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ADAPTING for CHANGE

MODULE 1 HOUSING SOLUTIONS

ReportfromLochaber session – 11 January 2017

Introduction

This report provides an evaluation of the Module delivered at Lochaber Housing Association

on 11 January 2017. It includes: ‘outputs’ from each of the key sessions in the Module which

help illustrate the level of engagement of the attendees; delegate comments from the

completed ‘pre’ and ‘end of course’ evaluation forms.

A good mix of staff attended the session:

4 x housing management staff (mix of Council and RSL)

1 x housing options officer

2 x Community Nurses

1 x District Nurse

1 x staff nurse (discharge planning)

2 x OT and 1 x OTA

2 x Integrated Team Leaders

1 x Health and Social Care Co-ordinator

1 x social worker

2 x Lochaber Care and Repair staff

1 x Community Learning Disability Nurse

1 x CPN (Older Adults)

1 – OUTPUTS from training module sessions

Intro Ice Breaker - What does Home mean to you?

A safe place for family and friends An open door for family and friends Home is wherever my wife is Home is my husband and family Somewhere for my family to come home to My comfort zone Bricks and mortar – dry and warm, centrally heated Home is an investment

A place to build memories A place where you can shut the rest of the world out A safe, comfortable and relaxing place My own space Home is where I can be myself It’s the best place in the world Where extended family gather Home is Fun! Home is where the wine is!

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SESSION 2 – ACTING EARLY (Case Studies)

What were the triggers?WHO should have done WHAT & WHEN?

Triggers

What

- Deteriorating health condition, various people would have been involved

- Who was monitoring medication?

- Who was assisting with shopping and meeting basic needs?

- A referral to housing was made a year earlier

Who, when

- Many involved in the lead in to the crisis: GP, Diabetic Nurse, OT, Social Care,

District Nurse, Housing, medical staff, family, personal responsibility, Consultant

- Housing should have been more involved much earlier

Opportunities?

- The integrated HSC team have weekly ‘huddles’ to identify intervention/prevention

actions. Housing conversations are not systemic to these arrangements although the

POP (Personal Outcome Plan) tool does include a section for housing outcomes.

- Currently assessments in the housing system for clients with ‘accessible housing

needs’ are undertaken centrally in Inverness by an OT positioned in NHSH Public

Health. It may be helpful to test localised ‘Accessible Housing Needs’ assessments

(via the Be@Home project?) and review whether this helps a more integrated

approach to housing conversations within the weekly ‘huddle’ model.

SESSION 2 - HAVING THE RIGHT HOUSING CONVERSATIONS

Who – GPs and/or Consultants were felt to hold a key role as it was felt that people tend to

defer to their advice over and above that of other professionals. Notwithstanding this, it was

felt that any and all those involved in supporting a person had opportunities at much earlier

stages in pathways to prompt conversations about how people felt they were doing at a

practical level at home, and what this might mean for the future.

What & How…

- A questioning and interested approach

- Careful about tone, and the importance of being conversational

- Pitching the conversation in a person centred way

- Aware of the sensitivities and attachments that people feel about their ‘home’

- Finding out what is important to that person

- Engaging with family to support the conversations, including at formal ‘huddle’

- Promoting ‘plan B, C or D’ – to help people think through options in a timely way

- Listen to the person

- Sharing risk with the person

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The Falkirk good practice ‘should I stay or should I move’ leaflet was considered a useful

and helpful approach. A District Nurse delegate noted her intention to promote this approach

to GPs in her practice. It was noted that the Be@Home project will be producing a local

version of this good practice leaflet for local distribution.

SESSION 3 - YOUR ROLES & RESPONSIBILITIES

- There was agreement with the suggestion to promote the housing solutions approach

to GPs

- All professionals should be encouraged to take a wider role approach to promoting

housing solutions as something for people to think about for the future

- All should take responsibility for their clients/patients in this way

- Joint working – is an attitude and behaviour – we can all practice with this approach

- Recognition that it was a culture shift to get people to think through and plan for their

future earlier – and that this is a shared and joint working responsibility

- Suggestion for all services to be providing and promoting the same leaflet with

consistent advice and information.

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2 – COURSE EVALUATION

Q 1. What do you understand as the key principles and aims of the AFC programme?

Pre course End of Course

Not aware of any principles as such yet

To provide solutions to help people live and carry out normal lives in their own homes and community

I have no understanding of AFC. Hope to address this at this training

Providing solutions to assist people to remain in the community

Community care. Choice.

To have an awareness of programme to help my tenants

How to keep someone independent at home

Very little

Education on housing

Maintaining independent living

Maintain each individual in their own home enabling them to keep their

It is everyone’s responsibility to notice a potential change in circumstances for person. It’s important to act timely, and person must be the one to make decisions. It has to be suitable for that person’s needs, it means adaptation has to be person centred.

