The journey of an Apprentice

Dementia misunderstandings

Perhaps not surprisingly, as there is still much to learn about the condition, there is much misunderstanding and confusion about dementia. In general, we still don’t know exactly what causes it and although there are treatments, there is no known cure. However, there are certain things we can say for definite and which should help you understand the disorder.

Dementia is not a natural part of ageing. If it was, everyone over the age of 65 would have it. It also occurs in younger people too.

You cannot catch dementia – it is not contagious.

People with dementia are not children, and will respond to how you treat them. They can still understand what is going on, even if they can’t tell you they understand.

Many people with dementia, with the right support and access to help and information, can lead productive and happy lives for many years.

Is it on the increase?

The outbreak of coronavirus (COVID-19) has led to unprecedented changes in the work and behaviour of general practices, therefore data relating to any primary care activity undertaken or recorded during the pandemic (March 2020 onwards) has to be interpreted with caution.

The main points are[1]:

since April 2020, there has been a consistent pattern of lower diagnosed prevalence rates for dementia in over 65 year-olds compared to before the pandemic

since January 2020, there has been a consistent pattern of lower proportions of dementia patients receiving a care plan or review compared to before the pandemic, with the gap widening as the year progressed

the variation across England of the proportion of patients receiving a care plan or review has increased significantly in December 2020 compared to before the pandemic

since March 2020, there has been a consistent pattern of higher antipsychotic prescribing rates for dementia patients compared to before the pandemic

About dementia

It is normal for memory to be affected by stress, tiredness, certain illnesses and medicines. But if you're becoming increasingly forgetful and it's affecting your daily life, particularly if you're over the age of 65, it's a good idea to talk to a GP about the early signs of dementia.

Dementia is not only about memory loss. It can also affect the way you speak, think, feel and behave.

What is dementia

Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline in brain functioning. It’s caused by different diseases that damage the brain. The symptoms get worse over time and include:

memory loss

confusion and needing help with daily tasks

problems with language and understanding

changes in behaviour.

Dementia is progressive, which means symptoms may be relatively mild at first, but they get worse over time.

There are many different causes of dementia, and many different types.

People often get confused about the difference between Alzheimer's disease and dementia. Alzheimer's disease is a type of dementia and, together with vascular dementia, makes up the majority of cases.

Alzheimer's disease

Alzheimer’s disease is a physical disease that affects the brain. It is named after Dr. Alois Alzheimer, a German physician who in 1906, first described "a peculiar disease" — one of profound memory loss and microscopic brain changes. Microscopic changes in the brain begin long before the first signs of memory loss.  The brain has 100 billion nerve cells (neurons). Each nerve cell connects with many others to form communication networks. Groups of nerve cells have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell.

To do their work, brain cells operate like tiny factories. They receive supplies, generate energy, construct equipment and get rid of waste. Cells also process and store information and communicate with other cells. Keeping everything running requires coordination as well as large amounts of fuel and oxygen.  Scientists believe Alzheimer's disease prevents parts of a cell's factory from running well. They are not sure where the trouble starts. But just like a real factory, backups and breakdowns in one system cause problems in other areas. As damage spreads, cells lose their ability to do their jobs and, eventually die, causing irreversible changes in the brain[2].

Vascular dementia

Vascular dementia is the second most common type of dementia (after Alzheimer's disease). Everyone experiences it differently. Symptoms vary depending on the person, the cause and the areas of the brain that are affected.  The most common symptoms of vascular dementia during the early stages are:

Problems with planning or organising, making decisions or solving problems

Difficulties following a series of steps (such as when cooking a meal)

Slower speed of thought

Problems concentrating, including short periods of sudden confusion.

A person in the early stages may also have difficulties with their memory and their language.

Many things increase a person’s chances of developing vascular dementia. For example, their age, other health conditions and lifestyle factors.

These are called ‘risk factors’:

Ageing – The biggest risk factor for vascular dementia is ageing. Once a person gets to 65, their risk of developing the condition roughly doubles every five years.

