Praxis Care is a registered charity which has been in operation for 27 years. It is a major provider of support services for adults and children with a learning disability, mental ill health, acquired brain injury and for older people, including people with dementia. Praxis Care operates in 4 jurisdictions: Northern Ireland, Republic of Ireland, England and the Isle of Man. The organisation supports around 1,500-2,000 service users per annum and currently has over 1,000 staff.

Praxis Care provides a range of supported living services including: residential care homes, shared group houses, residential flat clusters, dispersed intensively supported housing in the community, home support services for people in their own homes, befriending, drop-in services, flexible day activity, workskills projects and floating support.

Ethos and Value Base

The organisation’s value base permeates all aspects of our services. It asserts that individuals using Praxis Care services should be:

• Afforded opportunities, choice, privacy, the right of self-determination and the right to take risks in daily life having a quality of life which accords with those available to other citizens.
• Given the opportunity to live within local communities, and be provided with a standard of housing and local facilities that accord with those available to other members of the community.
• Encouraged to achieve their optimum level of independence through receiving practical help and support in dealing with everyday situations.

As such, the supported living services that Praxis Care provides aim to support an individual to live the life they want to, maximising their skills and abilities.

Praxis Care believes in partnership working - partnership first and foremost with our service users, partnership with their families and carers, partnership with our commissioners and others involved in the service.

Supported Living Unit for Individuals with Dementia

Praxis Care has a purpose built supported living unit for people with dementia called St Paul’s Court. St Paul’s Court enables older persons who require housing support with care to live successfully in the community. St Pauls is situated on land next to a church, hence its name. It is located in a fairly quiet residential area on the outskirts of the Lisburn town centre in Co Down close to shops and local amenities. Praxis Care works closely with South Eastern Area Trust and Trinity Housing Association to provide high quality support in a sheltered environment. The St Paul’s Court scheme is primarily aimed at:

• People who have dementia.
• People who meet the Northern Ireland (NI) Housing Executive’s complex needs criteria.
• People who currently have a care package in place which is delivered by South Eastern Area Trust personnel.

Phase 1 of St Paul’s Court consists of 15 2-bedroom bungalows set in a safe and secure environment, each with a small back garden, looking out onto a “courtyard type street” with a separate resource centre. There is also a separate block of 8 ground floor apartments situated around the atrium. The bungalows and apartments are finished to a high standard and have been planned with the needs of older people with dementia in mind. Praxis Care staff are on hand 24 hours per day to provide advice, guidance, support and care at a level appropriate to the individual’s needs. Each person has a staff key worker who is committed to assisting the older person to fulfil the aims outlined in his/her support plan.

The aim of the unit is to provide a place where people continue to have independence whilst having their support and care needs met, as well as supporting family carers. The environment can be adapted to the physical and social well-being of the residents and offers individual tailor-made care and support, depending on assessed needs. As all the bungalows have two bedrooms, family members or carers may live with the individual on a permanent or temporary basis. The development was originally planned to provide a home for life and was designed for people with mild to moderate dementia and people with complex needs.

Environment and Design

The Bungalows: Phase 1; The houses follow dementia friendly design principles, with all the rooms opening out from the front door entrance area. There are 2 good-sized bedrooms in each bungalow, an open plan lounge, a shower room with WC and a fully equipped kitchen with partially glass-fronted cupboards and back bedroom which looks out onto the back garden for each house. Garden furniture, washing lines, sheds and seats are provided for individual interests and tastes. Residents bring their own furniture because it is familiar and particular to them.

he Apartments: Phase 2; Phase 2 of the unit was opened in February 2009. It provides a further 8 tenancies (7 single and 1 double ) within a separate complex on the same grounds as phase 1 and is for individuals who have been assessed as having mild to moderate dementia. Residents have been gradually moved into their new home over the past few months.

The Resource Centre

The resource centre has a kitchen, two lounges, dining area, toilets, hobbies room, office accommodation and a staff sleepover room. Residents and carers use the lounge area frequently for social activities. Staff members also promote a model of social inclusion which encourages the older person to use social and leisure facilities in the local community. The new phase 2 building has a large atrium which is currently being used to host weekly Reminiscence Therapy events delivered by a tutor from the Workers Educational Association. Initial impressions are that these sessions have provided an opportunity for residents to get together and help foster a sense of community. Additional social activities offered include coffee mornings, lunch clubs, film nights, ‘pampering’ and cookie afternoons.

