AGEING AND PLACEMAKING IN THE UK AND JAPAN:
COMPARATIVE PERSPECTIVES
MARK BEVAN, CENTRE FOR HOUSING POLICY, UNIVERSITY OF YORK
DELIVERING SERVICES FOR OLDER PEOPLE IN RURAL AREAS
DRAFT
Introduction
I would like to focus upon delivering services for older people in rural areas.
The talk draws in part upon research undertaken within the Centre for
Housing Policy for the Commission for Rural Communities and the Housing
Corporation looking at the housing and support needs of older people in rural
areas. The research included discussions with older people in a range of
different rural areas in England, about their views, experiences and
aspirations. The talk also draws upon a wider literature to illustrate further
points.
Plan of talk
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Demographic trends in rural areas of England
Priorities of older people
Delivering services for older people: the rural context
A focus on housing and support
Demographic trends
Previous speakers have noted the particular trends in their respective
countries. I would briefly like to highlight demographic projections in rural
areas of England. Recent research has identified a number of key trends for
the future (Rural Evidence Research Centre, 2005):
Projected % Change in over 50’s 2003-2028
Major urban large
Large urban
Other urban
Significant rural
Rural-50
Rural-80
(Total
28.5
27.2
34.6
37.4
41.4
47.4
34.7)
(Source: Rural Evidence Research Centre, 2005)
NOTE: Rural/urban definition for England
The 354 districts in England are divided into 6 groups to reflect the structure
of districts:
Major Urban: districts with either 100,000 people or 50 percent of their
population in urban areas with a population of more than 750,000; there are
76 districts in this group.
Large Urban: districts with either 50,000 people or 25 percent of their
population in one of 17 urban areas with a population between 250,000 and
750,000; there are 45 districts in this group.
Other Urban: districts with fewer than 40,000 people or less than 25 percent
of their population in rural settlements: there are 55 districts in this group.
Significant Rural: districts with at least 40,000 people or at least 25 percent
of their population in rural settlements; there are 53 districts in this group.
Rural- 50: districts with at least 50 percent but less than 80 percent of their
population in rural settlements (including urban areas with between 10,000
and 30,000 population which are of rural functional importance); there are 52
districts in this group.
Rural- 80: districts with at least 80 percent of their population in rural
settlements (including urban areas with between 10,000 and 30,000
population which are of rural functional importance); there are 73 districts in
this group.
Priorities of older people
The starting point for how services should be configured and developed into
the future is the priorities and views of older people themselves – how can
services fit together to meet their priorities and aspirations.
Age Concern (2006) has reviewed a range of research that has sought to
identify key dimensions of older people’s lives who live in rural areas. These
include:
1. Independence
2. Being heard
3. Interdependence and reciprocity
4. An active life – keeping busy
5. Receiving help not care
6. Feeling safe
7. Continuity of place.
Delivering services for older people: the rural context
There can be a number of features of operating in a rural environment that
can affect the delivery services. I would like to note that there can be
opportunities and positive aspects to working in rural areas, just as much as
barriers and constraints.
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There is often a higher cost attached to providing services in many
rural areas.
Increasing centralisation of services, particularly of health care.
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Limited transport options may restrict mobility and access, increasing
dependency and exclusion.
Time required to develop local community trust and confidence in new
initiatives where past change and opportunities have been limited.
Achieving economies of scale
Models of service delivery
Overlaying these specific features of providing services in rural areas is the
diversity of rural areas themselves. A number of research projects have
focused attention on the particular features of models of service delivery that
perhaps work better in some types of rural areas compared with others, or are
attempting to identify aspects of models of delivery that can replicated in other
rural environments.
Just to give a couple of examples of what I mean from Scotland. A recent
research report in Scotland has noted a distinction between remote and
accessible rural areas in terms of the way that services might be configured –
and this is where broader strategic planning would need to come into play
across different types of service in terms of designing and evaluating the
effectiveness of services. This research suggested that in more accessible
rural areas a focus on transport to services in towns may be the most cost
effective approach. In contrast, remote communities may need the provision
of services on the ground (Accent Scotland and Mauthner, 2006).
There a number of ways that services can be configured to undertake that
role in remoter areas such as mobile services going out to communities.
Another suggested approach is the way that staff are trained up. In urban
areas you can afford to have staff trained in very specialised roles. In remoter
rural areas an alternative approach is to have staff trained up in a different
way to undertake a more generic role, in terms of either providing services
and/or signposting people to other services.
An example of learning which aspects of services can be replicated elsewhere
is the DESERVE project, which is funded by the European Union. This project
is a collaboration between Scotland, Sweden, Iceland and Finland to test the
transferability of models of service delivery to remote and rural areas. Each
participating region will implement a project utilising a model previously tested
by partners in their own countries. The emphasis is on the models of service
delivery to remote and rural areas rather than on the specific services
provided, so it may be hoped that some of the lessons may be learnt which
could be applied in the context of housing and support, even if projects have
not directly been involved in this type of service.
DESERVE project.
There is also an issue of the diversity of older people themselves. What might
work well for some people won’t work for others. One issue is the way that
services engage with ‘hard to reach’ groups of older people. There is a
geographical dimension to this issue in terms of the physical remoteness and
isolation of some people in very sparsely populated areas because of
remoteness. There may also be an unwillingness to engage with service
providers. For some people there is a lack of trust towards statutory services
and a feeling that they will lose control over their own lives. There is also often
reference to a culture in rural areas of ‘making do’ and not articulating needs.
How far that culture will continue across future generations is perhaps a
question for future research.
