Housing: building the third pillar of independence in later life

Independent Age’s campaign to “do care differently” will be met with a heart-felt ‘Amen’ in housing circles. Fundamental to that transformation is the need to see housing as the third pillar – alongside healthcare and social care – in supporting older people to live independently for as long as possible.

The evidence has been building for well over a decade that well-designed specialist retirement accommodation such as extra care housing can delay admission to a care home and provide a cost-effective alternative to expensive residential care. There is also some evidence that extra care housing, partly by promoting independence, social inclusion and activities, can reduce health and social care costs.

For example, the ExtraCare Charitable Trust’s model provides integrated housing, health, and social care. Aston University’s recent research (opens new window) on the outcomes of that model found that low level social care costs per resident were £1,222 (or 17.8%) lower than those for older people with similar needs across the wider community.  For residents receiving higher levels of social care, the cost was 26% per person lower.

Earlier this year the Housing LIN evaluated – and confirmed – evidence of system savings generated by extra care housing for the Kent Surrey Sussex Academic Health Science Network. Our report urged the NHS to look at releasing surplus health service land to develop extra care housing schemes.

This could lend some welcome momentum to the construction of retirement housing. Just 1% of the new housing built in the UK each year is specialist accommodation for older people – yet 27% of our population is aged over 65.

The HAPPI series of reports

It is eight years since the first report in the ‘HAPPI’ series – Housing our Ageing Population: Panel for Innovation. That report, and the follow-up HAPPI2 report of 2012, emphasised that the baby boomer generation which came of age in the 1960s will not settle for bland or uniform retirement housing options. They are looking for well-designed, aspirational homes that suit their life and style choices.

The HAPPI design principles are based on ten criteria aimed at promoting independence, producing a desirable living environment and supporting the delivery of flexible care packages as people’s needs change. Those principles are:

• Space and flexibility
• Daylight in the home and in shared spaces
• Balconies and outdoor space
• Adaptability and 'care ready' design
• Positive use of circulation space
• Shared facilities and 'hubs'
• Plants, trees, and the natural environment
• Energy efficiency and sustainable design
• Storage for belongings and bicycles
• External shared surfaces and 'home zones'.

Many of those elements are common to good general housing design. However, they need to be achieved in a way that allows the home to adapt over time to meet changing care and mobility needs.

For many people entering extra care housing – where access to care is available on-site round-the-clock – it can be a positive alternative to residential care. With their care needs met and their health and wellbeing monitored on-site, the incidence of sudden crises can be reduced – alleviating pressures on health and social care budgets.

Creating communities

As well as access to care and support in accessible flats, living in specialist retirement housing can create more ‘resilient communities’ by promoting social inclusion. We should build retirement housing within existing communities so that residents can maintain or forge new friendships and social networks. It should have stylish communal areas – and facilities such as cafes or hairdressers that are open to the wider community and offer a positive experience of later life living.

Several housing providers have built excellent dementia-friendly housing that lessens the impact of the disease and allows people to live safely and comfortably in their own homes. However, demand far outstrips supply.

Aids and adaptations 

Meanwhile, too few people with dementia are offered the aids and adaptations – such as alarm systems – that can make mainstream homes dementia-friendly and delay or prevent admission to institutional care. That reflects a wider under-use of aids and adaptations that can help people with mobility or other physical problems. In the digital era, the phrase ‘aids and adaptations’ means much more than grab-rails and hoists. Telecare, telehealth and SMART technology can maintain independent living and potentially cut care costs.

The third report in the HAPPI series addressed some of the wider issues that have led to cultural resistance to downsizing – or as we prefer to call it, ‘right-sizing’. Published earlier this year, it emphasised the need for a greater diversity of tenure, financing arrangements and control over service/care options to reflect individual circumstances.

Potential buyers or renters need clarity and transparency around leasehold arrangements, service fees and on-going or future potential costs. The government needs to act speedily on the recommendations that emerged from the Law Commission’s recent inquiry into ‘event fees’. These issues are an important part of the sector’s on-going image problem that deters thousands of people from moving to ‘care ready’ retirement accommodation while still relatively fit and healthy and in control of their lives.

That’s why we’ve been calling for the development of an industry kite-mark covering both construction quality and fees and cost. However, we would like to go one step further and see the establishment of a Retirement Villages Act (as in New Zealand or in Australia) which codifies the rights and responsibilities of residents and operators.

Other measures the latest HAPPI report called for included:

• Stamp duty exemption for people over pension age
• ‘Help-to-buy’ style assistance for people buying new property in older age
• Local authorities need to recognise the social and economic benefits of right-sizing in their local plans and planning policies
• Housing associations should build more care-ready homes – including the adoption of SMART technology.

There is no doubt that housing can be part of a comprehensive new approach to an integrated health and care economy but first we need to make older people a comprehensive and trusted housing offer.

First published by Independent Age on 29 August 2017 as part of their ‘Doing Care Differently’ (opens new window) series of blogs showcasing ideas, perspectives and challenges from today’s thought leaders for transforming social care and making it fit for the 21st century.

"Housing: building the third pillar of independence in later life"