GrumbleSmiles

For earlier stories on this subject, click on   “PRINCETHORPE COURT STORY”   in the TAG CLOUD.

The Staff Support Team

From the very outset of developing our new concept, it was not just about bricks and mortar, it was about creating a more fulfilling life for residents.   A life that was able to reach beyond the tasks of daily living  and lift residents above their concerns about increasing frailty.   That said, it was also about maintaining and promoting their independence, by empowering them to build on their valuable skills and considerable life experience.

In other housing and care models, the care element creates dependence and communal living can reinforce the negative images of getting old.   We wanted to reverse that thinking and create positive opportunities for ageing, with support to overcome increasing frailty.

To do this we needed a special staff team, who aspired to do much more than offer comfort and care.   Our first Princethorpe Court Manager was an inspired and inspirational appointment.   Sister Anne Miller was a Franciscan Nun ,with a background of working in the third world.   She did not have the obvious recent experience in care management, we had set out to look for.   I was one of the interview panel and I have to admit before I met her I was very apprehensive.   My Welsh Chapel upbringing made me very nervous about having an overly pious scheme.   I think I expected Anne to come to the interview in a habit and be rather timorous.   I could not have been more wrong.  There was no habit, just a cross on a necklace and timid she was not !   She was very self-assured.   Obviously compassionate about the elderly and quite a feisty lady.   She even argued with me, which was a dangerous step in a job interview, but her conviction ( not the CRB type 🙂 ) made a lasting impression on me.   I still was not 100% sure, but Liz Taylor argued very strongly in favour of Anne, and that swung the day.

We never had reason to regret the decision.  Anne proved to be an exceptional manager who helped improve our vision beyond measure.   She built a strong staff team around her and helped them to understand the difference between the care background most of them had come from, and the supportive environment we wished to create.   We didn’t rush in and do things for people, we wanted to help and encourage them to do things for themselves.   It is about restoring confidence to people.   This takes time and patience, which can easily be squeezed out of a hard pressed staff schedule.   The result is that care hastily delivered can often lead to greater dependency.   This lesson has certainly been lost in the modern-day express style speedy boarding NHS.   It was also seldom seen in minimum staff levelled residential care, where high staff turnover and frequent use of agency staff meant there was little time to really get to know residents’ individual needs.

At Princethorpe Court, Anne’s team developed support plans which embraced the whole of a residents’ life, not just their immediate care needs.   Later this became known as a “Book of Life” and was a written and photographic record of a resident’s past life and future ambitions.

It was testament to Anne Miller’s mentoring skills that her two senior staff, Mary Saint and Ginny Larkin, both went on to become managers of their own schemes in the ExtraCare Charitable Trust.   Many other staff also were promoted to managerial and team leader positions in the following years and transferred the Princethorpe culture to other schemes.

MORE TO COME

For earlier stories on this subject, look up “PRINCETHORPE COURT STORY” in the TAG CLOUD.

The Design

This section is not intended to be a design brief, I just want to illustrate how the concept we were developing permeated through the whole of the design, right down to the smallest detail.  We also wanted to get well away from the institutional feel of residential care which emphasised to residents they were living in someone else’s building, which was no longer their own home.

We were wanting to create an environment where people could live out the rest of their lives and not have to move on.  We also wanted it to be a community where you could enjoy the privacy of your own home but have the company and support of the neighbours around you.

The scheme had 48 flats which was considered large. at a time when 30-35 dwellings was more the norm.  The reason for the bigger project was related to the need for scale to support a care staff team and a restaurant.  The flats themselves were mainly one bedroom, but we insisted on them being 2-person i.e. big enough for a double bed.  This is a forgotten issue these days but one bed, one person was the standard at the time.  The flats were only 35m² which is very small compared to the 50m plus of the current day.  The Princethorpe flats were palaces compared to a 10m² bedroom in residential care!

A key principle was that there was level access throughout the scheme – lifts were provided to the first floor and their were no steps or stairs anywhere in the scheme ( except for fire escape stairs ) — all doors were extra wide to accommodate wheelchairs and fire doors were free-swing or held back on magnetic links and only closed automatically if there was a fire alarm.  These issues are standard today, but at the time they were exceptional and relatively expensive to provide.

Now let’s look at some of the more symbolic details in the scheme which were designed to emphasise the concept:-

• Individual House Front Doors.

