The Future of Extra Care Housing – Challenges and Opportunities

Following the launch of the NHS’s Long Term Plan earlier this year, the Local Government Chronicle and Mears Group hosted a roundtable event at the King’s Fund, in April, exploring the potential of extra care housing, homes designed specifically for the needs of older people, can provide significant cost benefits to both the NHS and local authority adult social care.

The discussion was focussed on how councils should go about approaching, delivering and benefiting from housing with extra care.

Planning and Development

At the beginning of the discussion the differences between the problems facing rural and urban local authorities was explored.

Dawn Wakeling, strategic director of adults, communities and health at Barnet LBC, said: “Land is hard to find in London so we’re looking to redevelop where possible. We have a very significant older population that is predicted to grow at a much faster rate than the rest of London and dementia rates that are predicted to grow faster than the rest of London and UK.” (See the Housing LIN’s SHOP@ tool provides forecasting of extra care housing needs for providers).

Andy Begley, Shropshire Council executive director, said: “We’ve got the opposite issue [to the London boroughs]: we’ve got lots of land, which creates its own issues. We’re also a net importer of older adults and exporter of economically active young people, which creates a fantastic mix, but how we deliver services in that environment is particularly challenging.” (See HAPPI 4 - Rural Housing for an Ageing Population: Preserving Independence).

David Williams, director of business development at Northamptonshire Healthcare NHS Foundation Trust, said extra care was “part of the solution” for wider elderly care and his team were currently working through the Home First principal, which provides short-term care and reablement in people’s homes or through step-down beds. (See the Housing LIN’s Home from Hospital pages for more information about local schemes).

Delivery and Funding

Bill Flood, managing director of council-owned Wokingham Housing and for-profit registered provider Loddon Homes, said Wokingham Housing had recently completed two schemes at the same time, which had caused a delay before rents started to flow in.

“The expectation of filling extra care needs to be understood because often you make commissioning decisions and when it gets to delivering them, you need to not be surprised [if the] the rent isn’t coming in.”

 He also stressed that when done well, extra care housing was “not a cheap thing to do”, and said it was critical to understand the costs and pressure points associated with the build early on.

Derek Rust, group director of growth and development at the Barnet Group, urged those delivering extra care housing “not to compromise on capital cost because if you do, you will regret it at the back end”. Don’t think these are buildings like any other. The architects and contractors you use should understand extra care. It’s not just a building project, it’s very different.” 

Andy Begley highlighted a number of flexible funding models his council was either trying or considering, particularly around maximising the benefits of those who are able to pay for their own care. “When we start to understand the basic economics of self-funders alongside people who are eligible for services then we could be really quite imaginative. So, do we wait for those self-funders to come into crisis and then suddenly need to move into a particular property or do we offer a different deal at different time in their lives? Could we perhaps say to somebody, ‘if you put a 10% deposit into a property, then the worst case scenario would be you become frail and you may need to move into that property, and the best case -scenario is that [property] would become part of your portfolio’ and that would increase my capacity in the market … these are the sorts of things we’re toying with.”

He also said Shropshire council is introducing a deal on up to 30 homes for the elderly. The customer pays £150,000 for the property, which they are able to live in for as long as they wish. They then get their money back once they move out.

Jeremy Porteus, chief executive of the Housing LIN, applauded this and said the sector needed to think more creatively about models and approaches to enable people to make informed decisions around their housing choices. (See the Housing LIN’s recent report with Shakespeare Martineau Shining a Spotlight on the Hidden Housing Market).

Changing Perceptions

Pete Fahy, director of adult services at Coventry City Council, said there needed to be a change to the language used to describe extra care “There’s a big public perception issue with anything that has care associated with it. As long as extra care housing is a property of adult social care, people will not be drawn to it. I meet very few people who want to be a user of social care. So maybe we should stop seeing extra care housing as a property of care and more a property of housing, where there’s a big, investable, private market.” (See Housing LIN factsheet Extra Care Housing: What is it?).

The Future of Extra Care Housing

Bernie Lally, commissioning manager at Northamptonshire CC, said the sector needs to think of ways to deliver extra care housing so it is integrated within the wider community, a point which garnered much support around the table.

Sian Davenport, Mears Group business development manager, said: “For the schemes we’ve worked in, those that work really well are the ones that are an integral part of the community.” 

Kim Wright of Hackney Council added that in addition to the scheme itself, it was important to think about how the wider neighbourhood supported and promoted independence. 

Jane Taylor, deputy director for urgent care, Nene and Corby CCGs, said projects which had facilities such as restaurants that were available to the wider community are a good way to integrate.

Alan Long, executive director of the Mears Group, said catering was a good way to make extra care marketable, particularly to private high-end or mid-market customers. 

Ian Copeman, Housing LIN principal consultant, said housing associations could be a way to bridge this gap. He said there was board-level interest among housing associations to translate the commercial success they had found within the likes of the first-time buyer market for homes for older citizens. 

Technology Enabled Care

The discussion ended with an exploration of the possibilities around technology across the sector.

Hana Alipour-Mehraban, Wandsworth and Richmond LBCs senior commissioning manager, said Richmond council is currently looking at how it could use a pot of funding for assisted technology.

Other participants also highlighted how smart technology could help not only with social care but with improving building management and environmental performance such as through improved energy efficiency.  

Sara Crofts, senior project manager, Gloucestershire CC & Gloucestershire CCG, summing up the importance of building for the future in relation to technology, said: “We need to think about who we are building for. They will be much more tech savvy, so need to incorporate that into the building and need to make it adaptable because what we’re building now, in 20 years will be completely obsolete.” 

The original LGC feature on the roundtable, with a full list of participants, appeared on 6 June 2019 can be viewed at: https://www.lgcplus.com/services/housing/roundtable-think-housing-to-deliver-care-independence-06-06-2019/ (opens new window)