West Midlands ADSS Network for Older People and Regional
Housing LIN Seminar:
Housing Issues for Older People
University of Birmingham 15th October, 2004
ELDERLY PEOPLE AND PRIVATE EXTRA CARE
HOUSING NEEDS AND ASPIRATION
Dr. Michael McCarthy
Managing Director, Retirement Security Limited
THE DEMOGRAPHY OF OLD AGE
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By 2031 there will be 27 million aged 50 and over
Those aged 85 and over in the UK population increased from 0.7% in
1961 to 1.9% in 2002. Projections to 2031 suggest people aged 85
and over then comprising 3.8% of the UK population.
This is the main age cohort to be found in Extra Care and Very
Sheltered housing
In 2002 there were 2.6 women for every man aged 85 and over but
this, too, is projected to fall to 1.5 by 2031. This will have implications
for services, for design and for the density of developments
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The Onset of Ill Health
• The UK now has 336,000 people aged 90 or over and nearly 4,000 of
these provide 50 or more hours of unpaid care a week to a spouse or
friend
• Though women expect to live longer than men, they are also more
likely to have more years in poor health
• The proportion of people with long term illness or disability which
restricts their daily activities increases with age
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The proportion of women aged 85 and over reporting such a disability
in 2001 (74%) was almost triple that for women aged 50 – 64 (26%).
For men it was 67% of those aged 85 and over and 27% in the younger
age group
This, too, will have implications in the location, design, service
arrangements and staffing of Housing with Care schemes for elderly
people
Moreover, these outcomes are increasingly likely to be owner-occupied
by tenure
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Women over 75 are more likely than men of the same age to suffer
from arthritis and rheumatism
Men are more likely than women to report respiratory diseases such as
bronchitis and emphysema
Many consider themselves in good health, even if they have a long
term limiting illness
Many make light of illness and of disability and favour low level support
rather than outright personal care
Private Extra Care Housing can meet most of these needs and reduce
costly admissions to / lengths of stay in hospital
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PROVISION OF UNPAID CARE
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In owner-occupied households in England and Wales in 2001 almost
2.8 million people aged 50 and over provided unpaid care for family
members, friends or neighbours
People in their 50s were the group most likely to be providing unpaid
care – more than 1 in 5 were doing so
5% of those aged 85 and over were still providing some form of unpaid
care
1 in 4 carers over the age of 50 spend 50 hours a week or more caring.
This proportion rose to 1 in 2 carers aged 85 and over
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OWNER OCCUPATION AMONG ELDERLY PEOPLE
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Owner occupation among elderly people continues to rise, primarily
among middle income people who are increasingly likely also to have
private pensions and other forms of financial security in place. Over
75% of this group (aged 65-79) are owner-occupiers – compared with
50% aged 80 years+
95% of those aged 65-97 and 88% of those 80+ in the richest quintile
own their homes. Growing home ownership in the population at large
is evident in the older age groups, leading to a large increase among
middle income older people
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These will be the drivers of and the principal target for private sector
solutions to housing with care over the next 10 years. They are a
growing consideration in the UK housing market and increasingly,
general housebuilders and specialist developers ignore them at their
peril
At the other end of the income scale, less than a quarter of elderly
people in the lowest quintile and less than 40% in the next own their
homes. This points up the incidence of poverty in old age
It poses the question of whether owner-occupancy can provide a
capital asset that can be used to meet housing (and care) needs and
alleviate poverty
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Releasing the Value of the Asset
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One fifth over 65 could generate some extra income from equity
release schemes
For a quarter, the gains would be less than £500 a year
Two fifths of older people still do not own their own homes and tend to
be the poorest
For home owners who receive benefits extra income can reduce their
benefit entitlement
Releasing equity will reduce wealth to pass on to their heirs or for their
own care needs
ODPM figures (2003) reveal that 12% of homeowners aged 70 or over
are unable to afford major repairs to their homes
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Housing renewal and adaptation can play a key part in preventing or
reducing expensive hospital admissions for older people
In the RSL scheme annual average hospital stays are under 4 nights a
year (but over 17 for the elderly population at large)
The public sector is beginning to acknowledge the role that the private
sector can play in joint ventures to develop purpose-built Extra Care
Housing solutions
To enable these to succeed it will be increasingly necessary for
government to find public means through measures such as Supporting
People and private means through new forms of equity release and
mortgages specifically tailored for old age
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LIVING ARRANGEMENTS
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Among women aged 85 and over, who live in private owner occupier
households, 71% lived alone in 2001, compared with 42% of men of
the same age
Nearly half of women aged 65 and over are widowed and this
proportion rises to 80% to those aged 85 or over – the key group in
private Very Sheltered Housing
Older women are more likely than older men to live in communal
establishments
For people aged 85 and over, the figures rise to 21% of women and
11% of men
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Women are more likely to be widowed without a spouse to care for
them – a key consideration in moving to private Very Sheltered Housing