Health conditions – There are lots of health problems that increase a person’s risk of developing vascular dementia.  These include: 

cardiovascular disease

cerebral amyloid angiopathy (CAA)

sleep apnoea

Lifestyle factors, such as: 

Physical inactivity

Smoking

Unhealthy diet

Too much alcohol

Ethnicity – People from Black African, Black Caribbean or South Asian ethnic groups in the UK have a higher risk of diabetes and cardiovascular diseases than people from White ethnic groups, especially if they are overweight. This means they may also have a higher risk of vascular dementia.

Most people who are living with dementia have Alzheimer’s disease or vascular dementia. However, many other diseases and conditions can also cause dementia:

Dementia with Lewy bodies (DLB) – is a type of dementia caused by Lewy bodies, which are clumps of protein in the cells of the brain. In this disease, tiny clumps of proteins known as Lewy bodies appear in the nerve cells of the brain. Lewy bodies cause a range of symptoms, some of which are shared by Alzheimer’s disease and some by Parkinson’s disease. For this reason, DLB is often wrongly diagnosed. About 1 in 10 people with dementia has DLB.

Frontotemporal dementia (FTD) – is sometimes called Pick's disease or frontal lobe dementia. The first noticeable FTD symptoms are changes in personality and behaviour and/or difficulties with language. There are two broad types of Frontotemporal dementia:

Behavioural variant FTD – where damage to the frontal lobes of the brain mainly causes problems with behaviour and personality.

Primary progressive aphasia (PPA) occurs when damage to the temporal lobes – on either side of the head nearest the ears – causes language problems.

Mixed dementia – is a condition in which a person has more than one type of dementia

Young-onset dementia – There are around 900,000 people in the UK living with dementia, and the likelihood of developing dementia increases significantly with age. When a person develops dementia before the age of 65, this is known as ‘young-onset dementia’. Over 42,000 people in the UK are living with young-onset dementia. Like all people with dementia, younger people may experience a wide range of symptoms, especially in the early stages of dementia. However, they are likely to need different support from older people.

Alcohol-related dementia – is a type of alcohol-related brain damage (ARBD). If a person has alcohol-related ‘dementia’ they will struggle with day-to-day tasks. This is because of the damage to their brain, caused by regularly drinking too much alcohol over many years. The person may have memory loss and difficulty thinking things through. They may have problems with more complex tasks, such as managing their finances. The symptoms may cause problems with daily life. For example, the person may no longer be able to cook a meal.

And many others – see https://www.alzheimers.org.uk/about-dementia/types-dementia

Your role[3]

By developing an understanding of dementia, you could make someone who is feeling isolated feel valued and welcome. You are in a position where you can influence the experience of a person with dementia. Thoughtful and helpful service from you could make a big difference to someone who is feeling vulnerable. You could also directly help somebody in difficulty or a situation that is uncomfortable for them or others.

People experience dementia in different ways and they can be affected differently by the people and environment around them.  In the UK 900,000 people are living with dementia[4].  They – along with their carers, friends and family members – depend on a wide range of products and services. They are looking for organisations that show support and understanding.  Don’t underestimate how important your knowledge and understanding might be.

When you are assisting a person with dementia, remember the following points.

Firstly, allow the person to take their time.

Try to understand how they might be feeling.

Put the person at ease – be friendly and smile.

Consider their feelings and respond to the emotions they are expressing.

If they are experiencing difficulty or appear distressed, ask direct questions such as whether there is someone they would like you to call, rather than ‘What would you like me to do?’

Communicate clearly

The key to helping someone is being able to communicate with them. A person with dementia may not understand what you are doing or remember what you have said. Treat them respectfully by addressing them in conversation as well as any partner or carer they may be with.

Body language and physical contact

Make eye contact

Make sure that your body language and facial expressions match what you are saying.

Never stand too close or stand over someone to communicate.

Do not cover your mouth. The person should be able to see your face clearly.

Speak clearly and calmly.

Use short, simple sentences.

Speak at a slightly slower pace.

Avoid speaking sharply or raising your voice.

Don’t talk about people with dementia as if they are not there or talk to them as you would to a young child.

