1 The Future Of Social Care for Older People: A Case Study National Council on Ageing 30 th Jan 2006 Sheena Scott Dunbar and Jorge Lagos Waltham Forest.

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The Future Of Social Care for Older People:

A Case Study

National Council on Ageing

30th Jan 2006

Sheena Scott Dunbar and Jorge Lagos

Waltham Forest

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The Waltham Forest Model

OfEarly Detection,

PreventionAnd

Healthy Ageing

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Developed and framed by key national policies including:

•NSF for Older People•Choosing Health•A Sure Start to Later Life•Opportunity Age•Admissions Avoidance•Link Age Plus•CSCI – Leaving Hospital Revisited•Green Paper

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It is about working collaboratively and integrating serviceswithin an equal opportunities framework

across sectors

across health and social care

but also across the wider system of local services

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Our Agenda

• Supporting older adults stay safe, healthy, active and independent for as long as possible

• Preventing ill health and social isolation but also promoting choice and control and quality of life

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We do this by:

•Offering services and information more proactively•By identifying needs as they emerge and before crisis occurs•By basing our work on evidence as far as is possible•By collecting further evidence•Listening to older adults and carers

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24 hourResidential care

Complex CareIn the community

Simple CareIn the Community

Healthy Ageing

Prevention and

Early Detection

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Older People’s Development Programme – Waltham Forest

Waltham Forest

Case Finding & Single Assessment

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The Project

The Waltham Forest Older People’s Development Programme (WFOPDP) was mainstreamed following a successful pilot as part of the London Older People’s Development Programme.

It was the only pilot site out of 29 in London to be led by a voluntary organisation (Age Concern Waltham Forest).

This highlighted the important role that the voluntary sector can play in achieving change and implementing innovative practice.

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Working together: The Partners

Age Concern Waltham Forest(and the Waltham Forest Older People’s Voluntary Sector Partnership)

Waltham Forest Primary Care Trust (previously Chingford, Wanstead and Woodford Primary Care Trust)

Whipps Cross University Hospital NHS Trust (North East London Mental Health Trust)

The London Borough of Waltham Forest Social Services Department

The Waltham ForestOlder People’s Development

Programme is working in partnership with:

Waltham Forest

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N

S

W E

Total population of people aged 60 and over living in Waltham Forest 33,930. All ages: 218,341 = 15.54%

Most OP aged 75 and above lives in Wards North of the LBWF

There is a significant concentration of BME population south of WF

50.20% of OP aged 60+ have a Limiting Long-Term Illness. The majority lives South LBWF rising to 77.3% of those aged 85 and over. Most of them lives in precarious socio-economics conditions.

Waltham Forest has the highest proportion of households with no central heating in London (12.3%),One in five aged 60 and above did not have central heating, rising to nearly one in three (28.8%) of those aged 85 and above. This group is particularly vulnerable to hypothermia and therefore winter death.

Winter deaths in England and Wales 2004 = 28,700

2002-2004

2005-2006

2006-2007

2008-2010

Life expectancy at birth over

75 years

Life expectancy

at birth bellow 74

years

SAP

SAP

SAP

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Methodology

The Waltham Forest Older People’s Development Programme:

Enables access to all services across sectors and disciplines before a preventable deterioration, accident or crisis occurs and/or to alleviate social isolation

A pro-active approach to identify older adults who are not necessarily known to or in touch with health and social services

Uses holistic assessment (Overview Single Assessment)

Offers options, information, and control to older adults

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Case Finding & Single Assessment Pathway

Cardiff-Newport Q.Identifies for..