Women are also likely to live in such establishments because of much
higher levels of disability than men
The incidence of women in private establishments is also greater
because they can expect to live longer than men, even though they are
also likely to have more years in poor health and suffer a limiting, long
standing illness
The proportion of women reporting a longer term illness or disability
which restricts their daily activities is 26% for the 50-64 age group but
triples to 74% for those aged 85. With men the figures are 27% and
67% respectively
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Why Older People Move to Private Very Sheltered Housing:
Attractions of Owner-Occupation
– Between September 2003 and January 2004 RSL surveyed the
views of nearly 500 elderly Leaseholders on the 29 developments it
manages
– Almost without exception purchasers were Owner-Occupiers before
their move. They wished to remain so. An overriding concern was
to retain their capital and independence as property owners
– ‘Ownership’ and ‘independence’ are seen as indivisible. They are
‘Owners’ and not ‘residents’
– Owner-occupation is seen as a key driver in upholding selfdetermination, accountability, governance, respect and dignity.
Owners see themselves (staff saw this also) as the ‘employer’ on
the development
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Owner occupation gives them the confidence to take a close interest in the
affairs or condition of the development and to complain if they wish to
Few said that the main purpose in retaining their capital in this way was to
ensure that their family benefited from the inheritance
Most see Owner-occupation as the most desirable form of tenure and as the
basis of their own security. Very few owners have sought to release equity from
their properties to fund their retirement
Overwhelmingly, Owners saw this combination of housing with care and
leasehold tenure as an alternative to Nursing and Residential Care. These were
rejected because of
– (1) their perceived lack of independence and
– (2) because they eroded the individual’s capital and their ability to control
their own affairs
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Owners relish the need to consult them about the annual budgets.
Many are on fixed incomes. A measure of financial control in the wider
affairs of the development was an attraction of this tenure
Repeatedly, we encountered the phrase ‘value for money’
Owners have a strong sense of proprietorship over the common
facilities in the development and many understand that these form part
of the overall asset value of their individual dwellings
Owners understand the financial inter-relationship between the
condition of the development generally, the need to support re-sales
and the value of their own property
Annual budget rounds can be hard fought, adversarial
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Primary Benefits of Moving to Private Extra Care Housing
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Quality of Life
– Progressive design
– Extensive core services
– Flexible additional services, e.g. Personal Care
– 24 hour staffing
– Communal facilities
– Restaurant meeting need and focal point of social interaction
– Extensive social life, networking, outward looking
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Primary Benefits of Moving to Private Very Sheltered Housing
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Independence
– Retain large measure of control over own property
– Service arrangements partially elective and individualised
– Management Company is Owner-led with Directors elected from
the Leaseholders
– The Owner is the ‘employer’
– The system is participative, responsive to consumers and
accountable
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Primary Benefits of Moving to Private Very Sheltered Housing
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Peace of Mind
– Staffing and service model provides reassurance; it is flexible and
progressive
– Secure living environment
– Companionship of peers
– In over 90% of cases Owners are able to live out their lives at the
Court
– The model is regarded highly by families of Owners: It reduces their
anxiety
– Advice and advocacy are available on the Welfare Rights
entitlement of Owners (currently 65% receive Attendance
Allowance and 15% Minimum Income Guarantee
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Primary Benefits of Moving to Private Very Sheltered Housing
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Reduced Visits to Hospital
– The model fulfils the ambitions of Government to reduce the time
spent and costs incurred by elderly people in hospital
– In the year to July 2004 the 1540 elderly Owners on RSL’s 29
developments had an average age of 83.3 years
– They spent on average less than 4 nights in hospital compared with
projections of over 17 nights for the same cohort in the population
at large
– Primary and Community Health Services are generally positive
about reduced stays and earlier discharges because of their
confidence in the supportive environment to which the individual is
returning
– In many cases the service and staffing arrangements enable often
very frail or disabled people to remain supported at home rather
than enter hospital or institutional care
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Why Purchasers Chose Private Extra Care Housing
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Concerns for own health or that of spouse
Companionship / reduce isolation
Availability of restaurant
24 hour emergency cover / staff sleep in
Active social life
Independent Living
Anticipation of future needs
Wanted to make just one final move
The model dealt with things that trouble me
It was affordable compared to other alternatives at my age
I am treated as an adult
Security / peace of mind
Location and Convenience
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No longer able to maintain previous home
Choice and quality of accommodation
Quality and attentiveness of the staff and management company
Able to have privacy and choose to socialise as I see fit
Help on hand when you need it
Family and friends close to hand
Wished to remain a property owner
Help on hand when you need it
Liked the overall design
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Should We Design Differently?
