1. Housing s role in dementia practice workshops: identifying skills and competencies

Transcription

1 1. Housing s role in dementia practice workshops: identifying skills and competencies Arneil Johnston, independent housing consultancy, has been commissioned by the Chartered Institute of Housing (CIH) to conduct research for the second phase of their successful Housing and Dementia Programme. This second phase will focus on improving links between housing organisations and partners in health, social care and the third sector, with a specific focus on the role of the housing professional in meeting the needs of those living with dementia. As part of this research, Arneil Johnston hosted a series of stakeholder events throughout the summer with a specific focus on: Examining key interactions, processes and pathways; Examining the role of the housing professional in dementia pathways; and Housing s role in building awareness and acceptance of dementia. The second round of these stakeholder engagement events focused on validating the roles, skills and knowledge requirements for housing professionals in each dementia pathway (as identified in the first round of events), in addition to defining the strategic priorities for developing dementia practice in each of the roles under examination (i.e. operational, specialist, managerial and strategic roles). These stakeholder engagement sessions were undertaken throughout September, the details of which are as follows: 1. 5 th September 2016, Tweed Horizons Centre, Newton St. Boswells; 2. 6 th September 2016, Dalziel Building, Lanarkshire; th September 2016, Lasswade Centre, Midlothian; and th September 2016, Elgin Town Hall, Moray. Each of the workshops were held from 2:00pm till 4:30pm and was based on the following programme: Timing Activity Nature of activity 14:00 14:10 Introduction & welcome AJ led briefing session 14:10 14:30 Session1: Housing & dementia practice quiz Interactive voting session 14:30 16:00 Session 2: The role of the housing professional in dementia pathways 16:00 16:20 Session 3: Developing the role in dementia practice: What are our priorities Interactive workstation activity Interactive activity 16:20 16:30 What happens next & close of session AJ led briefing session Briefing Paper Date 1

2 A range of professionals from Housing, Health, Social Care and Dementia services attended the stakeholder engagement events, with representatives from: Eildon Housing Association; North Ayrshire Council; Blackwood Housing Association; Midlothian Council; Scottish Borders Housing Association; Aberdeenshire Council; Hanover Housing Association; ; Link Group; Lochaber Care & Repair; Horizon Housing Association; Loretto Care; Cube Housing Association; Housing Support Enabling Unit; Clyde Valley Housing Association; Midlothian Health & Social Care Partnership; Loretto Housing Association; NHS Grampian; Bield Housing Association; NHS Lothian; Viewpoint Housing Association; Place, Home & Housing; Grampian Housing Association; Albyn Housing Society; Langstane Housing Association; Scottish Borders Council; North Lanarkshire Council; Housing Options for Older People (Wheatley Group); Dementia Services Development Centre; Midlothian Dementia Service; and Life Changes Trust. Briefing Paper Date 2

3 2. Key findings The skills and competencies workshops were designed to validate the role of housing professionals (defining the boundaries of operational, specialist, managerial and strategic roles) within each of the four dementia pathways, in addition to providing a validation of the core knowledge and skill requirements to support the delivery of each pathway. The key findings from these validation workshops are as follows: Generally, there was consensus across all of the events that the proposed role profile for housing professionals for each pathway was accurate and only a few minor amendments were highlighted by participants in relation to the language used. The only aspect of the role profile which was consistently questioned was in relation to pathway 1, namely To share information on the benefits of regular health screening. There was uncertainty surrounding the professional boundaries of Housing s role in relation to signposting into preventative Health services; In terms of the knowledge requirements, there was clear consensus across all of the events that specified requirements were reasonable within the role of the Housing worker and could support the delivery of each dementia pathway; Generally, there was consensus across all of the events that the proposed skill requirements were reasonable within the role of the Housing worker and could support the delivery of each dementia pathway. Only two minor amendments were identified by participants across all of the sessions, and these were in relation to the language used as opposed to the nature of the proposed skill requirement; With regards to the boundaries of operational, specialist, managerial and strategic roles, it was clear that there are some aspects of the housing role that are the responsibility of specific functional officers. Generally, where the roles have a direct customer focus, there was consensus that the functional responsibility should lie with frontline operational and specialist Housing staff. In contrast, where the roles have more of a strategic focus, there was consensus that the functional responsibility should lie with managers and strategic staff. Overall, the findings from the skills and competencies workshops show that the proposed role profiles, knowledge and skill requirements for each dementia pathway are accurate and could provide the foundation for testing knowledge and skill competencies with housing staff across the sector. The following sections of this briefing paper present the outcomes from the second round of stakeholder engagement events in further detail. Briefing Paper Date 3

