Ageing well

Introduction

This strategy focuses on enabling people as they get older to live independent, healthy and active lives for as long as possible.

People tell us that what matters to them is to live safely at home in their community, surrounded by their family and friends, where they can retain or develop their independence for as long as possible. We want to support people as they age in Devon to find the solutions, they need to achieve this.

As they grow older, people want to have choice, control and support to live independent lives, and when needed, to access outstanding quality care and support. For most people, most of the time that will be in their own homes although some may spend short periods in hospital or care settings to help them get home safely. In some instances, for people with the most complex care needs, they may need or choose to live in a care home. Care home providers should ensure people’s hopes, goals and needs are met and the people are able to access their local community and services.

Our vision is for you to have personalised care and support that focuses on your strengths, the outcomes you want to achieve and gives you choice and control. A longer life brings with it opportunities, not only for older people and their families, but also for society. Additional years provide the chance to pursue new activities such as further education, a new career, or a long-neglected passion. Older people also contribute in many ways to their families and communities. Yet the extent of these opportunities and contributions depends heavily on their health and personal sense of wellbeing

Adult Social Care works with people at all stages of their lives. What people would like to support them to age well and to be as independent as possible will change over time.

Our aims are to:

• Encourage you to stay well and support you to help yourself; and
• Work with you when you need help through personalised, strength-based support to keep you connected to your community.

Early intervention and prevention are vital to supporting people’s health and wellbeing as they get older. We will focus on supporting people early with targeted information and advice, community support and reablement services, to prevent or delay the need for longer term care and support.

This includes access to lifestyle support to remain active and working in partnership across the health and care system to increase confidence and prevent falls.

We will work in partnership with people to support them to be active in their community, to connect with others and to stay well. We will recognise and support the growing contribution and needs of voluntary, community and social enterprise organisations to improving the health and wellbeing of people and achieving different solutions, alongside the continuing development of services.

Voluntary, community and social enterprise organisations are involved and trusted within communities across Devon. It is important that adult social care works alongside these groups to support their crucial role in preventing the escalation of need and developing solutions together.

Encouraging you to stay well and supporting you to help yourself

• We help you to remain fit and well, or to improve or maintain your current abilities for longer by making informed choices.
• We encourage you to do as much as you can with support from your family, friends and community networks.
• We promote the use of technology and digital solutions where it can play a role in helping to maintain or improve your independence.
• We work with other organisations to ensure you can access advice and find out about local support and other services to help you look after yourself in your community.
• We contribute to making your local places, healthy and safe places. We will work with partners, in particular the NHS, GPs, communities and the Voluntary Sector, to achieve this.
• Where you have specific care needs, we help you to find support that increases your ability to manage them. This includes accessible public places to support mobility and wellbeing.
• We work with you to manage the transitions in your life as you age, including at the end of life.

Everything described is underpinned by a way of working that builds on people’s strengths. Strengths-based working is a collaboration between service professionals, you and your family and community, which draws on your skills, abilities, and networks. This approach maximises what you a achieve – it supports you to remain happier and independent for longer or progress towards independence and recovery whilst staying socially connected.

Where direct adult social care support is needed, we will make sure that the care and support is personalised and strength-based, and keeps people connected to their communities.

Working with you when you need help through personalised, strength-based support to keep you connected to your community

• When you are in need of direct support, we ensure you have timely access to health and social care services that meet your needs and are affordable for the County Council.

• The support you have focuses on achievement of goals, digital or equipment needs, existing or new community and family connections.
  
• We support you by commissioning housing and support that promotes and maintains your independence for as long as possible, by developing more modern settings and offering more short-term and goal-focused opportunities.
  
• We ensure that adults at risk are safeguarded from harm in ways that meet their desired outcomes.

Our vision and aims for people across Devon as they get older provide the framework for the outcomes we want to achieve with people and the priority areas we will focus on. These are set out in the infographic below and are developed further throughout this strategy.

The outcomes and priority areas of focus are informed by what people have told us and what we know about the current context in Devon.

What people have told us

Residents, carers and partners are at the heart of our work and are involved at all stages of planning and delivering care. We will continue to make sure that people’s views and experiences are heard, taken into account and influence how we achieve the best possible support for people.

The detail below sets out the key issues that older people have told us about through our conversations with them.

Support to be part of the community

I need to be able to easily find information, advice and guidance to enable me to have a choice and to plan as I get older. I have to tell you more than once. I do not have internet access or the digital skills I need to support me. I need more support to live as actively as possible.  