The importance of space
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Design which anticipates progressive need and which helps sustain the
homeowners independence
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Space is a key issue. We assume wrongly that space is less relevant
in old age. We reduce development footprints, minimise private living
space, erode car parking and in many instances eliminate private
amenity space
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We assume that elderly people:
do not need space to entertain
or to enable guests to stay
that their interest in cooking is limited
that they do not wish to undertake their own laundry
that they have little to store
that they do not need extensive wall space for books and collectables
that couples with particular needs can manage with a single
WC/bathroom
that they have never heard of the Internet and they do not watch Sky
that they have no wish to sit outside their own front door
or to potter about in their own garden space
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– Many older people are quite up to speed on issues such as
recycling, use of the Internet, ecology, gardening, TV systems and
technology and they would like developers to catch up
– Many think that private sector developers do not grasp the value of
assistive technology in sheltered housing
– Security is often an issue, especially insecure perimeters
– Changes of levels can be a problem and still exist on many
developments
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– Designs often do not anticipate adequately the onset of disability
– key concern is the quality of materials and workmanship and a fear
that elderly owner occupiers might not be able to afford the long
term upkeep of their developments
– Developers persist in seeing sheltered schemes as high in density
and low in cost – government is in danger of sustaining this view
– Many lack a specialist approach and are built on inappropriate
design and build contracts
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Elderly People and the Private Housing Market
Policy and Politics
• Housing policy is inextricably linked to wider political, social and
economic goals. It may be ‘steered’ for instrumental reasons which are
not wholly to do with housing (e.g. social integration, to reduce health
expenditure, to precipitate related investment). It may be used as a
means for wider social inclusion (e.g. public-private partnership)
• Given the pace of change in housing / care/ cash / health policies
affecting older people there may be an inherent conflict in trying to
resolve the problem of meeting demand on the one hand and ensuring
quality of design, building, services and staffing on the other. A key
challenge is to resolve this
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Private sector providers of housing with care are relatively few
They are uneven geographically, heterogeneous, mutable
Their workforce is experienced but largely untrained to meet new care
and regulatory challenges
They are inadequately resourced to effect a step change in expansion
of supply or in culture
Many are disinterested in or uncertain about working in partnership with
local authorities and health trusts
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Elderly People and the Housing Market
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Catalysts for Change
– (1) Reform of the planning process to facilitate and expedite projects that
have an agreed social utility
– (2) Direct financial support from government to fund training, retraining,
upskilling of staff to meet the requirements of a more quality assured culture
– (3) Help in identifying investors to secure land and finance development.
– (4) Creation of a ‘matchmaking’ service to link public and private partners
– (5) More qualitative research on local housing need to remove investment
uncertainty
– (6) Incentives for elderly people to purchase private extra care housing, e.g.
no Council Tax
– (7) Improved administration of Supporting People and Pension Credit
– (8) Top-up funding from Supporting People to improve Managers / staff
salaries
– (9) Penalties for poor developers / service providers – regulation?
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Shifting the Culture
• The orthodoxy of housing with care is likely to have to change radically.