Assistive Technology

Assistive technology is available and can be commissioned to meet individual requirements. A call system is in use and the older person can see the entrance to the scheme on a channel of their television. The accommodation has been designed to ensure that care and support can continue to be provided even as the person’s physical needs increase, so that another move, towards the end of one’s life, can hopefully be avoided.

The Evaluation

Praxis Care has an established Research Department that conducts a wide range of in-house and commissioned research in the health and social care field. The Department has carried out research on topics such as self-advocacy and user involvement, community health needs, volunteer befriending, alcohol related brain injury, and has evaluated various models of service provision.

The Department is currently conducting an evaluation of the St Paul’s phase 2 dementia unit. The researchers are using multiple methods within a case study design in order to explore the degree to which the unit meets its aims and objectives with data being collected shortly after admission and thereafter at three monthly intervals. The study is, at the time of writing, at the baseline data collection stage but will include information from the older people, primary carers and health and social care professionals. The evaluation will use the Joseph Rowntree Foundation ‘6 keys to a good life’ (JRF, 2009) as a framework for data collection (see box below).

JRF ‘6 keys to a good life’	Evaluation Information Source
Meaningful Relationships	Social web and interview
Personal Authority and Control	Interview and carer questionnaire
Home and Personal Surroundings	Observation and interview
Meaningful Daily and Community Life	Interview, questionnaire, observation
Personalised support and care	Record analysis, carer questionnaire
Personal identity and self-esteem	Interview, environment checklist

Some examples of the methods being used include:

• The six item Cognitive Impairment Test 6CIT (Brooke and Bullock 1999)
• The Bristol Activities of Daily Living Scale BADLS (Bucks et al 1996) which measures the older person’s ability to perform every day activities in areas such as feeding, hygiene and managing finances.
• The use of informal interviews in order to ‘map’ the extent and quality of clients’ social networks.
• Structured observation in order to capture the non-verbal cues of those clients who may not use speech as their primary method of communication.
• Semi-structured questionnaires administered to carers, Praxis Care staff and statutory health professionals.
• Secondary data analysis e.g. supports plans, critical incidents and activity sheets.

The intention is to use 6CIT and BADLS data to track change over time (baseline, 3 months, 6 months, 12 months) with analysis being confined to the use of descriptive statistical methods. The social network data for each resident will include both quantitative and qualitative information on their involvement in a series of ‘social domains’ (family, neighbourhood, services). This will allow the researcher to describe and map the extent of a resident’s social network over time while living in their new home. The research will also examine the quality of a client’s social network using sociograms and analytical concepts derived from graph theory (Nooy et al 2007). The work on the application of sociograms and social network analysis will form the basis of a poster which will be displayed at the Dementia Service Development Centre’s International Conference (York Racecourse 14 – 16 September 2009) (see: http://www.dementia.stir.ac.uk/conference_welcome)

Although the study is at an early stage, a tentative finding is that assessment tools like 6CIT may not be totally appropriate for use with this client group as it is possible that a client’s inability to answer standardised questions may unwittingly undermine self-esteem and well being. Indeed, the phenomenon of “personal detraction” or a negative interaction with a person with dementia has already been described in the literature by Kitwood (1997). As the research progresses, we will continue to explore the appropriateness of a range of assessment tools which are reliable, valid and sensitive to the emotional responses of clients.

If you have any suggestions or helpful advice on any of the above areas of research, we would very much like to hear from you. Please contact our Research Department (soniam awhinney@praxiscare.org.uk or paulwebb@praxiscare.org.uk). If you would like to visit the unit or find out more about the ‘home from home’ support that is provided, please contact our Central Office (028 9023 4555).

References

Brooke, P. and Bullock, R. (1999) Validation of the 6 Item Cognitive Impairment Test, with a view to Primary Care usage. International Journal of Geriatric Psychiatry, 14, 936-940.

Bucks, R.S., Ashworth, D.L., Wilcock, G.K., Siegfried, K (1996) Assessment of Activities of Daily Living in Dementia: Development of the Bristol Activities of Daily Living Scale. Age and Ageing, 25, 113 – 120.

Kitwood, T. (1997) Dementia Reconsidered. The Person Comes First. Open University Press: Buckingham.

Nooy, W.  D., Mrvar, A., Batagelj, V. (2007) Exploratory Social Network Analysis with Pajek. Cambridge University Press: Cambridge.

Joseph Rowntree Foundation. (2009) Older People’s Programme. Conference presentation, Belfast.

 

End of policy and practice section