Accommodation with care

Some older homeless people, particularly those who have had a long term alcohol dependency get to a point where they need  ongoing support and physical care on a daily basis.  When their care needs increase the main options are moving into a registered care home for older people or into an extra care type setting. This section looks at those options.

Older people needing a care setting are only likely to get funding when then they have high physical care needs or rapidly deteriorating mental health. This entails getting funding through a community care assessment.  This will generally mean that the resident has to make an agreement to hand over most of their benefits to pay for their board and lodging. For those who are alcohol dependent their alcohol intake is monitored or controlled by the care home. This can be a barrier to moving into registered care for some residents. However the main barrier is often getting a funding agreement from Adult Social care and finding an appropriate placement for people with complex needs.

Registered care home - Hilldrop Road, St Mungos - London

Hilldrop Road,  is a registered care home run by St Mungos for older men who have a history of homelessness and who have additional support needs including alcohol misuse, mental health and physical health problems. There are spaces for 29 men. The minimum age is 45 with no upper age limit. The current resident group is made up of vulnerable and fragile older men who may have been marginalized, bullied or overlooked in larger homes or hostels. Almost 80% of residents are over 60.

Tenants may drink in their own rooms, but not in communal areas. They have their own key and there are no access restrictions. Visitors are allowed between 9am and 9pm in the host residents' bedrooms only. There is no maximum length of stay at the project, but residents seeking move-on accommodation are put in contact with the appropriate services.

There are weekly visits from the nurse and CPN. A mental health worker visits monthly and an alcohol worker visits every two weeks.The staff at Hilldrop Road aim to create a secure and comfortable environment, which may enable residents to achieve a stable and self-reliant life style and greater integration within the home ad the local community. The project has a partnership with the City and Islington College and provides courses with in-house tutors.
There are 12 staff and 24-hour cover. There is a key work system in place (4-5 residents per key-worker)) and individual care planning. Care plans are reviewed monthly and cover health, social life, life skills, budgeting and personal care. All support is tailored to individual need and includes help with personal hygiene and accessing local resources. 

Registered care home - Bentinck Road, Framework - Nottingham

Bentinck Road is a specialist residential project for older homeless people aged 49+, providing a permanent home with a high level of support and care for residents who have aged prematurely due to homelessness, poor nutrition, mental health and alcohol problems. There are 20 beds, users are male and female with ages ranging from 49 to 82. Clients have a relatively low life expectancy and the service allows them to live in the community while addressing basic needs such as warmth, a stable diet and engagement with primary health care. It is registered as a care home with Social Services. Residents can drink in one of the public rooms.

Some older people wish to avoid the highly supervised setting of a registered care home, preferring instead a supported living option with more independence. Framework has developed 11 bedsits and a three bed shared house near the registered care home. This example of innovative service design provides choice for older clients when their needs change, enabling movement in either direction between residential care and supported housing.

The project takes a pro-active approach with residents: key workers and individual care plans ensure that residents identify their strengths, and staff build support and care around what residents themselves are able to achieve. Staff and residents have meaningful relationships with each other, and this helps to discourage residents from turning so much to alcohol as a comfort because of loneliness and isolation. A community care assessment and funding agreement is necessary to access Bentinck Road.

Extra care 

Extra care is a model that can work well for older people with a history of homelessness and complex needs. The combination of independence, their own front door, access to communal facilities and the availability of health and social care on site is the sort of model that some of this client group need. Many local authorities are developing extra care schemes and it is seen as the future housing model for older people with care and support needs. However there is currently little evidence of extra care schemes being accessible for older people with a history of homelessness, substance dependence and complex needs. Willow in Brent have had some success of moving older people with complex needs and a history of homelessness into extra care.

Older people with a history of homelessness and complex needs could either be accommodated in a generic extra care scheme or there could be consideration of developing a specialist project for older people who are alcohol dependent, have a history of homelessness and complex care needs.

The DH Housing LIN have produced a fact sheet on extra care and older homeless people.  The London Borough of Camden are in the process of working on such a development, they are considering re-modelling a sheltered scheme for the older homeless client group in conjunction with a RSL. The preliminary idea is that this will share features in common with an extra care scheme but that the balance of care and support would be tilted more to housing related support and less towards care.