Listen carefully to what the person is saying, and give them plenty of encouragement.

If you haven’t understood fully, tell the person what you have understood and check with them to see if you are right.

If possible, use visual clues – write your message down if the person is able to read and use objects or pictures to help the person understand. For example, show the person photographs of meals they can choose from.

Dealing with a difficult situation

Customer service can sometimes be demanding and stressful.  Practise your techniques for coping when your role is challenging and you are helping someone with dementia who is experiencing difficulties. Remember the following tips:

Stay calm.

Keep your breathing even.

Reassure the person with dementia or anyone with them that they are not under any pressure.

Explain to anyone else concerned that the situation is under control and that it will be resolved as soon as possible.

If the situation remains difficult, ask a colleague or supervisor for assistance.

For more help read “How to help people with dementia” - A guide for customer-facing staff. ©Alzheimer’s Society 2015   ISBN 978-1-906647-32-2

A useful resource is the Dementia & Housing Working Group ‘dementia information hub’.  The Dementia and Housing Working Group brings you a home for all of the best information, advice and support for people with dementia, their families and carers as well as policy makers, practitioners and academics.  https://padlet.com/dementiaandhousingworkinggroup/Dementia_Information_Hub

[1] Statistical commentary: Dementia profile, March 2021 update – Updated 5 July 2022 https://www.gov.uk/government/statistics/dementia-profile-updates/statistical-commentary-dementia-profile-march-2021-update#:~:text=Dementia%20and%20Alzheimer's%20disease%20prevalence,(%20CI%204.3%20to%204.3).

[2] https://www.alz.org/alzheimers-dementia/what-is-alzheimers

[3] For more help read “How to help people with dementia” - A guide for customer-facing staff. ©Alzheimer’s Society 2015   ISBN 978-1-906647-32-2

As we do not lock ourselves away in our offices each day, we have the opportunity to encounter our residents regularly.  We may be the first to notice the insidious onset of health problems coming into their lives.  Some conditions are abrupt in their presentation; one minute the resident is there and the next… gone forever.  Peter left us last week.  He was admitted to the hospital a couple of weeks ago after a fall in his flat, by far not his first.

Peter and Anna arrived a couple of years ago.  Obviously, a devoted couple, they were often to be seen strolling out, linked arm in arm.  Neither of them was of a large stature, they looked as if a strong wind could pick them up.  Despite his 90-plus years, Peter was light of foot and clear of mind. We had both had involvement in armed conflict, Peter during World War II and myself, as a military medic, in the Falklands and the Arabian Gulf.  Experiences are more easily shared when you both have tasted the same fears.  Anna was equally sprightly and I was impressed to often see her with a tablet in hand, a computer tablet that is, not one of her medications.  Over recent months, I could see changes in his behaviour, culminating late one morning, when I looked up from my desk, to see him standing alone in the garden, with tears in his eyes.  What took over was my gut instinct, knowledge and practice from my many years of caring for the unwell.  Leaving and quickly securing my office, I exited the development’s main entrance to see Anna standing by the door also very lachrymose.  “He won’t come in, Nigel.”

It had become very apparent in recent months that Peter’s health was declining.  Anna frequently came to my office for help in finding extra laundry spots as Peter, “Had had an accident”. Their appearance at the regular coffee mornings and exercise classes had also dramatically reduced.

“Hello Anna”, I said, “Could you hold the door open for me?”

Stepping out a few more paces into the garden area I could see Peter was not in any physical danger. His arms were raised and hands clenched.  His tearful eyes met mine, “I don’t know where I am, Nigel.” “Not a problem, Pete.  That’s why I’ve come out to guide you home.”  Gently cupping his arm and with Anna leading the way we went back to their apartment.  Peter sat gently in his favoured chair and to distract him from his immediate confusion I gave him a catalogue that was by his side and explained I needed a kettle and could he find me a few options.

Anna was in their kitchenette making a pot of tea.  My empathy with Anna was fostered by my personal experience watching my own father’s health deteriorate and the strain this had put on my mother. Anna and I had talked a few times about how she could get help.  This was the worst we had seen Peter and there was the danger that he may have had a medical episode such as a Transient Ischaemic Attack[1].  At times like this, it is good to remember a FAST[2] check.  I offered to pop into the surgery and let the staff know of this occurrence.