4 3. Session 1: Housing & Dementia Practice Quiz Following a short introduction that set out the background to the project and the first series of stakeholder engagement events, stakeholders were invited to take part in an interactive activity using an electronic voting system, which was used to facilitate an ask the audience style session, with the results available instantaneously. The voting session tested stakeholders knowledge and perceptions of the role of the housing professional in meeting the needs of people with dementia. Stakeholders were presented with a series of statements in relation to the key issues relating to housing and dementia and were asked whether they thought it was true, false or if they didn t know. The statements presented are outlined in the table below, with the correct answer and the proportion of stakeholders who answered the question correctly, across the four stakeholder engagement events. Statement True False Don t know 1. There is currently no known cure for dementia 2. People with a dementia diagnosis usually need to move quickly to a care home or similar facility 3. Once a person is diagnosed with dementia, the condition usually deteriorates very quickly 4. People with dementia are incapable of making rational choices over their housing situation 5. Housing organisations should develop policies for people with dementia 6. Appropriate housing adaptations are a key part of enabling people to live longer safely at home 7. The 5 Pillars approach to dementia support is a statutory entitlement for PWD 98% 2% % 4% 4% 96% 4% 17% 8% 75% 8. The 8 Pillars approach to dementia support is a statutory entitlement for PWD Table 3.1: Outcomes for Dementia Workshop 2 Interactive Quiz 6% 26% 68% As can be seen from Table 3.1, there is a strong understanding of the requirement for housing professionals and organisations to play a significant role in supporting people with dementia. It should be noted that only the stakeholders who attended the Moray event had a mixed understanding in relation to whether or not housing organisations should develop policies for people with dementia, compared with their colleagues who attended the three other events who had stronger recognition of the importance of this. It is worth noting that across all of the stakeholder engagement events, there was a lower understanding of both the 5 Pillars and 8 Pillars models and whether or not they are statutory entitlements for people with dementia. These finding suggests that Housing awareness and knowledge of both models of practice is very limited and on this basis, the ability of the sector to make a positive contribution to the post diagnosis support or integrated care process is hindered. Briefing Paper Date 4

5 4. Session 2: The role of the housing professional in dementia pathways Following the interactive quiz, the participants at each of the stakeholder engagement events were split into four smaller groups, each focusing on one of the following dementia pathways: 1. Assisting and supporting someone to seek a diagnosis; 2. Early assessment of the suitability of someone s home; 3. Identifying appropriate changes to enable the person with dementia to remain at home/be returned home quickly; and 4. Ensuring holistic consideration of all aspects of assistance and support as dementia progresses. Each group was asked to examine housing s role in the dementia pathway they were assigned to and to consider the extent to which operational, specialist, managerial and strategic functional roles are involved in supporting delivery. In addition to this, participants were asked to assess the key knowledge and skill requirements to perform the role in relation to their assigned dementia pathway. Each group was directed to the relevant workstation, each of which were dedicated to a dementia pathway as outlined above. The following materials were presented at the workstation for the associated dementia pathway: Firstly, participants were asked to examine the proposed elements of the housing role presented for their assigned dementia pathway and answer the following questions: 1. Is this the extent and nature of housing s role in this pathway, i.e. is this the extent and nature of involvement that housing professionals should engage in? 2. Are there other aspects of the role (in terms of function or responsibility) that need to be included? 3. Is there any aspect of this proposed role that is not a housing role and should be delivered by partners in health, social work or dementia services? Secondly, once the groups were satisfied that the elements of the housing role in their assigned pathway was accurate, participants were then asked to identify which elements of the role were the specific responsibility of each functional role (i.e. frontline operational, frontline specialist, leadership & management and planning & strategy). Girds were presented at each workstation, with each element of the housing role in a single column, with blank boxes under each specific functional role to allow participants to tick which functional roles have the responsibility for each of the roles identified under each dementia pathway. An example of the grid is provided below for reference: Following their assessment of the role profiles, each group was then asked to repeat the above process for both the proposed knowledge and skill requirements associated with housing s role for their assigned dementia pathway. Briefing Paper Date 5

6 Once participants had completed their assessment of their assigned dementia pathway, each group was asked to move to another workstation to validate a second dementia pathway and the first group s assessment of the role profile, knowledge and skill requirements. The responses of each group were tracked to enable differences in perceptions or opinions to be established. The following sections of this briefing paper outline the results of the assessments and validations of the role profiles, knowledge requirements and skill requirements associated with each dementia pathway, for each of the stakeholder engagement events. Appendix 1 of this briefing paper offers a detailed breakdown of staff validation and assessment for each pathway and across the functional roles specified The Role of the Housing Professional in Dementia Pathway 1 Staff considering the role profile associated with dementia pathway 1 ( Assisting and supporting someone to seek a dementia diagnosis ) were asked to consider the outcomes of Workshop 1 as follows: Staff then validated the role profile and associated knowledge and skill requirements developed as an outcome of the work to define the housing role in assisting and supporting diagnosis. Key validation outcomes on the role, knowledge and skills requirements for Pathway 1 are as follows: Role profile: assisting & supporting to someone to seek a diagnosis Across all of the stakeholder engagement events, participants felt that the proposed role profile for housing in dementia pathway 1 was accurate. The only profile which was questioned was to share information on the benefits of regular health screening as participants were unsure of the boundaries associated with this and the extent to which this was a major role for housing, i.e. perhaps a greater role for health and social work; In terms of additional aspects of the role, participants felt that there should be a role for housing in relation to understanding a person s capacity to make decisions and building strong links with customers POA; Briefing Paper Date 6

