Transcript Slide 1

Developing extra care
housing: new options for
providing supported
accommodation
ACSA Retirement Living Workshop
18.9.07
Professor Anthea Tinker, King’s College London
[email protected]
Outline of presentation
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What is extra care housing?
Why was it developed in the UK?
How extra care has been provided
The evidence for and against extra care
housing
5. Research on remodelling schemes
to extra care
1. What is extra care
housing?
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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
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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
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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
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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)
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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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
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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?
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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