This week I have talked to three single men who have had experience of care services over a long period of time. Their stories are different in many ways but the issues raised by their circumstances are worth some reflection. One of the men is my brother, I will leave him to last.
On Friday I had a day with colleagues looking at some of Metropolitan's sheltered housing schemes in Derby and Nottingham. We found many good things - buildings, staff and services - but we also found room for improvement particularly in relation to the physical and social standards which people rightly expect. Our rule of thumb was - would I live here, would I want my relative to live here? Unless we can answer yes to these questions, we can't be confident we are offering the best we can manage in housing, care and support services.
As we walked round we met several people, including two single men who I won't name here but will call John and David. John had Multiple Sclerosis and David Prader-Willi syndrome; both men were in their late fifties and had lived in sheltered housing for some time. They had both lived with their parents until they died, and clearly needed some kind of support to live on their own.
John told us that he had lived in a nursing home for 17 years after his mother died. He expressed real gratitude that eventually somebody questioned whether he could live independently and helped him to move to sheltered housing. In these relative terms John's experience is remarkable and truly positive - we had met him on his way back from the bank where he went on his motorised scooter.
But things could be better for John - we asked him whether he used the communal lounge or joined in activities. He told us that bingo and coffee mornings weren't of much interest - he liked music, rock music and would have appreciated something a bit more lively. John is a baby boomer, born in 1954 hitting 60 next year - he may be physically frail, but his mind certainly isn't. And he is a generation apart from the 80+ year olds who are his neighbours. Sheltered housing can be a practical option for younger people with physical disabilities but their social needs are likely to be very different from their older neighbours. We need to think about how the management of sheltered housing can encourage flexible use of facilities in order to benefit a wider range of tastes and needs.
At another scheme we met David, who told us he had Prader-Willi syndrome, a chromosone disorder which affects people in a variety of ways, but which includes a learning disability. David moved to sheltered housing after his parents died, and he manages a busy life of volunteering and fundraising. For David, one of the real benefits of living in sheltered housing was having personal contact every day with the Scheme Manager, but unfortunatley, this level of support has been cut by the Council, and this daily human contact has been lost. This might be part of the reason why David kept us talking for so long, enjoying some interested company.
As we looked at the different sheltered housing schemes and talked to residents, we began to ask ourselves what it was for? Enabling and re-abling people to help them to become or remain independent seemed to be core to its purpose. Our aim might be to support people to live well with a disability or into older age, and sheltered housing could not only be a permanent home for people, but also a place of transition to and from independent living. In order to fulfil this purpose we need to get better at co-ordination and integration with health and care services, working more effectively to match people and properties.
We saw some empty flats - an increasingly common occurance in older sheltered housing schemes - and could see how we might improve their presentation to make them more attractive. For some adapted flats with specialist features, it might be necessary to talk to social services or health partners about specific individuals rather than expect a choice based letting service to identify them.
And talking of specific individuals, there is my brother. Another single man finding himself adrift and vulnerable after a life at sea with everything provided including plenty of alcohol. As his life catches up on him he has spent 12 months of the last 24 flipping between hospital and nursing home, trying to establish a stable home and routine back in the UK after years living abroad.
This week he is hospital again, recovering from a bout of severe confusion caused by vitamin B deficiency. Today he was lucid enough to talk about what was happening to him, to commit to a healthier lifestyle and to discuss his living arrangements. I imagine he might fare well in sheltered housing, where he can be independent but with some kind of safety net of support if needed. I am thinking of John and David, it works for them, to an extent.
My brother, however, is not keen. He likes it where he is, living in a small room in a shared house, hoarding biscuits in his bedroom and endless packets of cuppa soup in a deep drawer in the kitchen. It seems odd him living like this, it's as if he is a 62 year old well-worn student. But to him, it's sheltered housing - his own private space, a communal lounge, help on hand in an emergency.
Seeing John, David and my brother this week has made me think deeply about independence, support , choice and the interface of housing, care and health services. We all need a place where we can be who we want to be, and we might be prepared to compromise other things to achieve that.