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BreakingRe-visioning older people’s housing

ContentsForeword 4

Introduction 5

Why break the mould now? 7

What do older people want? 10

Developing new business models 18

Overcoming the barriers 39

What is there to gain? 42

Conclusion 48

AcknowledgementsThanks are due to the following for their contributions:

Case studies

Brighter Futures, Caldmore Housing, Circle Anglia, Hanover Housing,Havebury Housing Association, Housing 21, Midland Heart, MHA CareGroup, One Housing Group, Orbit Group, Peabody Housing Trust, andThe ExtraCare Charitable Trust.

Breaking the mould project panel

Affinity Sutton, BCHAL, Cambridge Housing Association, CDS Co-operatives, Family Mosaic, Gentoo Group, Guinness, Hanover Housing, Home Group, Midland Heart, MHA Care Group, Moat, One Housing Group, Orbit Group, Osborne Homes, Plus Dane Group, Riverside, Swan, Synergy, Viridian, Willow Housing.

National Housing Federation staff

Lizzie Clifford, Jenny Pennington, Pippa Read, Amy Swan, Amy Williams.

Edited by Kathleen Boyle, independent consultant

Images reproduced by kind permission of Hanover Housing Group,Midland Heart, Sanctuary Housing, Metropolitan Housing Partnership,Moseley & District Churches Housing Association and Octavia Housing.

All rights reserved. No part of this publication may be reproduced, stored in a retrievalsystem, or transmitted, in any form or by any means, electronic, mechanical, photocopying,recording or otherwise, without the prior permission of the publishers.

While all reasonable care and attention has been taken in preparing this guide, the NationalHousing Federation regrets that it cannot assume responsibility for any errors or omissions.

© National Housing Federation ISBN 978 0 86297 562 3

First published in February 2011 by National Housing Federation, Lion Court, 25 Procter Street, London WC1V 6NY

Designed and produced in Great Britain by Ewens www.ewencom.com

Foreword

This report is not a one-off comment on older people’s housing, but part of a broadermovement to enhance the housing options available to people in later life and toeffectively ‘break the mould’ of older people’s housing. The Breaking the mouldproject, celebrating the 75th anniversary of the National Housing Federation, is aboutencouraging all housing associations to consider the future of housing, care andsupport for older people. This report is one of many project outputs providingassociations with the building bricks to do so.

The Breaking the mould project is happening at a pivotal time. The population isageing fast, with almost 10m people expected to be over the age of 65 by 2015,approximately one-fifth of the whole population of England. At the same time, theeconomic climate for developing homes and services to enable people to continueliving independently into old age is changing dramatically, with cuts being made toboth capital and revenue budgets.

Yet the need to ensure all older people, now and in the future, can live healthy, active,lives remains paramount. Housing associations already have a strong and positivereputation in meeting the needs of older people within their housing and services, butwith a third of all general needs tenants already over the age of 65, the sector needsto continue to plan strategically and innovatively to cater to their needs.

On top of that, this project is seeking to instil the idea that an ageing population bringsnew opportunities to develop housing and services which take into account the highlevels of owner occupation and housing equity owned by older people. The proposalsset out in this report could see housing associations broadening out their services andfacilities to the wider community, using any surplus from sales to continue to provideaffordable housing, care and support to those who need them most.

I am pleased to see the housing sector building on the outcomes of the Housing ourAgeing Population Panel of Innovation (HAPPI), which expressed a need for housingfor older people to become a positive choice for people in later life, with higher designstandards for space and quality. If housing associations can create a housing offerthat persuades older owners and tenants to down-size from homes with three ormore bedrooms – often with gardens – then desperately needed family housingbecomes available: and the new accommodation simultaneously meets the needs oftwo generations.

The Breaking the mould project takes this work a step further, setting out ideas fordeveloping both aspirational housing for older people and community services, andrightly looking to re-market older people’s housing, care and support as amainstream concern.

Richard Best OBE

Lord Best is President of the Local Government Association, Chairman of Hanover Housing Association and Chairman of the All Party Parliamentary Group on Housing and Care for Older People.

IntroductionCapital budgets for housingdevelopment have been severelycurtailed. Revenue budgets for socialcare and housing-related support areunder ever-increasing pressure. Careand support needs are increasing asthe population ages, and expectationsare rising as people rightly demandmore from their housing and care.Housing associations could easilyassume from the current climate thatit will be ever more difficult to ensurethat their older tenants are wellhoused and properly supported.

This report sets out an alternativeview. It describes a number of thebusiness opportunities that an ageingpopulation brings. It offers examplesof how care, support and otherpractical services such ashandyperson or ‘help at home’services can be developed and offeredto all older people in all types oftenure. There are very significantnumbers of older people who buy theirown care, and this number is set torise further as individual budgets arerolled out. Services developed for thisgroup are free from the constraintswhich revenue streams such asSupporting People (SP) often impose.The report also addresses capitalfunding, and argues that housingassociations should build larger, moreaccessible flats and houses which areattractive to older owner occupierswho want to move to an easier-to-manage home, but are not attracted totraditional models of older people’s

housing. Income from this source canthen be reinvested to improve the offerto older social renters.

The Breaking the mould project aimsto help providers to break the currentmould of older people’s housing andsupport, and build on the innovationwithin the sector to create a new andexciting offer.

In developing this project’s work, theFederation carried out research withhousing associations, local authoritiesand people over 50. This report drawsupon a literature review, polling ofpeople aged 60-75, and four focusgroups with people aged 50-65 and 65-75, who were either in privateaccommodation or affordable housing.The Federation also carried out asurvey and follow-up work with localauthorities to investigate whether theyhad an older people’s housingstrategy, and how they approached thedevelopment of housing, care andsupport options for older people.Finally, the Federation interviewedover 30 housing associations to findout the scope of their provision forolder people and to develop potentialbusiness proposals for other housingproviders to learn from. The findingsfrom these separate pieces ofresearch can be found on our website:www.housing.org.uk/olderpeople.

One in fivechildren borntoday canexpect to liveto 100 yearsof age

Why break the mould now?The notion of an ageing population is old news. The growingnumbers of older people have been accurately predicted formany years, and we know that 17.5% of the population inEngland, or 8.5m people, are now over 65. By 2031, this isexpected to rise to almost 15.8m people. One in five childrenborn today can expect to live to 100 years of age.1

Local authorities, housing providers and other local place-shapers have been working to address the issues presented byour changing demographics, but progress has not been able tokeep pace with the increasing needs of the population. The paceof change in demand and need has constantly outstripped thechanges in the volume and design of housing and services.

This publication sets out different ways in which housingproviders could respond to the demands of four groups of olderpeople:

• Older people in existing retirement housing: what needs tochange? Only 5% of all older people live in specialistretirement housing, and not all the stock is fit for purpose.What do these people want from the services they receive nowand in the future? How can the sector offer more flexibility andchoice within existing stock?

• Older people in general needs housing. The average age ofhousing association tenants is rising. Nearly one in threetenants is over the age of 652 and of those, over half live ingeneral needs housing.3 What adjustments do housingproviders need to make to their stock and housing services toensure they are serving their older customers well?

• Older people in the wider community. They may own their ownhome, but they are still in need of reasonably priced servicesfrom a trusted provider, to help them live independently or tomeet increasing care needs.

• A powerful generation of asset-rich, high-expectation ‘babyboomers’ is approaching retirement. Has the housing sectorrecognised how different their demands will be for housing inlater life? Are any of the sector’s current offers going to beattractive enough to this group?

While housing associations continue to adapt their services tomeet the needs of their older tenants, including providing arange of specialist housing, it is also important to look atbroader horizons. What models of housing and service could bedesigned to meet the needs of today’s and tomorrow’s affluentowner occupiers? Could income from this source help to financethe development of more aspirational and flexible housing for allolder people?

Housing: the gap betweensupply and need

Some specialist homes are being developedfor older people, but as demand outstripssupply older people will find it increasinglydifficult to secure a suitable property. Supplyin some areas is falling rather than rising, astraditional forms of sheltered housing aredecommissioned where they no longer meetcurrent expectations. A conservativeestimate by HGO consultancy for theNational Housing Federation in 2010suggests there are already around 70,000people aged 60+ in urgent need of housingand related support services. They areeffectively on a ‘waiting list’ for a suitablehome and support to allow them to continueto live independently. That figure is expectedto quadruple to at least 300,000 by 2019.

Preventative, independent models of housingand support are widely favoured by olderpeople. A YouGov survey commissioned bythe National Housing Federation in 2010found people aged between 60 and 65dreaded ending up in a care home orimposing themselves on relatives if theycould no longer cope with living on theirown. However, the poll also asked people torate different accommodation options if theycould no longer live independently in theirown home. The results were:

• 18% had a positive view of living in a carehome;

• 10% thought moving in with their familywould be a good idea;

• 80% were positive about downsizing to asmaller, more manageable home;

• 65% liked the idea of living in a self-contained home with support or careavailable if required.11

The picture of ageingThe positive aspects of an ageing society are well-rehearsed. People are enjoying longer, fuller retirementsor continuing to work into their 70s. Older people make aconsiderable voluntary contribution to society, oftenbringing valued life experiences to bear. Age UK estimatesthat people aged 50+ in the UK make an unpaidcontribution of £15.2bn per year as carers, £3.9bn inchildcare as grandparents and £5bn as volunteers. 50% ofthose aged 65-74 and 38% of those aged 75+ have takenpart in some form of volunteering.4

Many people are growing older with significant levels ofwealth in terms of housing equity. In 2004, 60% of peopleover 65 owned their home without a mortgage.5 Levels ofowner occupation continue to rise amongst older people.In 2001, 61% of those aged 85 or over were owneroccupiers, but this rose to 76% for those aged 65-74.6

However, while significant numbers who have benefitedfrom stable employment and final salary pensions aregrowing older with wealth, in terms of both assets anddisposable income, others are asset rich but income poor.Others still, have neither assets nor income. 23% of olderpeople live below the official income poverty line.7

The negative aspects of living longer have also been welldocumented. Disability, illness and poor health are notinevitable as people age, but their likelihood increases.More people are living longer with more complexconditions such as dementia and chronic illness. Anestimated 3.9m (33% of people aged 65-74 and 46% ofthose aged 75+) have a limiting, long-standing illness;there are 700,000 people in the UK with dementia, withnumbers likely to increase to 1.4m in the next 30 years.8 Alonger old age, coupled with the changing nature of familyrelationships means a more isolated life for many olderpeople. 12% of older people (over 1.1m) feel trapped intheir own home,9 with 11% having less than monthlycontact with friends and family.10

60% of people over 65owned their homewithout a mortgage

People are also worrying about how theywill fund care and support. The pollfound the following:

• 63% of people aged 65-75 wereconcerned they would not have enoughmoney to fund their retirement;

• 46% were concerned they would haveto sell their home to pay for care;

• 48% feared that the money theyplanned to leave as an inheritancewould be eaten away by the cost ofcare.

These figures suggest there is a sizeablegroup of affluent older people who wantpreventative housing options to enablethem to downsize and release equity tohelp pay for care if required, withoutjeopardising their ability to enjoyretirement and continue to liveindependently for longer.

The YouGov poll confirmed the finding ofmany other studies: that people haveclear ideas about where and how theywant to live if the time comes when theycan no longer cope on their own. Thechallenge for housing providers is toincrease the availability of the favouredoptions.

Services: the gap between supply and needLevels of unmet need in terms of care and support for olderpeople are deeply worrying. Budget increases for social care havefailed to keep pace with the needs driven by demographic changeand rising costs of equipment and staff.12 Many thousands ofvulnerable people are still not receiving the care or support theyneed. The Commission for Social Care Inspection estimated ashortfall of 1.4m hours of care in 2006/07 to 450,000 olderpeople.13

The cost of care for older people is a large call on publicresources, with 61% of the £14.2bn per year spent on adult socialcare by councils being spent on services for older people.14 It isestimated that by 2025 the number of older people unable tomanage at least one domestic task will double from 3.4m, and thenumber unable to manage at least one self-care task will doublefrom 2.8m.15 This inevitably means that the costs of care will risedramatically. Estimates vary, but the Community and LocalGovernment (CLG) strategy Lifetime homes, lifetimeneighbourhoods: a national strategy for housing in an ageingsociety16 used a figure of expenditure on long-term careincreasing by around 325% in real terms in the years between2002 and 2041.