I have, over the years, developed a bond with the GP’s practice, used by many of the residents, across the road.  Most of the reception staff and many of the clinical staff knew of current and previous roles. They listened to my story and indicated they would pass on the message to a GP who later that day called in to see Peter.

Later, I reflected on this experience and despite my own experience with my father and some 40 years of providing primary medical care my knowledge of dementia was sadly lacking.  The resulting notes I am happy to share.

[1] A transient ischaemic attack (TIA or mini-stroke) is the same as a stroke, but the symptoms last a short time. You get stroke symptoms because a clot is blocking the blood supply in your brain. When the clot moves away, the stroke symptoms stop.

[2]   A stroke is a medical emergency. The FAST test can help you recognise the most common signs.

Facial weakness: Can the person smile? Has their mouth or eye drooped?

Arm weakness: Can the person raise both arms?

Speech problems: Can the person speak clearly and understand what you say?

Time to call 999: if you see any of these signs.

Like many organisations, ours uses Yammer to connect leaders, communicators, and employees to build communities, share knowledge, and engage everyone. In one of the communities, a fellow Development Manager asked, “Are residents allowed to let someone move in and stay with them. the person is not a career, just has fallen on hard times and its not permanent.” The writer’s intent was, it appeared, to discover the legalities of the situation. However, my mind sprang to a more insidious thought. 'Cuckooing'. Cuckooing is a practice where people take over a person's home and use the property to facilitate exploitation. It takes the name from cuckoos that take over the nests of other birds. There are different types of cuckooing: Using the property to deal with, store or take illegal drugs is one of the more common.

Victims of ‘cuckooing’ can include older people, those suffering from mental or physical health problems, and those living on the breadline. Victims may suffer from forms of addiction, such as alcoholism themselves.

Perpetrators may begin by befriending the adult at risk – gangs will select members who are charming and manipulative for them to quickly build a rapport. They will then offer the adult at risk something of interest to them, this could be a relationship, friendship, drugs and/or alcohol, money or clothing.

In exchange they may ask to ‘borrow’ a room, to store something or meet other ‘friends’ at the property. In some cases, the gang may make it clear that this is for criminal purposes, i.e., drug supply, or they may use an excuse as to why they want to use the property.

Gradually the ‘benefits’ will reduce and may eventually come to an end, and more and more people will come and go from the address.

Once they gain control, gangs move in with the risk of domestic abuse, sexual exploitation and violence. Signs that cuckooing may be going on at a property include but are not limited to:

an increase in people entering and leaving;

an increase in cars or bikes outside;

an increase in anti-social behaviour;

people coming and going at strange times;

damage to the door / the door propped open;

unknown people pressing buzzers to gain access to the building;

you have not seen the person who lives there recently or, when you have, they have been anxious or distracted;

suspicion of physical assault / unexplained injuries;

self-harm or significant changes in emotional well-being;

lack of healthcare visitors;

presence of young people frequenting the property.

It is important to remember that not all of these issues will be a sign of cuckooing but may indicate other support needs. If you feel one of your residents may be at risk, you should follow their local safeguarding guidance. If you believe a person is in immediate risk of harm, you should contact the police.

Further reading:

Good customer service is a standard that all companies and individuals should aspire to achieve. In today’s multi-media world, many ways can be used to reflect one’s attitude to the service you have received.

Although this story has nothing to do with the Housing World it nevertheless is an example of what is, “Good”.

On Friday afternoon shopping in Lidl with my partner, she directed my attention to a Weather Station. She knew of my Englishman’s fascination with weather. With my Birthday fast approaching she was delighted to see, within our budget, an ideal present.

Once home, she graciously allowed me to unpack the display unit and the remote sensor. The instructions did tell me that it would take a few days for it to settle down and for the forecasting function to accurately reflect the conditions.

