Community care and care homes

I had the pleasure of chairing the second in a series of webinars for The Institution of Engineering and Technology (IET) on Healthy Living and Housing.  The focus for this session was on care homes and community care. This built on the first session that focused on the links between our lived environments and our health.

You can access the session by clicking the link here, and registering to watch on demand.

Speakers for this session included

• Shirley Ayres, Co-Founder, Connected Care Network*
• Dai Roberts, Senior Programme Innovation Lead, Health Innovation Manchester
• Shirley Hall, Head of Innovation and Wellbeing, The ExtraCare Charitable Trust
• Lee Fordham, Associate Director, Architype

Clip from The IET’s EngShorts series covering many of the points raised in this discussion.

Creating new living choices for older people

Shirley Ayres outlined some of the opportunities and challenges in the care sector, calling for a radically different approach. For Shirley, it’s time we had a long term care revolution.

To put in today’s context, this is clearly a sector that has been hit hard by the COVID-19 pandemic. Thousands have died in the UK in residential and community care. Care homes have also been hit hard financially with some listed as being at risk of closure due to no longer being financially viable. There is an immediate practical need to support care homes and many older people in the community to reduce the risk of infection and to minimise the impact of isolation and loneliness.

But at the same time we also have the prospect of the hundred year life. There are currently almost 12 million people aged 65 and over in the UK and 3.2 million people over the age of 80. This is coupled by different expectations and aspirations for how we age, from housing to health, from how we live in our communities and engage in our workplaces.

No one sector or organisation has all the answers, and the lack of collaboration and exploration across many sectors continues to a serious barrier to rethink how we will all address our needs as we age. Social care is not fit for purpose.

Shirley made the case for taking full advantage of engineering and technological advances which will improve our quality of life at every age. And we all have a role in deciding, defining and designing our futures. As present, there are few choices. COVID-19 has been a hard wake up call about what happens when older adults have to rely on a broken and fragmented market.

And some of the proposed solutions?

At the system level

• Think differently about how we provide services for older adults and by including older people as part of these reforms;
• Ensure tech and design are fit for purpose with a genuine focus on inclusive design;
• Recognise that ‘the elderly’ are not an homogenous group, but have different wants and needs;
• Challenge assumptions about older people including language and choices, for example the use of Do Not Resuscitate Orders being put on people because or age and/or disability without discussion;
• Improve financial planning for individuals and families with respect to social care requirements; and,
• Develop viable alternatives to the default position of institutionalisation.

In care homes

• Improved adoption of tech to support care;
• Improved digital access and support for residents and staff; and,
• Digital skills training to support residents in staying connected and increase their social connections.

Shirley went on to describe what she wants to see. First, real choices about where people live and grow older. For herself, she wants personalized care, driven by the power of technology, a well designed, smart small home with sensors, a virtual personal assistant. She also stressed the importance of living in multigenerational communities.

Care homes and digital transformation in Greater Manchester

Dai Roberts discussed the care home and digital transformation programme being delivered in Greater Manchester. As part of this, they have put together a digital, web based programme to support care homes. This has been embedded into care homes as well at the strategic level across the health and social care system. This work has been purposed in response to COVID-19.

Health Innovation Manchester are one of fifteen Academic Health Science Networks across England. They take a partnership approach with care providers across Greater Manchester, academia, and industry.

This programme is being delivered to address some of the inequitable access to digital innovation across social care. It is this inequitable access that prevents the care home sector from sharing their knowledge and experiences of residents’ heath and wellbeing, and doing so effectively.

Since the UK went into lockdown in March, Health Innovation Manchester has been working with partners, developing a web based applications for care homes. This has been to record residents’ COVID-19 status on a daily basis, presented on a tablet based platform. This is so reports can be shared directly with GPs and the clinical control team.

They started the design in March with the first deployment of the new system into care homes from April. By June, almost 2,000 assessment had been done. Assessments continue to come in on a daily basis. They intend to extend this report further around clinical observations, including oxygen saturation. It allows for effective communication to care home staff and the wider health team.

Dai provided a sample slide demonstrating how the health of residents in care homes with COVID-19 symptoms can be tracked. It can be used to report factors such as levels of confusion, support tracking if there’s a deterioration over days, and in this way, ensure that clinical support teams have the information that need to provide proactive clinical support.

This initiative has been embedded across each of the 10 commissioning provider localities. This means as well as having useful information at the individual resident level, it’s possible to have a system level overview across Greater Manchester.