Despite growing numbers of people in need, and before the 2010spending review announcement on cuts to Supporting People(SP), government funding for older people’s services through theSP programme had already fallen by £7.5m since 2006.17 The 2009CapGemini cost-benefit analysis of the programme concludedthat the revenue cost of providing housing-related supportservices to older people was £295m, whilst the total benefitderived was £1,570m.18 The CapGemini report looked at what waslikely to happen if SP funding was withdrawn. It found that theaverage cost of SP support for older people was £440 per year. IfSP were to be removed, the cost to other services would increaseby £550, made up of: £428 increased cost to social services; £55increased costs relating to hospital admissions; £67 increasedother costs (these are broken down in the report). These costsrelate only to those who continue to live independently followingthe withdrawal of SP services. Costs are considerably increasedby the fact that a proportion might require registered care.

Housing providers have responded to increasing needs anddecreasing funding in a variety of ways. The traditional form ofconcentrated support provided within sheltered housing isdiminishing, and moves to develop hub and spoke services haveaimed to improve the reach of support services to the widercommunity. Many housing associations have taken on contractsto deliver support to older people outside sheltered housing andacross all tenures, in a drive to support the wider community ofolder people to live independently in their homes. The value ofpreventative services such as help with shopping and gardeningor maintenance work is frequently recognised, although fundingis difficult to secure as local authorities increasingly concentrateon their statutory duties in times of financial austerity.

What do older people want?In the course of the Breaking the mould project, theFederation has carried out research with housingassociations, local authorities and people over 50.This involved:

• a literature review of older people’s housing, careand support;

• polling with people aged between 60 and 75conducted via YouGov;

• four focus groups with people aged 50-65, and 65-75, who were either in private accommodation oraffordable housing;

• a survey and follow-up work with local authoritiesto investigate whether they had an older people’shousing strategy, and how they approached thedevelopment of housing, care and support optionsfor older people;

• interviews with over 30 housing associations tofind out the scope of their provision for olderpeople and to develop potential business proposalsfor other housing providers to learn from.

The findings from these separate pieces of research can be found on our website:www.housing.org.uk/olderpeople. The focus in thepolling and the focus groups has been on theyounger old and those over retirement age, so as toget a sense of what older people want in the future.However, other research looked at the needs andaspirations of older people of all ages.

What is ‘old’?Survey results suggest that people are reluctant tothink about themselves as ageing. Peoplepsychologically delay placing themselves in thecategory ‘old’, partly fuelled by a wish not to haveothers describe them in these terms. Research hasrevealed a widely-held perception that people over 50tend to be ‘written off’ as old, but this presents abarrier to individuals’ preparation for their ownfutures.19 Research has shown that, in particular,many individuals fail to plan ahead or consider theirfuture housing needs.20

Participants in our focus groups felt that age was anineffective way of measuring their housing, care andsupport needs. They felt that older people were oftenviewed unfairly negatively.

‘If your health is good you’re alright at any age.’Participant from Sunderland

‘I think “older” when you’re not able to care foryourself and do the things that you used to do, it’skind of a flexible description. If you don’t feel yourage and if you’re fit and healthy, even if you’re 70,there’s no reason to be called old.’Participant from London

‘You read in the paper, “pensioner mugged”, myGod, 61?! The newspapers think you’re old at 60.’Participant from London

‘If you worry about it [life when you are older] allthe time you might as well drop dead now and bedone with it.’Participant from Norfolk

Older people today have quite different expectationsfrom those of previous generations, rightly expectinghigher space and design standards, a greater degreeof privacy than some more traditional shelteredschemes were designed to provide, and more flexibleand individualised services. If older people are toconsider retirement housing as a positive option,providers must have attractive and sustainableopportunities available to them. The debate aboutwhat models to develop must think beyondretirement housing. For example, could we develop arange of accessible housing that can be adapted andallow some degree of downsizing on the same site?Should hubs for care and support become muchmore widespread, and placed so that they canprovide a flexible service to older people in all typesof housing?In our research, nine themes stood out as central toolder people’s housing requirements. Older peopleinterviewed and surveyed wanted a home that:

1 is accessible2 is spacious and attractive3 is safe and secure4 is in an age-friendly environment5 offers freedom, choice and flexibility6 has help at hand7 provides flexible, personalised support8 lets you socialise and feel included9 allows you to make decisions.Each of these themes is discussed in this chapter,illustrated by comments from our focus groups and survey.

Our literature review found a growing body ofliterature on the need to design buildings sothat homes are fully accessible to those whoare less able to walk and get around. Muchresearch has been commissioned to provide anevidence base for the value for money of earlyintervention and accessible housing when itcomes to the health of people in later life.

Many focus group members referred to theimportance of a home which is manageableand accessible. Regardless of age or mobility,they recognised the value in taking proactivemeasures to live somewhere which wasaccessible and easily adaptable and flexible astheir needs increased.

‘I’ve actually gone from a house to groundfloor thinking I want something smaller anddownsize really, I’m thinking…it’s easier tomaintain, easier to keep, not such a biggarden, no stairs.’Participant from London

‘When we moved in there was a bath with ashower in it and both my wife and myselfhave had increasing problems stepping in andgetting into the bath for a shower. In fact mywife had to give up in the end. So now we’vehad a wet room installed.’Participant from Bradford

A home that is accessible

There are alreadyaround 70,000people aged 60+in urgent need ofhousing andrelated supportservices

The HAPPI panel21 argued that innovative architecture couldchange the image of older people’s housing by offeringelegant designs that avoid an institutionalised feel. They alsohighlighted the value of open-or flexible-plan homes, arguingthat sliding partitions between living spaces can provideflexible space, allowing a flow of light and ventilation throughthe home. Studies have shown that exposure to daylight andbeing able to see the outside world are important contributingfactors to good health.22

It is usually assumed that people automatically require lessspace as they grow older, ie, that they want to ‘downsize’.However, evidence suggests that many older people want tokeep the same sized accommodation as circumstanceschange.23 Older people contributing to the HAPPI reportwanted enough room to display the valued possessions andfurniture accumulated over a lifetime. Space is also oftenrequired for visiting friends or family, or for a carer to stayovernight.24 People in the 65+ age range may also want toretain a dining room if they have had one in previousaccommodation. Older people also tend to prioritise privategreen areas25 and while big gardens can be difficult tomaintain as mobility and health declines, large balconies canoffer a manageable substitute.26

The key to making housing association developments anaspirational choice for people as they age is therefore toprovide housing that is more accessible, more flexible, andmore manageable, but not necessarily smaller than generalneeds housing. This is especially true if housing associationswish to offer a tenure mix which attracts older asset-richowner occupiers.

However, the offer also has to be sustainable in terms ofdesign and the services available. Some forms of extra careare already out of date and in need of remodelling, even whenonly built in the 1990s. People’s expectations and needs willcontinue to change and, as discussed above, it is not easy toencourage people to focus on what types of housing theymight need in the future. Models therefore need to emphasiseflexibility, so they can adapt to changing needs andcircumstances.

The fear of crime is a significantissue for older people, and homesand neighbourhoods must bedesigned with the aim of reducingcrime and creating a sense of safety.Although evidence suggests that thatrisk of crime is lower amongstpeople aged over 60, a study by AgeUK has shown that fear of being avictim of crime increases with age.27This fear in itself can restrict thepossibility of engaging fully incommunity life, and can even be apredictor of ill health.28

‘I would never like to go back to ahouse again. The security is themain thing for me. I know once Icome in here and go to my own flatI’m fine and that’s how I feel.’

‘I wouldn’t feel secure at all backinto a house or bungalow oranything like that.’Participants from Sunderland

Participants living in retirementhousing flagged up the assurance ofhaving help at hand, which helped tomake them feel secure in theirhome.

‘Everything is there for you and ifyou need anything, assistance oranything you just pull the cord.’

‘It’s great just to know somebody isthere if you need them.’Participants from Sunderland

A home that is spaciousand attractive

A home that issafe and secure

The key to making housingassociation developments anaspirational choice is to providehousing that is accessible, moreflexible and more manageable

The neighbourhood is just as important asthe interior of the home in helping olderresidents maintain a high quality of life.The World Health Organisation haschampioned the argument that citiesshould be ‘age-friendly’29 and many reportshighlight the problems that poorneighbourhood design can cause the olderpopulation. Poor outside lighting, streetclutter and the lack of suitable seating orfacilities make it harder for older ordisabled people to get out and about.30Research in London has shown that a lackof public toilets and the fear of crime aresignificant barriers to older people’smobility.31 These issues partly explain theresult referred to earlier, that 1m olderpeople reported feeling trapped in theirown homes.

There is evidence that home andneighbourhood characteristics affect thephysical activity of older people – theamount of open space and ease ofpedestrian access can encourage olderpeople to get out and about, positivelyinfluencing health and well-being.32

Accessible housing is of limited use unlessit is developed in areas where there areadequate transport links to localfacilities.33 Practical features that helpaccessibility include disabled parking bays,green spaces, kerb design appropriate forwheelchair users, and sufficientinformation services.34

Older people are considerably more likelythan the rest of the population to havedifficulties accessing local amenities,35especially as many local post offices haveclosed in recent years, and large out-of-town shopping centres have widelyreplaced local convenience stores. If aneighbourhood is to be age-inclusive,thought must be given to maintaining localservices such as banks, restaurants andGP services.

Several participants from the focus groupsprioritised location as a key feature ofhousing in later life:

‘We do talk about downsizing, livingsomewhere, perhaps in a small town,where we can walk and when we’re notdriving, those sorts of things.’Participant from London

Evidence suggests that most older peoplewould live in a mixed-age communityrather than in specialist older persondevelopments,36 and some literature haspointed out that age-segregated housingcan be damaging to social interaction andintegration.37 Some participants from thefocus groups reflected this:

‘The other thing that I thoroughly enjoy isbeing part of a community, I love the weekid who’s across from me...and in any ofthese places that we’re talking about, youdon’t want a dumping ground for old folk.You’ve got to have the feeling of belongingto a community and not just beingdumped there. That’s the thing thatfrightens me most.’

‘I don’t want to be shoved in with all theold ‘uns! I don’t! And I’m old myself! I liketo see some youngsters about, I like tosee the kids skipping in the street so thatI know I’m still alive, not waiting to becarried off in my coffin!’Participants from Norfolk

This stresses the importance of choice.Some people will prefer a quieterenvironment in specialist retirementhousing whilst others will want to remainin the thick of things. In all settings, adegree of community interaction is vital tohelp combat social exclusion, particularlyfor those who are less mobile.

A home in an age-friendly environment

Much of the research on older people’s aspirationsemphasises the desire for independence. This was reflectedin our focus groups:

‘It’s important to have your own independence.’ [‘What doesthis mean?’] ‘Staying in your own home. Own home withadequate support.’Participant from Norfolk

‘I think that it would be nice if you had more carers to goand look after you in your bungalow, so you didn’t have tomove into a home or anything, that’s what I would like, tostay in my own home and have a carer stay with me.’Participant from Norfolk

Many of the participants from the focus groups, particularlythe younger groups who had gone through bad experienceswatching their parents grow old, were very fearful about theprospect of losing their independence, often equating thiswith going into a care home or being dependent on care.

‘I think my worst nightmare would be actually going intoone of these care homes; I would really hate that, just allsitting around the edge of the room, it’s horrible. Thatwould be my worst nightmare.’Participant from Sunderland

‘How can a person in a wheelchair sit 24-hours a day justwaiting for people to come in to make them a cup of tea, toget them ready for bed, then get them out of bed – that’snot promoting independence.’Participant from Bradford

Other fears were ‘being treated like a child’, ‘losing control of your everyday life’, or ‘being told when to go to bed’.

Some people regarded retirement housing as unattractive as a care home:

‘There is no way I would consider going into a housingcomplex where there’s a warden or anything, I justwouldn’t be interested in that at all.’Participant from London

Many others, on the other hand, chose retirement housingspecifically because they wanted to retain theirindependence.

A survey by one housing association found that 43% of residents moving into their retirement housing did so principally because they needed some help, but wanted to remain independent. 38

A home with freedom,choice and flexibility

Many older people do not need ongoing care andsupport services, but would find life much easierand more secure if there was help at hand forhousing maintenance and other tasks, and anassurance that support would be there shouldthey need it. This is equally true for people livingin general needs accommodation and those whohave already moved to more suitableaccommodation. Participants in the focusgroups highlighted the need for a little bit ofhelp in the garden, with their shopping, carryingout odd jobs in the home, or simply checking upon them when ill.

