Meeting the Housing Needs of Older People: A Seminar on Private Extra Care Housing

1. West Midlands ADSS Network for Older People and Regional Housing LIN Seminar:Housing Issues for Older PeopleUniversity of Birmingham 15th October, 2004 ELDERLY PEOPLE AND PRIVATE EXTRA CARE HOUSING NEEDS AND ASPIRATION Dr. Michael McCarthy Managing Director, Retirement Security Limited

2. THE DEMOGRAPHY OF OLD AGE • By 2031 there will be 27 million aged 50 and over • Those aged 85 and over in the UK population increased from 0.7% in 1961 to 1.9% in 2002. Projections to 2031 suggest people aged 85 and over then comprising 3.8% of the UK population. • This is the main age cohort to be found in Extra Care and Very Sheltered housing • In 2002 there were 2.6 women for every man aged 85 and over but this, too, is projected to fall to 1.5 by 2031. This will have implications for services, for design and for the density of developments

3. The Onset of Ill Health • The UK now has 336,000 people aged 90 or over and nearly 4,000 of these provide 50 or more hours of unpaid care a week to a spouse or friend • Though women expect to live longer than men, they are also more likely to have more years in poor health • The proportion of people with long term illness or disability which restricts their daily activities increases with age

4. The proportion of women aged 85 and over reporting such a disability in 2001 (74%) was almost triple that for women aged 50 – 64 (26%). • For men it was 67% of those aged 85 and over and 27% in the younger age group • This, too, will have implications in the location, design, service arrangements and staffing of Housing with Care schemes for elderly people • Moreover, these outcomes are increasingly likely to be owner-occupied by tenure

5. Women over 75 are more likely than men of the same age to suffer from arthritis and rheumatism • Men are more likely than women to report respiratory diseases such as bronchitis and emphysema • Many consider themselves in good health, even if they have a long term limiting illness • Many make light of illness and of disability and favour low level support rather than outright personal care • Private Extra Care Housing can meet most of these needs and reduce costly admissions to / lengths of stay in hospital

6. PROVISION OF UNPAID CARE • In owner-occupied households in England and Wales in 2001 almost 2.8 million people aged 50 and over provided unpaid care for family members, friends or neighbours • People in their 50s were the group most likely to be providing unpaid care – more than 1 in 5 were doing so • 5% of those aged 85 and over were still providing some form of unpaid care • 1 in 4 carers over the age of 50 spend 50 hours a week or more caring. • This proportion rose to 1 in 2 carers aged 85 and over

7. OWNER OCCUPATION AMONG ELDERLY PEOPLE • Owner occupation among elderly people continues to rise, primarily among middle income people who are increasingly likely also to have private pensions and other forms of financial security in place. Over 75% of this group (aged 65-79) are owner-occupiers – compared with 50% aged 80 years+ • 95% of those aged 65-97 and 88% of those 80+ in the richest quintile own their homes. Growing home ownership in the population at large is evident in the older age groups, leading to a large increase among middle income older people

8. These will be the drivers of and the principal target for private sector solutions to housing with care over the next 10 years. They are a growing consideration in the UK housing market and increasingly, general housebuilders and specialist developers ignore them at their peril • At the other end of the income scale, less than a quarter of elderly people in the lowest quintile and less than 40% in the next own their homes. This points up the incidence of poverty in old age • It poses the question of whether owner-occupancy can provide a capital asset that can be used to meet housing (and care) needs and alleviate poverty

9. Releasing the Value of the Asset • One fifth over 65 could generate some extra income from equity release schemes • For a quarter, the gains would be less than £500 a year • Two fifths of older people still do not own their own homes and tend to be the poorest • For home owners who receive benefits extra income can reduce their benefit entitlement • Releasing equity will reduce wealth to pass on to their heirs or for their own care needs • ODPM figures (2003) reveal that 12% of homeowners aged 70 or over are unable to afford major repairs to their homes