The growth in numbers of elderly people, increased longevity,
expansion of owner occupation, concentrations of elderly people in
major towns and cities and the scarcity of development land means that
developers and planners will almost certainly have to consider ‘highrise’ solutions
• Modular, volumetric solutions must gain ground and pass the credibility
test with funders and consumers alike. They offer a fast track supply
solution. They are likely to be more affordable; they are potentially
better constructed; they may hold important lessons for life cycle costs,
maintenance and making the fixed income of most elderly people who
have to pay service charges go further
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Need, Care, Sustainability
• The needs of elderly people in rural areas is a particular concern where
development land is subject to particular aesthetic and spatial
constraints and where the critical population mass is lacking. Rural
authorities, rural enablers, the Housing Corporation, developers and
funders must be brought together to explore a coherent strategy for
sustainable development and service provision
• Housebuilders must be encouraged or obliged if necessary to
incorporate a housing with care component(s) in larger scale
developments. They could be encouraged through more flexible
planning arrangements. Government should reappraise outworn
concepts of ‘affordable’ and ‘social housing’ and consider the ‘utility’ of
housing schemes. Housing with care should be seen as a direct
alternative to some social or affordable criteria
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Choice and Lifestyle
• Developers should also be encouraged/incentivised to embark on a
significant programme of Lifetime Housing as a further diversification of
choice in the provision of housing solutions to older people
• Private retirement housing (all forms) remains the Cinderella of the UK
housebuilding sector characterised by unimaginative design, lack of
innovation, over-densification, little regard to consumer feedback,
cramped footprints, lack of interest in green construction methods,
inappropriate design and build contracts and often by less than
satisfactory execution
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Elderly people increasingly expect their housing to deliver other
outcomes…. leisure, (assistive) technology, services, social
opportunities, entertainment, continuing education and learning,
lifestyle. The ‘home’ must be a conduit for each of these expectations
The elderly owner occupied market is not monolithic. It extends across
a range of models, price levels, locations. The market is more
sophisticated than ever
Perceptions about sheltered and very sheltered as exclusively focused
on needs are increasingly misplaced. Aspiration is now a very
significant factor in the owner occupied sector
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Developers, Managers and Consumers increasingly see services and
facilities as having a needs / aspiration duality. Examples include the
installation of restaurants, laundries, heated pools, internet facilities,
hairdressing and chiropody suites, flexible staff services for shopping,
companionship, catering, travel
Design has a long way to go yet to catch up with and integrate this
duality but architects, ergonomists, developers and consumers too are
beginning to pool their thinking
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Innovation and New Technology
• In 10 years it will be common practice for private Extra Care Housing to
feature
– intelligent systems
– greater awareness of energy and building efficiency
– more barrier-free layouts with demountable partitioning, fluid design
– more responsive fixtures and fittings
– a wide use of assistive technology
– integrated leisure and entertainment systems
– greatly improved alarm and communication systems
– systemic interfacing with primary and community healthcare
services
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Elderly owner occupiers will become a front line in testing the
capacities of housing that will check their heartbeat, their pulse rate and
link them with their GP; they will receive reports back on their health
status; their TV/PC will expand to enable them to home shop, check
their bank accounts, act as a virtual learning centre, enable video
linking, monitor systems, aid security
Later still, but not so far away, their homes will have the capacity to
identify them as the owner-occupier. They will recognise and adapt to
their needs. We will see this in areas such as lighting, heating, use of
baths and showers, TV and HI-Fi, the telephone, key items of furniture
such as chairs and beds. And …. The fridge really will ultimately be
able to ‘talk’ to the television
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Meeting the Demands of a Sophisticated Market
• Increasingly, older people will not only want and require housing with
these facilities but they will be able to afford to pay for them and will
reward developers / managers who invest in them
• To meet the investment, supply, quality assurance and timetabling
needs of a growing market of elderly owner occupiers we can predict
that ….manufacture and construction will become the prime fulcrum of
change. Increasingly the current and expensive model of
sheltered housebuilding (unpredictable voids, cash flow
exposure, difficulties in phasing, lack of choice within a formulaic
design and build culture) will subside in favour of house
production
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In 10 years it will be commonplace to be offered a choice of homes
which have for the large part been manufactured off-site under exact
factory conditions and then delivered, assembled and fitted out on site
at an optimal time. For older people we will truly see new light in a
dusty world
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