‘I used to do all my own gardening but now Ican’t, I have to have someone to come and doit, I’m waiting for them now to cut the grass.’Participant from Norfolk

‘I know you could come to a point where youneed full support but most people could getaway with a small support and they’d be farbetter off in their own home.’Participant from Norfolk

‘You must have somebody that you can rely onsome time in your later life, especially whenyou have got something wrong with you. We’reall independent, we all say “that’s all rightlove, I can do that” but there is a time when youcan’t do it.’Participant from Norfolk

‘Last winter, as I stated before, I live down aprivate lane and it’s a very rough lane, I was illand I was in bed more or less for three weeks.If it hadn’t have been for Mary ringing up, myfriends ringing up, my neighbour knocking onthe window to see if I was okay, I was still inthis world, I wouldn’t have seen or heardanything, you know?’Participant from Norfolk

Older people who need ongoing supportservices want these to be personalised, torespond in a more flexible way to theirindividual needs and to give the person morecontrol over the services they receive.39Services need to be high-quality and reliable,as well as personalised.

‘I’ve just had a nightmare, my mum’s 92 andwhat she wants is continuity. We get adifferent carer every day, they don’t doanything; they’re supposed to prompt Mumto take her medication, it’s still there when Iget there. My mum’s lucky because I’mthere practically every day but for an oldperson that was on her own, it would be anightmare.’Participant from London

Participants from the focus groups oftenhighlighted their changing care and supportneeds:

‘I do have osteoporosis of the spine and Ihad a really bad fall at Easter where Ifractured three vertebrae in the spine sotherefore I did have to have care because Icould hardly walk. But now I am very, veryindependent.’Participant from Bradford

Homes should be ‘care-ready’, with flexibleand ‘invisible’ services if required. There isoften a concern that increasinglypersonalised care and support might resultin extra ‘traffic’ of less-familiar peoplecoming in and out of their homeenvironment.40 The challenge is to bring thismodel of flexibility to all forms of tenure andto older people living in accessible generalneeds accommodation.

A home with help at hand A home with flexible, personalised support

46% of people aged 65-75 were concerned theywould have to sell their home to pay for care

Large numbers of older people in this country currently live alone. Data from theProtecting Older People Population Information System (POPPI) predicted that by2010, over 2m people over 75 would be living alone in the UK. A strong theme thatemerges in the literature is therefore the need to address social isolation of olderpeople, particularly amongst those who have health or mobility issues that preventthem from getting out into the community.

The report A Sure Start to Later Life has raised the profile of older people in relationto the issue of social exclusion, having conducted research showing that 29% ofolder people experience exclusion by one or more measures including socialrelations, cultural activities or civic participation. They found that as age increased,levels of exclusion tended to increase, with nearly a third of people aged over 80excluded from basic services, compared with only 5% of those in their 50s.41 Asurvey by Help the Aged in 2008 found that over 1.2m older people always or oftenfeel lonely.42

The HAPPI panel heard from a range of older residents of the importance of thefreedom to choose when to be alone and when to be with others,43 necessitatingflexibility within building designs that offer communal and private spaces.Participants from our focus group who live in retirement housing were clear aboutthe benefits of being able to mix with friends and neighbours when they wantedcompany:

‘We had our own property, we had a cottage for over 30 years and I was moreisolated there, for all I knew everybody, than I’ve ever been coming in [here].’

‘It’s the library as well, it’s got a little café place so it’s more community-basedso people can go in and choose a book and have a cup of coffee and things likethat, and mix with the residents as well, which is nice.’

‘There is family coming in, there are all different people, relations come in,friends come in, little ‘uns come in. It’s not just for older people.’Participants from Sunderland

Our research emphasised a real need for consultation and engagement with olderpeople, which can itself contribute to the well-being and satisfaction of olderresidents.44 This could be one tool to help older people, who are often time-rich, tobecome increasingly important agents in shaping the homes and services theywant.45 The objectives of increased choice and control can also be achieved byencouraging the participation of older people themselves in contributing to thedevelopment of the communities in which they live and the services they receive.46

The HAPPI report stressed that providers and designers should put effort intounderstanding what appeals to the ‘younger old’; those whose children have lefthome, and who have the opportunity to downsize from houses with large, high-maintenance gardens, for example, or move away from amenities such as schoolsinto new communities. Co-operative models of housing have been very successfulin engaging residents in the management of their scheme, including decisionsabout allocations and the use of maintenance funding.47 Co-housing has potentialfor this demographic in particular, who can take an active role in designing theirown housing.

A home where you can socialise and feel included

A home where you make the decisions

As lifestyles, health and care needs andlevels of wealth across the older populationbecome increasingly diverse, it is importantthat the choice of services and housingoptions expands to keep pace with thisincreasing diversity. The eight themeshighlighted above, including accessibility,flexibility, and sociability, need to beavailable across all tenures, and for peoplewith all levels and types of care and supportneeds.

The literature review and the focus groupshighlighted the existence of a broadspectrum of demand for housing, care andsupport, ranging from accessible housingwith no care and support, to extra care andnursing home provision. The challenge is tofill in this spectrum with housing andservices which meet the needs of the ageingpopulation.

Not everyone who grows older will be inneed of care, but may require some supportor a little bit of help with shopping orgardening. People’s needs can vary overtime, and can decrease as well as increase;older people’s health conditions canimprove or disappear, so models are neededwhich do not trap people into dependency.The second half of this publication looks atgood practice and business models forproviding a range of flexible housing andsupport services in different settings. Thesemodels all focus on the themes ofindependence and choice.

Conclusion

Developing new business modelsThis section describes a number of business models which housing providers havedeveloped in response to the changing context in which they operate. These aresummarised as:

Business model Developed in response to

1 Improved options for homeownership in older age

• Asset-rich older generation with increased expectations

• Need to increase capital resources available to invest inimproved options for older social housing tenants

2 Providing community facilities • Current political agenda

• Increasing financial austerity and difficulty of makingsome facilities break even

3 Providing services to self-funders • Increasing numbers of self-funders

4 Providing commissionedservices to the widercommunity

• Increasing financial austerity and potential forreinvesting funds in other services or housing

• Increasing age profile of people in general needs stock

• Need to make use of economies of scale

Improved options for home ownership in older ageOlder people’s assets

Today’s older people are wealthier than those of previous generations. Households ofpeople over 65 collectively own around £500bn of unmortgaged property equity,48 while over50s account for 40% of consumer spending, 60% of UK total savings, and 80% of thenation’s wealth.49 There are therefore sizeable numbers of people with money to spend onservices to enable them to continue living independently, specialist older people’s housing,or more accessible and flexible housing sited within general housing. This will only happenif the offer is sufficiently attractive.

The global financial crisis and the ensuing recession have resulted in a particularly difficultenvironment in which to develop new affordable homes. The recent ComprehensiveSpending Review cut the budget for new affordable homes by over 60%. The Governmentproposes that the gap caused by these significant cuts should be filled by increasingrevenue from rents, of up to 80% of market rent on new-build properties and some re-lets.Government funding for social housing can no longer be taken for granted, and everyincome stream available must be analysed and capitalised on, if the social housing sector isto continue to fulfil its mission to provide affordable housing for those who need it most. Theoption of generating capital resources by providing accessible flexible housing for wealthierolder people must therefore be considered seriously, not only because it helps to house thisgroup of the population well, but also because surpluses generated can be re-invested toimprove the offer to less wealthy older people.

Mixed tenure

Our research shows there is a need for both aspecialist and a non-specialist offer to olderpeople. Where the only options available aresheltered and extra-care housing there is a riskof older people either remaining ininappropriate housing, or being forced to movesomewhere at a time of crisis. The provision ofwell-designed, accessible housing, located in adesirable position with access to amenities,would be very attractive to people looking tomove perhaps in their 60s, but still aspiring tolive somewhere which is not necessarilylabelled ‘older people’s’ housing and where theycan fit all their furniture. Proximity or access toa local hub for care and support when needed infuture would also make this an attractive offer.

Our research also supports the idea that somepeople will choose a specialist retirementhousing development. The traditional retirementhousing product for owner occupiers haslimitations, in that if an owner develops a careneed which cannot be met within the housingand has to move, their options for selling theirflat are extremely restricted. By comparison, thepotential demand for owner occupation in theextra-care market is much bigger. However, up-front capital costs are high, and not alldevelopments have managed to pitch the offercorrectly so that the development is self-supporting or income-generating. Some owneroccupiers may have experienced a reduction inproperty values, as well as income frompensions and investments. Other over 50s willbe looking to free up equity to help theirchildren purchase homes.

The over 50s account for40% of consumer spending,60% of UK total savings and80% of the nation’s wealth

In 2004 the Joseph Rowntree Housing Trust(JRHT), Hartlepool Borough Council (HBC) andother local partners started working togetherto develop Hartfields, a new retirement villagein Hartlepool. The development was supportedby funding from the Department of Health’sExtra Care Housing Fund and the (then)Housing Corporation.

It opened in August 2008. It has 242 units ofone and two bedrooms (predominantlyapartments) all designed to Lifetime Homesstandards. It has extensive communalfacilities, including a healthy living suite, artsand crafts room, convenience store, bar,library, IT room and hair salon. The village iswell integrated with the local community byproviding facilities that would be open to thepublic – a restaurant, fitness suite, day centre– as well as offices for health and social careprofessionals serving Hartfields and the widercommunity.

Hartfields was designed to attract people over60 with a strong connection to Hartlepool. Itprovides vibrant independent living, whilst alsoaccommodating significant numbers of peoplewith high levels of need for care and supportwho would otherwise be living in residentialcare. It is a mixed-tenure development.Properties are available for full purchase orshared ownership, or for rent to thosenominated by HBC. Of the total 242 units, 97are available for sale and 48 for sharedownership.

Tenants and owners are mixed across thescheme and the intention is to maintain abalance of care needs across the differenttenures.

Development of Hartfields was not without itschallenges, but progress was greatly helped bythe supportive attitude of the HBC planningdepartment. Between identifying the site andcompleting the purchase, the price of the landrose by £0.9m. This meant additional units ofaccommodation had to be built for sale, andthe proportion of homes for rent was

decreased from 50% to 40%. Joseph Rowntreebought the entire retirement village site from adeveloper after it had secured outline planningfor residential development for a larger site.The Trust took the risk of securing detailedplanning and selling the sharedownership/sale units itself. The affordableelement of the retirement village was part of as106 agreement for the larger site.

Effective marketing of the scheme was crucial.Activities included: local media coverage,promotional materials distributed acrossHartlepool, and roadshows promoting thescheme. Demand for rented properties wasand remains high, but the slowdown in thehousing market has meant that the sale offull-purchase properties has been slower thananticipated.

JRHT and the residents continue to work withthe local council to lobby for better localamenities, and especially a better local busservice. This is important in making the towncentre accessible to village residents.

The slower than expected rate of take-up offull-purchase properties has meant that thevillage has not yet reached full capacity.However, the development is working well as asupportive community. Most services on-siteare provided by JRHT. For those renting theirproperty, rent and service charges are eligiblefor housing benefit. People are charged astandard support charge, and for thoseassessed as eligible, this is covered by aSupporting People block grant from HBC.There are then three tiers of additional carepackages which can be purchased frompersonalised budgets. The move topersonalisation has increased the flexibility ofservices which can be purchased, and on thewhole people have opted to continue topurchase the on-site options. This provides amost positive sign that residents are happywith the service JRHT is offering.

Focus on: Developing a thriving retirement village

Since the Extracare Charitable Trust’sLark Hill Village in Nottingham openedin summer 2009, ExtraCare CharitableTrust has reported strong demand forhomes at the newly-opened retirementscheme, the largest of its kind in the UK,with 200 of the 244 purchase propertiesexchanged within six months of opening,and the remainder sold by November2010. The Village comprises 327 homeson a 24-acre site: 255 self-containedapartments and 72 bungalows. Eachhome (of 55-100m2) has its own frontdoor, kitchen, living room and one or twobedrooms. All properties have their ownshower room with toilet. There aresubstantial balconies to 262 properties.Ninety-eight properties are outright-purchased, 146 part-purchased and 83are rented. The scheme is devised to beaffordable to anyone, including rentersor home owners who only have a stateretirement pension and/or limitedsavings.

Residents at Lark Hill Village haveaccess to 18 health and leisure facilitiesincluding a gym, restaurant and craftroom, IT suite and greenhouse, and up to24-hour assessed care is availablethrough the village’s qualified care teamshould they need it. About one-third ofresidents have such a care package. Allresidents also receive specialist welfareadvice (which has so far found £295,000in unclaimed benefits on behalf ofpotential villagers), support withpreventative health care andmembership of a 300-strong Lark HillFriends Club which introducesprospective residents to the community.