To provide solutions to help people live and carry out normal lives in their own homes and community

To think about the person, what is the best thing for them and how can we work in partnership with other agencies to achieve the best outcome, in partnership with the person!

Improve services. Provide services to assist people to remain at home. Raise awareness of options.

Personal choice. Person centred. Integrated working. Personal responsibility.

Better understanding of how other agencies fit in or relay information to our service

More about roles and responsibilities

More now

Thinking about processes and behaviours

Maintaining people’s wishes if possible, with living arrangements

To anticipate people’s housing needs early, and to encourage discussion

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independence.

Maintaining independence in own home

Maintaining independence safely in people’s own home. Providing seamless and equitable access to adaptations

Have no prior knowledge of AFC programme

Right housing conversations – shared roles, anticipatory, who’s risk? Streamlined services – tenure neutral, reduced complexity, delays in the system – grants process. Partnership working.

Being relatively new to the role I am not terribly familiar with the programme hence my attendance today! Allowing people to live at home safely

Providing solutions for people living in community with extra needs

with them, family, health professionals. To encourage participation from primary care colleagues.

Finding best solution for an individual regarding staying at home based on their choice and working with them to accomplish this.

Using multi-disciplinary/multi agency approach – maintain people’s independence in their own homes. Equitable access to adaptations. People aware of options available to them.

Better partnership between services. more streamlined. Integrated services. Person centred and everyone’s responsibility.

Right housing conversations – shared roles, anticipatory, who’s risk? Streamlined services – tenure neutral, reduced complexity, delays in the system – grants process. Partnership working.

That all agencies and departments have a responsibility to work together to help keep people safe at home or consider alternatives/changes to suit their future needs.

Improve services – raise awareness. Solutions delivered at an earlier stage

Q 2. Describe the different Housing based solutions available to help people live

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safely within their communities?

Pre course End of Course

Adapted housing to wheelchair user to access and maintain independence

Rehousing to accommodation friendlier to their needs. Aids and adaptations to live safely within their communities

Provide houses to allow people to live safely and independently, especially those affected by dementia

Telecare, home adaptions, mobility aids

Adaptations, support, care

Sheltered

Adaptations, care packages, support agencies, carer training, sheltered housing, telecare

Aids and adaptations. Help from NHS – e.g tuck in service, district nurse. Help from social service – e.g. meals, day centres. Help from other sources – police and voluntary organisations. Specialist housing – e.g. sheltered housing

Shared housing, adapted housing – level access, telecare, sheltered, care homes

Sheltered housing. Disability adapted housing. Telecare. Help Call systems.

Adaptations, sheltered housing, key housing, Telecare

Telecare, housing options, equipment, adaptations

As before, plus the possible use of technology

Look at the housing situation, does the person need a new house, would they actually be better moving or is there not a better way that will be more beneficial to them.

Adaptations, telecare, housing changes, aids for the home

Support (all). Adaptations (all). Resilience and perseverance – personal choice

Sheltered, SW, OT etc

Aids/adaptations/technology. Packages of care, telecare, be@home service, sheltered housing

Aids and adaptations. Help from NHS – e.g tuck in service, district nurse. Help from social service – e.g. meals, day centres. Help from other sources – police and voluntary organisations. Specialist housing – e.g. sheltered housing

Shared housing, adapted housing – level access, telecare, sheltered, care homes

Adaptations. Changes in lifestyle i.e. housebound, living in one room.

Adaptations – multi disciplinary approach with housing, social work, nursing, OT

Telecare, adaptations, aids, various

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Sheltered housing, adaptations, care packages, Telecare

Dementia services, adaptations, care packages, rehousing, telecare, provision of equipment

OT service providing equipment/adaptations. Disabled access housing. Telecare.

Provision of equipment, adaptation large/small. Technology

Adaptations, grants, council/housing association, social care and health services

Handrails and other mobility solutions, stair rails, ramps, adaptations. Monitoring systems – motion alarms, falls, help call, telecare

housing types e.g. sheltered, amenity

Dementia services, adaptations, care packages, rehousing, telecare, provision of equipment

OT service providing equipment/adaptations. Disabled access housing. Telecare.

Provision of equipment, adaptation large/small. Technology

Housing options, equipment, technology, adaptations

Adaptations, telecare, alternative housing

Q 3. What would you describe as your key roles and responsibilities in relation to supporting people to understand the range of Housing solutions/choices available to them…..when should you intervene and how should you engage with people?

Pre course End of Course

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People that require input from housing solutions are entitled to any information that is available and will have a right to discuss their needs for any housing adaptation

To assess people in their homes and to advise them or refer them to other organisations that can help them with their needs. I would intervene when a person is referred to the service but I would go beyond the referral and assess any other needs they may have. I would build up a rapport with a person and advise them of the help available with explanations if necessary but only implement ‘solutions’ with the persons agreement.