7 Generally speaking, there was consensus that both frontline operational and frontline specialist staff should be involved in almost all aspects of the role profile for housing, with the exception being in relation to using Housing Contribution Statements, where there was consensus that both managers and strategy staff have a greater level of responsibility for this aspect of the role Knowledge requirements: Assisting & supporting to someone to seek a diagnosis Across all of the stakeholder engagement events, there was consensus that the proposed knowledge requirements were accurate and could support the delivery of pathway 1 and no amendments were identified; Generally, there was consensus across all of the groups that all members of staff should have the majority of the proposed knowledge requirements to deliver pathway 1. However, there is a clear distinction in functional responsibility in relation to knowledge of the personal and property signals where frontline operational and specialist staff should have greater knowledge of these signals, and this should be less of a requirement for managers and strategy staff Skill requirements: Assisting & supporting to someone to seek a diagnosis Across all of the stakeholder engagement events, there was consensus that the proposed skill requirements were accurate and could support the delivery of pathway 1 and no amendments were identified; For 5 of the proposed skill requirements, there is a clear divide in relation to functional responsibility, namely: Recognise the signs and signals of dementia where it was highlighted that all frontline staff should have the skills to recognise these dementia related signs and signals given the nature of their role, but this should be less of a requirement for managers and strategy staff; Where signs and signals of dementia are present, active signposting to services where it was highlighted that all frontline staff should be able to actively signpost customers to relevant services where dementia signs and signals are present, but this should be less of a requirement for managers and strategy staff; Understand how to manage sensitive conversations where it was highlighted that all frontline staff and managers should have the skills to manage these sensitive conversations given the nature of their roles, but there is little or no requirement for strategy staff to have these skills; Ability to build confidence and trust where it was highlighted that all frontline staff and managers should have the skills to be able to build confidence and trust with customers, given the nature of their roles, but there is little or no requirement for strategy staff to have these skills; and Develop Housing Contribution Statements where it was highlighted that managers and strategy staff should have the skills to develop these Statements given the strategic nature of their roles, but there is little or no requirement for frontline staff to have these skills. Briefing Paper Date 7

8 4.2. The Role of the Housing Professional in Dementia Pathway 2 Staff considering the role profile associated with dementia pathway 2 ( Early assessment of the suitability of someone s home ) were asked to consider the outcomes of Workshop 2 as follows: Staff then validated the role profile and associated knowledge and skill requirements developed as an outcome of the work to define the housing role in early assessment of the suitability of the home environment. Key validation outcomes for the role, knowledge and skills requirements for Pathway 2 are as follows: Role profile: Early assessment of the suitability of someone s home Across all of the stakeholder engagement events, participants felt that the proposed role profile for housing was accurate and no amendments were noted by any participants; Participants identified two potential additions to the proposed role profile, namely: The need for housing adaptations to be identified and implemented by housing organisations at the earliest possible stage; and The need for a supporting role in relation to multi-disciplinary planning. Generally speaking, there was consensus that both frontline operational and frontline specialist staff should be involved in the majority of the proposed role profile for housing. However, there are some aspects of the role profile where managers and strategy staff having greater functional responsibility, all of which have a focus on either strategy development or funding processes. Briefing Paper Date 8

9 Knowledge requirements: Early assessment of the suitability of someone s home Across all of the stakeholder engagement events, there was consensus that the proposed knowledge requirements were accurate and could support the delivery of pathway 2 and no amendments were identified; Generally, there was consensus across all of the events that all members of staff should have the majority of the proposed knowledge requirements to deliver pathway 2. However, there is a clear distinction in functional responsibility in relation to knowledge of appropriate commissioning routes where strategy staff and managers should have greater knowledge of these routes, and this should be less of a requirement for frontline operational and specialist staff Skill requirements: Early assessment of the suitability of someone s home Across all of the stakeholder engagement events, there was consensus that the proposed skill requirements were accurate and could support the delivery of pathway 2. Participants highlighted one potential amendment in relation to Collaborate with dementia design experts where it was felt that the language could be improved, i.e. collaborate to work with ; Generally, there was consensus across all of the events that managers and strategy staff should possess the vast majority of the skill requirements to support the delivery of pathway 2, with a lower level of skills required for all frontline staff. This divide in functional responsibility is particularly evident in relation to four of the proposed skill requirements (which either focus on commissioning arrangements or strategic planning), namely; Ability to commission housing suitability and dementia friendly design appraisals ; Ability to commission agreed property adaptations, manage funding and delivery processes ; Asset management and investment planning that promotes dementia friendly design principles ; and Evidence needs and associated resource requirements for investment in dementia related adaptations as part of Housing Contribution and LHS processes. Briefing Paper Date 9