Wednesday evening and all looked well, radio-signal clock settled, interior and external temperature displays looking good. I decided to go outside and secure the sensor in a more permanent position. I am not now or ever have been Mr DIY. And, sure enough, it went wrong; I dropped the sensor onto a very hard surface and the display disappeared from the sensor and no readings were getting through to the main display unit. The next morning I gave Lidl’s Customer Service centre a call. Within a couple of minutes, a very neutral accented Jake took details of the unit and listened to my honest account of how I dropped it and how I wondered if it was possible to obtain a new unit. I am always courteous to Call Centre operators, they are human and respond so much better, I feel, to a bit of empathy. In response to my question, he told me he was in Germany. He told me that he would pass on my request to the manufacturer, also in Germany and to expect a reply within a day or so.

How did that happen…

An issue that had been raised, at a recent meeting at Swallow Court, was the apparent failure of a call for help made on a resident’s alarm call system.  The resident, Penny, had been hospitalised as a result of her condition.

On this particular day, the new DM was off-site attending an Area Team Meeting. 

Agenda item:

 Operation of the Pull Cord System

Discussion:

Concern that one resident had no response to an alarm activation

How the system worked

Layout of alarms in the common areas

Conclusions:

Area Manager (AM) will review the Call Centre records to try and determine why the call was not answered.

The Pull Cord system, when the Development Manager (DM) is on site, sounds the alarm in the office.  Should the DM be unavailable the alarm call, after two minutes, is routed back to the Call Centre. Similarly, if the DM is not onsite the call immediately goes to the Call Centre.

Changes to the location of the alarm system would come at a significant cost to the residents.  The cost is unlikely to be borne by the building’s owners and FirstPort as the Managing Agents do not fund any building works.

The Area Manager had reviewed the Call centre’s records and they did not show a call being made.  A family member of Penny, who was attending the meeting was adamant that Penny had told her she had tried to raise the alarm late morning.  This was confusing as Penny later took a call from the call centre, to see if an ambulance had attended.  Either the call had been made or had two calls been made.  Later checking of the records did show a call had been made but in the early afternoon.

The residents were concerned that the new DM had ignored the call and as a result, residents could be dying without attention being paid to them.

Unfortunately, during this period, the DM was herself off sick.  With raised feelings at the Development, the Area Manager asked me to spend some time at the Development so that the residents did not feel they had been abandoned.  On one of my visits, I did see that Penny was back in her apartment and I took the opportunity to call in and see her.  I discussed her recent collapse and her unanswered call.  Immediately I could see that she wore a call pendant around her neck and had used that to try and summon assistance when she collapsed in the bathroom.  I borrowed her pendant and took it to the office to see if it worked.  It did.  I took it back to her apartment and tried it by the door and in her lounge where a push on the button was met by activation on the system.  However, it did not work in the bathroom.  The pendants are a Radio Frequency device and the additional walls of the bathroom must be preventing the signal from getting to the receiver.

For the first time since commencing the apprenticeship, I felt the real benefit of a Continuous Professional Development (CPD) opportunity in Conflict Management undertaken recently.  The course detailed at https://www.irpmlearninghub.org.uk/course/view.php?id=54 was the only formal training I have undertaken, despite having had a career where I have faced down guns and knives.  Not, I hasten to add, in a retirement complex.

One of the nearby developments, Bankhouse Court, has had a poor record of retaining staff; there have been four Development Managers (DM) in the last five years.  I have come to realise that in any development, no matter what the size, you tend to see certain character traits appear; the Mother Hen, The Queen Bee, the Serial Complainer, and the Manager are but a few.   In training a DM, I have yet to find a textbook guide on how to deal with them.

