Keep hold of sheltered housing: A prized asset for older people

Written by Anne Ludlow, Secretary, Sheltered Housing UK

The current disintegration of largely social rented sheltered housing arises from a well-intentioned but sadly misguided legal decision which took place twelve years ago. This blog spells out my thoughts on the very serious knock-on costs (both economic and social) that have ensued from that decision. Sheltered housing should be a crucial national asset, serving as the pivotal meeting point of two interconnected fields: Housing and Health. In my view, the many cuts it has suffered over the past twelve years have proved to be a major false economy on both fronts.

For more than a decade, I have been researching conditions in sheltered housing, by the simple and direct method of visiting schemes all over the country and talking directly with the residents. What I have found is that, overwhelmingly, residents came to sheltered housing for the sake of security, human contact, and the promise of assistance "in any emergency, large or small"; especially the presence of an on-site warden or scheme manager.

As a result, I believe that the most significant source of decay in this formerly thriving form of retirement housing is not in the buildings themselves, but in the systematic withdrawal of warden cover. The warden was the lynchpin in the community life that gave the elderly residents a sense of security and belonging. With that lynchpin removed, this vital national commodity has lost its identity and its purpose.

Historically, this change began when the government initiated a judicial review which determined that Housing Benefit should not be allowed to provide any support to sheltered housing residents. The reasoning, I believe, was that this was unjust to all the elderly Housing Benefit recipients who still lived in their own homes, and within a very limited context this judgement may appear to be correct. But, in failing to look at the wider ramifications of this question, this judgement was (in my view) profoundly flawed and needs to be seriously reconsidered. In particular, I consider it failed to take into account:

1. the fact that the approximately 500,000 elderly and vulnerable people then already living in sheltered housing had received assurances (many in writing) that this support would be available to them. It was on this basis that they made their decision to downsize from their family-sized homes. Withdrawing this promised support without any prior notification or consultation with the residents was in itself unlawful. (And the meaningless after-the-fact "Consultation Exercises" to which the residents were subsequently subjected were unlawful in themselves, in the opinion of a noted Barrister specialising in housing matters).
2. a significant number of sheltered housing residents are not on Housing Benefit at all, but are self-funded. As the support services have been withdrawn, their service charges have not been correspondingly reduced - quite the contrary, they have seen steady increases every year, even though in some cases the support available has now been reduced to zero. These self-funding residents have thus been systematically defrauded, which again is clearly unlawful.
3. the provision of support to sheltered housing residents did not in fact represent any injustice to elderly people still living in their own homes, because it was potentially available to all of them without exception, and provided a very powerful incentive for downsizing from properties that were no longer manageable - thus freeing up family homes and keeping the housing market in a healthy state of free-flow. The much-touted policy of "keeping elderly people in their own homes" has had profound negative effects, stagnating the housing market, increasing isolation and loneliness, and vastly increasing the mileage costs and driving times of home-care personnel. In my view, it has also led to hugely wasteful expenditure by necessitating adaptations to individual homes, which then must be ripped out when the property does change hands.

I also believe that the taxpayers at large have also suffered from the knock-on costs of the withdrawal of support to sheltered housing residents. The warden provided primary-response assistance in emergency situations, and could discriminate between those that required the attendance of the Emergency Services and those that did not. If the paramedics or fire service were needed, the presence of a responsible adult on-site also enabled them easy access to the building and provided them with critical first-hand information about the situation they were dealing with.

Now, the Emergency Services must attend every call to sheltered housing, no matter how insignificant, and in a profoundly ironic reversal of the residents' "security" they often find that they are locked out of the building (or the individual flat) where they are needed. The amount of time that is wasted while they try to gain access is not only tremendously (and needlessly) costly, it also puts lives in serious danger - not only that of the individual resident, but of members of the general public who might be requiring emergency attendance elsewhere.

The knock-on costs to the NHS are also staggering; for example, in the form of increased hospital admissions (and re-admissions, as elderly patients who are discharged to a sheltered housing scheme with no support available are all too apt to return to hospital within a day or two) and consequent bed-blocking.

In addition, the increased necessity of anti-anxiety drugs for residents who are living in daily fear adds another huge cost, as does the well-documented deleterious effect of isolation and loneliness - a major factor in the development or exacerbation of dementia. These factors have been shown to be more deleterious to health than alcohol or tobacco, and cost the NHS an estimated £1 billion a year.

Also profoundly costly are the resultant admissions to residential or nursing homes. In one sheltered housing scheme, research showed a tenfold increase in such admissions in the year after the warden's support services were withdrawn. The warden's salary was c. £17,000 per annum; to keep ten people in residential care costs c. £375,000 per annum. The figures speak for themselves.

The EU Working Time Directive has been often used as a spurious excuse for the withdrawal of warden cover. Clearly, no single warden could possibly be expected to be on call for 168 hours every week - to that extent, the WTD is fully justified. But the sensible solution to this problem is not to withdraw warden cover altogether: a rota of cover provides the ideal solution. Creative local solutions involving volunteers and/or peer-to-peer support from the surrounding community could keep costs down, but even if five professional staff members were to be hired (providing extra cover for sickness and holidays), in my view, the total cost of £85,000 per annum still compares favourably with all the knock-on social and financial costs of warden withdrawal.

Besides losing the security and community life that they had been promised, the residents of sheltered housing have been subjected to a profound ignominy over the past twelve years: under the jurisdiction of local authority "Supporting People" programmes, they have been lumped together with a number of disparate client groups whose needs are diametrically opposed to their own. Consequently, many now find that they are sharing their formerly "sheltered" scheme with people who lead chaotic lives; for example, drug addicts, alcoholics, and people with a variety of mental health problems. Clearly, these groups do require support, but it is entirely unjustifiable to house them alongside vulnerable elderly people because there is a lack of supply supported housing or inadequate access to housing related support available locally, especially when there is no responsible adult on the premises to ensure their safety. I am aware that some residents have suffered attacks or sexual molestation; many others simply lock themselves in their flats and thus end their lives as virtual prisoners in solitary confinement - in the very buildings which were built to offer them a sense of security.

And finally, the elderly members of our society are not "benefit scroungers" - they include hard-working, tax-paying citizens from all walks of life, who deserve to choose if they want to live out their years of retirement in a secure and happy community setting with an age-appropriate social life. However, this choice is increasingly under threat and we must recognise sheltered housing as a prized asset for people in retirement.

I therefore fully agree with Mr. Jeremy Porteus that sheltered housing should be returned to its rightful role as the "jewel in the crown" of the UK social care system. The advantages would extend to the furthest reaches of society.

Published by the Housing LIN on 2 July 2015