10 4.3. The Role of the Housing Professional in Dementia Pathway 3 Staff considering the role profile associated with dementia pathway 3 ( Identifying appropriate changes to enable the PWD to remain/return to home quickly ) were asked to consider the outcomes of Workshop 3 as follows: Staff then validated the role profile and associated knowledge and skill requirements developed as an outcome of the work to define the housing role in enabling a person with dementia to remain and return home. Key validation outcomes for the role, knowledge and skills requirements for Pathway 3 are as follows: Role profile: Identifying appropriate changes to enable the PWD to remain/return to home quickly Across all of the stakeholder engagement events, although it was agreed that generally the proposed role profile for housing was accurate, some of the participants felt that to interact with occupational therapists should also include interactions with colleagues in health; Participants also noted that in relation to supporting hospital discharge planning, housing should have less of a role here and that colleagues in health and social work services should have a greater role; There was consensus across all of the stakeholder engagement events that all members of housing staff have a greater role to play in relation to pathway 3. However, the divide in functional responsibility is evident in relation to two aspects of the role profile, namely: To interact with occupational therapists, carers and the family where there was clear consensus across all of the groups that this should be a role for both frontline operational and specialist staff, given the level of interaction with customers; and Briefing Paper Date 10

11 To integrate proven dementia friendly housing design features where there was clear consensus across the vast majority of groups that this should be a role for both managers and strategy staff, given the links with financial and asset planning strategies Knowledge requirements: Identifying appropriate changes to enable the PWD to remain/return to home quickly Across all of the stakeholder engagement events, there was consensus that the proposed knowledge requirements were accurate and could support the delivery of pathway 3 and no amendments were identified; Generally, there was consensus across all of the events that all members of staff should have the majority of the proposed knowledge requirements to deliver pathway 3. However, the divide in functional responsibility is evident in relation to three aspects of the knowledge requirements, namely: Awareness of the 8 Pillars Model where it was highlighted that strategy staff and managers should have a greater knowledge of the Model in comparison to frontline operational and specialist staff; Awareness of the range of health services available where it was highlighted that all frontline staff and managers should have knowledge of these services but this is less of a requirement for strategy staff; and Awareness of the need to share contact details where it was highlighted that all frontline staff and managers should have knowledge of the need to share the contact details of housing leads but this is less of a requirement for strategy staff Skill requirements: Identifying appropriate changes to enable the PWD to remain/return to home quickly Across all of the stakeholder engagement events, there was consensus that the proposed skill requirements were accurate and could support the delivery of pathway 3; Participants highlighted one potential amendment in relation to Understand the need to proactively provide key housing circumstances where it was felt that the words with landlords should be removed; Generally, there was consensus across all of the events that all frontline staff should possess the vast majority of the skill requirements to support the delivery of pathway 3, with a lower level of skills required for managers and strategy staff. This divide in functional responsibility is particularly evident in relation to three of the proposed skill requirements (which either relate to tenancy management or customer support), namely; Ability to recognize the key signs (e.g. increases in accidents at home) and signals that typically indicate a person with dementia is at risk of a health emergency or hospital admission to inform preventative action with care managers ; Deliver a robust approach to tenancy management to protect the housing status of a person with dementia admitted to hospital or respite, e.g. ensuring the property is completely secure ; and Supporting the involvement of a person with dementia to ensure outcomes are optimised when remaining at home or transitioning to alternative accommodation. Briefing Paper Date 11

12 4.4. The Role of the Housing Professional in Dementia Pathway 4 Staff considering the role profile associated with dementia pathway 4 ( Ensuring holistic consideration of all aspects of assistance and support as dementia progresses ) were asked to consider the outcomes of Workshop 4 as follows: Staff then validated the role profile and associated knowledge and skill requirements developed as an outcome of the work to define the housing role in holistic assistance and support. Key validation outcomes for the role, knowledge and skills requirements for Pathway 4 are as follows: Role profile: Ensuring holistic consideration of all aspects of assistance and support as dementia progresses Although participants felt that the proposed role profile for housing in relation to pathway 4 was accurate, two potential amendments were identified, namely: To develop dementia specific customer care standards should change to dementia friendly standards ; and In addition to the organisational strategies and policies outlined in role profile 4, participants noted that policies which provide clarity on housing s role in an integrated approach should also be included. In terms of additional aspects of the role profile that should be included, participants felt that there should be a process for sharing information and concerns about PWD across services. Generally, there was consensus across all of the groups that all members of housing staff have a greater role to play in relation to pathway 4. However, there is one aspect of the role profile where this is not the case and the functional responsibility has been taken away from frontline operational staff, i.e. To integrate Briefing Paper Date 12

