So much more than a tenancy with support

Realising the Potential of Extra Care Housing

Martin Routledge, Helen Sanderson and Sharon Wilton

Pete had a passion for dogs – he had them as pets throughout his childhood, had trained them during his time in the armed forces and had worked with them in sheepdog trials for many years. Many years passed and Pete came to live in an extra care housing tenancy, where to be honest, not much was going on until a new support provider took over and the council supported them to embed community circles. Sharon met him there and talked to him about the things he loved. Together they explored various ways for him to spend time with dogs. They looked at volunteering with a local animal shelter, made links to a national organisation where Pete could spend time with people’s dogs whist they were at work etc. While waiting for a match Sharon thought about the importance of “bringing your whole self to work”. She had a dog, Sam at home – could Pete borrow her dog?

Pete had found himself in real rut, frankly fed up, but now he was getting up in the morning, where previously he would stay in bed for most of the day. He was suddenly active spending time outdoors with Sam, where he would now sit chatting to others who lived in the same group of flats. Pete had a support worker who couldn’t believe the change in him noting that on his last few visits Pete had only spent about 5% of his time talking previous issues and the rest of the time talking about dogs. Staff members began to explore how they could build on this – maybe they could bring own their dogs to work so people living in the tenancies who wanted to spend time with dogs could do so? What else like this could they do?

Pete’s personality now really shone through – he had always been a sociable bloke with good memories of his time in the forces. He spoke fondly to others about those days and along with three other local veterans a Veteran’s Circle was formed. The four guys met regularly to chat, reminisce, have a laugh and support each other. The guys were then linked to the local Veterans hub who offered additional support and also invited them to join them for fishing tournaments and Veterans breakfasts.

To some this might not sound like that big a deal maybe? But for Pete it was really a life saver and it wasn’t happening before Sharon brought some approaches and ideas and supported the staff team to do this stuff. By keeping an absolute focus on what mattered to Pete as an individual, and by thinking about how we can “do what we can, with what we have, where we are”, Sharon showed individual and group Circles can not only get going but can flourish, grow and sustain. This brought all sorts of resources to bear that were left unused before.

Realising potential

For the past few years Community Circles and Wellbeing Teams have been working in a wide range of places and with many people concerned to achieve the best that we can currently imagine around supporting and generating community. As part of this, we have been exploring the potential of extra care housing, alongside commissioners and support and housing providers.

We agree with the Local Government Association and Association of Directors of Adult Social Care that we need to see significant growth of options beyond residential care such as true supported living, shared lives, home-share and other non-institutional forms of support, to give more options to people who move from their original homes. We think a growth in extra care housing could play a part in rebalancing the provision of accommodation with support.

At the same time, we have to be clear-eyed that much existing extra care housing provision is not realising it’s potential. Too many people have a tenancy with some support, but not a great life in a thriving place, well connected to local community links and resources. There is a danger, as extra care expands that “cheaper than residential care” becomes the only commissioning goal. This would let down thousands of people living in extra care housing. It is critical that person and community centred approaches are designed in.

The good news is that there are great examples to learn from and we have been privileged to benefit from and add to this in recent years. As we look to a likely expansion of extra-care we want to share some learning and possibilities from both Community Circles' experience and other work that Wellbeing Teams have done. This experience points us towards the best that we can currently imagine around supporting and generating community. We are currently looking for people and places that want to model this.

Community Circles have been working with a number of extra care settings that wanted to support tenants to have good lives through purpose and connections and to become thriving hubs well linked to their communities. It has also been great to see these places gain recognition from the regulator. Our lead on this work, Sharon talks of her mission and approach in starting work with three extra care settings in a north west authority:

“Although initially it was evident that isolation and loneliness were common-place in the settings I supported, our aim was to see communal areas buzz whilst being used to their full potential, for Circle meetings, and by community groups who had been introduced as a consequence of actions from those Circles. Within those environments every person I have met has a fascinating history and a wealth of skills and knowledge. We always kept in mind the value that these wonderful people could add both inside and outside of their respective extra care settings - helping each individual feel an important contributor to their respective communities. I have watched this initial vision for the future come to fruition -through collaborative, person-centred approaches and just a little bit of imagination sprinkled in for good measure”!