The Dementia Home Enablement Project allows people to live independently and safely by making small interventions. My role is to record all data for reporting to our funders and to ensure all interventions are carried out safely and timeously

Assessing people and housing at visits. Discuss with patient/family support available

Information. Prevention stage/early. Engage where possible. Home visits/medical/community groups. Early development stages – housing, planning

A major part of my job is dealing with and building a relationship with tenants. I can become involved at an early stage at the request of the tenant and/or their family.

Provide information. Risk assess regularly. Interview when risk of harm. Refer to appropriate supports. Involve significant others as appropriate. Empower to make decisions.

Supporting people to make an informed choice to promote their independence, ensure safety and good quality of life

Should be intervening at the earliest possible stage. Engage with people in a sensitive way taking into account their emotions and fears.

Key roles and responsibilities include working with partners – get away from working in silos. Think about the person and how they are feeling, and what would be best for them. Early discussion can test things, and prepare the person for more difficult conversations at a later date – prior to crisis point

Assess each patient on an individual basis. Take ownership for individual care. Involve multi disciplinary working in care

Listen to the person. Inform the person. Communicate local information and practical possibilities. Inform of national policy if local practice is a problem.

Better inter service relationships

Ensuring the conversation happens. Share with colleagues. Interview early. Provide information to allow people to make informed choice. Shared responsibility. Outcomes approach.

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Intervention should be as early on in the process as possible, should be client centred, and outcomes should be the greatest to the service user, and practicable to achieve.

Provide basic home information and support a person. To signpost to correct service to access appropriate housing. At times could be involved in advising on type of housing required.

Discharge planning

Refer people through various agencies. Single point of contact. Discharge planning meetings for patients in hospital to ensure correct situation reached

My role involves communication with people ‘new’ to services to explain what services are available etc. Engaging with people via telephone or face to face listening etc.

Discharge planning, NHS resource allocation, MDT discussions, provision of and ensuring availability of equipment

Identify housing risks/problems, and refer to senior staff member. Very limited knowledge of housing solutions – assess during regular visits

Discussing with people re housing options – does it meet their needs now and in the future. Other family. Discussing rehousing. Identifying not just peoples physical health, mental and emotional wellbeing just

As before plus, the importance of joined up working between the services. The importance of proactive and pre-emptory working

Now thinking about handing out leaflet (to be made), and consider conversations early. Learned more about housing officers input – positive for my role to support in housing discussions.

Identifying needs in agreement with patients. Discussing with multi disciplinary team.

To accept ownership and take responsibility for liaising with GPs and community nursing colleagues about early conversations regarding housing

Interviewing as soon as possible through discussion with the person (service user). Engaging in a way that is respectful: listening to the persons concerns etc, and by answering any questions they may have – or finding answers if not already known.

Ensure staff aware of be@home project. Encourage attendance at training. Ensure right people around the table, at huddles, MDTs – including the person and family in decision making. Take ownership of issues identified.

To assess suitability of housing at initial visit, and to raise concerns with client/patient. To make colleagues aware of AFC programme

I will now include as part of initial OT introduction to service as part of menu offered. Provision of leaflet from Falkirk alongside environment checklist

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as important. Use of technology, timely and in practice

Intervene any time an opportunity arises

Assessing for risk – referring to appropriate service for provision of services. POP. Intervene when need identified. Discussions, listening, offer advice. Refer to appropriate member of MDT.

Anyone can plant the seeds of change at any time

Assess each person individually in a person centred way and in an anticipatory way. Distribute available information.

End of Course

In general terms have your needs been met by this module?

Yes, I have more awareness about housing solutions

Yes

Yes, more awareness of the importance of early identification and partnership working

Yes

Yes, very informative

Yes

Yes

Yes

Very interesting conversations, good mix of people, food for thought

Yes

Yes

I think so. Emphasis on each intervention. Good communication. Integrated working. Access to information.

Anything you liked?

Discussing case studies

Flow of presentation, relaxed environment, both speakers very good

Other agencies made aware of housing limitation

Group discussions

All of it

Case studies

Group interaction was effective and informative

Group work. Hearing solutions from other agencies. Hearing from other project groups

Liked all of it. Good group discussions between mixed agencies helped with understanding of each other’s roles

Presentation. Both speakers were easy to understand and interesting.

Anything you would change?

No

No

Room very small and crowded

Size of room

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No

No

No

No

Room slightly bigger

Any other comments?

Very thought provoking interactive session, thank you.

Very good course

Lovely lunch supplied by Maureen – thank you.

Thanks. Very helpful and informative and food for thought

Very interesting. Communication was good.