13 proven dementia friendly housing design features. The responsibility of this aspect of the role profile has fallen with frontline specialist staff, strategy staff and managers, given the links with financial and asset management strategies Knowledge requirements: Ensuring holistic consideration of all aspects of assistance and support as dementia progresses Across all of the stakeholder engagement events, there was consensus that the proposed knowledge requirements were accurate and could support the delivery of pathway 4 and no amendments were identified; Generally, there was consensus across all of the events that all members of staff should have the majority of the proposed knowledge requirements to deliver pathway 4. However the divide in functional responsibility is evident in relation to two aspects of the knowledge requirements, namely: Knowledge of the key principles of the 5 and 8 Pillar Models where it was highlighted that managers along with frontline specialist and strategy staff should have knowledge of these models but this is less of a requirement for frontline operational staff; and Awareness of the range of local partners and resources where it was highlighted that all frontline staff and managers should have knowledge of these local resources given the nature of their role, this is less of a requirement for strategy staff Skill requirements: Ensuring holistic consideration of all aspects of assistance and support as dementia progresses Across all of the stakeholder engagement events, there was consensus that the proposed skill requirements were accurate and could support the delivery of pathway 4 and no amendments were identified; Generally, there was consensus across all of the events that managers and strategy staff should possess the majority of the skills required to support the delivery of the pathway 4, with a lower level of skills required for all frontline staff (in most cases). This divide in functional responsibility is particularly evident in relation to three of the proposed skill requirements (which all have a very strategic focus), namely: Ability to develop coherent strategy, action plans and organisational policies which promote housing s role in an integrated approach to dementia care ; Ability to assimilate knowledge of specialist guidance and best practice on dementia and operationalise into effective housing policy ; and Leadership and promotion of the many benefits of housing intervention and investment in dementia care to H&SC partnerships. In relation to two of the proposed skill requirements for pathway 4, there was consensus that all frontline staff should possess these skills as opposed to managers and strategy staff (which focused on Housing Options and communication with people with dementia), namely: Housing options skills including diagnostic needs assessment, customer empowerment, positive action planning ; and Effective communication (including active listening) and proactive engagement with people with dementia, their carers and families. Briefing Paper Date 13

14 5. Session 3 Developing the housing role in dementia practice: What are our priorities? For the final activity, each of the proposed knowledge and skill requirements were displayed at individual workstations for each dementia pathway. Participants were then asked to review each of the pathways which they had considered in the previous activity, and select both one knowledge and skill requirement that has the potential to be transformative in relation to housing service delivery. Appendix 2 outlines the proportion of participants who selected each knowledge and skill requirement as being transformational for each dementia pathway. Across each of the four workshops, the knowledge and skill requirements which were identified as having the most potential to be transformative to frontline housing practice for each dementia pathways are as follows: Briefing Paper Date 14

15 Appendix 1 - Validation of Housing Role Profile in Each Dementia Pathway Briefing Paper Date 15

16 Appendix 1 - Validation of role profiles Through discussion, each group examined the proposed role profile for their assigned dementia pathway. In order to establish, which functional housing staff were most involved in delivery, the proportion of the total score assigned to each staff category was calculated and then ranked. The high level outcomes are as follows: Pathway Dementia Pathway 1: Assisting & supporting someone to seek a diagnosis Dementia Pathway 2: Early assessment of the suitability of someone s home Dementia Pathway 3: Identifying appropriate changes to enable the PWD to remain/return to home quickly Dementia Pathway 4: Ensuring holistic consideration of all aspects of assistance and support as dementia progresses Frontline operational Frontline specialist Leaders & managers Strategy & planning 3 31% 21% 18% 24% 26% 26% 24% 25% 28% 25% 22% 2 24% 31% 25% There was consensus that both frontline operational and frontline specialist staff should play a key role in pathway 1; There was consensus that all staff should be involved in delivering pathway 2; There was consensus that all staff to some extent have a role to play in relation to delivering pathway 3, in particular frontline specialist staff and less so strategy and planning staff; and There was consensus that both leaders and managers should have a key role in the delivery of pathway 4. Briefing Paper Date 16

17 Session 2 - Validation of Knowledge & Skills requirements Through discussion, each group examined the proposed role profile for their assigned dementia pathway. In order to establish, which functional housing staff were most involved in delivery, the proportion of the total score assigned to each staff category was calculated and then ranked. The outcomes for each functional role profile and for each dementia pathways are set out in the following summary tables: Knowledge / Skill Requirement Frontline Operational Pathway 1 10 Top Knowledge Requirement Pathway 2 89% Pathway 3 9 Pathway 4 89% Pathway 1 92% Top Skills Pathway 2 67% Pathway 3 10 Pathway 4 36% Frontline operational staff need all aspects of the proposed knowledge requirements to deliver pathway 1; Frontline operational staff need the majority of the proposed knowledge requirements to deliver pathway 2, with the exception of commissioning routes for implementing design appraisals, specifying work and subsequent procurement; Frontline operational staff should have the majority of the proposed knowledge requirements to deliver pathway 3, with the exception of having the awareness of the 8 Pillars Model under evaluation and the role of housing and environment within an integrated approach to dementia care; Frontline operational staff should have the majority of the proposed knowledge requirements to deliver pathway 4, with the exception of having the knowledge of the key principles of the 5 and 8 Pillar models and housing s role within an integrated approach to dementia care; Frontline operational staff need all aspects of the proposed skill requirements to deliver pathway 1, with the exception of developing Housing Contribution Statements; Frontline operational staff need all aspects of the proposed skill requirements to deliver pathway 2, with the main exception of asset management and investment planning that promotes dementia friendly design principles; Frontline operational staff should have all aspects of the proposed skill requirements to deliver pathway 3; and Frontline operational staff need core skills in customer care and effective communication (within the context of dementia) to deliver pathway 4. Briefing Paper Date 17