With the Area Manager away, I was asked to look at three letters written recently by Mr & Mrs Collins.  It is easy to read a letter as someone registering a complaint.  However, I try to read looking for an insight into the writer’s expectations. By definition, customer expectations are any set of behaviours or actions that individuals anticipate when interacting with a company. Historically, customers have expected basics like quality service and fair pricing — but modern customers have much higher expectations, such as proactive service, personalised interactions, and connected experiences across all channels[1].  Clearly, from the content of their letters they had expectations that were not being met.  They had asked for a meeting to discuss their issues.  I arranged a date and time when I could be on-site and, in a communication to the residents invited anybody else who wished to attend.  My preparations included thinking about each of their issues and reviewing if they could be met under the terms of the Development lease, the roles and responsibilities of a DM, company policies and even the law such as the H&S at work act.  It was apparent that over recent years, some practices had become common which were questionable and misunderstood from what could be achieved.  You break expectations by changing what someone’s already used to. You change expectations by giving them something new[2].

The recent CPD introduced me to the Thomas-Kilmann model of conflict management. This model is used for resolving conflict since it involves considering the most important factors before deciding how to handle the problem. The key is to be more conscious, and less reactionary in the way you handle conflict. Recognising which of the five approaches to conflict management you are most comfortable with and broaden the ways you manage conflict by using the Thomas-Kilmann model. When dealing with conflict, analyse the intrapersonal, interpersonal, and intergroup conflict present in your role, and how it affects your personal and company performance.

Meeting Agenda item:

Concern over the DM’s roles and responsibilities.

Discussion:

Concern was raised by a number of residents that the frequent change in DM’s was resulting in a confused, patchy and inconsistent approach to the building’s management.  The DM may find, in her daily activities, that previous roles are influencing her decisions.  The residents may have expectations that are not being met.

Conclusions:

The importance of clear, concise and friendly communication was agreed by all.  The AM has to ensure there is a consistent provision of service.  The DM is still undergoing her initial training and is daily receiving support from the Area Trainer. When residents have a concern, they need to raise it directly with the DM and, if within a week, they still feel their concerns have not been addressed they should contact the AM.  The DM should be available daily in the site office to hear and exchange views.  The Residents’ Afternoon tea sessions are also an ideal time to listen to what is concerning residents.

Action items

Continue to provide training and guidance - Area Training Manager

An understanding that issues can usually be quickly addressed when you listen, reflect and inquire - All parties

Recognize that other viewpoints are possible and likely - All parties

Be open-minded to creative options - All parties

[1] https://www.salesforce.com/resources/articles/customer-expectations/

Friday afternoons are a curious mixture of relief and anticipation.  A week of dealing with problems and issues is tempered with the anticipation of time with my partner.  She lives in her own apartment close to where I work and when she is in the UK, will come home to relax in my village life.  My normal working hours are 08:30 – 14:30 leaving us plenty of time for a weekly food shop before heading home.  I was closing down my computer and doing a security check of the office as I called her, telling her I would be along shortly to pick her up.  Her happy squeals were however drowned out by the lift alarm.

Answering the alarm, a resident told me that there was a man who had collapsed in the lift.  I could hear a voice saying, “I’m alright.” So, I was comfortable this was not a medical emergency.  Routines click into place at times like this:

Mobile phone in the pocket – Check

Alarm Centre Call System switched to offsite – Check

The lift door is just to the left of my office door and I could see that the car was on the 1st floor.  I took a few minutes to walk the corridors but was soon on site.  Clare was standing in the doorway, keeping them open; I had my lift key at hand to take control of the lift.  She stood to one side to let me in and she volunteered to hang on for a while.

Peter was lying on the car floor with his knees drawn up, he was giggling and repeating his happy mantra of “I’m alright, my legs just gave way.”  Many years of nursing care step to the foreground of my actions;

Danger – There were no obvious dangers; the lift door was not going to close and the car would not move without pressing buttons.

Response AVPU – Peter understood my questions (Alert, Voice, Pain, Unresponsive)

Airway – He was speaking so he had a clear airway.

Breathing – Speech is also indicative of good respiratory movement

Circulation – Despite the front of his jeans being wet, there were no obvious pools of the red stuff, so I concluded that too was OK.

The company’s instructions are that no resident should be lifted.  However, Peter, with some encouragement and a supporting arm was able to leave the lift.  His apartment was only a few feet from the lift door and he was guided in and led to his couch.

Staying home

It may be the individual, family, friends or a concerned neighbour that raises the question that the time has come when living at home just isn't safe or comfortable anymore. It's not an easy subject to discuss, but there are lots of housing options.