10. Housing renewal and adaptation can play a key part in preventing or reducing expensive hospital admissions for older people • In the RSL scheme annual average hospital stays are under 4 nights a year (but over 17 for the elderly population at large) • The public sector is beginning to acknowledge the role that the private sector can play in joint ventures to develop purpose-built Extra Care Housing solutions • To enable these to succeed it will be increasingly necessary for government to find public means through measures such as Supporting People and private means through new forms of equity release and mortgages specifically tailored for old age

11. LIVING ARRANGEMENTS • Among women aged 85 and over, who live in private owner occupier households, 71% lived alone in 2001, compared with 42% of men of the same age • Nearly half of women aged 65 and over are widowed and this proportion rises to 80% to those aged 85 or over – the key group in private Very Sheltered Housing • Older women are more likely than older men to live in communal establishments • For people aged 85 and over, the figures rise to 21% of women and 11% of men

12. Women are more likely to be widowed without a spouse to care for them – a key consideration in moving to private Very Sheltered Housing • Women are also likely to live in such establishments because of much higher levels of disability than men • The incidence of women in private establishments is also greater because they can expect to live longer than men, even though they are also likely to have more years in poor health and suffer a limiting, long standing illness • The proportion of women reporting a longer term illness or disability which restricts their daily activities is 26% for the 50-64 age group but triples to 74% for those aged 85. With men the figures are 27% and 67% respectively

13. Why Older People Move to Private Very Sheltered Housing:Attractions of Owner-Occupation • Between September 2003 and January 2004 RSL surveyed the views of nearly 500 elderly Leaseholders on the 29 developments it manages • Almost without exception purchasers were Owner-Occupiers before their move. They wished to remain so. An overriding concern was to retain their capital and independence as property owners • ‘Ownership’ and ‘independence’ are seen as indivisible. They are ‘Owners’ and not ‘residents’ • Owner-occupation is seen as a key driver in upholding self-determination, accountability, governance, respect and dignity. Owners see themselves (staff saw this also) as the ‘employer’ on the development

14. Owner occupation gives them the confidence to take a close interest in the affairs or condition of the development and to complain if they wish to • Few said that the main purpose in retaining their capital in this way was to ensure that their family benefited from the inheritance • Most see Owner-occupation as the most desirable form of tenure and as the basis of their own security. Very few owners have sought to release equity from their properties to fund their retirement • Overwhelmingly, Owners saw this combination of housing with care and leasehold tenure as an alternative to Nursing and Residential Care. These were rejected because of • (1) their perceived lack of independence and • (2) because they eroded the individual’s capital and their ability to control their own affairs

15. Owners relish the need to consult them about the annual budgets. Many are on fixed incomes. A measure of financial control in the wider affairs of the development was an attraction of this tenure • Repeatedly, we encountered the phrase ‘value for money’ • Owners have a strong sense of proprietorship over the common facilities in the development and many understand that these form part of the overall asset value of their individual dwellings • Owners understand the financial inter-relationship between the condition of the development generally, the need to support re-sales and the value of their own property • Annual budget rounds can be hard fought, adversarial

16. Primary Benefits of Moving to Private Extra Care Housing • Quality of Life • Progressive design • Extensive core services • Flexible additional services, e.g. Personal Care • 24 hour staffing • Communal facilities • Restaurant meeting need and focal point of social interaction • Extensive social life, networking, outward looking

17. Primary Benefits of Moving to Private Very Sheltered Housing • Independence • Retain large measure of control over own property • Service arrangements partially elective and individualised • Management Company is Owner-led with Directors elected from the Leaseholders • The Owner is the ‘employer’ • The system is participative, responsive to consumers and accountable

18. Primary Benefits of Moving to Private Very Sheltered Housing • Peace of Mind • Staffing and service model provides reassurance; it is flexible and progressive • Secure living environment • Companionship of peers • In over 90% of cases Owners are able to live out their lives at the Court • The model is regarded highly by families of Owners: It reduces their anxiety • Advice and advocacy are available on the Welfare Rights entitlement of Owners (currently 65% receive Attendance Allowance and 15% Minimum Income Guarantee

