The Englishmans home may no longer be his castle, but as a nation we want most of all to live out our days behind our own front doors. And we do pretty well on it - provided we can overcome maintenance problems, coping with sloping halls and terrifying staircases, fear of intruders and hypothermia. But arguably the biggest problem is the debilitating effect of loneliness, isolation and consequent depression.
Our neighbours in northern Europe have for decades overcome this problem by providing their elders with attractive housing developments which combine good design and modern technology with facilities - and leisure opportunities - on the doorstep. Why pay the rent on the family four-bedder when you can move in your seventies to a compact home like this - and pocket the difference every week? The fact that most Britons own rather than rent may be significant here. Of course weve had sheltered housing for years, but much of the older stock is of little use to people with significant health or mobility problems. Then theres the warden - a slender resource who can be guardian angel or absentee landlord. No wonder a recent Joseph Rowntree study showed that (ordinary) sheltered housing made no measurable impact on probability of needing nursing or residential care.
Enter stage left, about twenty years ago actually, the supercharged model VERY sheltered housing. This has the added ingredients of indoor connections within the scheme, a full range of restaurant and leisure facilities and not merely a warden but a whole care team funded by Social Services. Tenants (or they might be owners) have a wide choice of arrangements from living in splendid isolation with or without carer input through to a highly social existence, never out of the spa bath, further education resource room or restaurant!
"A bit like a modern EPH" you might say. Actually not if the care staff respond to their "independence orientated" training. More important, a good VSH scheme carefully maintains a balance of dependencies so theres always activity and energy in the public places - aided by day care visitors (and other guests) from outside. In fact the theory goes that the patterns of self-sufficiency and stimulation laid down in ones first year or so in VSH sets a positive pattern for later times. And it does deliver. Repeated research on VSHs shows diversions over 80% from residential care; many schemes have never lost a tenant to the local EPH! However, the eventual need for specialised high dependency care with built-in nurse provision units for a minority is undiminished in European studies, so nursing homes still have a role.
What role can VSH play in support for older people with mental health problems? Well, the environment greatly reduces the prevalence of depression. VSH clearly isnt at its best if used as a placement for someone with established significant dementia as it adds to disorientation. However, the relatively safe environment, stimulation and scope for establishing positive routines is likely to delay destructive dementia, and make its management later much easier, especially using the latest domotic gadgets. There is still further work to be done on VSH in this field, and collaborative projects would be beneficial in exploring new approaches.
All this promises much - so its just as well that Bristol City Council and many partners are investing in several, with one open (ABC at Whitchurch), two more under construction and several more planned.