Remodelling sheltered housing and residential care homes to extra care housing: Some findings

Professor Anthea Tinker and Dr Fay Wright , King’s College London* Housing and Care for Older People Research Network, 17.4.07

*Presentation on behalf of the research team

Outline of presentation

1. The project, funder and timing 2. The research team 3. The importance of the subject: policies and practice 4. What the research is covering and methods 5. Some findings 6. Next steps

1.

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)

2. The research team*

Professor Anthea Tinker and Dr Fay Wright, King’s College London, Institute of Gerontology Professor Julienne Hanson and Hedieh Wojgani - University College London Dr Alan Holmans , University of Cambridge Dr Ruth Mayagoitia-Hill and Els van Boxstael – King’s College London, Centre of Rehabilitation Engineering (3 student projects) * Presentation given on behalf of the team

3. The importance of the subject: policies and practice

• Remodelling presents challenges over and above those relating to new build schemes • Perceived problems with inadequate help for older people at home and in sheltered housing • Criticism of residential care and lack of places • Difficult to let sheltered housing • Need for closer links between services (e.g. Single Assessment Process) • More funding from DH • Previous research on the value of extra care

a.

c.

b.

4. What the research is covering and methods

Examining a sample of schemes which had been converted from residential care homes to extra care housing (5 schemes were planned and 2 achieved) Examining a sample of schemes which had been converted from sheltered to extra care housing (5 schemes were planned and 8 achieved) Examining these schemes in local authorities (5 planned and 4 achieved - 2 existing and 2 which had recently been transferred to Housing associations) and housing associations (5 planned and 6 achieved) Both a and b involved considering the role of assistive technology

What the research is covering: summary

• Only social housing – a sample of schemes which have been converted since 2000 to extra care • Examining what the care, building and AT changes were and what is likely to be needed in the future • Obtaining the views of older people and staff to look at the advantages and disadvantages • Costing the changes to the schemes, and • Providing guidance based on the findings

5. Some findings

a.

b.

General From a social policy perspective (the focus of this presentation) But note that other findings come from: c. An architectural perspective (plans were examined for all the schemes) d. An assistive technology perspective (44 typical flats were audited) e. A costings perspective

5. Some findings: a. General

• The lack of an agreed definition of extra care • The high level of interest in the project • The rapid turnover of staff in the schemes • The great differences between schemes in almost all respects e.g. some have remodelled all but some part of the scheme, the amount of AT, levels of dependency of tenants, etc

Some findings: a. General

• General satisfaction by tenants of their flats (especially compared with residential care) • Schemes have, in general, become more accessible compared with before remodelling • Most flats and facilities (for tenants and staff) are bigger and better • Often the grounds/gardens are better than before • Problems over lifts in many schemes

5. Some findings: b. From a social policy perspective*

• Variations in admission criteria and care provided • Variations over provision of a cooked meal • Significant input from relatives • Tensions between tenants • Not all schemes provided opportunities to socialise • Major access problems and problems with lifts * (including interviews with staff and tenants)

Some findings:social issues

• Post-remodelling tenants positive • Pre-remodelling tenants hostile to extra care • Communal meals are an issue • What is the role of care staff?

Post-remodelling tenants positive

• Removal of worry • Glad not a care home • Glad of privacy • Enthusiastic about care staff in most schemes • Misfits- younger tenants with a disability

Pre-remodelling tenants hostile

• In six out of ten schemes some tenants in situ during remodelling • Tenant consultation about remodelling process • Lack of consultation about the change to extra care • Hostility to dependant newcomers

Issues around communal meals

• Four out of ten schemes had optional communal lunch • Six schemes had no regular communal lunch • Three schemes with no communal lunch had an unused commercial kitchen • Tenant views of communal lunches

What is the role of care staff?

• Extra care inspected by CSCI as domiciliary care • Should care staff work with tenants or for tenants?

• Conflicts between tenants and care staff • Dilemmas for private agency staff

6 . Next steps

• An architect, social scientist, OT and a rehabilitation engineer will examine each of the schemes at the end of the project to decide (on agreed criteria) what additional structural, engineering and innovatory AT changes will be necessary to house the tenants that become progressively disabled

6. Next steps

• Guidance will be provided for local authorities and housing associations on the pros and cons of remodelling to extra care housing