Quality statement 7: Design and adaptation of housing

Quality statement

People with dementia live in housing that meets their specific needs.

Rationale

Housing can be designed or adapted in a way that helps people with dementia manage their surroundings, retain their independence, and reduce feelings of confusion and anxiety.

Quality measure

Structure:

a) Evidence of local arrangements to ensure that staff are trained to recognise when adaptations to housing can help meet the specific needs of people with dementia.

b) Evidence of local arrangements to ensure that new housing for people with dementia is designed to meet their specific needs.

Process:

a) Proportion of people with dementia and receiving care at home whose housing has been adapted to meet their specific needs.

Numerator – the number of people in the denominator whose housing has been adapted to meet their specific needs.

Denominator – the number of people with dementia and receiving care at home.

b) Proportion of care homes designed or adapted to meet the specific needs of people with dementia.

Numerator – the number of care homes designed or adapted to meet the specific needs of people with dementia.

Denominator – the number of care homes with people with dementia.

c) Proportion of extra-care housing that has been designed or adapted to meet the specific needs of people with dementia.

Numerator – the number of extra-care housing units that have been designed or adapted to meet the specific needs of people with dementia.

Denominator – the number of extra-care housing units.

d) Proportion of sheltered housing that has been designed or adapted to meet the specific needs of people with dementia.

Numerator – the number of sheltered housing units that have been designed or adapted to meet the specific needs of people with dementia.

Denominator – the number of sheltered housing units.

Outcome:

a) Feedback from people with dementia that their housing has been adapted to meet their specific needs.

b) Feedback from the carers of people with dementia that the person they support has had their housing adapted to meet their specific needs.

What the quality statement means for each audience

People with dementia live in housing that is adapted to help them maintain their independence.

Carers of people with dementia are involved in helping to identify how the housing of the person they support may be adapted to help maintain their independence.

Local authorities and others commissioning services work with providers to ensure the housing they commission is designed or adapted to meet the specific needs of people with dementia and also commission services that can adapt the homes of people with dementia to better meet their specific needs.

Organisations providing care and support ensure housing is designed or adapted to meet the specific needs of people with dementia.

Social care staff ensure housing meets the specific needs of people with dementia.

Source guidance

NICE clinical guideline 42 recommendations 1.1.10.1, 1.1.10.2 and 1.1.10.3.

SCIE guide 15: Practical assistance.

SCIE guide 47: Personalisation – a rough guide.

Data source

Structure: a) and b) Local data collection.

Process: a), b), c) and d) Local data collection.

Outcome: a) and b) Local data collection.

Definitions

Housing

This statement applies equally to people with dementia receiving care in their own homes or living in residential or care homes.

Design and adaptation

The design and adaptation of housing to help meet the needs of people with dementia could include changes to and use of:

  • lighting

  • colour schemes

  • floor coverings

  • assistive technology

  • signage

  • wide doorways

  • flat gardens, low-wall flower beds

  • glass-fronted cupboard doors in kitchens so people can see what is inside

  • memory cues

  • colour contrasts

  • minimising reflections and glare

  • notice boards.

Further suggestions are included in the King's Fund document Developing supportive design for people with dementia. Any adaptation should take into account the preferences of the person with dementia.

Extra-care housing

There is some local variance in the specific features of extra-care housing. The National Dementia Strategy implementation group produced a commissioning guide for extra care housing and dementia which describes extra-care housing as including the following features:

  • Care and support available to occupants around the clock.

  • Sheltered housing, not residential care. Occupants live in their own homes, have security of tenure via assured tenancy or lease, and can determine who comes into their homes and who delivers their support plan.

  • Often purpose built to Home For Life standards, and often includes a range of communal facilities.

  • Some aspects of Extra Care such as housing design and management are covered by housing legislation, regulations and standards, and other aspects, for example, care provision, by the non-residential community care framework and care registration requirements.

Sheltered housing

NHS Choices describes sheltered housing as including the following features:

  • Aimed at people over 60 years of age, although some schemes are available for over 55s.

  • Self-contained, purpose-built flats, houses or bungalows with their own front doors, kitchens and bathrooms.

  • Available for couples or single people and offering independent living with extra help if needed.

  • Run by scheme managers or wardens who may live on the site or work office hours. The scheme manager is there to help arrange suitable support for residents, to manage any repair work on the properties and to help out in emergencies.

  • Access to 24-hour emergency care assistance via an alarm system linked to a monitoring centre, which will contact a family member, GP or emergency service if needed.

Equality and diversity considerations

Social care and healthcare staff should identify the specific needs of people with dementia and their carers arising from diversity, including gender, sexuality, ethnicity, age and religion. These needs should be recorded in care plans and addressed (NICE clinical guideline 42 recommendations 1.1.1.3 and 1.1.1.5).