Functional DeclineEmotional & Social IsolationContinenceDepressionFallsMemoryMedications

Known to services No

Yes

Send appropriateinformation

NFA

Single AssessmentInterview

No

Send appropriateinformation

NFA

YesRisk

AssessmentSA tool

(services provided)

CommissionsEquipment

Handy personElectrician

ACWF-VSP(80+ partners)

Medicine Management

District Nurse

ContinenceService

Healthy Ageing Info & Advocacy

Specialist Assessment

GPs

OT

D. Nurses

S Services

First Follow up

After6 weeks

No

Discovery Interviews

SA Starts here

Referrals from:SS

WXHACWF

Self-referrals

Soc.Service

Mental Health

Footcare

OtherACWF

Services

GPs involved in the programme identify patients 65+ and make information available to the programme

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Case Finding and Single Assessment Links with other services

SAP

Voluntary Service Partnership

District Nurse

OTs

Incontinence Service

WF Social Services

Equipment Commissioning

WF Older People’s

Collaborative

Handyperson Service

GPs

WF Falls Collaborative

ACWF Services

Medicine

Management

Discovery Interviews

Housing

Pension Services

Whipps Cross Hospital

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Statistical returns: May 2002 – Sep 2005Total single and multiple referrals per risk factor of OP not currently known in the system (%)

Update 2002-2005

Total population of older people aged 65+ in Waltham Forest: 25,528 (Census 2001)

Questionnaire sent out May 2002 – September 2005: 4100

16.0% of all older people in Waltham Forest have been sent questionnaires and above a quarter of OP have been referred for Single Assessment

Case Finding ReturnsStats Summary 2002-2005

May 2002 - September 2005

Case finding results 2002-2003 Total

Total questionnaires sent out 4100

Total Questionnaires returned 2157

Total Conditions Identified 1921

People referred for Single Assessment 1006

Older People identified per

Risk Factor (not known to services) Total

Depression 43

Memory 339

Continence 190

Functional decline 157

Social Interaction 545

Falls 2 317

Falls 1 99

Total 1690Over 600 older people received services through Single Assessment, over 70% of these were provided by Age Concern Waltham Forest and the WFOPVSP. Falls 1 = OP that have fallen

Falls 2 = OP at risk of falls

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1. The close participation and co-operation of all agencies involved.

2. The commitment of Senior Managers in all agencies

3. All agencies involved meet on a regular basis to review progress and plan future actions.

4. Responses to clients’ needs are fast and tailor-made to the individual’s assessed needs – older adults like it.

Main reasons for the success of the project:

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“Following on from your visit, recently I am certain that you will be pleased to learn that I feel so

much better. Your kindness and patience to

me filled me with hope that life is worth living and that not all people are unkind and thoughtless. We all need to feel we are worthwhile and you most certainly made me feel

this”.

“….it was sensitively and intelligently done and I enjoyed the

meeting. I heartily endorse a serious attempt to work out the needs both

now and in the future of the population and only hope the findings are

matched by practical, properly funded solutions”…

“…Such a good idea in principle.

I will be very pleased if the SA is on record if we need it in the

future....”

“I’m so pleased, I didn’t expect any help and am pleased at how quickly it

happened”

“…after the SA we now have a wheelchair for my husband. It will make

such a difference. My husband will be able to go out

in the chair and meet neighbours he hasn’t seen for years, or we can just sit together in the sunshine on the green..”

Quotes from Older People on Single Assessment

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Age Concern Waltham Forest

Waltham Forest

WF Voluntary Sector Partnership (VSP)

Social Inclusion

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WF Older People’s Voluntary Sector Partnership

• part of the WF Older People’s Service Development Programme

• administered by ACWF

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ACWF’s Statement to MembersMarch 2002

Age Concern Waltham Forest is committed to working in partnership with members to develop a Partnership that delivers for older people in the borough and for their organisations/groups.We wish to see Waltham Forest become the borough leading the way in a whole system approach with the voluntary sector as a fully integrated and equal partner.The Partnership systems that we develop must ensure that the smallest, least resourced groups in the borough can participate as well as the larger, better resourced groups.

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WF OPVSP – aims: To be a strong, vibrant and sustainable local partnership

of voluntary sector organisations/groups/projects

that:

•acts as a coordinating, support and development body for older people’s voluntary sector organisations / groups/ projects in Waltham Forest.