Providing support in retirement villages

Shirley Hall spoke about providing digital support to care homes and to residents, and supporting the development of sustainable communities that meet people’s needs. The ExtraCare Charitable Trust is a large retirement village provider and has over 20 locations. They provide homes that people want, that meet lifestyle requirements, and provide care if and when needed. Sites also include activities and voluntary coordinators. They also provide annual wellbeing assessments. On site, the villages have onsite domiciliary care, providing care to about 20% to 25% of residents.

All the new villages incorporate tech, done in discussion with residents. Examples of tech being used include Alexa and Google home speakers and systems to open and close blinds and doors. In addition, they can include sensors in apartments to measure temperature, humidity, or when residents might be getting up during the night. Relevant support and training is provided.

ExtraCare have been having smart markets over the last two years. As part of this, they have a knowledge transfer partnership with Bristol University. They also have a smart technology specialist who works with residents to showcase what is available.

And there are real health benefits. Shirley gave the example of one resident using a fitbit. Through this, they identified an irregular heartbeat. The resident went on to have a pacemaker fitted.

In response to COVID-19, they have ensured that all residents have the availability of broadband to contact friends and family via videocalls. This has involved training residents on how to use features such as Zoom. Zoom has also been used for exercise classes.

Building healthier care homes

Lee Fordham discussed the approach Architype take in designing buildings with a focus on reducing energy consumption, energy, and costs, improving wellbeing, and delivering positive building performance.

Lee went on to explain what a Passivhaus is. Think of the difference between a thermos flask and a cafetiere. A Passivhaus would be the thermos flask in that the fabric of the flask has been designed to have good insulation, be airtight, and it keeps the tea or coffee warm. On the other hand, a cafetiere keeps your coffee warm but uses a lot of energy to do it, wasting a lot in the meantime. So it’s about the fabric of the building ensuring that minimal energy is lost. It also includes a rigorous comfort standard. Underpinning this is the collection and application of data.

Passivhaus was developed in Germany about 30 years ago by Wolfgang Feist who was concerned about the performance gap between design and actual performance.

Lee talked through the St. Loyes Extra Care Scheme, a Social Care Unit just south of Exeter City Centre. It is currently being developed.  While the site itself is very tight in terms of what is possible, it’s been designed with particular features including:

• that all residents will have good views of the gardens
• the inclusion of ‘memory’ window that allow occupiers to look into communal spaces
• each flat has a direct link to communal spaces
• working with dementia care specialists, to include features such as rest places at the end of corridors
• the inclusion of natural materials and the exclusion of materials that are carcinogenic or have particulate matter offsetting of them
• the landscape design includes circular areas that people can wander around in and come back to where they began which will be important for those with dementia
• the heating system uses a MVHR (Mechanical Ventilation with Heat Recovery) system, providing fresh filtered air into the rooms which retaining most of the energy that has been used to heat it. It means that each flat has its own ventilation system and that air isn’t being recycled within rooms, leading to better health outcomes
• and measures have been put in place to ensure that the building remains comfortable for residents in the future give the predicted increase in global temperatures.

Key discussion points

Applicability of Passivhaus to existing housing stock

• In addition to new builds, Passivhaus principles and requirements can be used for upgrading existing housing stock. Requirements are slightly lower due to the complexity of retrofit, but there are many benefits. [See the EnerPHit Retrofit Plan]

Recommendations for how UK government could enhance support for care homes and the NHS

• While additional funding is important, what’s needed is for social care to be put on a similar footing to healthcare. As part of this, home care needs to be supported to meet needs.
• On workforce, there’s a real need to have highly qualified individuals with approach career structure in place in care homes and delivering care in the community.
• Data systems and structures in place to support individual care.
• With respect to the built environment, we need are better understanding of how care homes and people’s homes work – are they a healthy place to live? Are they ventilated correctly? Are there issues with damp? Are they energy efficient to reduce the risk of people falling into fuel poverty

Scaling up innovations

• We need to move beyond the ‘not invented here’ blocker to scaling up innovations. There remain challenges in scaling up new ideas and products.
• Social media is one potential avenue.
• Another is through networks such as the Academic Health Science Network. The Network brings together health and care, commercial partners, and others.

*Image courtesy of Shirley Ayres

As part of The IET’s series on Responding to COVID-19: Healthy Living and the home

1. Healthy living and housing
2. Community care and care homes
3. Monitoring vulnerable patients and remote diagnostics
4. Reducing social isolation and loneliness
5. Smart home tech to support people’s needs
6. The future of Intelligent homes to support health