The result of an 11-year partnershipbetween Nottingham City Council,Nottingham City Primary Care Trust(PCT), the Department of Health and theExtraCare Charitable Trust the ambitionis that residents will have a safe andsociable ‘home for life’ where couplescan remain together and whereresidents should not need to be admittedto a hospital or a nursing homeenvironment.

ExtraCare Charitable Trust received £3mfrom the Department of Health ExtraCare Housing Fund. The land waspurchased from Nottingham City Councilwho then retained the nomination rightsfor the rental stock. The Trust workedclosely with Nottingham City Council aspart of the joint allocations panel,assessing each application for the rentalhomes on a range of lettings criteriafrom individual finance, age, carerequirements and current housingprovision. ExtraCare Charitable Trustheld regular meetings with socialservices, agreeing care levels andappropriate funding models. The PCTwas involved from the outset as ascheme partner and contributes to thecosts of those residents with highnursing care needs. The substantialcommunal facilities were funded in partthrough a £3m fundraising campaign.The scheme benefited from historicallylow development interest rates.

The opportunity to apply to live in thevillage is open to the over 60s (55s inspecial circumstances) living in the Cityof Nottingham, or to those who candemonstrate a local connection.Residents come from a broad range ofsocio-economic backgrounds madepossible by the flexibility of tenure; thosemoving in have come in part from boththe private and local authority rentalmarket, the rest being part-purchasersand owner occupiers who wish topurchase outright.

ExtraCare Charitable Trust’s marketingstrategy was formulated by feedbackderived from a series of consultationdays held to promote the concept of avillage, garner support for the planningapplication and generate a database ofprospective clients. Invitations to attend‘friends’ meetings’ were then sent to allthose on the database. Friends’meetings generally start 12 months inadvance of opening with the objective ofmaintaining interest in the development,giving prospective residents a ‘taster’ of the activities and lifestyle they canexpect and ultimately forming theframework for the community prior to occupation.

Focus on: A successful model for home ownership

Housing 21, a national specialist older people’s housingprovider, opened Waltham House in Wirksworth in 2008.Located in the heart of a market town, it comprises 39 one-and two-bedroom apartments with a mix of tenures. The 17one-bed and 22 two-bed apartments form part of anoriginal grade II listed building which was carefully restoredto provide five of the apartments, with the remainder beingdeveloped in a new building to the rear, formed around acentral courtyard.

It was built following a partnership between Housing 21,Derbyshire County Council, Derbyshire Dales DistrictCouncil and the Wirksworth Care Centre Project.Derbyshire County Council provided discounted land for thedevelopment, and Housing 21 also purchased land fromDerbyshire NHS. The association received funding from theDepartment of Health of £2.22m and the Wirksworth CareCentre Project, who successfully lobbied for thedevelopment of retirement housing on the site, helped togenerate some funding through local fundraising. Housing21’s business model for the development was reliant onincome from the sale of properties at Waltham House.

On-site facilities include a restaurant and communallounge, conservatory, health care suite, library and visitinghairdresser. A day centre is also available at WalthamHouse and a community care service operates from thecourt.

The court has an active, community atmosphere whereresidents enjoy regular activities, including games, filmafternoons, music, reading and listening groups, talks andcoffee mornings. Wirksworth in Bloom, Community Fayreand Carers’ Support Group are among the facilities open tothe wider community too.

Of the 39 units, 15 were intended for shared ownership and10 for outright sale. Demand for all apartments was goodand just one of the apartments intended for outright salewas later converted to rental. Today there is a waiting listfor re-sale properties. Waltham House’s town centrelocation has made it a popular choice, both for renting andfor ownership. Being located just 20 yards from a bus stopand 100 yards from the local shop have undoubtedly helpedin its popularity. The post office and local GP are alsonearby.

Focus on: Increasing demand for re-sale properties

‘I haven’t got a pension, I didn’t think I’d needone and in reality it’s not worth doing thatnow, I’ve got other assets.’Participant in London focus group

There are a great many different models ofequity release available to older people, butmany are inflexible and do not entirely meetpeople’s needs. Equity release would beparticularly useful for those older people whoare not eligible for state financial support,therefore widening the potential customer basefor housing associations.50

Research by One Housing Group has shownthat equity release is currently used to fundcare and support for older people in only 1% ofcases, compared to 70% of cases where it isused for home improvements or adaptations.51Surveys and focus groups with older peoplehave revealed that there is interest in usingequity to fund care and support in old age, butthat products need to be simple to understand,cheap to administer, flexible to adapt as careand support services develop, and meet a rangeof different personal circumstances.52

Modelling by One Housing has shown that ifsomeone owns their house outright, in themajority of cases equity release would providemore than enough money to cover the costs ofextra care.53 There is therefore a majorincentive for associations to work in partnershipto encourage the development of better equityrelease products.

Models of equity release for older peopleinclude the following:

• A popular model involves borrowing moneyagainst the security of the property. Nointerest is due until the owner dies or sellsthe property. However, the monthly incomereceived from the cash sum will reduce theamount of benefits received. Furthermore,conditions attached to lifetime mortgagesoften mean that retirement schemes, sharedownership and schemes with significantservice charges are excluded from theproduct.54 Models need to be developed that

are inexpensive to set up, release smallamounts of capital at a time, addressconcerns about compound interest andpotential negative equity, and do not adverselyaffect benefit eligibility.55

• Some banks and building societies offerreverse mortgages, in which they pay moneyto the home owner monthly until theownership is fully transferred to theorganisation.

• Housing associations can defer care andrepair charges for leaseholders until the pointof sale, at which stage the association canrecoup the costs, with compound interest,from the proceeds of the sale. While this is aparticularly attractive option for older peopleon limited incomes as they will not have topay for care out of their limited income, it maybe unappealing for associations who wouldhave to fund care and repairs out of theirgeneral cash flow until the money isrecouped.56

New business opportunities for associations todevelop products in relation to privately ownedaccommodation include arrangements whereassociations provide repairs and adaptations inexchange for acquiring equity stakes.Associations could acquire a share of propertyfrom older owners, repair them and operatelike a shared ownership scheme. Eligibility forhousing benefit may still apply for the ownereven after releasing part of the equity as capital,if it can be proved that they would have beenunable to stay in the property otherwise.57Housing associations may wish to allow sharedownership residents to staircase down theirowned share in order to release equity intranches to fund care and support needs.58

Equity release

Focus on:Creative asset managementHanover Housing, a national specialist olderpeople’s housing provider, has designed ‘tenureneutral’ to improve the choices that older peoplecan make in their retirement. The initiativeacknowledges the benefits of mixed-tenurecommunities as well as the advantages that canbe achieved by enabling older people to investtheir housing wealth to release the potential forfurther investment in new retirement housing.Hanover is therefore actively seeking to increasethe proportion of home ownership and individualchoice on its estates.

Sales income surplus will be solely invested innew retirement properties for older people andHanover has set an initial target to build at least1,000 new retirement housing properties.

Importantly, prospective residents can nowchoose a Hanover property and then ‘self-select’the type of tenure. Buying a home on estates thatwere previously only rented may provide anaffordable option for older people with modesthousing wealth.

The tenure neutral offer

The new offer comprises two parts: ‘opportunityto buy’ (existing tenants) and ‘direct sales’ (futureapplicants). Hanover has exempted some estates,including extra care, from phase 1 of theprogramme.

Opportunity to buy

• Hanover residents can purchase their homesubject to an independent valuation

• The valuation fee is refunded to residents if theyproceed with the purchase.

Direct sales

• Every fourth vacancy that arises on Hanoverestates will be offered for sale. This allowsHanover to honour its nomination agreementswith local authorities and to continue towelcome older people who wish to rent

• £15,000 from the first direct sales ‘sale’ will begiven to the estate to spend in consultation withresidents

• The properties will be sold via local estateagents

• Hanover will offer a £1,000 cash-back incentiveto buyers who can complete within eight weeksof offer acceptance to minimise the void loss tothe association.

Preparation for tenure neutral

This is a significant development that willrevolutionise the Hanover offer. The direct salesinitiative builds on a 2008 pilot by Hanover thatindicated demand for affordable home ownership.

Significant work has gone into reviewingoperational management and into aligning thetenancy agreement and lease terms to ensurethat the services provided are truly tenure neutral.

Staff have been extensively briefed and equippedto manage the change of approach and providesupport equally to tenants and home owners.Success will ultimately depend on staffunderstanding and support to appeal to existingand potential tenants and leaseholders.

Next steps

Tenure neutral was initially launched in phases atthe end of 2010 and now applies across Hanoverto all eligible estates.

Future innovations that Hanover intends toconsider may include a flexible shared ownershipoption that allows people purchasing properties torelease equity by staircasing down theirinvestment and renting the proportion of theproperty that they haven’t got in ownership.

Extending home ownership

Housing providers may also wish to consideroffering older people the opportunity to buy or part-buy their homes. This increases theassociation’s development potential, andallows a broader portfolio approach to newdevelopment.

Not all retirement housing is of a sufficientquality to be offered for sale. Some units aresmall, the resident profile is increasingly frail,there is often a lack of dementia care,communal areas are sometimes under-used,and a poor location can make access tocommunity facilities difficult. If the retirementhousing of the future is to be attractive toowner occupiers, it will need to meet theirdemands for space (at least two bedrooms inmost cases), services, and location.

Given that needs and expectations areconstantly changing, as noted throughout thisreport, there will always be a risk of newdesigns becoming obsolete. This risk is greatlyreduced if new retirement housing has one ormore of the following features:

• developments designed as ‘care ready’ sothat even if there is no immediate need, careservices can be ‘plugged in’ as and whenneeded;

• developments which have some facility forresidential or nursing care either on thesame site or close by, so that for those whodo have to move on to a care or nursingsetting the move is not so traumatic;

• developments designed to such a standardand in such a way that they would beattractive to people of all ages, so that theycan be used as general needs housingshould demand for specialist retirementhousing diminish;

• developments designed specifically to meetthe current and future needs of the localmarket, and built in the right location;

• developments with communal facilities ofinterest to older people, but also well linkedto local services.

Providing communityfacilitiesThe government’s ‘localism’ agenda offerssome significant opportunities, but it alsoposes real challenges in the provision andmanagement of housing and related services.The recent spending review announced thepossibility for communities to be given newrights to run services and own assets,especially where they might close or be cutback. Communities, citizens and volunteers arebeing urged to play a bigger role in shaping andproviding services. There will not be a ‘one sizefits all’ approach to localism, and localauthorities, housing organisations and thehouse-building industry will need to maintainstrong relationships with local communitiesand local people.

It is vital that older people are included in thisagenda, and some specialist housingdevelopments provide an ideal location forputting the Big Society into action, with olderpeople setting the pace and direction ofprogress. There are opportunities to assist thecapacity-building of local communities andgroups and providing services to the localcommunity. Housing providers may also wantto consider changing their organisationalstructure to increase community or staff powerin local decision-making.

The following case study describes a mixed-use scheme designed to be a vibrant andwelcoming community with high qualityhousing and communal facilities designed toensure the scheme is an integral part of thelocal community. The case study alsohighlights the challenges in making such adevelopment break even, and provides food forthought about what would need to be donedifferently if this were to be replicated morewidely.

Hanover has set aninitial target to build at least 1,000 newretirement properties

Darwin Court, a development by PeabodyHousing Trust, is an exciting and innovativesocial housing scheme for people over 50,although younger family members are welcome.It has 76 units: 40 supported flats and 36general needs flats, with 39 two-bed flats and 37one-bed flats, which allows a flexible responseto tenants’ changing needs. All properties arebuilt to Lifetime Homes standards and arewheelchair accessible. Communal balconies (aswell as individual ones) on each floor are a nicedesign feature.

The development was on a site already owned byPeabody, so although there were demolitioncosts, the site did not have to be purchased.Peabody was creative in securing a diverse arrayof capital grant funding – from the (nowdisbanded) Single Regeneration Budget, socialhousing grant, charitable trusts andfoundations, banks (capital grants, not loans)commuted s106 sums from Southwark Counciland by selling nomination rights to variousboroughs. Planning permission was granted in1998 and the scheme opened in 2003.

There is a resource centre on the ground floorwhich includes consultation rooms, an IT suite,a restaurant and a swimming pool. Several ofthe rooms are leased to third party serviceproviders, including a hairdresser and areflexologist who pay heavily discounted rents inreturn for providing reduced rate services toresidents. Originally it was hoped that a local GPsurgery might base itself within the scheme andalthough this did not happen, Peabody continuesto look for opportunities to bring communityhealth services within the building. Peabody hasalso forged good links with local educationproviders and the IT suite has been used bySouthwark College.