Circles in extra care are as individual as the places and the people who live within them. They flex and grow with the people involved and work with the environment and local community with the goal of supporting people to do more of what matters to them. At their heart are the person-centred approaches that ensure we keep the person and their purpose at the heart of everything we do.

Three years ago, across very different extra care settings the work began to develop, embed and sustain Circles. We began with the focus on individual circles, focussing on what mattered to that person. We introduced a volunteer to each person and together we would meet regularly to talk about what was important and to look at a series of actions to support them to move towards doing more of what mattered, whilst also supporting connections to others and their community.

With success we had a growing number of people being identified by care and support managers as potentially benefitting from a Circle, but not enough volunteers to match the need - so we also explored bringing people together, connecting around shared interests while always starting from individual purpose. The focus was on the things people wanted to connect to and the assets of local communities – looking at how they could also contribute to this adapted Circle model. We saw people grow in confidence with a purpose on which to focus. Communal areas were no longer under-utilised and people were regularly co-facilitating Circles, sharing knowledge both with others in the setting and externally.

Local children from nursery, primary and secondary schools, community charities, groups and organisations all played a part. We had input on everything from gardening and chickens to paragliding. Managers began to consider how team members could be more involved with Circles to ensure the model was sustainable. Those team members also brought a wealth of experience and began to contribute their time to art, baking, poetry and singing Circles (to name a few), those gifts of the head, heart and hands were valued and formed an important part of keeping the Circles model alive after our original project ended.

By working with our environment and keeping a focus on what matters most to people we can work together to build a great life in a thriving place.

Some of the main benefits we have witnessed from the Circles in Extra Care include:

•   Growth in people’s confidence and increased ability to lead their lives well
• People rediscovering purpose for their lives
• Making new friends and social contacts
• People feeling valued – sharing skills and talents with others
• Wanting to contribute to and be part of something bigger
• Positive mental health
• Improved health and mobility
• A flourishing of local links and community connections

With support from Skills for Care we pulled together practical learning and approaches from our early work into a handbook (currently in its second draft iteration) for others to use – with support if required. The new draft handbook offers detailed tools, advice and examples for people in a range of roles enabling support and housing providers to optimise the use of their available resources in enabling great lives and growing thriving communities. We are sharing it free and have a short development course starting in the spring

In parallel, Wellbeing Teams have been exploring and learning great approaches that can now be used with extra care. In the same way that we're taking an asset-based approach to the local community, we're taking a similar approach to people and their lives - looking at what matters to you, but going beyond that to thinking about the contributions that people might want to make. What are your gifts of the head, heart and hands? What's your personal purpose - what does a good life look like? Once we've learnt with people what their gifts are, what their strengths are, where they need support, we have conversations with them about "what does a good day and a good life look like" - both at home, where you live, in the community, and also online. So, we ask the question, "What do you want to do? How do you want to spend your time?" But also, "how do you want to contribute?" So, how do you want to bring your gifts of the head, heart and hands to what happens where you live, what happens online, and what happens in the local community?

To support this we can use the “support sequence”, which is:

• How do we support you to have the resources and confidence to take your ideas forward and live the life that you want?
• How can we use technology to do that?
• What could we do online?
• What can your friends and family and neighbours support you to do as well?
• What's available in the local community?
• What might you need paid support help you to do?

So we explore, can tech help? How can we connect you to what's going on in the local community. If what you want to do is not currently available in the local community, can we start an initiative together? Who might be interested in joining in that? So the outcome is that we have a weekly and monthly plan that people use to help structure their days, weeks and months, and that plan has what's going on at the hub, what's going on in the local community, and what's going on online. And one thing that we've been testing out is the possibility of a Tuesday morning coffee club, for example, where people get together, with a Community Connector, to help people plan their week and talk about what they're going to do and how that's going to happen.