•enables voluntary sector organisations / groups / projects working with older people and their carers to develop systems to work in partnership with each other and with the statutory sector to develop integrated services for older people

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•works in partnership with the Waltham Forest Healthy Ageing Programme.

•increases the capacity of the voluntary sector to address the emotional, cultural and socialisation needs of older people.

•provides a single point of access to voluntary sector services for older people and their carers.

•provides a single point of access for professional referrals to voluntary sector services for older people and their carers.

•agrees, develops and maintains common referral, monitoring and feedback procedures with health and social care partners (PCT, Social Services, Whipps Cross University Hospital and NELMHT.

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•enables local groups and older people to come together to influence policy, to respond more effectively to consultations and to effect a stronger voice for older people across all local communities in the borough.

•acts together to challenge ageism, racism and other forms of discrimination and to counter negative images of older people.

•works to involve more people in community activity and to attract more older people to volunteer in the borough.

•enhances shared learning across sectors.

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Other initiatives for Members:

Fees paid for participation

Training Provided (IT, Human Rights, Health and Safety, Manual Handling Elder Abuse, First Aid)

Access to ACWF’s Small Grants Scheme

Administration of the Council’s Health and Social Care Grants Scheme

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Forthcoming Local Developmentsin March 2006

• Launch of Waltham Forest’s Older People’s Corporate Strategy

• Waltham Forest Older People’s ‘Community Council’

• Mayor’s Celebration of Older Volunteers

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The (VSP) receives referrals from:

Whipps Cross University Hospital Trust

General Practitioners

Self-referrals

Community

Social Services

Case Finding

Age Concern Waltham Forest (other)

Referral System

Since 2002 the (VSP) has received over 500 referrals from Case Finding and 939 referrals form the Welcome Home project at Whipps Cross Hospital.

Information distributed to partners and older people since 2002 = 37,000

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African & Caribbean Disablement AssociationAfrican Women RefugeeAfro Caribbean Elderly Women's ProjectAfro Caribbean Elders AssociationAge Concern Waltham ForestAll Saint's Bridge ClubAlzheimer's Society Waltham Forest BranchArabic Speaking Women's AssociationArthritis Care WF SouthAsia Link NetworkAsian Community CentreBasantu Outreach ProjectBME Alliance Waltham ForestBridge Club 50+ (Ross Wyld)Centre International Des CompassionsChakwal PAK Welfare AssociationChest Clinic Amenities FundCircle 33

Connaught Stroke ClubContact the ElderlyCreative Pastimes Arts and Crafts GroupCRESTDisability Resource Centre WF (DCR)Disabled Asian Women's Network WFELOP (East London Out Project)Emanuel Christian CentreEvergreen Club50+ Elderly Asian ClubFriday Hill Community AssociationGood Life ClubGrange Park OAP ClubHealth Wellspring TrustHigham Hill Common AllotmentsHighams Park 60+ ClubIslamic Association (WF)LBWF Retired PensionersLeyton Old Folks Social Club

Leyton Old People's Welfare Committee

Voluntary Service Partnership (VSP) – Members

Members:

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Lloyd Park Tuesday ClubLondon & Quadrant Housing TrustMencapMultiple Sclerosis SocietyMuslim Advice & Community Welfare CouncilMuslim Women's Welfare AssociationNew Horizon Women's GroupNew Testament Assembly Community ProjectNHS Retirement Fellowship (R@WF)Pakistani Women's Welfare AssociationParish of Walthamstow ChurchesParkinson's Disease SocietyPhoenix Counseling ServiceRestore Hope MissionRoshni Asian Women AssociationSenior Citizens Asian GroupSikh Community Care ProjectShopmobility Waltham ForestSidama Support NetworkSt Andrew's 60+ ClubSt Stephen's Church Friendship ClubSt. Anne's Evening Women's FellowshipStarlighters Musical Theatre