A focus on housing and support
Specifically I would like to focus the rest of the talk on how delivering housing
and support services in rural areas can impact upon continuity of place for
older people. By support services I mean statutory services that deliver
personal care to people, but also much wider formal and informal help that
can be delivered not only by statutory services, but also the voluntary sector
and by friends and relatives. There are two issues here. The first is how
housing and support services can enable older people to continue living in
their current homes. The second is how these services can help to facilitate
positive moves to different locations, if these are required or desired by older
people.
Part of policy response to ageing has been developments around combating
age discrimination. The Housing and Older Persons Development Group have
stressed that planning for older peoples’ housing needs to go beyond
equating accommodation requirements for older people with specialised
accommodation.
The majority of older people live in their own home and are owners occupiers.
The 2001 Census showed that of households in Britain with one person of
pensionable age - 90% lived in mainstream housing. The remainder either
lived in sheltered accommodation or a registered nursing home.
Research has highlighted that that most older people want to remain living in
their own home. Discussions with respondents in rural areas also emphasised
this point.
One challenge for spatial planning to enable people to continue living in their
own homes, linking together issues such housing, health, transport and
access to services, the preventative agenda, and access to advice and
information. These issues were reflected in discussions with older people in
rural areas as part of research. Successful housing solutions often linked with
other factors such as transport and access to services. Time and again,
respondents discussed what would happen when they had to give up driving,
and the impact of this upon housing decisions.
There is also an important role for planning to play in providing viable and
attractive alternatives for people if they need or want to move to alternative
settings such as housing with care. One issue on rural areas which perhaps
could be examined further by research is how far people say they want to
remain in their homes because there isn’t an attractive option available to
them within a reasonable distance. Further a recent paper by Robin Means
has highlighted groups of older people who lack the choices open to older
people generally such as people with dementia.
Housing with care, or extra care, has been put forward as a model for
increasing independence and can have a preventative function for those who
need housing-led personal care and support care. In rural areas it can also
provide a base for other services, such as Intermediate Care, that might
otherwise be absent from a rural area and from which outreach services can
be delivered to a wider area. However, there are major hurdles to be
overcome in providing this type of service in rural areas. The costs of
providing this type of service in smaller communities can be prohibitive, and it
is more often associated with market towns to achieve economies of scale.
One scheme in Suffolk had been built in a village, and provided very valuable
range of services to surrounding community. However, revenue costs were
such that housing manager stated that would be unable to replicate this model
in other areas.
The main issue is how far housing that meets high standards of design with
regard to access and flexibility in use can be made part of the mainstream,
general housing stock. The aim is to make a home easier to use and also
adapt as a household’s needs change over time. The wider intention is to
provide accommodation which can provide flexibility in use across different
occupants over time, and across as wide a range of the population as
possible.
The Lifetime Homes standard provides an example of one model for
accessible housing. The lifetime homes standard is based on 16 principles
such as adequate space for wheelchair access; potential to adapt a stairway
for a stair-lift; one point to make is that Lifetime Homes as a model is
contested. One issue is space for storage.
The Department of Communities and Local Government is currently
consulting on whether to include lifetime homes standards as an essential
element of the Code for Sustainable Homes, to encourage the adoption of
lifetime homes standards by the housebuilding industry. It is already intended
that most government funded new build housing schemes will adopt the
Lifetime Homes standards from 2010.
The Department of Communities and Local Government has estimated that
by 2050, about one third of the housing stock will have been built between
now and then. However, what is not clear is how that figure of one third will
vary geographically. In areas of traditional planning constraint in many rural
areas, including areas such as National Parks that figure could well be much
lower.
What this suggests is that there are very limited opportunities for diversifying
the housing stock in many rural areas in relation to the proportion of new build
accessible housing. So is there an argument for saying that any new build
going into rural communities – both public and private - should at least meet
lifetime homes standards. Given the fuss that the private sector made over
the last changes in 1999 to part M of the Building Regulations, one can
imagine intense lobbying around this issue.
Another conclusion to draw is that if new build is likely to have a limited impact
in many rural communities, the focus of attention in these areas should then
be on improving the existing housing stock. And that suggests a greater
emphasis on for example, Care & Repair, Staying Put services. Worryingly,
these types of service tend to operate at a lower level that found in urban
areas (Molineux and Appleton – Learning and Improvement Network).
A further problem affecting urban and rural areas alike is the current pressure
on personal care services provided to older people on a statutory basis by
social care services. There is an intense level of needs relative to resources
that is affecting how statutory services can respond. This problem is reflected
in the fact that many local authorities are having to target higher levels of care
needs only, and cannot cater for people with lower levels of need. One
example of the pressure on social care services in a rural area in the research
we conducted was illustrated in the following quote by a practitioner in social
care services:
About five years ago five per cent of people supported by social
services were self-funders who had run out of money. But now 25-30
per cent of the purchasing budget for nursing and residential care is for
self-funders who have run out of money.
What this quote reveals is not only the increasing pressure on social services
budgets, but also a very particular trajectory of ageing – people who have run
out of money.
Instead, preventative services also have a key role to play in enabling people
to continue living in their own homes. Preventative services as those that:
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prevent or delay the need for more costly intensive services or
promote the quality of life of older people and engagement with the
community
Research has demonstrated the high value that older people place on
services that help them small tasks around the home, or enable them to
socialise and get out of their homes. The context in rural areas of limited
housing options, and also poor access to transport services means that low
level support and preventative services can play a particularly crucial role in
rural areas in helping people to sustain their lifestyles in the own homes.