Windows of opportunity: prevention and early intervention in dementia
Interventions: Building social capital - Case studies
Camden Networkers Open
The RSVP Camden Networkers project recruits older volunteers to pass on information about healthy living and accessing health-related services and activities to older people. The project particularly targets isolated older people and older people with mental health problems, both as volunteers and as beneficiaries of the service.
The project supports and empowers people to access health services and information that might not otherwise reach them. Equally, older people who have experienced mental health problems who have been recruited as volunteers are enjoying opportunities to develop their skills, contribute to their community and make new friends. Volunteers and beneficiaries become less isolated.
Networkers and beneficiaries attend regular social events to hear programme updates and talks from local organisations of interest and share ideas so that they have the most up-to-date information. 60% of the 120 volunteers are from BME communities.
The Networkers enhance local partnership arrangements by taking place in promoting and developing local events and sharing information and resources.
Caring with confidenceOpen
The programme which helps carers make a positive difference to their life and that of the person they care for. The training courses are designed to take place in a supportive peer environment with other carers to provide participants with the opportunity to learn from professional practitioners about all aspects of care. Courses aim to increase carers’ knowledge and skills and to give them greater confidence in their caring role. Evidence shows that outcomes for carers include:
- More positive about their caring situation
- More confident in their caring role
- Less impact on physical health
- Less isolated and more supported
- More skilled and able to give a better quality of care
The Connected Care model aims to improve community well-being by reshaping the relationship between services and the communities in which they are delivered. The stated aim is to connect health and social care services with housing, education, employment, community safety, transport and other services, based upon a belief that the gaps between services can be bridged by ensuring that the legitimacy of local user and community voices is recognised.
In their evaluation of the Connected Care Centre in one ward in Hartlepool, Callaghan and Wistow (2008) note that if community social capital can be built through involvement and devolved power, the role of the state can then become one of facilitator in a self-sustaining process, rather than a provider of unresponsive services.
In effect, the production and ownership of knowledge would become the province of the community rather than the ‘expert’ professional.
In the case of Hartlepool, a community audit was used as the basis for specifying a new model for ward-based commissioning and service delivery which included proposals for workforce development such as:
- care navigators working on an outreach basis (and possibly recruited from among local residents) to improve access, promote early interventions, support choice and ensure a holistic approach
- a complex care team integrating specialist health, social care and housing support for residents with long-term needs
- a transformation coordinator to manage the service and promote change in existing services so that they are joined up.
Generation Xchange Open
An intergenerational project (not specific to dementia) that provides opportunities for young people to learn skills from older people and vice versa. It was established on the foundation of a successful initiative to provide lunch for older people in 50 schools across the district, encouraging cross-generational communication and increased social cohesion.
A citizen-led network with the aim of connecting the residents of Harringay, sharing information and building stronger connections.
KeyRing is a housing and advisory service developed for people with learning difficulties (though in principle there is no reason why the model could not be used to support older people). There are over 105 networks nationally. The approach is to set up a series of local networks which each have nine adult members, and one volunteer, each living independently, usually within a 10-15 minute walk of each other.
The networks provide mutual support, support for independent living, and links into other local networks and resources. Volunteers provide regular housing related support, such as helping to pay bills, organising maintenance and other work helping members connect into the community. In return they receive free accommodation. Once networks have matured, the support becomes more mutual within the network, and the volunteer role is reduced as members turn to each other. The volunteer is often perceived as a peer by members.
Elements of co-production are evident across the service. It is a members’ organisation driven by and for the members. At least two members are involved in the recruitment of new KeyRing staff and members are trustees on the board. Members also refer new members and actively increase the network, shape the development of networks and facilitate network meetings. Critically the networks developed are not simply for other people with a learning difficulty, but instead incorporate a wide range of people from the local community.
Local Area Co-ordination (LAC) Open
The LAC approach is designed to help people to stay strong rather than waiting for them to fall into crisis before intervening to fit them into services. Instead, LAC works with individuals, families and local communities to build on and share assets and skills, capacities and passions to make local communities more welcoming and to value everyone’s contributions.
Local Area Co-ordination has a number of elements to it, including individual co-ordination, personal advocacy, information and advice, family support, building social capital, early intervention and handing back control. LAC also aims to make the system less complicated. A local area co-ordinator works as a single accessible point of contact in a defined local area, supporting between 50-60 individuals and their families.
Co-ordinators get to know people, their assets and skills, strengths and aspirations, and the local communities in which they live. They provide and support access to accurate and timely information from a variety of sources. They support people to be heard through promoting self advocacy, advocating with people and accessing local advocacy services. They also contribute to building welcoming, inclusive communities, identifying community opportunities and responding to gaps in local communities. But one of the key areas – and this is what makes co-production central to LAC’s approach – is that they help people develop personal and community networks to enable practical responses to their needs and aspirations, and they help people to contribute and share their skills, assets and strengths through these networks.
Peer Support Networks Open
The aim of these new networks is to provide local peer support for people with dementia and their carers and to enable them to take an active role in shaping their local services.
The peer support networks will provide practical and emotional support, reduce social isolation and promote self-care, while also providing a source of information to inform commissioning decisions.
The voluntary sector is involved in supporting and providing new services.
Southwark Circle (SC) is a membership organisation representing a cultural shift in the relationship between older people and state sponsored support. Membership is open to all residents over the age of 50, without any financial or needs assessment required.