18 Knowledge / Skill Requirement Top Knowledge Requirement Top Skills Frontline Specialist Pathway 1 10 Pathway 2 89% Pathway 3 10 Pathway 4 10 Pathway 1 92% Pathway 2 75% Pathway 3 10 Pathway 4 45% Frontline specialist staff need all aspects of the proposed knowledge requirements to deliver pathway 1; Frontline specialist staff should have all aspects of the proposed knowledge requirements to deliver pathway 2, with the exception of commissioning routes for implementing design appraisals, specifying work and subsequent procurement; Frontline specialist staff need all aspects of the proposed knowledge requirements to deliver pathway 3; Frontline specialist staff need all aspects of the proposed knowledge requirements to deliver pathway 4; Frontline specialist staff need all aspects of the proposed skill requirements to deliver pathway 1, with the exception of developing Housing Contribution Statements; Frontline specialist staff need all aspects of the proposed skill requirements to deliver pathway 2, with the exception of asset management and investment planning that promotes dementia friendly design principles; Frontline specialist staff need all aspects of the proposed skill requirements to deliver pathway 3; and Frontline specialist staff skills needed to deliver pathway 4 focus on customer care in the context of dementia awareness. Briefing Paper Date 18

19 Knowledge / Skill Requirement Top Knowledge Requirement Top Skills Leaders & Managers Pathway 1 9 Pathway 2 10 Pathway 3 10 Pathway 4 10 Pathway 1 92% Pathway 2 10 Pathway 3 67% Pathway 4 82% Leaders and managers need all aspects of the proposed knowledge requirements to deliver pathway 1, with the exception of the knowledge of the signs and signals associated with dementia; Leaders and managers need all aspects of the proposed knowledge requirements to deliver pathway 2; Leaders and managers need all aspects of the proposed knowledge requirements to deliver pathway 3; Leaders and managers need all aspects of the proposed knowledge requirements to deliver pathway 4; Leaders and managers need all aspects of the proposed skill requirements to deliver pathway 1, with the exception of recognising the signs and signals of dementia and where diagnosis could be beneficial to well-being and housing sustainment; Leaders and managers need all aspects of the proposed skill requirements to deliver pathway 2; Leaders and managers need skill associated with developing and maintaining effective partnerships and joint working arrangements as well as the ability to engage in effective information sharing to deliver pathway 3; and Leaders and managers need all aspects of the proposed skill requirements to deliver pathway 4, with the exception of housing option skills and effective communication Briefing Paper Date 19

20 Knowledge / Skill Requirement Top Knowledge Requirement Top Skills Strategy & Planning Pathway 1 8 Pathway 2 10 Pathway 3 8 Pathway 4 67% Pathway 1 67% Pathway 2 10 Pathway 3 44% Pathway 4 64% Strategy and planning staff need all aspects of the proposed knowledge requirements to deliver pathway 1, with the exception of knowledge of the personal and property signals as well as the awareness of 4 key pathways to diagnosis; Strategy and planning staff need all aspects of the proposed knowledge requirements to deliver pathway 2; Strategy and planning staff need all aspects of proposed knowledge requirements to deliver pathway 3, with the exception of awareness of the range of health services available and the need to share contact details; Strategy and planning staff need minimum proposed knowledge of the 5 & 8 Pillar Models, operational policies and procedures and the importance of organisational strategy and policies in order to deliver pathway 4; Strategy and planning staff need skills to promote the delivery of a housing options approach in order to deliver pathway 1; Strategy and planning staff need all aspects of the proposed skill requirements to deliver pathway 2; Strategy and planning staff need skills associated with the delivery of a housing options approach to discharge planning to identify and assess accommodation solutions and options to support independent living, in order to deliver pathway 3 Strategy and planning staff need skills which enable the co-production of dementia related housing policy and strategy as well as establishing robust data on the scale of the issues associated with housing and dementia, in order to deliver pathway 4 Briefing Paper Date 20