19. Primary Benefits of Moving to Private Very Sheltered Housing • Reduced Visits to Hospital • The model fulfils the ambitions of Government to reduce the time spent and costs incurred by elderly people in hospital • In the year to July 2004 the 1540 elderly Owners on RSL’s 29 developments had an average age of 83.3 years • They spent on average less than 4 nights in hospital compared with projections of over 17 nights for the same cohort in the population at large • Primary and Community Health Services are generally positive about reduced stays and earlier discharges because of their confidence in the supportive environment to which the individual is returning • In many cases the service and staffing arrangements enable often very frail or disabled people to remain supported at home rather than enter hospital or institutional care

20. Why Purchasers Chose Private Extra Care Housing • Concerns for own health or that of spouse • Companionship / reduce isolation • Availability of restaurant • 24 hour emergency cover / staff sleep in • Active social life • Independent Living • Anticipation of future needs • Wanted to make just one final move • The model dealt with things that trouble me • It was affordable compared to other alternatives at my age • I am treated as an adult • Security / peace of mind • Location and Convenience

21. No longer able to maintain previous home • Choice and quality of accommodation • Quality and attentiveness of the staff and management company • Able to have privacy and choose to socialise as I see fit • Help on hand when you need it • Family and friends close to hand • Wished to remain a property owner • Help on hand when you need it • Liked the overall design

22. Should We Design Differently? The importance of space • Design which anticipates progressive need and which helps sustain the homeowners independence • Space is a key issue. We assume wrongly that space is less relevant in old age. We reduce development footprints, minimise private living space, erode car parking and in many instances eliminate private amenity space

23. We assume that elderly people: - do not need space to entertain - or to enable guests to stay - that their interest in cooking is limited - that they do not wish to undertake their own laundry - that they have little to store - that they do not need extensive wall space for books and collectables - that couples with particular needs can manage with a single WC/bathroom - that they have never heard of the Internet and they do not watch Sky - that they have no wish to sit outside their own front door - or to potter about in their own garden space

24. Many older people are quite up to speed on issues such as recycling, use of the Internet, ecology, gardening, TV systems and technology and they would like developers to catch up • Many think that private sector developers do not grasp the value of assistive technology in sheltered housing • Security is often an issue, especially insecure perimeters • Changes of levels can be a problem and still exist on many developments

25. Designs often do not anticipate adequately the onset of disability • key concern is the quality of materials and workmanship and a fear that elderly owner occupiers might not be able to afford the long term upkeep of their developments • Developers persist in seeing sheltered schemes as high in density and low in cost – government is in danger of sustaining this view • Many lack a specialist approach and are built on inappropriate design and build contracts

26. Elderly People and the Private Housing Market Policy and Politics • Housing policy is inextricably linked to wider political, social and economic goals. It may be ‘steered’ for instrumental reasons which are not wholly to do with housing (e.g. social integration, to reduce health expenditure, to precipitate related investment). It may be used as a means for wider social inclusion (e.g. public-private partnership) • Given the pace of change in housing / care/ cash / health policies affecting older people there may be an inherent conflict in trying to resolve the problem of meeting demand on the one hand and ensuring quality of design, building, services and staffing on the other. A key challenge is to resolve this

27. Private sector providers of housing with care are relatively few • They are uneven geographically, heterogeneous, mutable • Their workforce is experienced but largely untrained to meet new care and regulatory challenges • They are inadequately resourced to effect a step change in expansion of supply or in culture • Many are disinterested in or uncertain about working in partnership with local authorities and health trusts

28. Elderly People and the Housing Market • Catalysts for Change • (1) Reform of the planning process to facilitate and expedite projects that have an agreed social utility • (2) Direct financial support from government to fund training, retraining, upskilling of staff to meet the requirements of a more quality assured culture • (3) Help in identifying investors to secure land and finance development. • (4) Creation of a ‘matchmaking’ service to link public and private partners • (5) More qualitative research on local housing need to remove investment uncertainty • (6) Incentives for elderly people to purchase private extra care housing, e.g. no Council Tax • (7) Improved administration of Supporting People and Pension Credit • (8) Top-up funding from Supporting People to improve Managers / staff salaries • (9) Penalties for poor developers / service providers – regulation?

