Developing extra care housing: new options for providing supported accommodation

Developing extra care housing: new options for providing supported accommodation ACSA Retirement Living Workshop 18.9.07 Professor Anthea Tinker, King’s College London anthea.tinker@kcl.ac.uk

Outline of presentation • 1. What is extra care housing? • 2. Why was it developed in the UK? • 3. How extra care has been provided • 4. The evidence for and against extra care housing • 5. Research on remodelling schemes to extra care

1. What is extra care housing? • There is no agreed definition – legal or otherwise • Generally agreed to be sheltered housing (i.e. independent accommodation, some communal facilities, a warden and an alarm) PLUS extra communal facilities, 24 hour support from staff, at least one hot meal per day provided

2. Why was extra care housing developed in the UK? Positive reasons • To provide better accommodation • To reduce isolation • To help rationalise services • To help provide a hub for services for other people in the area • Because families (and politicians) seemed to want it • To provide an alternative to institutional care

Why was extra care housing developed in the UK? Negative reasons • Sheltered housing (perceived inability to provide enough support/some difficult to let) • Residential care (i.e. same as hostels) (poor facilities and standards) • In own homes (inadequate/unsuitable housing, lack of support)

3. How extra care has been provided • Most is free standing i.e. not as part of a retirement village • Why the lack of enthusiasm for retirement villages until recently? • Some adjacent to other types of housing/residential care • Mainly be new build but now increasingly remodelled (see last section)

4. The evidence for and against extra care housing 2 national evaluations and some smaller ones mainly in social housing • Generally popular with tenants (felt independent and secure though some would have preferred to stay in own home) and families • Was more expensive to the public purse that staying at home but little recent evidence about cost effectiveness

4. The evidence for and against extra care housing (ctd) • Mixed views on independence from tenants and staff • Quality of life – little evidence either way • Does it reduce isolation? Mixed results • A home for life? Not always • Can they cope with demented tenants? Now some special schemes

5. Research on remodelling sheltered housing and residential care to extra care schemes

The project, funder and timing Remodelling sheltered housing and residential care homes to extra care housing • Funded by the Engineering and Physical Sciences Research Council (EPSRC – EP/C5329451) • A multi-disciplinary project • May 1 2005, for 2 years (extended to 31.7.07)

A multidisciplinary research team • Professor Anthea Tinker and Dr Fay Wright, King’s College London, Social Gerontologists • Professor Julienne Hanson and Hede Wojgani, University College London, Architects • Dr Ruth Mayagoitia-Hill (Engineer) and Els Van Boxtel (OT), King’s College London • Dr Alan Holmans, Cambridge University, economist • 3 student projects

The importance of the subject All the reasons already given for extra care + • The desire to keep tenants in place • Growing attention to poor spatial standards in sheltered housing and residential care homes • The challenge of remodelling compared with new build • Incentives in policy and funding (grants)

What the research has covered • 10 social housing schemes in different parts of England • 8 housing associations and 2 local authorities • 8 sheltered housing schemes and 2 residential care homes • In all cases examined the role of assistive technology

What the research has covered • A sample of schemes which have been converted since 2000 to extra care • Examined what the care, building and AT changes were and what is likely to be needed in the future • Obtained the views of older people and staff to look at the advantages and disadvantages • Costed the changes to the schemes • Providing guidance based on the findings

Some findings: A mixed picture with no scheme the same In some cases: • The whole scheme was remodelled • Only the individual flats were remodelled • Part of the building was remodelled • A wing was added • Older people stayed but in others they were decanted

Some findings from the architectural perspective • Remodelling was far from straightforward and there were numerous delays • Unforeseen problems were found in all the schemes • There were problems when tenants remained in situ • 9 out of 10 projects overspent the original budget

Some findings from the architectural perspective (ctd) • Most flats and facilities (for tenants and staff) were bigger and better but there was variation within schemes • Often the grounds/gardens were better • Problems over lifts in most schemes

Some findings from the social aspect • Tenants admitted after remodelling were generally enthusiastic (especially those who had moved from care homes – glad of privacy, removal of worry, glad not care home) • Tenants who remained in situ were generally hostile to people with high levels of dependency who had come in. • Not all schemes provided a hot meal and this needs review

Some findings from the social aspect • Levels of care were arbitrary and some tenants needed less care after entry and some new ones more than was provided • There was a rapid turnover of staff • The considerable input from relatives continued

Some findings from the assistive technology perspective • Little incorporation of AT • Compliance with accessibility standards was patchy and this could result in more input from staff • No wheelchair accessible kitchen was found • Little knowledge about AT

Some findings from the financial perspective • There was variation between costs in schemes • It cannot be assumed that remodelling is a cheaper option than new build • The lowest cost/flat was £20K (a refurbishment); the highest was £110,230 (a heritage building). The average was £64,300

Some conclusions about remodelling • General satisfaction by tenants with their flats • Remodelling needs to be a careful choice when other alternatives, including rebuilding, have been examined • Some good examples of good practice were found and need disseminating

What can be learned from this research and how far is it applicable to other countries? • The need for a real discussion about the options of new build and remodelling for each scheme • In some cases, e.g. lack of land/historic building, there may be little option but to remodel • How far are the findings about social housing applicable to the private sector? • Will these standards be acceptable to the next generation of older people?

What is happening now? • A hard copy summary is being provided • Detailed advice for local authorities and housing associations is being put on the web • Articles and presentations are being done

Developing extra care housing: new options for providing supported accommodation