Housing opportunities in the community

I want more supported housing options in communities to help me to live independently and/or be supported by my family and friends. Housing for people with more complex needs is hard to find. I want to remain living in my own home for as long as possible. I have a clear preference for any care home placement to be either as close to the community I have lived in as possible or near to family and friends. Transitions from hospital to home are not always managed well for me.

Professional practice (care and support)

I do not always have timely conversations with professionals about my care. COVID-19 has restricted the capacity of professionals to support me. There is a need to explore ways of engaging with me in the future. I want continuity of home care at the time I prefer, with a consistent support team. Practicalities are determined by availability of staff than my wishes. More support is needed for people with dementia and there are barriers to me staying at home with dementia. I want short-term flexible support when I need it.  

Quality and safety

I do not always feel safe where I live. Families are often worried about the care their loved one is experiencing. Safeguarding referrals are not always addressed in timely way.  

Access to Healthcare*

The cost-of-living crisis is impacting me. There are long waiting times to see my GP and for planned surgery. I find it hard to get an NHS dentist and/or dental appointments. I want mental health to have parity with physical health, and that includes dementia.

Alongside this feedback, Adult Social Care staff tell us that they do not always feel safe at work and experience racism. The Council is committed to being an anti-racist (Anti-racism at Devon County Council) and inclusive Council that is intolerant to prejudice and discrimination. We want our staff, providers and communities (including people we support) to feel empowered to challenge the inequalities they may see or face and contribute towards the actions in our strategy.

*Whilst this strategy focuses on transforming Adult Social Care in Devon, it will be achieved as part of the wider health and care system. This strategy will help organisations that support the health and wellbeing of people as they grow older to focus on the things that matter most to people in their local communities This includes GPs and other health service providers, organisations providing housing, leisure facilities, transport and those who help make sure that our communities are safe.

Where we are now

Devon’s population is ageing and growing, with proportionately more older people than nationally. People and their unpaid carers increasingly require support to self-manage their health and wellbeing to live independently.

More than 1 in 4 (25%) of the total Devon County Council population is aged over 65, compared to less than 1 in 5 of the total England population. 14% of these are 85 years or over, which is 0.6% higher than for England.

Between 2020 to 2040, the population of people aged 65 to 84 within Devon County Council’s footprint is predicted to increase by 27% (from 177,000 to 225,000) and the 85+ population will nearly double in that time (from 29,000 to 56,000).

The table below sets out the population projections in Devon by age group through to 2040.

Vital Statistics tool – Devon Health and Wellbeing

Devon spends significantly more on supporting people with memory and cognition needs, both in longer and short-term services, than all national and comparable Local Authorities. We need to better understand why this is and develop the market to support people’s needs. Many care homes are not purpose built, making it difficult to adapt the environment along dementia design guidelines, and to meet complex needs.

Based on national prevalence, it is estimated that by 2030 there will be a 19% increase in older people with a learning disability and a 20% increase in older people with a limiting long-term illness.

We need to have more timely and proactive conversations with people about how best to support them to develop and maintain independence. This includes changing the culture and practice of social work in Devon to have conversations with people that focus on the achievement of goals, the home environment, equipment needs, and existing or new community and family connections. We must improve the frequency and number of strength-based reviews of the support people need to live as independently as possible and increase the use of digital solutions and Technology Enabled Care and Support (TECS).

There are significant workforce challenges in Devon. We need to continue to grow the social care workforce and ensure that new ways of working are adopted, including digital and TECS solutions. Skills for Care estimates that the staff turnover rate for the independent provider market in Devon was 39.9% in 2021, which was higher than the region average of 32.0% and higher than England at 29.5%. Not all turnover results in workers leaving the sector, as many leave for another role in social care, but this churn can impact on service and provider quality (continuity of care and training/development) and efficiency (indirect spend to recruitment and agency staff).

In Devon, the pandemic has highlighted the limitations of building-based day services and short break/replacement care models. Many people want to access outreach support in the community. We need to invest in a more diverse set of opportunities for enabling and independence in communities that is short-term and goal focused, to allow people to regain independence. We also need to develop replacement care models alongside this.

Housing is becoming increasingly unaffordable, with property in Devon costing more than 10 times the average salary in 2021; about 20% higher than the rest of the UK. Private rent stock levels across Devon fell by around 50% between 2019 and 2021. Devon had 11,100 second homes registered during 2021, an increase of around 2% since 2019. These figures underestimate the real number of homes being used for Airbnb and other purposes.

