This case study exemplify one or more of the Principles of Excellence that was identified during the research and engagement work of the Commission on the Role of housing in the future of care and support.
Model of housing or service: Housing with care
Principles of excellence: adopting innovation; person centred and outcome focused; community connectedness
Introduction and overview
Cullingtree Meadows, in Belfast, Northern Ireland, is a public sector supported housing scheme for people living with dementia. The facility provides 30 modern apartments and is a partnership between Belfast Health and Social Care Trust and Clanmil Housing Group. Prior to the development of Cullingtree Meadows in 2018 there were no supported housing schemes in the locality for people with dementia.
Promoting independence through inclusive and accessible design
KnoxClayton Architects consulted with experts from Stirling University’s Dementia Services Development Centre to establish the principles of design and layout for this project. The overall concept was to create a responsive and accessible design which ‘makes sense’ to the people who live there with the creation of a homely, pleasant, private and safe environment rather than an ‘institutional’ atmosphere.
The two-storey building has been planned around the principles of the ‘Dementia Design Standard’ and is orientated around a central triangular external courtyard. There are circulation and communal spaces wrapped around this courtyard area, allowing tenants to easily understand their location within the building at any time. The circulation corridors avoid dead-end space, while places of interest and rest are provided throughout to allow lots of opportunity for residents to meet and relax.
The layout of the scheme was very important; creating wide open, but interconnected spaces with airy hallways and lots of windows, offering visually recognisable markers throughout, regardless of location.
Each apartment has a range of assistive technology and is furnished as the tenant requests. The technology allows for discrete monitoring, with a call system, cooker alarm sensor, fridge alarm sensor, floor/water sensor, motion sensor, chair sensor, bed sensor and falls bracelets all linked back to a building management system which is continually monitored by staff. This helps promote independent living and enhance tenant safety.
The elevations fronting onto the road have a traditional Belfast ‘street feel’ and provide an easily recognisable domestic building. The scheme also benefits from a linear garden, which provides tenants with an alternative external private space to allow meaningful wandering and a pleasant place to spend time with friends and family.
In 2019 Cullingtree Meadows was awarded ‘Best Housing Development’ by Chartered Institute of Housing.
Other communal accommodation provided within the scheme includes:
- Two tenant lounges for entertainment and activities
- Quiet room opening onto the courtyard
- Laundry facilities
- Hairdressing salon
- Potting shed
Reducing isolation and promoting community connectedness
Social activities are available on a regular basis, from museum trips to gardening or arts and crafts. These activities promote quality of life and give tenants a chance to enjoy each other’s company and also offer the opportunity to keep connected with the local community.
Cullingtree Meadows also provides a hub to promote the development of a dementia-friendly community for local people living with dementia, and helps the wider community to understand and include people with dementia in a social context. A partnership with the local primary school allows for tenants to attend school activities and the local parish choir host their practices at the housing scheme, encouraging tenants to join in.
Person-centred care
Cullingtree Meadows combines innovative housing design with 24-hour support services. Each tenant is encouraged to remain independent and stay actively involved in all decisions about their health and wellbeing. In its two most recent inspections, 2019 and 2021, The Regulation and Quality Improvement Authority (RQAI) found that staff were well trained and registration with Northern Ireland Social Care Council (NISSC) was a compulsory requirement for all staff. New staff receive comprehensive induction which includes regular meetings and the opportunity to shadow experienced staff. This shadowing allows staff to become familiar with the needs of individuals and ensure that tenants that access care are introduced to new staff prior to them providing care on a one-to-one basis.
RQAI inspectors found that Cullingtree Meadows promoted service users’ human rights, particularly in relation to areas of autonomy, equality, choice, care planning, decision-making, privacy, dignity, confidentiality and effective service user engagement.
Culling Tree Meadows uses an ‘About Me’ format to gather and record information on tenants’ preferences. This aims to provide succinct ‘need-to-know’ information about the person which enables staff to adopt a consistent, person-centred and user-led approach.
Conclusions and key learning
Cullingtree Meadows illustrated to the Commission that careful and intentional building design coupled with purposeful and well-structured staff training can promote independence and improve the experience of people that are living with dementia. This purpose-built retirement community is a promising example of how consultation with experts in dementia, right from the initial stages of planning, can create a living environment that is enabling and reduces the opportunities for frustration for those who live there. Removing ‘dead-ends’ by using a triangular configuration and including regular visual prompts are just two examples of how applying knowledge and understanding of dementia to building design can result in a more user-friendly environment.
The emphasis on good-quality staff training has resulted in benefits for staff, who feel better equipped to carry out their role, and tenants who report feeling well cared for and listened to. The links with the local community are helping people living with dementia to retain their identity and maintain their involvement with those around them as well as developing understanding of dementia amongst those living locally. Prior to the development of Cullingtree Meadows, there was no supported living scheme in the locality for older people living with dementia. Now the community has purpose-built apartments with well-trained staff who deliver person-centred care. A positive example of what can be achieved when people share a vision.