Including a swimming pool in the developmentwas the most ambitious and unusual feature.Since Peabody had no previous experience of aswimming pool in an older people’s housingdevelopment, it employed a specialist company –Fusion – to provide lifeguards and runswimming lessons for local primary schools. Inthe early days, Fusion received the income fromschool swims (which has proved to be the mostlucrative), while Peabody received the minimalincome from public swims. Now that experiencehas been gained, Peabody is looking at how itmight employ the lifeguards directly. This willadd liability, but Peabody is already responsiblefor all pool and plant maintenance. Theadditional risk of pool management is thoughtreasonable considering the income it couldgenerate.

The restaurant is run by Peabody and is verywell used by residents and people from the localcommunity. The restaurant runs as a separatebusiness model with its own budget, with theaim to cover running costs while providing low-cost healthy meals from fresh ingredients.

The resource centre is a significant communityamenity. It has taken time to build links withlocal agencies, and to discover what types ofservices local residents are interested in. Itcontinues to be a work in progress to ensure allaspects of the resource centre are bringing insufficient income, but Peabody and the residentsare convinced that this is progress which is wellworth pursuing.

As well as drawing in the local community, thescheme offers outreach services to people livingin their own homes. A handyperson scheme wasinitially offered to people living in and near to thescheme. It has been so successful that it, alongwith a decorating service, is being rolled outacross all tenures in Southwark. Thehandyperson service is £15 per hour for thoseon benefits and £30 per hour for others. Thedecorating service is £100 per room for those onbenefits and £200 for others.

Focus on:Providing popular community amenities

Research by the National Housing Federation59 shows that proposed cuts of 12%to the CLG-funded Supporting People programme would lead to the loss ofhome-based support for 122,500 people. Since local government revenue grantsare set to decrease by 28%, it is likely the impact will be even greater. In suchfinancially challenging times, it is important to look in all possible directions fornew income streams which could be reinvested in supporting vulnerablecustomers.

85% of older people do not use local authority care services.60 It is much harder toanalyse how many of these 85% are funding their own care services, how manyare receiving unpaid care from family or neighbours, how many are going withoutthe care they need, and how many have no care needs. Many of those who chooseto fund their own care have never been assessed by statutory services andtherefore their needs are not recorded on any systems. PSSRU61 estimated that2m older people currently need care services, and that this number can bebroken down as follows:

This estimate puts the number currently self-funding their own care at 290,000,rising to 430,000 by 2026. On top of this is an additional 820,000 (rising to 1.28m)people who need a service but do not receive one, either because they areunwilling to become involved in statutory assessments or because they areunwilling to fund their own care, or because they are not aware of any serviceswhich would suit them.

People’s personal finances represent a significant contribution to expenditure oncare and support amongst the older client-group, and the Audit Commissionestimates that, if current trends in self-funding and means-testing continue,private spending on care will more than double between 2010 and 2026.62

There is therefore a significant market for individually purchased care services.Many people who are not eligible for, or do not wish to receive, statutorily-fundedcare services might well want a wider range of opportunities and services fromhealth to leisure and recreation, in order to maintain independent and activelifestyles. If providers are able to provide attractive offers to meet the needs andaspirations of older people this opens opportunities for generating income to bere-invested.

Housing associations are well placed to offer a range of services to self-fundersin that they are trusted providers, committed to the community in the long-run,well connected to local services and able to direct people towards the assistancethey need. Many providers will need to consider how to increase the awarenessof their organisation with owner occupiers, who generally have little knowledgeof the wide range of activities in which associations are involved or services theycan offer. In many areas, there is a gap in the services available, as evidenced byour focus group participants with low-level support needs, who wanted just thatlittle bit of extra help to enable them to continue to live independently for longer.

Number whose care isfunded or part-funded by

statutory services(millions)

Year

2010 0.88 0.29 0.82 1.99

1.17 0.43 1.28 2.882026

Number whoprivately fundtheir own care

(millions)

Number who havesome care needs but do not receive anyservices (millions)

Number ofpeople withsome need(millions)

Providing services to self-funders

Recently there has also been an increasing recognition of the assets offered by older people tosociety, in terms of economic and social capital. People over 50 are an important social resource ofvolunteering, caring and civic participation, saving the Government thousands of pounds in carecosts, particularly in looking after grandchildren and their own elderly parents or partners.Approximately 5m people over 50 take part in unpaid voluntary work, and this age group is the sourceof over half of all unpaid care in the UK. Recent policy and best practice literature, particularly fromCLG, has emphasised the need to harness this ‘age dividend’ for the good of the wider socialeconomy.63 It may be that some older people might be interested in volunteering their time tosupplement paid-for support services, or offer befriending services to others who live locally.

Caldmore Housing in Walsall (part of the AccordGroup) and Age UK Walsall have created apartnership to provide a cross-tenure supportservice to older people who need some helparound the home. Walsall Help at Home Serviceoffers flexible help with regular jobs such asgardening or one-off tasks including DIY,accompanying people to medical appointmentsand trips to the shops. The service acts as a one-stop shop for older people. It does not providecare, but assists people to contact the localauthority or other care services as appropriate.

Caldmore Housing funded the start-up cost of aco-ordinator for the service for 12 months, aswell as the costs of back office functions and atelephone line. Age UK Walsall provided thefunding for an extensive and very successfulmarketing campaign promoting the service. Age UK Walsall also brought two landscapegardening staff from a previous contract tocontribute to the project.

Prior to the development of the service,Caldmore Housing carried out an analysis of thelocal competition. The local authority had tried todevelop a similar service through SupportingPeople which had been unsuccessful, and therewas a private sector competitor in one area.From this, Caldmore was able to identify the bestpricing strategy and strengthen its role as a local,trusted provider in the advertising campaign. Theservice has now been running for four monthsand plans to break even after a period of 12-18months. It already has around 50 customers.

The service is based on a simple pricingstructure, and all the services are chargeabledirectly to the user (or their representative, suchas a family member). There is an annualmembership fee of £104 which can be paid yearlyor monthly. A £10 discount is offered to thosewho pay yearly in advance. Services are thencharged at £12 per hour, with charges beingcalculated in 15 minute increments after the firsthour. Non-members may also purchase servicesfor £18 per hour. The service runs a free tastersession for those wishing to find out more aboutwhat the service offers. It also offers a daily ‘safeand well’ call.

Both Age UK Walsall and Caldmore Housing havean in-house volunteer programme, whichprovides them with the infrastructure to engagevolunteers in the delivery of the service. Many ofthe volunteers are unemployed and the serviceboosts their self-esteem and helps them getback into work. Some of the volunteers are olderthemselves, which increases the service’s‘trusted provider’ status with potentialcustomers.

The Help at Home service has been a catalyst forother changes within Caldmore Housing. Theconcept of charging for services is new to theorganisation, and considerable internal work hasbeen needed to ensure staff understand therationale for the service. Caldmore used aseparate regeneration agency (Walsall HousingRegeneration Agency) chaired by the AccordGroup chief executive to oversee the project.

Focus on: Charging for low-level support

Orbit Housing Group recognised a need forhome care and support in the local communityas the local authority was reducing the scope ofdomiciliary services available. As more peoplewere staying longer at home and had access toa personalised budget, there was not only anidentified need, but also a clear market forthese types of services.

In developing the service, Orbit formed aworking party, including a range of teammembers at all levels, to research, plan andscope the project. Existing partners andregulators were consulted to advise on theproject and help to promote the new service toolder people in the community.

Orbit consulted with customers and the carersof people using the Brandon Day Centre, as wellas other local organisations and groups. Thisenabled it to assess the need, range of servicesthat people would be interested in purchasing,and the likely demand and take up of services,as well as a giving a steer on an affordable pricefor the service.

Orbit also made links, through a socialenterprise forum, with a Business Link adviserwho offered to review its business plan free ofcharge, offered some helpful suggestions andsignposted to other potential partners and links.

The service is delivered through an establishedretirement scheme that Orbit has been runningfor over 10 years. This gave the new servicecredibility. A lot of local advertising was carriedout, including free local papers, flyers in localGP services, posters in local shops, and Orbiteven asked local shops to deliver flyers withtheir local deliveries.

The service went live as a pilot in December2010 and already has 33 customers. Servicesoffered range from personal care (such asbathing, dressing or specialised dementia care)to low level support (such as shopping,preparing meals and accompanying on visits toGPs). The service is priced at £13 per hour forthe care service and £9.50 per hour for thesupport service. The service also offers daycarepackages, which include transport, lunch, and avariety of activities. The cost of these servicesranges from £5.50 to £27. Orbit is reviewing theservice at three-monthly intervals. If the pilot isa success, Orbit will expand the service to otherparts of Suffolk. After some initial start-up costsfor marketing and training of new staff, Orbit ishoping the service will break even by early 2012.Any profit made will be put towards the runningcosts of the day centre.

Focus on: Providing affordable home care to the wider community

There are also opportunities with self-funders who could purchase care services. As quoted above,private spending on care will more than double between 2010 and 2026.64 People are looking for aproduct which offers them the quality of care they require and the flexibility they need to continue tolive independently. Personalisation could also bring extensive opportunities in this area, with theopportunity to become a preferred provider in the community. Any provider looking to develop a careoffer will have to register as a domiciliary care provider, as well as a residential care provider if itwants to provide services to people in their own homes.

With the number of people with dementia likely to increase from 700,000 to 1.4m in the next 30years,65 the need for specialised dementia care is growing all the time. The increase in older peoplewith dementia will have a clear impact on our current housing and support models, as moreintensive support is required and eventually specialist care. The Government’s national dementiastrategy Living well with dementia (2009) does focus on the importance of enabling people withdementia to continue living in their own home where this is a desired and suitable outcome, and italso focuses on early intervention and early provision of support at home, which can decreaseinstitutionalisation by 22%.

Methodist Homes (MHA) is a specialistprovider of housing care and support forolder people. It has around 50 retirementhousing and extra care schemes across theUK, as well as over 70 care homes and 50community services. Over the last year, ithas been offering an enhanced service inall its housing schemes. Each schememanager offers a menu of services toresidents, which can include cleaningservices, laundry and shopping. They canalso plan to offer personal care providedthrough MHA’s domiciliary care service. Foreach scheme, the price and range ofservices is based on what is available in thelocal area. Prices range from £10-£15 perhour. The income from these additionalservices is used to fund the extra staffingrequirement and other additional costsassociated with the services.

In all cases, MHA is expanding services outof its building-based provision to the widercommunity and it has converted ninesheltered housing schemes to extra care.This offers residents a well-being servicepackage, which provides 24-hour staffing inthe scheme, help in emergencies and adaily drop in or call, as required. There is aweekly charge for the well-being serviceand personal care is then purchased ontop. The charge for personal care variesand some care services are sold inpackages, rather than by the hour, to focuson the needs of the user. This approach hashelped MHA to move away from reliance onthe commissioned block-contracted modelof care and support. Although theseschemes have required MHA subsidy in theearly stages, they are all on target to befinancially viable within three years of setup. The MHA subsidy includes a one-yeardiscounted rate for existing housingresidents for the 24-hour support service,so that residents pay only 25% of thecharge.

There are two specialist dementia careservices for people living in the widercommunity. Both are based in extra carefacilities; one is a block-contracted service,but the other, in Leeds, is a pilot offeringservices for purchase by individuals in thecommunity. MHA specialises in dementiacare, with its first facility having opened in1989 and the subsequent development ofaround 45 additional residential services. The association has found through the pilotthat standard domiciliary care services areoften not equipped to work with people withadvanced dementia, signifying both a gap inthe market and an acute need in thecommunity for these services, which it isaddressing through this scheme. The pilotservice is only offered to people within amile of the extra care scheme, which helpsto keep the costs low by minimising traveltime.

MHA uses some of the surpluses itgenerates in combination withcontributions from its charitable income tofund a national network of 50 ‘Live atHome’ services, which bring together localpeople to provide services and activities forolder people in the community. These aremembership organisations which offeropportunities for enhancing the lives ofolder people and of the volunteers who getinvolved. MHA funds managers for thesegroups, but each Live at Home has a localcommittee which supports the work of thegroup. Services are provided by volunteers,who are often themselves older people; themost common age group of thosevolunteering is 60-70 year-olds. Theservices include luncheon clubs, transportto appointments, outings, befriending andlifelong learning. The voluntary committeeattracts other funding, such as voluntarysector or charitable grants, as well as themoney it raises from the small charges itmakes for some of the services.