29. Shifting the Culture • The orthodoxy of housing with care is likely to have to change radically. The growth in numbers of elderly people, increased longevity, expansion of owner occupation, concentrations of elderly people in major towns and cities and the scarcity of development land means that developers and planners will almost certainly have to consider ‘high-rise’ solutions • Modular, volumetric solutions must gain ground and pass the credibility test with funders and consumers alike. They offer a fast track supply solution. They are likely to be more affordable; they are potentially better constructed; they may hold important lessons for life cycle costs, maintenance and making the fixed income of most elderly people who have to pay service charges go further

30. Need, Care, Sustainability • The needs of elderly people in rural areas is a particular concern where development land is subject to particular aesthetic and spatial constraints and where the critical population mass is lacking. Rural authorities, rural enablers, the Housing Corporation, developers and funders must be brought together to explore a coherent strategy for sustainable development and service provision • Housebuilders must be encouraged or obliged if necessary to incorporate a housing with care component(s) in larger scale developments. They could be encouraged through more flexible planning arrangements. Government should reappraise outworn concepts of ‘affordable’ and ‘social housing’ and consider the ‘utility’ of housing schemes. Housing with care should be seen as a direct alternative to some social or affordable criteria

31. Choice and Lifestyle • Developers should also be encouraged/incentivised to embark on a significant programme of Lifetime Housing as a further diversification of choice in the provision of housing solutions to older people • Private retirement housing (all forms) remains the Cinderella of the UK housebuilding sector characterised by unimaginative design, lack of innovation, over-densification, little regard to consumer feedback, cramped footprints, lack of interest in green construction methods, inappropriate design and build contracts and often by less than satisfactory execution

32. Elderly people increasingly expect their housing to deliver other outcomes…. leisure, (assistive) technology, services, social opportunities, entertainment, continuing education and learning, lifestyle. The ‘home’ must be a conduit for each of these expectations • The elderly owner occupied market is not monolithic. It extends across a range of models, price levels, locations. The market is more sophisticated than ever • Perceptions about sheltered and very sheltered as exclusively focused on needs are increasingly misplaced. Aspiration is now a very significant factor in the owner occupied sector

33. Developers, Managers and Consumers increasingly see services and facilities as having a needs / aspiration duality. Examples include the installation of restaurants, laundries, heated pools, internet facilities, hairdressing and chiropody suites, flexible staff services for shopping, companionship, catering, travel • Design has a long way to go yet to catch up with and integrate this duality but architects, ergonomists, developers and consumers too are beginning to pool their thinking

34. Innovation and New Technology • In 10 years it will be common practice for private Extra Care Housing to feature • intelligent systems • greater awareness of energy and building efficiency • more barrier-free layouts with demountable partitioning, fluid design • more responsive fixtures and fittings • a wide use of assistive technology • integrated leisure and entertainment systems • greatly improved alarm and communication systems • systemic interfacing with primary and community healthcare services

35. Elderly owner occupiers will become a front line in testing the capacities of housing that will check their heartbeat, their pulse rate and link them with their GP; they will receive reports back on their health status; their TV/PC will expand to enable them to home shop, check their bank accounts, act as a virtual learning centre, enable video linking, monitor systems, aid security • Later still, but not so far away, their homes will have the capacity to identify them as the owner-occupier. They will recognise and adapt to their needs. We will see this in areas such as lighting, heating, use of baths and showers, TV and HI-Fi, the telephone, key items of furniture such as chairs and beds. And …. The fridge really will ultimately be able to ‘talk’ to the television

36. Meeting the Demands of a Sophisticated Market • Increasingly, older people will not only want and require housing with these facilities but they will be able to afford to pay for them and will reward developers / managers who invest in them • To meet the investment, supply, quality assurance and timetabling needs of a growing market of elderly owner occupiers we can predict that ….manufacture and construction will become the prime fulcrum of change. Increasingly the current and expensive model of sheltered housebuilding(unpredictable voids, cash flow exposure, difficulties in phasing, lack of choice within a formulaic design and build culture) will subside in favour of house production

37. In 10 years it will be commonplace to be offered a choice of homes which have for the large part been manufactured off-site under exact factory conditions and then delivered, assembled and fitted out on site at an optimal time. For older people we will truly see new light in a dusty world