Tamil Welfare Assoc. UKThe Amir Khusro SocietyThe Samaritans of Waltham ForestThe SeniorsTom Oakman Centre for the ElderlyWaltham Forest Blind AssociationWaltham Forest Community InitiativeWaltham Forest Crossroad - Caring for Carers LTDWaltham Forest Disability ActionWalthamstow Social Centre for the BlindWalthamstow Deaf ClubWaltham Forest Stroke AssociationWesleyan Day Care CentreWF Asian Disabled AssociationWF Asian Senior's ClubWF Gujerati Mandal 55+Whittingham Roots and Shoots Gardening ClubWood Street Drop-in CentreYoung at HeartYoung OnesYoung Ones

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Support Groups for OPWith particular conditions

Social & Physical Activities

Community Care

Housing

BME: Information/AdviceTranslation/Support Groups

Mental Health

Befriending & Outreach

Mobility

WFOPDP & Falls Collaborative

Signposting Services

Information Support & Development

Social Isolation

Preventative Health

Education: ACWF Silversurfers

AlzheimerArthritisLung DiseaseDisabilityLearning Disabilities (MENCAP)ParkinsonBlind Association StrokeStress

Clubs, Education, Talks and walksGardeningHealthy Ageing

Counselling, Bereavement, Depression

ShoppingBefriendingOutreachEquipment Supply AccessMobilityInfo & AdviceBME services

Case Finding, Single Assessment and Falls Collaborative

ACWF Healthy Ageing

VSP Links - Service Domains

ACWF Silversurfers

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The Waltham ForestHealthy Ageing Programme

Working Collaboratively

in Waltham Forest

Since 2002

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Background Information

National Service Framework for Older People – standard 8

“Promoting health and active life in older age through a coordinated programme of action led by the NHS with support from councils”

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The Aim of the Programme

To tackle the many issues associated with the health and well being of older people by drawing on recent research undertaken across a number of disciplines and cultures to empower older people in Waltham Forest to live as full, independent, healthy and active a life as possible throughout their old age.

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It is based on research carried out in Okinawa where:

over a third of the residents lived to be 100 years or more.

they remained fit, active and happy throughout their older years

had the lowest incidence of coronary heart disease, stroke and cancer (the 3 leading killers in the West), than anywhere else in the world.

(This is now changing due to the Western influence on diet etc.)

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Main components of the programme

Diet

Activity

Spirituality

Social networks

(Health Promotion)

The Okinawa Way by Bradley Willcox MD, Craig Willcox PhD and Makoto Suzuki MD

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Programme Outline –

•To provide older adults with information on lifestyle choices for their health and well-being

•To work with partners to establish services that support older people in achieving their health and lifestyle aims

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Initiatives include:

•Healthy Ageing Partnership with the WFOPVSP

•Private partnership to provide low-cost chiropody

•Partnership with the John Ding School of Tai Chi Chuan to provide trainers for older people’s classes

•Provision of ‘Looking to the Future’ Groups

•Production of a local Healthy Ageing Video

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•Message in a bottle scheme – 8700 bottles distributed since 2004

•Partnership with Falls Collaborative and PCT to provide Balance Classes – 1000 older people have benefited this year

•Partnership with Allotments Association and WF College to provide organic gardening classes to older people – 37 older people have taken part thus far

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Participants have reported:

•Improved Balance •Improved breathing•More confidence in going out•Improved sleeping•General feeling of well-being

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Older People’s Development Programme – Waltham Forest

Waltham Forest

WF Falls Collaborative

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THE WF Falls Collaborative

Waltham Forest was one of the twenty sites in England who together formed the National Falls Collaborative. The WF Falls collaborative has now been mainstreamed and is working together with its partners in falls reduction in Waltham Forest.

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THE STANDARD

The NHS, working in partnership with councils, takes action to prevent falls and reduce resultant fractures or other injuries in their populations of

older people. Older people who have fallen receive effective treatment and rehabilitation and

with their carers, receive advice on prevention through a specialised falls service.

National Service Framework for Older People Standard Six, Falls.

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Why falls prevention?