85% of older people do not use localauthority care services

Focus on:Extending sheltered housing servicesto the wider community

The new Government aims to increase the paceof change to create a diverse market with publicservices such as adult social care andcommunity health being delivered by non-stateproviders. At the same time, local budgets arebeing drastically cut, and local statutory agenciesare looking for increased value for money. Amove from a scheme-based warden to a flexiblecross-tenure floating support service supportinglarger numbers of people sits firmly within thisvalue for money agenda. Housing providers are ina position to deliver these services, sometimesusing a sheltered housing scheme as a supporthub for the local area.

The development of community-based, cross-tenure support services also provides a basis forextending the service to self-funders and thosewith individual budgets, thereby openingopportunities for expanded income streams.

Many housing providers are funded to providefloating support to older people in thecommunity. One Housing Group’s service,described overleaf, is notable for its scale anduse of a sophisticated IT system.

Providing commissionedservices to the widercommunity

The number of people withdementia is likely to increase from700,000 to 1.4m inthe next 30 years

In 2009, One Housing Group wasawarded a five-year Supporting Peopleblock gross contract to provide floatingsupport to 400 older people in Hackney. Itgrew from a service to replace on-sitewarden support in five shelteredschemes, and then moved into the widercommunity.

A staff team of 20 provides a serviceseven days a week. The service is two-tiered, depending on the customers’needs allowing resources to be moreeffectively targeted.

One Housing Group has established anoffice which functions as a ‘supportbeehive’ for staff from this and otherservices. Set-up costs were between£40,000 and 50,000 including IT andoffice set-up. Around £15,000 of the totalwas spent on directly employed projectmanagers to oversee the project launch.These staff were employed before theservice began, as it was recognised thatsupport workers would not have theskill-set required to launch the projectsuccessfully. These elements werecosted within the contract price.

Former warden staff were incorporatedinto the project through Transfer ofUndertakings (Protection of Employment)Regulations 2006 (TUPE). As is often thecase, TUPE required time andnegotiation, but was successfullycompleted and performance levels ofthese staff have been above target.Again, these costs were met by the SPcontract.

The scheme uses a bespoke IT system:MyPersonal Support. This has beendeveloped at the cost of more than£300k, but the cost has been sharedbetween a number of support projectsusing the software. It is a web-based andpaperless system that will shortly beopened to consumers, enabling them tomonitor their own support plans.

One Housing Group provides the serviceon a business basis, without any cross-subsidy from other parts of the Group. Itgenerates a sustainable surplus of 2-5%of contract value. In view of theincreasing pressure on budgets, OneHousing Group is considering ways ofdrawing in other finance. It is profiling itscurrent customer base and the widercommunity to estimate the demand for aself-funded service for those who areable to pay for it either from their ownfunds or from their individual budget.This expansion of the service mightinclude marketing a menu of options forclients who can use their individualbudgets to purchase this, as well astopping up with their own income if there are desirable options they wouldlike to have.

Focus on: Successful cross-tenure floating support

The service offers particular help to olderpeople to manage their own health carequestions and needs

The health service is going through unprecedented change, with the proposedabolition of PCTs and the advent of GP-consortia commissioning. Local authoritiesare set to take on the public health role and establish statutory health and well-being boards, pulling together local partners to achieve health outcomes, bringingnew ways to influence the public health agenda locally. These changes mean thatrelationships formed with key players must be based on an understanding of howthe landscape is changing, and where the various responsibilities will lie in thefuture. Many agencies are in a state of flux, but there are opportunities to provideservices on their behalf, either through joint funding with social care, or directfunding from health.In order to demonstrate more explicitly how they can contribute to health objectives,housing associations may need to consider how to describe services in languagemore recognised within health circles. For example, how can their services becomea formalised part of the care pathway? Care pathways are used widely in manyareas of health care and aim to improve the continuity and co-ordination of careacross different sectors. Commissioners want to invest in initiatives proven toprevent the need for care, and to transfer care from the acute sector to thecommunity setting.

Brighter Futures, a housing provider in the West Midlands, runs a floating supportscheme called ‘Safe and Sound’ in Stoke-on-Trent, which is jointly funded bySupporting People and NHS Stoke. It began in 2009 with the capacity to support upto 102 people aged 55+ and living in any tenure, and employs six full-time supportstaff.

The service receives referrals from hospital discharge teams and communityrehabilitation staff. Support staff work with the tenant to generally improve theirhealth and well-being, help them with finances, and signpost on to other health andcare services. They provide practical support and help to arrange access to aids andadaptations and grants for home improvements. The team works holistically byreconnecting people with family, friends and community, offering choices inactivities that help people to be less socially isolated.

The service offers particular help to older people to manage their own health carequestions and needs. When requested staff accompany customers to hospital forthe first stages of consultation and treatment. With the reassurance of support,customers feel more confident in asking questions and checking their ownunderstanding of their diagnosis and the plans for their treatment and care whichthey can otherwise find complex and confusing.

Focus on:Working with the NHS to provide support

Havebury Housing Association, workingin partnership with the NHS, hastransformed an unused schememanager’s flat in Bury St Edmunds intoan additional sheltered housing unit anda transitional flat for people to use whenthey come out of hospital and are waitingfor alternative accommodation or foradaptations to be carried out to theirhome.

The flat has an adapted bathroom andkitchen, widened doors and an accessramp for wheelchair users. Each newresident has been able to select a bedthat is appropriate for their needs andhave it installed for them in the flat. Theremodelling was part-funded by the localauthority adult social care division.

Havebury charges £155 a week to stay inthe flat, which includes a service charge.The total charge is eligible for housingbenefit. This is a considerable saving onthe local costs of a hospital bed ataround £400 a day, which presents asaving to the NHS of £2,800 a week.

The anticipated length of stay wasbetween 1-12 weeks, but in practice onlytwo people lived there in the first ninemonths of the service, since it took muchlonger than expected to arrange move-on.

This initiative helps Havebury HousingAssociation, the NHS and social servicesall to achieve their goals:

• it gives Havebury income on a flatwhich would otherwise have been void,and provides a much needed service toHavebury tenants as well as olderpeople living in their own homes;

• it saves the NHS money becausepeople can be discharged fromhospital earlier than would otherwisehave been the case;

• it saves social services money becauseit reduces the likelihood that an olderperson may have to be placed inregistered care because they are notwell enough to return home.

The project has also helped to forgegreater understanding between thehealth service and Havebury HousingAssociation, and now that each hasrecognised how the other can helpcontribute to the meeting of jointly-heldpriorities, this has increased thelikelihood of further co-operation in thefuture.

Focus on:Saving NHS funding through transitional housing

Only 10% of local authorities have made anyestimate of the financial impact of provision forincreasing numbers of older people

In 2008 Housing 21 Dementia Voice wasawarded funding from the King’s Fund fora two-year pilot project to employ acommunity-based End of Life Care Nurseto work within its dementia services teamin London.

The need for a dementia specialist end oflife care service had been identified byHousing 21 staff providing services forpeople with dementia from TreshamResource Centre in Westminster. Theteam was regularly working with peoplewith dementia and their families in theirhomes at the very end of their illness and,more often than not, was providing theonly palliative care service available tothem in the community.

The dementia care nurse, Morejoy Saineti,has wide and specialist knowledge andskills, including psychiatric and generalnursing qualifications, plus additionalknowledge and experience of socialservices, care providers and housing. Shehas worked as an adult and mental healthnurse for 25 years and has a master’sdegree in health research and acounselling certificate. Her role is to bean effective communicator who acts as anexpert practitioner, advocate andfacilitator; co-ordinating services andproviding a link with GPs and othercommunity health care practitioners.Morejoy Saineti was awarded runner up inthe Guardian Public Service Awards 2010and also Nurse of the Year in theInternational Dementia ExcellenceAwards 2010.

An evaluation of the first 12 months of theservice elicited very positive results andfeedback. It can be seen that the servicehas led to the avoidance of hospital,nursing and care home admissions andenabled earlier hospital discharges. It isestimated that the Dementia Voice Nurse

service wholly or partly contributed tototal cost savings in the region of£239,072 over a 19-month period. This isbased upon avoided hospital, residentialand nursing home admissions, earlyhospital discharges and savings onambulance services. Service users havebeen able to remain in their homes forlonger than they otherwise would havedone, some through to the end of theirlives. Admissions to hospital or nursinghomes have been avoided.

Improvements in communications andbetter co-ordination of services have beennoted. The Dementia Voice Nurse has ledto some services changing practices inthe care of people with dementia,including those on hospital wards – suchas refraining from unnecessary feedingand suctioning during the last hours andencouraging a more appropriate palliativerather than curative care approach.Concerns by care workers about changesin health or well-being of a service userare taken seriously by GPs and caremanagers as they are channelled,investigated and verified through theDementia Voice Nurse. Diagnosis, care,medication, care and support haveimproved or increased, includingsignificantly better identification andmanagement of pain. Families have beenable to recognise their relatives arenearing the end of their lives and beengiven advice and information on planningand decision-making for the future.

The service is currently funded byWestminster PCT until April 2011.Housing 21 is awaiting the results of areview of Westminster’s palliative careplans for future funding for the post.

Focus on:Responding to growing dementia needs

This publication suggests a number of ways in which housing associations could radically alterthe scope and type of housing and service they offer to older people. The following sectionoutlines some of the barriers to such developments and discusses ways to overcome these.

External barriersLack of comprehensive information on future needs

Despite the wealth of projections about the expanding care and support needs of the ageing population, the implications ofdemographic trends are not alwaysacknowledged by councils, local planners and policy makers. The Audit Commission’sreview of a sample of 112 local authorities’medium-term financial plans showed thatonly 10% made any estimate of the financialimpact of provision for increasing numbers ofolder people.66 Those that did tended to focuson traditional older people’s services such asconcessionary bus travel and social careneeds. It seems that longer-term issues suchas housing and leisure, community safety and assistive technology, were widely ignoredby local government.

Researchers have highlighted the need forbetter profiling of the local population interms of health, age, levels of financialresources and support networks, in order toplan effectively for long-term housing andcare needs.67 Policy makers need more robustevidence on which to base future strategy anddevelopments. Two-tier authorities faceparticular challenges in ensuring that theirhousing and support strategies meshtogether to address older people’s needs.

There is need for an agreed methodology forassessing future housing and support needs.Such a methodology would be complex todevelop, but would reap rewards withinplanning at local authority and neighbourhoodlevels by giving clear information on needs,and helping society avoid costly mistakes ofdevelopments which do not meet needs.

In October 2010 the Federation surveyed 345English local councils on older people’shousing strategies. These were a mixture ofborough, district and county councils. Onehundred and fifty-three councils responded tothe survey. The results showed that:

• 45% of local authorities responding haddeveloped a housing strategy for olderpeople;

• 23% were in the process of developing one;

• 32% had neither a strategy nor plans todevelop one.

In those areas where there is a strategy, oftenit is not comprehensive. For example, manystrategies do not consider the provision ofsupport, the need for handyperson services ora reform of the adaptations system. Some arevery focused on the provision of extra care,neglecting the need to remodel a range ofsheltered housing, while others do notconsider the future housing needs of olderpeople in private housing.

Housing providers must ensure they have astrong voice in the development of local olderpeople’s strategies. They already hold a greatdeal of information and knowledge on theneeds of the older population, and shouldhave a store of proposals on a range ofoptions for buildings and services which willmeet future needs. They can alsodemonstrate demand for and value ofservices such as handypersons by pilotingsuch services and taking the results tostatutory agencies, inviting them to fund theroll-out of the service to the wider community.They can also facilitate service userinvolvement and empowerment in strategyand service development. Housing providersmust position themselves as key communityproviders for older people, and improve theawareness of their brand amongst health andlocal authority members and officers.

Overcoming the barriers

Pressures on land supply and planning difficulties

The case studies in this report highlight theimportance of free or discounted land in developingolder people’s housing, as the build costs of highquality older people’s housing are increased byspecialist features and greater space standards.Local authorities and other public agencies shouldbe urged to consider a free transfer of surplus landto older people’s housing developers. This is adifficult case to make in times of financial austerity,when local authorities rightly need to maximise theirincome. However, by persuading them to considerthe long-term benefits, as well as saving in otherhealth-related budgets, the case is strengthened.This can only be achieved by greater co-ordinationand co-operation between local authority planners,valuers and housing departments, and a robustevidence base on the part of the housing association.