With both Wellbeing Teams and with Community Circles, we've developed questionnaires about those things, because often, people are not aware of what's possible. So what we've found is that the value of questionnaires is it shows people what's possible, and it means that we can prioritise what the majority of people are interested in exploring. So when we did this with Wellbeing Teams in a north west authority, we did crafts events, which really challenged assumptions about what older people would be interested in doing - so as well as Knit & Natter, people wanted to do pebble painting, do crafts and create things, and be makers. So we were able to put those on, and we looked at indoor gardening as well. So that's how we can gather data about what people's priorities are, and make sure that those priorities are reflected in the weekly and monthly programme that can be created.

Thriving people and places

We are now looking to support those who want to build even more ambitiously from this experience and a wealth of examples of approaches gathered from ours and other’s learning around the country.

To offer an example, we have recently started a collaboration with Charlie Ratchford House in Camden. In an early development session to explore possibilities we started with the question "what's great here" 

“ how can we build on what's already going on around Charlie Ratchford - if we took a five-mile or a ten-mile radius, what's the richness of community life that's already happening that we can support people to connect to and be part of? But we also want to know, what else do people want to do here”?

We then started exploring elements of the approach we could take:

•  Make a physical community map, so people can see what's going on locally kept up to date by people living and working at Charlie Ratchford - working closely with local social prescribers who will also have this information, mutually sharing understanding about what's going on locally. Taking an asset-based approach - what's great about here and what's going on here, and how we can connect people to what's happening
• An aspiration is to be a hub for the local community. Traditionally, that would just be done with a cafe or an inside space, but much more is possible, starting with inclusive spaces, both inside and outside. An example of use of outside space would be the wonderful Incredible Edibles up in Todmorden – building ways to create food that people can eat that could both serve people living in Charlie Ratchford and the local community too. Another example is History Pin, where we look at creating oral and written records of the history around a place in the local community, developing things like story exhibitions - then hosting exhibitions for the local community These are just some ideas about how we can think more radically about a community hub, and a space that both serves people that live in Charlie Ratchford and the local community.
• Microenterprises and work-space - is it possible to have some of the community space, or the communal space with hotdesks that people could use - possibly with computers that they could rent or borrow supporting the upsurge in people being self-employed, doing small bits of work, as well as voluntary work. Community Catalysts could help with this and we could also connect with people in Camden who might also be working in this area - so that people are contributing to the community in a different way, not just around passions and volunteers. We can see this as an opportunity for people to build working opportunities too. Another example from elsewhere is electric bikes and a bike hub. Also pop-up makers' markets - so it may be that some of the work space is used by makers
• A focus on intergenerational opportunities - we’ve been supporting developments in care homes and extra care prior to COVID around different activities being based there or coming in, like nursery hubs for example. This might mean a local nursery or the local playgroup being based in extra care, and that creating opportunities for volunteering for some of the people who will live there.
• Circles Connected - something that we've been doing throughout COVID. Rather than being able to support people to meet locally, and support people to take advantage of what's happening, which we had started pre-covid, we've been doing this through Facebook (link). Essentially, we’ve put on a programme via the Circles Connected Facebook group of events or social activities that people can join online. And one of the ways that we've been developing this is to be able to support people to think about how they can plan their week using Facebook, so they can have a good day or a good week online using Facebook
• Small Sparks - this was developed by Carl Poll, inspired by activities that had happened in the States. ￡100 or ￡150 was donated, that people could use literally with a plan that could be written on the back of an envelope, that didn't have to go through multiple permissions. It could be, for example, an event that brings people together in a socially distanced way, to celebrate something locally. It could be doing something that's an intergenerational activity, with a local school and the local nursery that explores a particular activity or a theme. It could be to start up six weeks of regular activity around a theme. It could be to invest in the pop-up makers' market where people are trying different things to make, that they then sell in the makers' market
• It is important to build these approaches sustainably and a big challenge is that commissioned funds won’t usually support them, certainly beyond a start up period. Two possibilities we are looking to explore, initially hosted through Community Circles:

o  One is a 100 Club - something that already exists in some areas based on finding local businesses who are prepared to invest ￡100 on a monthly basis, a quarterly basis or an annual basis, which would ultimately then fund either the Small Sparks grants or some of the activities and social events that are happening. So for example, if you're a knitting business to give an example - you might support us by donations that enable us to buy wool for a Knit & Natter group that happens as part of the community hub. The business gets local publicity for this sponsorship of a community asset - letting people know that they're supporting our work