Front doors to flats in residential care and in a lot of Local Authority / Housing Association sheltered housing were generally flush style internal doors, often all gloss painted the same colour to minimise initial and future maintenance costs.  At Princethorpe Court we took the opposite view.  Your front door is a symbol of your home as your castle.  Front doors were panelled external doors with brass door knockers, brass house numbers and letter boxes.  The knocker said to staff, knock and wait before you enter someone’s home – this often was not the practice in residential care.

The letter box was even more contentious, with the fire officer and the Post Office.  Fire officers didn’t want a hole in a fire door, and this debate lasted until we found a compromise, but we kept the letter boxes!  The Post Office just did not want the hassle of delivering post within the scheme, when in a residential care home they could do one delivery to the manager’s office.  This argument raged for many months, but we were adamant that residents had their own address and were entitled to receive their mail through their own individual letter box.  We won in the end but there were some grumpy postmen to start with.

Once we had the letter box, we could also have newspapers delivered and leave people to pay their own bills, which underlined the concept of people living independently in their own homes.

This idea extended to milk deliveries and a shelf was provided outside each front door.

• Internal Streets.

The internal corridors of most residential care homes were long, straight, bare-walled   and only punctuated by regularly spaced identical front doors.   Small filing cabinet labels were the only way of knowing somebody lived inside the flats.  The easy slip-in and out label was an indication of how long they were expected to stay.

We were building homes for people to live long happy lives and we wanted them to be proud of their new homes.

At this point I must mention the designer of Princethorpe Court.  Ian Hardy was an exceptionally talented architect and he bought into the concept completely.  He also took us literally when we said we wanted an excellent design and that’s what he gave us – but it wasn’t cheap.  Still he gave us design ideas which ExtraCare Charitable Trust is still using to this day.

In the internal corridors, Ian styled them as external streets.  The flats all had kitchen windows looking onto the street.  The walls were constructed with an expensive external rustic brindle brick that matched the outside of the scheme.  External wall lamps illuminated the corridors focussed around the porch of the flats’ front doors.  The corridor floor was a jute matting which was imported from Holland.  It was not only expensive, but we were worried about its durability.  Thirty years later, it is still there and looking good.  The widths of the corridors were relatively wide and at corners were opened out to include planting boxes full of rubber plants, ferns and assorted jungle vegetation.

To finally seal the idea that this was more like an external environment, the first residents to move in were invited to give each corridor a separate “street” name which then became part of their address.

These are only two examples of the many issues we debated over long hours – developing the concept.  We were fortunate to have Ian Hardy’s design flare to interpret them so well.  It is testament to the whole team that many of these themes continue to be used to this day.

MORE TO COME

For the first story on this subject, look up “PRINCETHORPE COURT STORY” in the TAG CLOUD.

Looking back, there were four key elements to the story and although they only clearly emerge with hindsight, they are perhaps the essential ingredients to many breakthrough projects.  Whether we knew it or not at the time, it was a breakthrough that was required.

The Project Team

The first key was the group of people involved in the project at the outset.  The leader and most significant player was Bill Martin, the Chief Executive of Coventry Churches Housing Association.  Bill was never satisfied with the status quo and always wanted to improve everything around him.  He encouraged, and at times, drove his team to do the same.  Second best was never good enough.  Boundaries, rules and regulations were there to be stretched.  What was good enough for everybody else was never a yardstick to be copied.  I’ll bet as a kid in winter, Bill was the one who always wanted to be the first to walk in fresh snow.  He was the hardest, most demanding boss I ever worked for and also the very best.  He remains a good friend to this day.

The second central player was the CCHA Housing Director, Stewart Fergusson.  Stewart was the son of an East End bookies runner with all the cheek, and 100-word-a-minute patter that you find on market trader stalls.  Stewart’s abilities went way beyond the market place.  He had a history degree from Cambridge University and an intellect capable of challenging any issue.  He was supported by one of his Team Leaders, Liz Taylor, who had a qualified background in housing management and considerable experience of managing sheltered housing schemes.  Both Stewart and Liz had a wholistic approach which looked beyond the immediate housing needs of the elderly and was concerned about the pressure that increasing frailty could bring.

My role at the time was as CCHA’s Development Director and I was charged with getting the design project off the ground and successfully constructed.  Whilst I did much of the pushing and shoving, I was more than ably assisted by my right hand man – Andy Hillier, who has worked alongside me for thirty years and is a master of project co-ordination and specification.

Whilst many others made strong contributions later in the process, it was this small group who initially developed the concept of what we then called Very Sheltered Housing.