Older people’s housing needs to be built on highquality, accessible land in suitable areas, wherethere is a demonstrated need, and not in isolated,low-value sites. Housing associations know fromexperience that the location of housing becomesever more important as people’s mobility decreases.High-specification housing on a poor site is of littleinterest to older people who want to be able to take abus or walk to local facilities. Sought-after sitescould be allocated or zoned for older people’shousing in local and even neighbourhood plans.Consideration should be given to what proportion ofthis older people’s housing that local assessment ofneed demonstrates should be affordable. This isparticularly relevant to smaller sites whereaffordable thresholds may not apply.

Where there is a demonstrated need for specifictypes of specialist and supported housing, localauthorities should be encouraged to use s106agreements to deliver older people’s housing as wellas general needs affordable housing. Some of thecase studies demonstrate the value of harnessings106 agreements.

National consistency regarding Planning UseClasses for older people’s housing wouldsignificantly improve developer understanding andlender appetite. Developing a flexible Planning UseClass would also enable older people’s housing to bemore easily converted, responding to changing localor neighbourhood need and aiding viability if certainfunding mechanisms were withdrawn.

Shortage of revenue funding anddifficulty of measuring success

Until 2003, housing association services to olderresidents were largely provided through a wardensystem funded by housing benefit. SupportingPeople changed that, transferring part of the wardenfunding to a locally-held grant. This broughtopportunities as well as threats, with someassociations being awarded increased funding toextend their services to older people in the widercommunity. A more common experience has been tosee budgets tightened or even removed.

The next stage in the evolution of funding is thepayment by results framework that will see blockcontracts change to a system of payment by resultsthrough tariff payments. Contracts will requireproviders to take on more risk during thedevelopment phase of the service, or they will offer alow basic payment with a bonus system onceoutcomes have been delivered. Social impact bondsare being piloted as a model for funding services, inwhich investors earn a return when the outcomes ofthe service have been delivered.

It is not yet clear what outcome targets will be usedto measure success. For older people’s services,where the client is receiving a low-level preventativeservice, it can be difficult to set targets whichdemonstrate maintaining someone’s independencerather than producing a specific change.

Providers will have to think laterally about how tomeasure and demonstrate success not only forcustomers, but for partner agencies. For example, iftheir service delays older people’s admission intocare services then the value for money is easy todemonstrate to the social care commissioners.Other outcomes, such as better planned hospitaldischarge, provide savings to the total public purse,but the particular savings are to a health budget. Asmall investment in handyperson services to keepolder people’s homes secure, watertight anddraught-free can save significant sums across arange of services, including reduced need for GPservices and reduced levels of burglaries.These savings are more difficult to capture, but efforts should be made, and good practiceshared in methodologies to record the value of suchservices.

63% of people aged 65-75 were concerned they wouldnot have enough money to fund their retirement

Whilst the external barriers described above are significant, they are surmountable; but there remains adebate to be had within housing associations as to why developing in this direction is a good option. Some ofthe internal barriers are discussed below.

Internal barriers

Desire to stay focused on core housing mission

Many housing associations would not see it as anobvious part of their core mission to expand intomixed-tenure developments for older people, or toprovide services for older people in the community.They may feel that the wealthier older generation iswell catered for by private developers and privatecare providers. In increasingly difficult times, it wouldseem to be a diversion to target people with lowerneeds than current social housing tenants. As shownin this report, older people do have a particular set ofneeds, whether or not they are wealthy in terms ofassets and/or income. Many tens of thousands ofolder people need assistance to help them live asindependently as they can for as long as they want to.Housing associations are perfectly placed to helpthem do so.

Housing associations are proud to be iN business forneighbourhoods, and older people are a significantpart of every neighbourhood. If they can stay put, theneighbourhood retains a richness and diversity. Asalso described elsewhere in this report, older citizensprovide far more of their share of voluntary work andcaring responsibilities. They are a valuable asset insustaining society, and a relatively small investmentmay be all it takes to sustain their position.

Risk aversion

The reduction in Supporting People income has ledsome housing associations to conclude that anyfuture involvement in support and care is too risky tojustify. Margins are extremely tight, and theinvestment of time needed to win contracts can betoo much for associations to cope with.

The future would certainly look bleak if SupportingPeople was the only funding source from whichmodels of care and support might be funded. Thisreport sets out ways in which associations couldchose to respond to the great levels of unmet needwithin the older population at large, including self-funders. The margins may remain small, but thepotential volume is very large.

Housing associations are skilled in finding out whattheir own tenants want. If their own older tenantswould value an extended range of services, includinghandyperson, gardening or decorating, theneconomies of scale could easily be realised byoffering this service to all older people living locally.

Development departments may look askance atproposals to build larger, Lifetime Homes standardaccommodation for older people. It is harder toproduce a viable project if space standards are largerthan usual; for rented housing, donated or recycledland is likely to continue to be needed in manyinstances. There are, as described in this report,opportunities for building mixed-tenure schemeswhere income from owner occupiers and sharedowners can help to finance the social rented units.There are a great many older owner occupierswith considerable assets who would move if therewas an attractive, accessible development which waslarge enough for them to bring their furniture, stillhave a guest bedroom, be able to park their car, andcontinue to live an active life.

Competitive edge

Current models of housing and services are notsufficient to meet the needs and aspirations of oldertenants. Some models are unsustainable given thepressures on capital grant, Supporting People andother revenue funding. At the same time there isunmet demand within the older population. Thechallenge for housing providers will be to think widelyabout how they might provide the housing andservices wanted by the many different generations ofolder people, thereby extending the income streamsavailable to them, and increasing their ability tohouse and support their own tenants.

Dependence on local authority revenue funding forsupport services has not always resulted in a vibrantand flexible support sector. Current pressures willmake it even less likely that a radically improvedfuture can be achieved. The challenge is therefore tothink beyond current models and redesign serviceswhich are flexible enough to serve older people of alllevels of wealth, and living in all tenures.

This report aims to set out different ways of planningstrategically for the needs of older people and of enhancing thecurrent housing offer available to them. There are a number ofbusiness opportunities in older people’s housing and servicesthat look beyond social rented tenants, to encompass the needsof older owner occupiers and the wider older community. It isvital that we bring discussion and action on older people’shousing, care and support issues into the mainstream.

There are no clearly defined pathways for any housing providerin taking on these opportunities and responding to thechallenges an ageing population brings. Funding will posesignificant challenges, and there is no blueprint that willprovide all the solutions. However, the examples in this reporthave tried to illustrate that by taking on some risks, andthinking creatively about which solutions work best in any givencontext, major benefits could be realised for housingassociations, their tenants and the wider community they seekto serve.

‘The gains are more than just creating new businessopportunities or making more efficient use of your stock.Changing the way you deliver services makes a realdifference to real people. Until recently, our oldest shelteredresident was 102. On his death his family wrote “with yourhelp dad was able to stay in his own home which is what hewanted above all else”.’Vanessa Connolly, Bedford Citizens Housing Association

‘There is a fantastic opportunity to join up a number ofagendas around older people’s housing and support, we needto work together to make sure we maximise this opportunity.’Caroline Gitsham, Gentoo Group

‘I know for sure that my own organisation will be looking foropportunities to develop a range of housing options for olderpeople.’Joy Kingsbury, Synergy Housing

‘The key to innovation in services for older people is knowingwhat our customers want, ensuring they are aware of whatfunding is available and providing a range of housing, careand support options in response.’Paul Watson, Guinness Care and Support

‘Our approach to providing homes and services for olderpeople is going to have to change. All providers have to betterunderstand this growing and varied segment of UKhouseholds, rethink our traditional approaches to housingolder people, and provide ever more innovative housing andservice solutions.’Stewart Fergusson, Orbit Group

What is there to gain?

Providing a better range of housing for older peopleThe gap between demand and supply for innovative solutions to older people’s needs isgetting wider. Older people, in common with other age groups, have a very wide range ofneeds and aspirations, and supply has not kept pace. Often when an older person wants tomove, the options are limited and unattractive. Taking forward some of the proposals outlinedin this report will increase the satisfaction of older tenants by providing housing better suitedto their needs.

‘It’s nice when you get to a certain age and you think “well, I want something different, ifthere is something like this that you could come into”. Years ago there wasn’t and the likesof my parents when they got old, if you couldn’t look after them, it was a home and you hadno choice, that’s what had to happen.’Older resident in a Gentoo independent living scheme in Sunderland

Reducing expenditure on adaptationsRetrofitting adaptations is costly and not always satisfactory, depending on the originaldesign of the building. By designing a higher proportion of accessible stock and increasingthe choice of housing available to people as they grow older, helping to improve mobilitywithin the sector, housing associations can reduce the need for one-off adaptations.

Freeing-up of family-sized stockOlder tenants who no longer need their family-sized house, or are finding it difficult tomanage, are often offered little choice if they want to move. Sometimes the only option is atraditional sheltered housing scheme. By developing a range of high quality accessiblehousing for older people, either in separate schemes or within general housingdevelopments, it makes it much more likely that older tenants will want to move there.

Reducing demand on care and support servicesGood housing and related preventative services make a fundamental difference to health andwell-being and have a critical contribution to make to the value and effectiveness of thehealth and care systems. Good design helps older people to live more independently forlonger. Services such as handyperson schemes, gardening and decorating allow people tomaintain their homes and avoid the difficulty of having to find a contractor and the fear ofhaving a stranger in the home. This can delay people’s need to move to more specialist olderpeople’s housing. This report also contains examples of services designed specifically toreduce the need for care services, such as the Havebury Housing Association scheme whichsupports hospital discharge.

It is vital that we bring discussion and actionon older people’s housing, care and supportissues into the mainstream

Many older people own their own home and have paid off their mortgages, but this does not meanthat their homes are suitable for their needs or in decent condition. Some older owners may nothave sufficient funds to repair their homes and maintain them, and some homes will not besuitable for future adaptations as their occupants become frailer and more infirm.

Housing providers are in a good position not only to be able to meet the growing needs of existingolder customers, but also those of future older customers both in the community and amongstgeneral needs tenants. Providers could, in some cases, offer services that go beyond just simpleaccommodation, in order to offer innovative services which people want.

Some providers have already started to consider their offer to general needs tenants and how thiscould be extended to the wider community:

To reflect the increasingly ageing population,Circle Anglia is developing a specific offer for itsolder residents. To kick off the process CircleAnglia conducted some in-depth research intothe demographics of its residents, whichidentified that 32% or 13,400 residents wereover the age of 60. In addition, Circle Angliareviewed the current services offered to olderresidents in the Group’s nine partner housingassociations, including services such ashandyperson and decoration assistance, someof which had been set up originally as a result ofstock transfer promises.

From this research, Circle Anglia developed amenu of service ideas (as wide as gardening tohealth checks) that could be offered to olderpeople. This menu was then testedindependently with focus groups of olderresidents. It also tested a range of servicedrivers – such as independence and safety – todetermine what older people considered to bemost important to them.

The results were surprising. Residents indicatedthat they wanted Circle Anglia to concentrateprimarily on its remit as a housing and relatedsupport provider, and in some cases where itprovided extra services; older customers wereprepared to pay more. In addition, residents feltthat there would be enormous value in CircleAnglia providing proactive ‘signposting’ towardsservices that are provided by other agencies andin developing and promoting partnerships withthem. Residents also said that maintainingindependence and dignity, together withimproving safety, were the most importantservice drivers.

To explore how it could improve partnershipswith others, Circle Anglia also held a roundtable event with key service providers. Furtherwork is now taking place to develop the serviceoffer and consider how signposting can improve.This includes reviewing how services will befunded going forward.

A better quality of life for older owneroccupiers as well as tenants

Focus on: Developing a new offer for older tenants

Over 22% of Midland Heart customers aged over60 years live in general needs properties that arepredominately unadapted and under-occupied

Midland Heart currently provides over 4,100 unitsof specifically designated housing for olderpeople in the form of retirement, extra care andhomeless housing, spread across 45 localauthority areas. Currently, the older people’sservice within care and support manages over100 designated schemes, with a total of 385 staff.Equally significantly, over 22% of Midland Heartcustomers aged over 60 years currently live ingeneral needs properties that are predominatelyunadapted, and where there is incidence ofunder-occupation.

Midland Heart has produced an older people’sstrategy that provides clear direction for thedevelopment of older people’s services acrossthe group. The strategy considers how to:

• provide flexible opportunities for older people’shousing options and choices;

• deliver housing and support services whichmeet the specific needs of older peopleincluding the provision of assistive technology;

• ensure information, communications andadvice meet the needs of older people living inMidland Heart homes;

• work with residents to maximise good healthand well-being;

• maximise older people’s opportunities withinMidland Heart and within the neighbourhoodsin which they live;

• minimise poverty and maximise financialsecurity amongst older people living in MidlandHeart homes;

• recognise the diversity of the older population.

