West Midlands ADSS Network for Older People and Regional Housing LIN Seminar: Housing Issues for Old

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West Midlands ADSS Network for Older People and
Regional Housing LIN SeminarHousing 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

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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

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• 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

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• 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

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• 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

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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

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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

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• 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

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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

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• 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

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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

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• 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

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Why Older People Move to Private Very Sheltered
HousingAttractions 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

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• 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 individuals capital
  and their ability to control their own affairs

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• 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

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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

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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

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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

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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 RSLs 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

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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

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• 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

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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

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• 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

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• 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

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• 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

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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

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• 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

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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?

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• 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

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• 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

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• 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

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• 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

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• 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

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• 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

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• 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

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• 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

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• 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