21 Appendix 2: Transformational Knowledge & Skills Requirements Briefing Paper Date 21

22 Appendix 2 Transformational Knowledge & Skills Requirements Participants were asked to review each dementia pathway, examined in detailed in interactive activity 2, and select one knowledge and skill requirement that has the potential to be transformative in relation to frontline housing practice. The detailed results are set out in the following tables Pathway 1: Assisting & supporting someone to seek a diagnosis Transformational knowledge % Transformational skills % 1. Baseline understanding of the natural ageing process and how it affects the lives of older people 2. Baseline understanding of dementia and how it affects daily living including the challenges for someone with dementia to maintain housing status 3. Knowledge of the signs and signals associated with dementia including awareness of the '3 D's: delirium, dementia and depression 4. Knowledge of the personal and property signals that indicate where changes in a person s pattern of behaviour (mood, conduct, social interaction or property standard) could be dementia related 5. Awareness of the benefits of early diagnosis in enabling a person with dementia to have an active voice in decisions about housing, support and care 6. Knowledge of acceptable language to use when talking about dementia 7. Knowledge of the principles and practice of '5 Pillars Model' of post diagnostic support 8. Awareness of 4 key pathways to diagnosis: (i) motivate person to make selfreferral to GP; (ii) make social work referral with consent; (iii) make adult protection referral without consent; (iv) signpost with consent to support services 9. Awareness of local support services for newly diagnosed individuals 10. Knowledge of the housing options available to support a person living with dementia as part of an integrated approach to care planning 4% 1. Recognise the signs and signals of dementia and where diagnosis could be beneficial to wellbeing and housing sustainment 21% 2. Where signs and signals of dementia are present, active signposting to services that support well-being and housing sustainment (including routine health screening) 4% 3. Understand how to manage sensitive conversations regarding the potential need for dementia diagnosis, i.e. simple, informal interactions that build trust and encourage service engagement 21% 4. Understand the need for consent to share information within each diagnosis pathway and the right of the individual to provide or withhold information 36% 5. Understand the pathway for expressing concern regarding dementia diagnosis including ability to activate appropriate adult protection processes and pathway 6. Ability to build confidence and trust so that engaging people in early conversations about well-being and dementia is possible 7. Understand and promote the benefit of early dementia diagnosis by improving staff, customer and community awareness of the condition 7% 8. Encourage awareness and acceptance of dementia issues to reduce the stigma associated with talking about dementia at a customer and community level 4% 9. Understand the dementia diagnosis pathway and how to signpost/support someone to enter that pathway 4% 10. Post diagnosis, support co-production of decision making on housing options and enable client involvement 11. Understand and promote the role of housing in post diagnostic support planning, highlighting the preventative impact of housing interventions 12. Develop Housing Contribution Statements which develop integrated protocols that encourage early interaction between housing, health, social work and dementia services 3 7% 17% 1 7% 3% 7% 1 3% 7% Briefing Paper Date 22

23 Pathway 2: Early assessment of the suitability of someone s home Transformational knowledge % Transformational skills % 1. Awareness of the importance of housing layout and design factors in promoting wellbeing and the importance of maintaining continuity at home whilst enhancing safety and security 2. Awareness of the 6 key principles of dementia friendly design and how they contribute to safety and wellbeing for people with dementia 3. Knowledge of the top 10 adaptations for people with dementia 4. Knowledge of how dementia affects spatial and visual awareness and the range of design interventions that can improve safety and wellbeing 5. Knowledge of what works in specifying property adaptations and design interventions in terms of the dwelling type and external environment 6. Knowledge of the process for commissioning housing suitability appraisal 7. Knowledge of appropriate commissioning routes for implementing design appraisals, specifying work and subsequent procurement 8. Knowledge of specialist or expert advisors on dementia friendly design and housing interventions, e.g. OTs and dementia designers 9. Knowledge of the key assistive technology options which may enhance adaptations to the home environment 36% 1. Understand the impact of old age and dementia, why environments matter in dementia care and the range of housing interventions that can be considered to adapt the home environment 3 2. Understand the role of the housing suitability assessment in a holistic and integrated approach to dementia care 18% 3. Recognise and address common hazards in a home environment as part of an integrated approach to housing, care and support planning 9% 4. Advocate customer choice in defining options within the housing suitability appraisal 1% 5. Ability to engage people with dementia, carers or family to explain housing options and design interventions or solutions 6. Collaborate with dementia design experts to define housing interventions and adaptions that are person centred, effective and efficient 7. Understand the links between property adaptations, assistive technology and support options in supporting an integrated approach to dementia care 9% 8. Understanding the links between housing suitability appraisals and a housing options approach to meeting the needs of people with dementia 9. Ability to commission housing suitability and dementia friendly design appraisals 10. Ability to commission agreed property adaptations, manage funding and delivery processes 11. Asset management and investment planning that promotes dementia friendly design principles 12. Evidence needs and associated resource requirements for investment in dementia related adaptations as part of Housing Contribution and LHS processes 42% 9% 9% 3% 12% 9% 15% Briefing Paper Date 23