Southwark Circle helps its members sort out practical matters, stay socially connected and lead a purposeful life. It is a ‘quality of life’ membership society that provides one single destination for a wide range of services and activities such as:
- ‘On Demand’ helps with life’s practical matters through our neighbourhood helpers;
- Meet-ups and other opportunities to meet like-minded people and build relationships in the community;
- Opportunities to continue working and learning;
- Reliable recommendations from other members for plumbers, electricians, cleaners, carers and more;
- Expert advice and information on a range of practical issues, from personal finance to technology;
- Opportunities to put experience to good use and help others.
Southwark Circle is a social enterprise that is legally structured as a Community Interest Company (CIC). It has solicited and received initial seed investment and aims to become self-sustaining within three years of launch. For its members, Southwark Circle is an entry point to a local ecosystem of social and practical resources. It is designed to convert members’ observed demand and behaviour into innovative, low-cost services and increased social interaction. As a social enterprise, this is crucial because it aligns Southwark Circle’s social mission and its financial sustainability.
Southwark Circle’s core competencies are:
- Social Engineering – facilitating, matching, knowing ‘who you’d get on with’, making it happen and then getting out of the way;
- Resourcefulness - being handy and relevant to people’s daily lives. It’s not just information and advice, it’s a neighbourly solution.
- Community Intelligence – meticulously gathering, managing and leveraging data and other information for members’ benefit through our custom CRM solution built on top of the world-class Salesforce.com platform
Southwark Circle annual membership costs £10, and then members typically purchase between £30 and £75 per quarter for Neighbourhood Helper visits and transport. Neighbourhood Helpers are local community members that provide flexible, practical help to people in their neighbourhood. In our experience, at least a third will be over 50 themselves and many both give and receive help. Neighbourhood Helpers, provide a diverse range of practical tasks for members. As a value proposition, it is fairly unique in that it combines creation of social capital with being paid a decent hourly wage (Helper hourly rate is pegged to the London Living Wage).
This hybrid concept has struck a chord with many people who appreciate a flexible, local way to contribute their skills, while also, say, paying off their monthly mobile bill. When combined with unpaid Helpers, this created a larger, more flexible and responsive network of resources to support members. Helpers may redeem by gifting services to other members or using the credit built up by their hours to contribute towards ‘on demand’ services, discounts and social networking opportunities. These kinds of non-monetary transactions will enrich the community and facilitate the growth of an active membership by lowering costs.
Time is used as a currency that can quantify and record the contributions that people make in helping neighbours. There are no tax or benefit consequences. Participants make time ‘deposits’ when they make a community contribution; they ‘withdraw’ deposits when they need something doing themselves. 100 or so schemes already in operation. Some noteworthy variants include:
1. Timebanking and primary care
Paxton Green Timebank is linked to a GP practice and reports that is has “a proven record of improving mental and physical wellbeing among our patients.” What makes Paxton Green different from the mainstream primary care is their attitude to their patients. They recognise that these are people who, whatever health problems they might have, also have huge experience, skills, often time – certainly the human ability to connect with other people.
They also recognise that both the prevention and management of someone’s health often needs more than a prescription. These are important resources which are usually wasted. Many doctors are aware of the problem that the patients in front of them don’t really need pills, but would benefit from a friendly visit once a week. Having a time bank means they can write them a prescription for that and the time bank will fulfil it, a type of social prescribing that brings mutual solutions.
2. Care Share schemes
Based on successful scheme Japan called Fureai Kippu, whereby volunteers are awarded non-monetary credits in a volunteers ‘time account’ for the help they provide to older people. The account is managed exactly like a savings account, except that the unit of account is hours of service instead of yen.
Different values apply to different kinds of tasks – for instance a meal served between 9am and 5pm has a lower credit value than those served outside of that time slot. Household chores and shopping have a lower credit value than personal care. These health care credits are guaranteed to be available to the volunteers themselves, or to someone of their choice, within or outside of the family whenever they need similar help. Some private services make sure that if someone can provide help in Tokyo, the time credits become available to his or her parents anywhere else in the country.
A surprising part of the project has been that members tend to prefer the services provided by people paid in Fureai Kippu over those paid in yen because of the nature of the relationship. Having this system in place means that the limited time available by qualified professional staff can be focussed on the most valuable areas in which they can provide support, making this paid-for system most efficient. Fureai Kippu continues to be widespread in Japan and has also now spread to China.
Elderplan is another variant run by health insurance companies in New York. They originally launched their “Member to Member” scheme as a way of getting their members to look after people who were slightly more infirm, so that they could stay in their own homes for longer. People earned ‘time dollars’ for the hours of effort they put in, which gave them the right to draw down time from somebody else in the system when they needed it.
It was an outline of a mutual support system which measured and rewarded the effort everyone put in, and utilised key assets in the community. To Elderplan’s surprise, the real health impact wasn’t gained by those being helped; it was in fact enjoyed by those doing most of the helping. It gave them a purpose; a reason for getting out of bed in the morning. So much so that Elderplan members were allowed to pay a quarter of their insurance premiums with the credits they had earned helping neighbours.
Tyze - social networking for a purposeOpen
There are opportunities for technology to provide ways to improve care, safety and to reduce isolation. Tyze is an online service that uses the potential of the internet to develop a virtual ‘circle of support’. It allows a secure network to be built for people who are experiencing challenges and those who support them. The networks co-ordinate community involvement and provide practical tools for friends, family and neighbours to care for one another. With a Tyze network users can:
- Message other members
- Post events
- Create tasks
- Co-ordinate schedules
- Share documents