FACTS!Falls are very common – one in three adults aged 65+ living in the community fall each year

Every 5 hours an older person dies as a result of an accidental fall in the home

40% of care home admissions are as a result of a fall

Fear of falling can inhibit people’s daily activities

42% of fallers have at least an 18% reduction in activity after a fall

Hip fractures cost the NHS £1.7 billion per year

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LOCATION OF FALLS Total (%)

PUBLIC PARK 1 0.05

LEISURE CENTRE 1 0.05

PUBLIC HOUSE /CLUB 11 0.50

PUBLIC TRANSPORT 25 1.14

SHOP/STORE 8 0.37

PUBLIC PLACE (UNSPEC) 477 21.79

HOSPITAL 16 0.73

KITCHEN 82 3.75

BATHROOM/TOILET 90 4.11

LIVING ROOM 405 18.50

BEDROOM 253 11.56

HALLWAY 142 6.49

STAIRS 82 3.75

GARDEN 96 4.39

RESIDENTIAL HOME 141 6.44

UNSPECIFIED LOCATION 359 16.40

Total 2189 100.00

1150 or 52.53% of all falls reported ocurred in home

Local StatisticsLocation of Falls

(A&E Whipps Cross Hospital)

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MAJOR CAUSES OF FALLS AMONG OLDER PEOPLE

Unsafefootwear

Insufficientphysical activity

MedicationManagement

Underlyingphysicalconditions

Unsafe publicenvironment

Visiondeterioration

Unsafe homeenvironment

Risk Factors:Falls in Older People

Changes inBalance and gait

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What do we do?

Information on falls to older people : How to

prevent falls

Single Assessment interview if required and

referrals of OP to a professional-specialist (s) for further assessment if

needed

Signpost OP to services available in the borough:

What is on offer!

Refer OP to the ACWF Voluntary Service Partnership (VSP)

We held two Training Conferences on Falls Prevention July-August 2005

Provide services on the spot:Handyman Electrician

Commission Small equipments to prevent further falls

We hold Sloppy Slippers Exchange events with ACWF.

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Age Concern Waltham Forest Presence At Whipps Cross University Hospital Trust

Waltham Forest

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The A&E Escorted Discharge Service provides a service to older adults, who are being discharged from A & E and would go home with a relative, if available.

The service also settles the older adult into his/her home surroundings and provide shopping, pension collection and minor housework tasks. A second visit can be initiated if there is any concern about an older person.

A contact telephone number is always left with the older person.

A & E Escorted Discharge

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The Welcome Home Service provides a visit to older adults on return home from hospital – the service

provided is the same as the A&E Escorted Service.

Welcome Home Service

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The project aims to identify older adults being discharged from hospital without a package of

care and to address any concerns about discharge or coping at home thus making the transition from hospital to home as safe and

comfortable as possible.

As part of the project, socially isolated older adults and fallers are identified and referred to

appropriate services. ( March 2002 – December 2003: 939 referrals, 514

of which to WFOPVSP)

Information and a telephone number also provided.

Discharge Lounge and Ward Project

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Age Concern Waltham Forest

Waltham Forest

The Link-Up Project

Teleconference

Home visiting

Link-Up Support

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Befriending Service

Provides a voluntary weekly visitor for housebound and or isolated older adults living in the London Borough of Waltham Forest, in order to offer friendship and company to help….

alleviate social isolation

overcome the fear of loneliness

restore confidence

and encourage participation in social groups within the community.

This service is limited to a six month period.

The Link-Up Befriending Service

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TelephoneChatting

Link-Up Teleconferencing

Operates a telephone conference, this involves a group of six people and a facilitator from Age Concern Waltham Forest being linked together for a chat and lively discussion.

These sessions are weekly for up to 8 weeks and are free of charge.

At the end of the eight weeks,a coffee morning is held which is very popular.

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The Link-Up - Volunteers

One example of a Befriending Visits being enjoyed by Freda with her Volunteer Visitor, Normagene, who has been part of the Link-Up Volunteer team since June 2002

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“As I cannot get out by myself, I love going for a drive and doing some of my shopping.I am very

pleased with the service that Age Concern gives. Thank you so much

for all your help and support”.