24 Pathway 3: Identifying appropriate changes to enable the person with dementia to remain at home/be returned home quickly Transformational knowledge % Transformational skills % 1. Basic awareness of the signs, signals and impairments associated with the most common types of dementia and how this affects day to day living in a home environment 2. Knowledge of the range of interventions that can be pursued to enable a person with dementia to live independently (design changes/adaptations, assistive technology and housing options assessment) 3. Awareness of the 5 Pillars Model and the role of the named person in planning and coordinating post diagnostic support 4. Awareness of the 8 Pillars Model under evaluation and the role of housing and environment within an integrated approach to dementia care 5. Knowledge of key housing interventions to support independent living including top ten aids and adaptations and the benefits of assistive technology 6. Awareness of Alzheimer Scotland s Dementia Circle work including the range of products that can help people with dementia remain independent for longer 7. Awareness of the range of health services available to provide support in a home environment to prevent emergency or unplanned admissions 8. Awareness of the need to share contact details of housing leads with health and social care staff on admission to enable an early approach to discharge planning 9. Awareness of Housing s role in support planning for hospital discharge via housing suitability appraisals to define the options for adaptations, technology, housing support or specialist accommodation 10. Understand the links between dementia and social isolation and encourage engagement with social activity and wider community participation. 31% 1. Ability to recognise the key signs (e.g. increases in accidents at home) and signals that typically indicate a person with dementia is at risk of a health emergency or hospital admission to inform preventative action with care managers 38% 2. Ability to develop and maintain effective partnerships and joint working arrangements with health, social work and third sector partners as part of an integrated approach to dementia care 3% 3. Ability to engage in effective information sharing as part of an integrated approach to dementia care 3% 4. Understanding the need to proactively provide 'key housing circumstances' information to improve communication with landlords and enable better continuity of care 6% 5. Deliver a robust approach to tenancy management to protect the housing status of a person with dementia admitted to hospital or respite, e.g. ensuring the property is completely secure 6. Define options for adaptations, technology, housing support or specialist accommodation as part of discharge planning processes 13% 7. Promote the delivery of a housing options approach to discharge planning to identify and assess accommodation solutions and options to support independent living 3% 8. Supporting the involvement of a person with dementia to ensure outcomes are optimised when remaining at home or transitioning to alternative accommodation 3% 9. Provide comprehensive information and advice on local resources, promoting engagement with preventative support services and community activities 35% 29% 3% 9% 3% 3% 18% Briefing Paper Date 24

25 Pathway 4: Ensuring holistic consideration of all aspects of assistance and support as dementia progresses Transformational knowledge % Transformational skills % 1. Basic awareness of the signs, signals and impairments associated with the most common types of dementia and how this affects day to day living in a home environment 2. Knowledge of the range of interventions that can be pursued to enable a person with dementia to live independently (design changes/adaptations, assistive technology and housing options assessment) and the importance of early intervention as dementia progresses 3. Knowledge of housing and dementia training options including SVQ s, Promoting Excellence (Level 1 for all housing practitioners/ Level 2 training for all specialised staff), DSDC Courses, Dementia Friends training 4. Knowledge of available learning and best practice materials to support positive practice in meeting the needs of people with dementia including resources from DSDC, Alzheimer Scotland and Age Concern 5. Knowledge of the key principles of the 5 and 8 Pillar models and housing s role within an integrated approach to dementia care 6. Awareness of importance of organisational strategy and policies to support people with dementia 7. Awareness of operational policies and procedures to promote positive housing outcomes in meeting the needs of people with dementia (including customer care standards) 8. Awareness of the range of local partners and resources that can be used to support people with dementia 9. Knowledge of the housing options available to support a person living with dementia as part of an integrated approach to care planning 3 1. Training needs analysis in the context of dementia awareness and best practice 19% 2. Housing options skills including diagnostic needs assessment, customer empowerment, positive action planning 7% 3. Leadership in promoting dementia awareness, organisational behaviour and service culture which enables a proactive role for housing in meeting the needs of people with dementia 2% 4. Customer care in the context of dementia awareness 7% 5. Effective communication (including active listening) and proactive engagement with people with dementia, their carers and families 5% 6. Ability to develop coherent strategy, action plans and organisational policies which promote housing s role in an integrated approach to dementia care 14% 7. Ability to assimilate knowledge of specialist guidance and best practice on dementia and operationalise into effective housing policy 7% 8. Engagement and relationship building with partners involved in meeting the needs of people with dementia at a local level 9% 9. Ability to enable co-production of dementia related housing policy and strategy in partnership with people with dementia 10. Leadership and promotion of the many benefits of housing intervention and investment in dementia care to H&SC partnerships 11. Establish robust data on the scale of the issues associated with housing and dementia to ensure that policy and strategy implementation is adequately resourced 6% 6% 28% 22% 11% 6% 11% 11% Briefing Paper Date 25