Fuel poverty and poor housing conditions, particularly in the private rented sector, are a major issue, especially in rural parts of North and West Devon, which impacts on health and wellbeing.

The supported housing available to people as they grow older in Devon is limited and housing options are often focused on age rather than need, which limits choice. For example, Extra Care Housing is currently exclusively for older people and Supported Living is mainly for people with disabilities and/or mental health needs. There are also limited options in the community to support people with dementia and we need more and greater flexibility of these housing models across Devon.

The Supported Living market in Devon is fragile and characterised by an outdated model of shared houses in remote areas where people cannot connect with their communities or easily get to work. Supported Living services need to be redesigned so that support is shaped around people and we increase their choice and control over how and where they live. We want to ensure some consistency in the type of support provided and ensure quality of tenancies.

Care at home in Devon is usually commissioned by the amount of time needed to perform a particular task (‘time and task’) and can result in inflexible blocks of time that do not empower providers to adjust a care plan in partnership with people/their family.

Poor mental health and wellbeing has a considerable impact on quality of life and is a major contributor to premature death. Mental and physical health needs are closely linked. Loneliness is often a precursor for mental health needs and is seen in people of all ages. People in many Devon communities have a high risk of loneliness. Younger renters with little sense of belonging to their area, unmarried middle-agers with long-term conditions and widowed older people living alone with long-term conditions are at increased risk.

The Covid-19 pandemic has led to an increase in the number of people aged 50-64 who are out of work. Many more people in their 50s and 60s are not working nor looking for work: they have left the workforce altogether. Some might have stopped working for health reasons or because they need to care for someone else. Others may want to work but are struggling to find a job that fits their needs. Research from before the pandemic shows that older workers who lose their jobs are more than twice as likely as other age groups to be unemployed for at least two years.

How we will achieve our vision

As stated in our introduction, the priority areas that we will focus on over the next five years are set within the context of our vision, aims and outcomes for people as they get older across Devon.

The actions that we will take over the next five years to achieve our vision are described below.

AIM: Encourage you to stay well and support you to help yourself

1. Prevention and Early Intervention

People want better access to information about services (in a way that suits them) and tell us that they want more opportunities to support them to remain active in their local communities. An increased focus on prevention and early intervention will promote better outcomes for people and will lead to a longer-term financial sustainability for the Council and our partners.

We will improve timely and targeted access to information and advice. We will:

• Review our current information offer to identify where a digital approach will improve access. This includes health improvement, screening, immunisation and falls prevention programmes.
• Provide accessible information about housing choices so that people can make informed decisions about where and how they live throughout their lives and to plan for older age.

We will review and reshape our front door to Adult Social Care with increased use of technology, digital solutions, community equipment and personalised care which helps people to be as independent as possible and which:

• Enables people to take more control of their support through digital communications with the Council via web chat, online self-assessment and financial self-assessment. Alternative approaches will still be available for people who do not prefer a digital approach.
• Helps people to live independently in their own home for as long as possible through increased use of and information about Technology Enabled Care and Support, so that they can keep doing things for themselves.
• Proactively identifies areas for digital and technological improvement and share best practice across the health and care system.
• Support adults with disabilities who live at home with elderly/frail carers to develop independent living skills and plan for older life.
• Encourage people as they age to develop end of life plans and to consider how they will age well with adaptations in their homes and how they plan to pay for care.

2. Community

Independence and a good quality of life should be less about services and more about increasing capacity for early intervention and enabling life experiences. We will build on the innovative ways that people were supported during the pandemic by developing support in communities that is short-term and goal focused. We will:

• Develop support of volunteers to achieve different solutions for people as they age, including adults with disabilities. This includes improving access/pathways into voluntary support and developing volunteering as a pathway into employment.
• Support community and providers to have a shared knowledge of local support needed and enable community groups, who are trusted, established and connected in communities, to directly design and deliver support. 
• Work with independent providers to agree personalised outcomes and monitor progress.
• Consider whether place-based budgets which pool resources between separate services would be more capable of aligning the risk and reward of investment in early intervention.
• Build more opportunities for people to use Direct Payments to access care and support opportunities local to them. Direct Payments provide people with more choice and control over how they meet their care and support needs.

3. Housing

Good quality supported housing is vital. It provides a safe, stable and supportive place to live and opens up opportunities for people to live the independent life that is right for them. People want to be able to access safe and good quality housing at the right time as they grow older, which meets their changing needs and is value for money.