o  A Two Hours Club is asking for two hours of volunteering time either each month or each quarter. The volunteers would then support the different activities and social events that will be happening either in person or online. So for example, one of the things that's happening on Circles Connected has been a quiz time. So one possibility is somebody volunteers their time to host the quiz for an hour a week, and that we support people to join that. Because we can tap into Community Circles, and because we'll be bringing together volunteers nationally, Charlie Ratchford folk would benefit from a national network of volunteers who are contributing to Community Circles and Circles Connected, so it's more likely we can have great things happening that people can tap into.

• Technology. There are many possibilities, both in terms of:

1. Health - such as supporting the use of wearables
2. Home – such as use of smart home technology
3. Community - that might, for example, be having a number of tablets that people can use to tap into what's going on online through Circles Connected etc.
4. We may have some volunteers or co-production partners or tech champions who, if required or if asked by other people living in Camden could see what's possible around smart technology, around use of wearables. We know that this is possible, and people are proud to contribute their knowledge and skills that way.
5. One of the ways that we could use funding from the 100 Club, for example, or through Community Circles, is to generate a tech library, as we've done through Community Circles in our work in Abingdon, where we have a number of tablets that can be lent out to people who might be interested in accessing the Circles Connected programme.

•  Community Circles - where people come together in their sitting rooms or around a kitchen table to say, "How can we support each other to have the best life possible?" We've done this with in-person facilitators who might be volunteers; we've also got a virtual way of doing this to talk people through the Community Circle process - which is simply about looking at what's working and not working in your own life, thinking about who you might want to bring together, which might be neighbours that you live with or other people to support you to have the best life possible. This is a way that we organise the assets and community resources that are present in a slightly more formalised way, which is different to people hanging out together in the community hub.
• Community champions - these are people who don't live in extra care but do live in the local community - to be a community champion for a specific area. So one might be a local history community champion, one might be a gardening community champion, who might be able to connect us to local allotments alongside people who live in Charlie Ratchford and team members...

Roles, recruitment, values

At Charlie Ratchford we have the opportunity to start up something different and are exploring new team roles to support this activity and action at recruitment to get people ready for this new way of doing things. But even where new roles are not possible we will be really explicit in value-based recruitment and development that we're excited about inviting people to bring their whole self to work. That part of what will happen in their role is we'll be exploring with them what their gifts of the head, heart and hands are; we'll be looking at their work and life histories with them to see what gifts they bring. We do that right at the beginning in induction. We also do something called Future Focus that says, "What do you personally want to experience in your life? What do you want to contribute in your life? And how do you want to grow and develop?" And we use all of those three to ask people to think about and to explore together, "what do you want to do and how do you want to contribute?" So that some of paid working hours get channelled, either in the weekly or monthly plan, or to directly support individuals around good days at home, good days in the community. So, every single worker will be doing something that contributes to community people would like to do to inform both what happens at the hub and the community events, and be able to extend Small Sparks to everyone.

Conclusion/An invitation

We are looking for 5 – 7 Local Authorities who are eager to do something different in Extra Care. Based on learning from Community Circles and Wellbeing Teams

This could mean:

• A Fresh Focus: Wanting to create a service that focusses on Wellbeing and Community.
• New roles and a different way to organise support: Wanting to explore different ways of recruiting teams, with different roles and ways of working that support wellbeing and build community connections as well as providing CQC registered personal care support.
• New ways to provide support and deliver outcomes: Wanting to embed The Support Sequence so that self-care, technology and community is always considered when we co-design support with people.
• You may also be interested in re-thinking Extra Care and Home Care together
• We think that teams based within Extra Care could also support people in the same neighbourhood, delivering the support currently delivered by home care.
• Could we re-invent Extra Care and Home Care, to deliver it from a community hub, with the emphasis on wellbeing and community?

If you are interested, we have a small number of places at an on-line session in late February to explore what we can offer. Get in touch via [email protected]