If moving out is not an option then information is available to enable more independent living in your own home:

· adapting your home

· help at home from a paid carer

For those having problems with their current home, they can use the Housing Options for Older People online tool to identify the most important difficulties and get suggestions for dealing with them.

If you don't want to move out of your home and you have a spare room, an option is to share your home. Homeshare is a scheme that connects you with people who need accommodation and are happy to keep you company and help around the house. Usually, you don't charge rent but share the household bills. In return, the homesharer helps out by cooking meals, running errands etc.

Homeshare UK: find more information about homeshare schemes

The local council or housing association may be able to help find more suitable accommodation by arranging an exchange or "swap" for another council or housing association property.

Sheltered housing

Sheltered housing is for people who are normally able to live quite independently, but need occasional help or support.

Sheltered housing properties may have a warden or an alarm system that can be called in an emergency. Communal facilities such as a laundry, lounge and garden, as well as offering social activities and events are common.

Sheltered housing may be provided by your local council, or you can buy or rent a property privately. It is very important to check whether:

· there's a service charge and if so, how much it is

· there are any rules that could impact you, such as rules on keeping pets

Extra care housing

Extra care housing (also called "assisted living" or "very sheltered housing") offers more support than sheltered accommodation.

You live in a self-contained flat, but you may have services provided by on-site staff, such as meals or personal care and domestic support.

There are usually communal areas such as cafes and lounges, too.

You don't have to sign up to receive care and support when you first move in, and the level of assistance can be increased as your needs change.

Extra care is usually available to rent or buy.

Housing LIN: find more information about extra care housing

Close Care

For couples who have different needs Close Care is housing (usually a flat or bungalow) that's on the same site as a care home. The care home provides services and allows you to move there in the future if you want to.

EAC Housing Care: find more information about close care housing

Retirement villages

The elderly may be finding it difficult to manage in their own home, or would prefer to move somewhere else.

They may want to live somewhere smaller and easier to maintain, or may want to live somewhere more suited to their physical needs, such as a bungalow. The preference may be to live nearer family or friends, or have easier access to facilities such as transport and leisure.

Or they may want to live in a community where they can retain independence, but where care and support are available on site if needed or might be required in the future.

While buying or renting a different property or moving into a care home might be the first options that spring to mind, there are many others you could consider.

These include:

Exchanging a council or housing association property

Independent living apartments

Sheltered housing

Extra care housing

Close care

Retirement villages

The Fountains was a purpose-built block of apartments, completed in the mid ‘80’s. Developers, when building such complexes, will have decided what market they are aiming for and will have designed the building with these in mind. One of the major differences in this building is who can live there. In almost every apartment building in England, life is governed by the contents of the lease. In this case the lease stipulates that the residents have to be at least 60. As no living support is directly provised to the residents, The Fountains is considered, ‘Independent Living’.

What is independent living? Essentially, it is living just like everyone else – having opportunities to make decisions that affect one's life, able to pursue activities of one's own choosing – limited only in the same ways that one's less aged neighbours are limited.

Independent living is not defined in terms of living on one's own, being employed or retired, or having an active social life. These are aspects of living independently. Independent living has to do with self-determination. It is having the right and the opportunity to pursue a course of action.

Without me sitting in my command chair, the Fountains and its residents managed to survive the passage into the New Year. Prevalent through the development there was still a hesitancy about living a ‘normal’ life. The scourge of the decade will surely go down as the epidemic onslaught of the coronavirus disease, caused by the SARS-CoV-2 virus, (COVID-19) that was first reported from Wuhan, China, on 31 December 2019.

In the coming months and years, much will be looked at and dissected to understand why so much physical, mental and financial harm came to the people of planet Earth. To date (early January 2022) some 5.5 million deaths have been attributed to Covid-19. The emotional pain and financial damages are, I suspect, uncountable. Most people infected with the virus experienced mild to moderate respiratory illness and recovered without requiring special treatment. However, some become seriously ill, requiring medical attention and too many succumbed to the onslaught and died Given that the development’s population, of approximately 50, comprises of elderly people many with underlying medical conditions like cardiovascular disease, diabetes and chronic respiratory disease they were more likely to develop serious illness. 2021 passed by with remarkable little obvious distress to the residents. Two people did become ill enough to require hospital treatment, one of whom almost certainly contracted the illness during her hospitalisation for another reason.