Extra Care Housing and Supported Living, accommodation with care delivered on site, gives people greater independence and a choice over the care that is provided for them in their own property. People living in this accommodation have a tenancy or can buy their flat outright. Adult Social Care is only responsible for funding the care costs but not the housing costs. We want to greatly increase this type of housing across Devon to support people to live more independently in the community.

We will move away from our reliance on residential and/or nursing care homes for people as they get older. This means that we will commission more support within the community for older people and increase the amount of Extra Care Housing, Supported Living and care at home. This will be accompanied by an increased emphasis in reablement, short-term support and social care culture change. We will:

• Work collaboratively with partners to assess local need and demand for supported housing in communities, to jointly plan with District/City Councils to inform development of the market and increase supply.
• Develop more Extra Care Homes schemes in Devon for people to benefit from community-based support as they get older.
• Use Extra Care schemes more effectively; move away from block contracts and increase usage.
• Implement a new Supported Living contract to increase people’s choice and control and ensure quality of tenancies through the separation of housing and support, alongside a clear pricing structure.
• Redesign Supported Living and increase the supply of alternatives to shared houses to meet demand. This includes individual self-contained units within a core and cluster model and Homeshare schemes.
• Develop short-term crisis support for people with complex needs to prevent hospital admission and unplanned moves to other areas.
• Invest in new, modern provision to support adults with complex dementia and the increasing number of frail older people who are in poor health, often living with multiple conditions.
• Review the impact of short-term bedded solutions (including in Extra Care Housing) to get people out of hospital and back into their home.
• Whilst our aim is for people to live in their own homes, we recognise there will always be a need for quality residential and nursing care for people with the most complex health and care needs.
• Work in partnership with the care home market to ensure we have sufficient beds and to ensure they can meet the needs of people who need a residential or nursing care setting.
• Support the independent provider market to develop more fit for purpose and modern care homes that can support people with the most complex needs.
• Set out with the independent provider market the strategic objectives that we are working to achieve in Devon, including quality provision, sustainability and the training/skills required.

AIM: Work with you when you need help through personalised, strength-based support to keep you connected to your community

4. Strength-based and personalised practice that is goal focused

People tell us that they want more personalised and timely support to promote their independence, and that they want the transitions in their lives to be better managed. We will:

• Change the culture and practice of social work so that it focuses on achievement of goals and includes a wider conversation with people about their home environment, equipment needs, existing or new community and family connections.
• Improve the frequency and number of strength-based reviews of the support people need to live as independently as possible.
• Ensure strength-based assessments are directed by people and support personal choice and control in how assessed eligible needs are met, including the use of personal budgets.
• Set out our core values for social work practice, that aligns to this vision and supports transformation of how we work with people and their families or carers. These are set out below.

• Increase the use of digital solutions and Technology Enabled Care and Support to enable people to live as independently as possible.
• Develop our commissioned offer for digital solutions and technology enabled care and support, including awareness raising and increasing diversity of prescribers.
• Collaborate with the NHS and other partners to ensure people who use our services and their carers experience joined up working and good quality service which meets their needs.
• Consider how we commission care and support in people’s homes to promote achievement of their preferred outcomes and empower independent care providers to deliver positive outcomes for people, with flexibility over how and when they do this.

5. Safeguard adults at risk from harm

Keeping people safe and helping them to stay safe is a key priority for us all. We need to ensure that staff are well trained to support prompt responses to any allegation of abuse and that the public, unpaid carers, volunteers and professionals have a good understanding of safeguarding. We will:

• Listen to people and their families and carers about what matters to them.
• Support individuals to speak out, with the help of trained advocates if required.
• Make sure that all services we provide or commission are fully up to date in safeguarding training of their staff and in respect of the Mental Capacity Act Deprivation of Liberty Safeguards.
• Commission services that deliver kind and compassionate care that helps to keep people safe through contract management of quality of provision.
• Monitor the number of cases for people aged over 65 years where Making Safeguarding Personal questions have been asked.
• We will monitor and quality assure our own and partner agency safeguarding activity to ensure a timely and proportionate approach.

6. Be an anti-racist council

A number of actions are being taken forward across Devon County Council to support our intent to be an anti-racist organisation. We will:

• Support staff to feel safe, including listening and providing support to staff and managers.
• Improve data on equalities and ethnicity, including in the independent provider market.
• Improve representation in our engagement forums.
• Include a clause in our social care contracts with acceptable standards that are monitored.
• Consider race equality as part of all commissioning strategies.