As a result of this strategy, Midland Heart will:

• ensure that all its older customers are awareof and have access to specialist older people’shousing;

• ensure that all older people are aware of andhave access to specialist services within theirown homes;

• produce a comprehensive housing list ofspecific properties with aids and adaptationsacross Midland Heart;

• provide assistance to vulnerable older peopleto increase the number who are able to live athome;

• with enhanced information on customers’needs, provide more targeted services anddevelop a range of products appropriate totheir requirements;

• in line with the personalisation agenda, pilotdomiciliary care services to residents who donot live within an extra care environment;

• enhance the repairs service for older residents;

• promote safety and security through variousinitiatives, eg, keypads, safety checks, windowlocks and smoke alarms;

• continue to deliver scheme manager serviceswithin retirement housing ,but also developmore hub and spoke services in the areaimmediately adjacent to schemes;

• provide an annual Well-Being event for allolder people living in Midland Heart properties;

• extend ‘Magic Moments’ to include all olderpeople within Midland Heart. This schemeoffers activity-based events to help meet olderpeople’s social, emotional, physical andintellectual needs. Events are based onpeople’s suggestions and to date have includedhelicopter flights, theatre trips, canal cruises,abseiling, plane flights, games, competitions,darts, dominoes and bowling…the possibilitiesare endless.

Focus on: Producing an older people’s strategy

A responsible extension of core businessThe model of financing social housingdevelopment has been changed substantially andquickly by the coalition government, and revenuefunding will become even scarcer. Housingassociations could take this opportunity to lookbeyond their core business at potential newsources of funding which reduce their reliance ongrant and statutory funding. The housing andsupport needs of older people are more complexthan those of younger generations; the ‘need’goes beyond the economic and includes issues ofcommunity belonging and independence.

Improving housing for existing older socialhousing tenants sits clearly within the corebusiness of housing associations. Yet thispublication also illustrates why a move intohousing older owner occupiers could be seen asa responsible extension of core business. Thereis a great deal of unmet need in this group,coupled with unsuitable housing and poverty(even when on the surface people appear wealthybecause of the value of their home). This is agroup of people in need of assistance, whichhousing associations could provide. The addedvalue of such an extension of core business isthat it brings in new income streams which couldbe re-invested in core business.

New income streamsCapital income: Building high quality, accessibleaccommodation in varying sizes will give accessto a great many potential new customersamongst older owner occupiers who want tomove to somewhere more suitable.

Revenue income: Providing a range of servicesto older tenants in general needsaccommodation and also to those living in thecommunity opens up the potential for incomewhich is independent of statutory sources.Services can range from care and support,targeted at self-funders and those with individualbudgets, as well as those funded by a contractfrom the local authority, to practicalhandyperson, gardening and decorating services.

A strong position as a key community playerDeveloping housing and services for older peoplenot only meets older people’s needs, it alsoconfirms the housing provider as a keycommunity player and draws in otheropportunities for partnership working with thelocal authority, increasing the scope for newbusiness development. As people grow older, andstart to need help with smaller tasks in the homeand garden, or support to get out and about to doshopping and see friends, they are looking for atrusted provider who can offer these servicesquickly, at a decent price and with little hassle orform-filling. Local authorities and other localpartners are looking for cost-effective solutionsto deal with the ageing population in a way thatmaintains people’s independence and providesthe population with security and peace of mindas they grow older.

Access to the skills and resources of older people‘When people sometimes talk about olderpeople, they’re talking about a drain on societyand it really is very wrong...the skills that we’vegot, older folk have got, what a resource, lookat them!’Participant in Norfolk focus group

As people get older, they should not be viewed asan additional cost, but as a valuable resource toan organisation. As mentioned above,approximately 5m people over 50 take part inunpaid voluntary work. This is an enormouslyvaluable community resource which housingassociations could harness. Examples of thisinclude:

• befriending services for lonely and isolatedolder people;

• volunteer driving services;

• assisting other older people to understand ITso they can get good access to information;

• undertaking neighbourhood audits;

• membership of focus groups or mysteryshopping exercises.

ConclusionThere are two ways of considering the opportunitiesoutlined in this report. Firstly, they provideopportunities for increasing capital resources andrevenue funding that can be re-invested in the corebusiness of providing affordable housing for currentand future older people. Secondly, they provideopportunities which are important in their own rightto pursue, regardless of the added value they bring toexisting business.

The Breaking the mould project aims to illustrate avariety of significant new market opportunities forhousing associations. This report builds on theliterature review, focus groups and pollinginformation in confirming that older people arealready demanding more from services and housing.The Breaking the mould website,www.housing.org.uk/olderpeople, also contains moredetailed findings from our research.

Older people’s housing, care and support needs to bethought about much more widely in relation to whatoffer should be made to older generations within thebroader neighbourhood or area. The economies ofscale this brings, and the income and resources ofolder people, make innovative and aspirationalsolutions much easier to achieve.

The average age of housing association tenants isincreasing. Needs and expectations are rising andthe pace of change in supply is insufficient to keepup. The financial climate is austere, and thisincreases the need to source alternative funding. Bypursuing some of the options outlined in this report,additional resources can be unlocked, for the benefitof all.

1 Lifetime Homes, Lifetime Neighbourhoods: ANational Strategy for Housing in an AgeingSociety. CLG, 2008.

2 Survey of Existing Tenants survey. NationalHousing Federation, July 2006.

3 RSR 2007, Existing Tenants Survey 2004/05,CORE data. Housing Corporation, 2007.

4 Citizenship Survey 2005. Home Office, 2005.

5 National Statistics Focus on Older People. Officefor National Statistics, 2004.

6 Care services efficiency delivery. ProjectingOlder People Population Information system(POPPI). http://www.poppi.org.uk.

7 Households Below Average Income 2006/07,chapters 2 and 6 (figures quoted before housingcosts). DWP, 2008.

8 Living well with dementia: a national dementiastrategy. Department of Health, 2009.

9 Spotlight 2006 survey. GfK NOP, 2006.

10 Loneliness, Social Isolation and Living Alone inLater Life, C. Victor et al., 2003.

11 Numbers add to greater than 100% becausemultiple answers were encouraged.

12 Never Too late for living: Inquiry into services forolder people, p.4. All Party Parliamentary LocalGovernment Group, July 2008.

13 Never Too late for living: Inquiry into services forolder people, p.5 citing State of Social Care inEngland 2006-07. All Party Parliamentary LocalGovernment Group, July 2008.

14 2005-06 figures. CSCI 2008.

15 People aged 65 and over: results of anindependent study carried out on behalf of theDepartment of Health as part of the 1998General Household Survey, page 46, A.Bridgwood. 1998.

16 Lifetime homes, lifetime neighbourhoods: anational strategy for housing in an ageingsociety, citing Future Demand for Long-termcare, 2006, R. Wittenberg, Comas-Herrera, A.,King, D., Malley J., Pickard, L., and Darton, R.CLG, 2008.

17 In Your Lifetime. National Housing Federation,2009.

18 Research into the financial benefits of theSupporting People programme. CLG, 2009.

19 Attitudes to age in Britain 2004-08, ResearchReport No 599, Dominic Abrams, Eilola, T., andSwift, H. DWP, 2009.

20 See Age Concern Lifeforce Survey, Edwards andHarding, 2008. Counsel and Care 2003, HAPPI,2002.

21 Housing our ageing population: Panel forInnovation. HAPPI, 2009.

22 Housing our ageing population: Panel forInnovation, p.36. HAPPI, 2009.

23 Building Our Futures: meeting the housingneeds of an ageing population, revised 2008edition, Margaret Edwards and Harding, Ed.2008.

24 Housing our ageing population: Panel forInnovation, HAPPI, 2009, and Lifetime homes,lifetime neighbourhoods: a national strategy forhousing in an ageing society. CLG, 2008.

25 Lifetime homes, lifetime neighbourhoods: anational strategy for housing in an ageingsociety. CLG, 2008.

26 Housing our ageing population: Panel forInnovation, HAPPI, 2009.

27 ‘Crime and Fear of Crime’, Policy Statement.Help the Aged, 2006.

28 A Sure Start to Later Life: ending inequalitiesfor older people, a Social Exclusion Unit finalreport, Office of the Deputy Prime Minister.Good housing and good health? A review andrecommendations for housing and healthpractitioners. Housing Corporation, 2006.

29 ‘What makes a city age-friendly? London’scontribution to the World Health Organisation’sage-friendly cities pilot’. Help the Aged andWorld Health Organisation, 2007.


31 ‘What makes a city age-friendly? London’scontribution to the World Health Organisation’sage-friendly cities pilot’. Help the Aged andWorld Health Organisation, 2007.

32 Building Our Futures: meeting the housingneeds of an ageing population, revised 2008edition, Margaret Edwards and Harding, Ed.2008; and Lifetime homes, lifetimeneighbourhoods: a national strategy for housingin an ageing society. CLG, 2008.

33 Guide to developing inclusive communities.Papworth Trust 2008.


35 A Sure Start to Later Life: ending inequalitiesfor older people, a Social Exclusion Unit finalreport. Office of the Deputy Prime Minister,2006.


37 Housing with care for later life, A literaturereview, Karen Croucher, Hicks, Leslie andJackson, Karen. Joseph Rowntree Foundation,2006.

38 Report of a survey of recent entrants to HanoverHousing Association: reasons for moving andthe nature of the move, Janet Ford and Rhodes,D. University of York Centre for Housing Policy,2008.

39 Your health, your care, your say. Researchreport prepared for Department of Health byOpinion Leader Research, January 2006.http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@en/documents/digitalasset/dh_4127462.pdf.

40 Building Choices part 2: ‘Getting Personal’ – theimpact of personalisation on older people’shousing. Overall project summary. TSA andHousing 21, 2009.

41 A Sure Start to Later Life: ending inequalitiesfor older people, a Social Exclusion Unit finalreport. Office of the Deputy Prime Minister,2006.

42 One Voice: Shaping our ageing society. AgeConcern and Help the Aged, 2009.

43 Housing our ageing population: Panel forInnovation. HAPPI, 2009.

44 Towards lifetime neighbourhoods: designingsustainable communities for all – a discussionpaper, Ed Harding. CLG, 2007.

45 Never too late for living: Inquiry into services forolder people. All Party Parliamentary LocalGovernment Group, 2008.

46 See, for example, Lifetime homes, lifetimeneighbourhoods: a national strategy for housingin an ageing society. CLG, 2008.

47 Co-operatives in the Big Society, theconservative co-operative movement, 2009.

48 Never too late for living: Inquiry into services forolder people. All Party Parliamentary LocalGovernment Group, July 2008.

49 Cited in Lifetime homes, lifetimeneighbourhoods: a national strategy for housingin an ageing society. CLG, 2008.

50 One Housing Group, 2009.


52 Aspiration Age: delivering capital solutions topromote greater choice and independence forolder people. One Housing Group, 2009.



55 Can equity release help older home-ownersimprove their quality of life? Joseph RowntreeFoundation, 2010.



58 Aspiration Age: delivering capital solutions topromote greater choice and independence forolder people. One Housing Group, 2009.

59 Research based on 2009 CLG SP data. NationalHousing Federation, October 2010.

60 Under Pressure: tackling the financial challengefor councils of an ageing population, LocalGovernment report. Audit Commission,February 2010.

61 Informal Care for Older People Provided byTheir Adult Children: Projections of Supply andDemand to 2041 in England, Linda Pritchard.PSSRU, 2008.


63 CLG, 2007.


65 Living well with dementia: a national dementiastrategy. Department of Health, 2009.



References

Breaking the mouldRe-visioning older people’s housingCare and support needs are increasing as the populationages, and expectations are rising as older people rightlydemand more from their housing. The pace of change indemand and need has constantly outstripped the changes inthe volume and design of housing and services. It is vital thatwe bring discussion and action on older people’s housing,care and support issues into the mainstream. This report:

• Focuses on ways of planning strategically for the needs ofolder people and of enhancing the current housing offeravailable

• Aims to support providers in breaking the current mould ofolder people’s housing and support

• Looks to build on the innovation within the sector to createa new and exciting offer.

Find out more about the Federation’s work on older people’shousing, care and support at:

www.housing.org.uk/olderpeople

The National Housing Federation represents 1,200 independent, not-for-profit housing associations in England and is the voice ofaffordable housing. Our members provide two and a half millionhomes for more than five million people.

National Housing FederationLion Court, 25 Procter StreetLondon WC1V [email protected]

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