Preparation of the Fountains development was consistent with the sporadic and sometimes changing Government advice, direction and at times, legal measures. With some minor adjustments over time, the general precautions were an understanding that the best way to prevent and slow down transmission was to keep the residents well informed about the disease and how the virus spreads. How to protect themselves and others from infection by social distancing, frequent washing of hands and using an alcohol-based rub. Later, wearing a properly fitting mask and getting vaccinated. It was important to practise respiratory etiquette, for example by coughing into a flexed elbow and staying in their apartment foregoing regular social gatherings particularly if they felt unwell.

For ten years, I had had a successful life working in the Oil & Gas Industry, travelling the globe in a well-paid job. I had previously spent twenty-five years caring for the crews of Royal Naval ships, submarines and bases worldwide. For the entire period, my client base was invariably men, later women, aged from teenagers to those approaching their 60's and in the twilight of their careers. In 2014 life was full and rewarding, two teenage daughters and a home in a small Cheshire village. With oil prices at over $100 per barrel, work was plentiful. The only blot on the page of life was a folding marriage. Not so uncommon in my line of work. Other warning bells were sounding; oil prices were tumbling and for me, in October 2015, my contracts dried up. Suddenly, for the first time in my working life, I did not know from where or when my next pay cheque was going to materialise.

For two years I survived on income generated from such varying sources as making ice cream in a local factory, stacking shelves for Tesco and helping out local companies with work generated under the banner of "Office Administration with Researched Solutions".

As an independent living development, you may expect the residents to be able to live independently. An example this week ate into my time. Sadly, a number of the residents have no family to call upon for help. This can sometimes be because of choice through family disharmony or through no surviving siblings or children.

Brenda fits into the former. I have never questioned why, but I have been met with a very firm rebuttal if I mention family in any conversation even having a point of contact in an emergency. Always well dressed and coiffured, Brenda is capable of looking after herself so it was unusual to hear she was asking for help. The day before her phone had stopped working and she had engaged a local handyman to obtain and install a new phone for her. With still no working phone, it was he that asked me to contact BT to report the fault;

Time x . Look up number for BT faults. No, I don't want to text ... No, I don't want to use a live web chat ... I want to talk to a human, ah... 0800 800 150

Time x + 24 minutes. Human answers phone. However, they cannot find Brenda's account. Transferred to special team in Belfast that track down accounts. He couldn't find an account. He asked me if by any chance she had another supplier, this little question had never occurred to me. I called Brenda on the intercom, she told me that she paid money to the Post Office. I apologised to the BT chappie.

Time x + 40 minutes. I asked her to bring down a copy of her bill. Luckily this had a contact number and the Post Office was duly called.

Time x + 55 minutes. Call answered and after the usual hassle over security I was told that since the 8th of February, Brenda had been transferred to Shell Energy https://www.moneysavingexpert.com/news/2021/02/post-office-broadband-to-join-shell-energy---what-it-means-for-4/. "Oh", says Brenda, "I did wonder what that letter was about." She returned to her apartment, via the lift, and called me on the intercom with her new account number and a contact telephone number.

Time x + 110 minutes. Call answered by Post Office telephones. "Yes, it is a bit confusing," the operator told me. She gave me another number.

Time x + 135 minutes. With a Low Battery alarm flashing on my handset, my call was answered by a Shell Energy faults team member. Some simple tests were done to the line and a fault confirmed. More personal details were taken, forms filled out and the fault passed on to BT. Yes, BT, those people I was talking to 2 1/2 hours ago.

As I put my coat on, I updated Brenda that it might take 7 - 10 days before an engineer could attend. Dire warnings were also conveyed that if it was her fault, for example the cable in her apartment was damaged, she would be presented with the bill.