On the outside of the team, we were fortunate to have Tom White as the Director of Social Services in Coventry.  Tom was very positive about the concept from the outset, even though he could see that in the long-term this housing and care provision would undermine the City’s much older stock of “old people’s homes”.  His support was vital because the referrals for care came from Social Services, at a time when many social workers felt that frail residents could not be looked after in housing and needed to move to residential care.

We were on the edge of legislation and regulation on several fronts and constantly had to argue our case for this new model.  The Housing Corporation felt we were over-sizing the communal facilities and straying into providing care, which was not the role of Housing Associations.  We had quite a few skirmishes with them but they did eventually capital- fund the project.    The planners and building regulators could not make up their minds whether this was housing or health care provision and were constantly trying to put us in an “institutional” box.  We didn’t give in and were adamant that this was housing, not residential care.   The health care regulators reluctantly left us alone because we were only providing domiciliary care.   This was outside their remit in those days.

You can see why the combined skills of the initial development team were so essential to the early negotiation of the project.  It very much challenged the conventional wisdom that frailer old people could not cope or be coped with in housing.

Thirty years on and extracare housing is a well liked and accepted model of housing and care provision.

MORE TO FOLLOW

Thirty years ago I was lucky enough to be in at the beginning of a remarkable project, which helped start a change in how housing and care for older people was perceived in the UK.  It’s physical expression was a retirement housing scheme called “Princethorpe Court”, which is still going strong today in a housing neighbourhood of Coventry.

The Background

It is important to understand the context in which this new form of provision was conceived, because many of the issues we faced then are still just as relevant today.  Furthermore, a lot of the lessons we learned on our journey have still to be learned by many current policy makers and providers.

In the 1970’s and 1980’s sheltered housing had become an established form of retirement housing and it endures as a very effective first move into retirement accommodation for the majority of elderly people who have to or choose to move out of their family homes.  Major specialist housing associations lead the way in developing this type of accommodation – Anchor, Hanover and Royal British Legion (now Housing 21).   McCarthy and Stone was the only significant house builder to develop this provision in the private sector.  Both were later copied by many other housing associations and house builders as the increasing size of the elderly population became more obvious. 

 There was a significant schism between the two types of providers.  Housing associations were heavily subsidised with capital grants from the Government via the Housing Corporation, which enabled them to provide low-cost rented accommodation.  The house builders didn’t have access to Government grants and therefore focussed entirely on housing for sale.

The key limitation of both types of accommodation was the need for care beyond emergency alarms.  Once care was needed it was assumed people would move through a series of types of housing as their health became deteriorated :-

Category 1    –     Sheltered Housing – Individual bungalows or flats sometimes with a communal lounge ;

Category 2     –     Sheltered Housing –  as above but linked by internal corridors and with slightly more communal accomodation ;

Category 3     –     Residential Care Homes ( or Local Authority Old Peoples Homes )

Category 4     –     Nursing Homes

Category 5     –    N H S Geriatric Hospitals

These types of provision were born out of the boundaries of Government Departments and their funding responsibilities.  They were a rough and ready solution to ending a lifetime.  The concept that elderly people could move easily from one category to the next in later life ignored the reality that moving home is a very traumatic experience.  What’s more the prospects of increasing frailty, more and more dependency, and less and less control over your life, were certainly not designed to offer a great outlook in later life.

More often than not, any move was forced upon people through increasing frailty, or driven by the concerns of relatives or Social Services.  Some elderly people  made a proactive decision to move to sheltered housing so that they could feel safer and more secure.  Virtually no-one moved to residential care or old people’s homes with enthusiasm – a small, single or shared bedroom, a shared toilet and a chair in the communal lounge were just not that appealing.   Absolutely no-one moved into a nursing home out of choice.   It was a decision made by professionals.   The ony way you moved onto geriatric wards was straight from an ambulance into a hospital bed, —–usually never to emerge again.

The social policy driver of all this provision was safety and security – the second lowest step on Maslow’s hierarchy of needs.   There was no lofty ambition to offer new opportunities to older people in retirement, just a desire to find more economic housing and care for those who could no longer cope on their own.   In the early 1980’s, a small Midlands based Housing Association – Coventry Churches Housing Association  (later called CCHA,  then Touchstone and finally Midland Heart), set out on a path that would go on to influence more recently developed retirement housing throughout the United Kingdom.

That is where the story of Princethorpe Court really begins.

SEE NEXT WEEK’S THRILLING EPISODE