andrew live together in a two-bedroom bungalow, which is part of the Westwood Park extra care housing scheme. The scheme is run as a partnership between Bradford social services department and Hanover Housing Association. Joanne and Andrew are delighted. As Joanne puts it: "You've got your own privacy, you can do what you want, it's fantastic. I just
can't say how happy I am to have a place of my own."
She admits to being worried before they made the move, but now says: "I don't want to go in a home again, no way. I want my independence. I think independence is great for disabled people."
In its response to the government's green paper on adult social care, the Association of Directors of Social Services said that there was scope for expanding new models of care such as extra care housing but pointed to the need to develop knowledge about what really works.(1) Most of the development of extra care housing to date has been for older people, and this client group, along with people with learning difficulties, are the focus of the government's extra care housing fund. But the Westwood Park scheme is clear evidence that extra care housing can work for younger physically disabled adults and is a genuine alternative to long-term residential (or even nursing) home provision.
At one time, Beechwood had been home to up to 40 disabled people but in the early 1990s it became clear that the building could not be economically upgraded to meet new registration standards. From the very outset the residents of Beechwood were involved in trying to find a solution, and after much discussion and visits by them to various schemes around the country, they decided that they wanted independent living but with 24/7 care and support.
When the local NHS decided to sell a large hospital site not far from Bradford city centre, the opportunity was seized to develop a major scheme specifically for younger disabled people that would be fully integrated as part of a prestigious upmarket owner-occupier housing estate. Hanover Housing Association had experience of extra care accommodation for older people and, although it had never developed a scheme for younger disabled people, was keen to work with Bradford Council on the initiative.
From 1997 a project group oversaw the development of the scheme in full consultation with the residents of Beechwood. Phase one of the scheme was ready for habitation in July 2001.
The remaining 26 residents at Beechwood all moved to Westwood Park, either to live in Eden Gardens (the extra care block of 20 self-contained flats), into one of the bungalows or a cluster of self-contained flats. The staff team at Beechwood moved as well, effectively becoming a specialist home support team offering 24/7 care and support on the new scheme.
Four years on and 20 of the original 26 Beechwood residents remain, along with 31 other people with a wide range of physical impairments, some very severe. This is proof positive that extra care housing schemes of this kind are a realistic alternative to institutional care. A second phase of the scheme opened in February 2002 so that in total the whole scheme now comprises 50 units of fully accessible housing for disabled people comprising a mixture of two-bedroom bungalows, one-bedroom flats in cluster blocks and 20 one-bedroom flats in an extra care block. In addition to these 50 units there is a respite care cluster of three flats with a carer flat for staff.
Every person living on the scheme has an individually tailored package of care and support that is delivered by the on-site team. Hanover employs an estate manager who is also based on site and is able to deal with issues around rent, bills and housing maintenance. There is a joint allocations panel operated by Hanover and Bradford Council that considers every application and prioritises against an agreed set of criteria so that on the rare occasions that a unit becomes available there is no delay in offering it to the most suitable highest priority candidate.
Although the staff at Beechwood were confident that the scheme would work, even they were surprised at how dependency levels dropped once people moved out of residential care and started to exercise real choice in their lives. One woman moved to Beechwood following a stroke. She had poor mobility and speech problems and needed a high degree of care. When she moved to the new scheme into a flat, after a short time she was able to manage all her own personal care tasks. Staff worked with her on budgeting skills and household tasks. She was accompanied and assisted with purchasing shopping. After a while she became confident enough to go to the shops by herself. After working closely with occupational therapy and support staff, and purchasing the necessary equipment, she was able to prepare her own meals. She is now virtually independent in her own home and only uses the support staff through the on-call system in an emergency.
A formal evaluation of the scheme in July 2003 has led Hanover to develop a new brand of supported accommodation called AccessAble, based on the Beechwood model. AccessAble is specifically for younger disabled people with severe or multiple disabilities.
Peter Kay, head of adult services, offers the following advice to other local authorities thinking of following suit: "We involved disabled people, their families and the local community right from the start; our project team was informal yet businesslike; we worked hard to ensure that the staff and residents were well prepared for the move; and we didn't allow the inevitable obstacles and delays to discourage us. Most importantly the scheme is located in an excellent setting fully integrated with the surrounding housing."
Design of scheme
These features are provided in the extra care accommodation:
Fully wheelchair accessible throughout, including extra-wide corridors.
Remote door entry to flats.
Provision of closi-mat toilets.
Alarm call system.
Flats designed for easy installation of ceiling track hoists.
Communal facilities include:
Restaurant providing fresh meals.
Room for recharging wheelchairs.
Jim Ledwidge manages the physical disabilities and sensory needs section of Bradford social services department. He qualified as a social worker in 1982 and worked both in Lambeth and Westminster before moving to Bradford in 1988
Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals' learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.
This article describes an innovative large supported housing scheme in Bradford which demonstrates that the extra care housing model is not just for older people. It can work well for severely disabled adults under pension age and be a genuine alternative to residential care. The author illustrates how the right environment and support reduces levels of dependency and reduces the need for intensive packages of care.
(1) Independence, Well-being and Choice - The ADSS response to the Green Paper on Adult Social Care, 2005 from www.adss.org.uk/
Mark Foord, Paul Simic (ed) Housing, Community Care and Supported Housing, Chartered Institute of Housing 2005
Extra-care Housing Markets 2005, Laing and Buisson, 2005. email@example.com
Understanding Public Services and Markets: Summary Paper of the Report Commissioned by the King's Fund for the Care Services Inquiry, Personal Social Services Research Unit (PSSRU), Discussion Paper 2111, 4 June 2005. From www.pssru.ac.uk/pdf/dp2123_2.pdf.
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