“Visits most welcome. I look forward to seeing her, we do some

shopping. The visits cheer me us, and as a bonus make me laugh. Thank you

Link-Up Support”

“…I don’t see many people so I did enjoy telephone chatter, I felt that part of my week was

spent with friends on air. Thank you for doing this for

me.”

“It’s the company I enjoy. It makes you feel alive”

“…such fun and lovely happy times well spent. Many thanks. I enjoyed

speaking to friends on the phone club and link-Up, I hope many will enjoy the

pleasure it gave me.”

Quotes from Link-Up Service Users

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Age Concern Waltham Forest

Waltham Forest

Older People’s Safety Campaign

A safer community for older people

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Age Concern Waltham Forest believes that older people should be able to live safely and securely in their own

homes and community with out fear of crime or harassment

Security at home and in the neighborhood plays a key role in the well being of older people.

The psychological and emotional impact of crime is difficult to measure but can have a high impact on the

life of an individual.

Community Safety

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In order to reduce and prevent crime against older people, and following the example of Age Concern Colchester which pioneered the scheme, a Safety

Campaign was launched in November 2004 in Waltham Forest

Safety Campaign for Older People

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London Fire BrigadeMetropolitan PoliceB&Q ChingfordNet Community Safety PartnershipHEET – Home Energy Efficiency TrainingThe Home OfficeLondon EnergyRotary Club Chingford and Waltham ForestThames WaterWaltham Forest Council Trading Standards Department Waltham Forest Older People Voluntary Sector Partnership

Safety Campaign Partners

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The campaign provides an information pack that includes:

Home security remainder stickerHome safety door reminderEnergywatch (gas and electricity) watchdog - Free servicesHow to recognize a scamIs your electric blanket safe?Avoid Burglary, Protect Your Property How to beat the bogus callerProtect your home from fireYour guide to keeping control of doorstep sales Useful telephone numbers

Most utility companies provide a password scheme to deter bogus callers. These are featured in the pack

What the Campaign provides

Since the start of the scheme more than 4,300 Bogus Packs have been distributed in Waltham Forest

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The scheme also provides safety equipment

Since November 2004, it has issued:

Net bags 7Letterbox cages 28Smoke alarms 122Personal alarms 36Segment timers 41Spy holes 3Stairs lights 203Door chains 86Safe cans 48Total 674

The scheme arranges fitting free of charge where appropriate.

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•Single Assessment•Self referrals•Voluntary Sector Partnership•ACWF Services

Close working relationships with the London Fire Brigade and the London Metropolitan Police have developed and they now regularly refer older people to Age Concern Waltham Forest.

To reach older people,Special Events are held. There is also a Referral System.

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Age Concern

Waltham Forest

Information, Advice and Advocacy Service

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Integrated Working

• Preventative services• Reaching all communities including BME

communities • Income maximisation • Person-centred care• Links to case finding and hospital discharge

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DWP Alternative Office

• Went live on 22nd December 2004

• First live in Waltham Forest

• Second live in London

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Good News for Older Adults

• Claims process greatly simplified

• Can verify client’s documents

• Easier to track progress of claim

• More person centred approach

• Clients made aware of all benefits they are entitled to claim

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Claims Forwarded to DWP

• Attendance Allowance 67

• Disability Living Allowance 5

• Carer’s Allowance 2

Total 74

(85% success rate)

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The Future

Referrals from the DWP/Joint Visiting Team into ACWF and the Waltham Forest Older People’s Voluntary Sector Partnership to increase preventative work and healthy ageing in WF?

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Waltham Forest Older People’s Information Strategy

(Public Stream)• Collaborative website

(25000 + hits monthly)

• ACWF website

(25000 + hits monthly)

• ACWF newsletter

• Waltham Forest Council Newsletter

• Events

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Delivered in Waltham Forest for and with older adults and their carers

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The End

www.ageconcernwf.org,uk

www.wfolderpeople.com

[email protected]@ageconcernwf.org.uk