Developing extra care housing new options for providing supported accommodation
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Developing extra care housing: new options for providing supported accommodation. ACSA Retirement Living Workshop 18.9.07 Professor Anthea Tinker, King’s College London [email protected] Outline of presentation. 1. What is extra care housing? 2. Why was it developed in the UK?

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Developing extra care housing new options for providing supported accommodation

Developing extra care housing: new options for providing supported accommodation

ACSA Retirement Living Workshop

18.9.07

Professor Anthea Tinker, King’s College London

[email protected]


Outline of presentation

Outline of presentation

  • 1. What is extra care housing?

  • 2. Why was it developed in the UK?

  • 3. How extra care has been provided

  • 4. The evidence for and against extra care

    housing

  • 5. Research on remodelling schemes

    to extra care


1 what is extra care housing

1. What is extra care housing?

  • There is no agreed definition – legal or otherwise

  • Generally agreed to be sheltered housing (i.e. independent accommodation, some communal facilities, a warden and an alarm) PLUS extra communal facilities, 24 hour support from staff, at least one hot meal per day provided


2 why was extra care housing developed in the uk positive reasons

2. Why was extra care housing developed in the UK? Positive reasons

  • To provide better accommodation

  • To reduce isolation

  • To help rationalise services

  • To help provide a hub for services for other people in the area

  • Because families (and politicians) seemed to want it

  • To provide an alternative to institutional care


Why was extra care housing developed in the uk negative reasons

Why was extra care housing developed in the UK? Negative reasons

  • Sheltered housing (perceived inability to provide enough support/some difficult to let)

  • Residential care (i.e. same as hostels) (poor facilities and standards)

  • In own homes (inadequate/unsuitable housing, lack of support)


3 how extra care has been provided

3. How extra care has been provided

  • Most is free standing i.e. not as part of a retirement village

  • Why the lack of enthusiasm for retirement villages until recently?

  • Some adjacent to other types of housing/residential care

  • Mainly be new build but now increasingly remodelled (see last section)


4 the evidence for and against extra care housing

4. The evidence for and against extra care housing

2 national evaluations and some smaller ones mainly in social housing

  • Generally popular with tenants (felt independent and secure though some would have preferred to stay in own home) and families

  • Was more expensive to the public purse that staying at home but little recent evidence about cost effectiveness


4 the evidence for and against extra care housing ctd

4. The evidence for and against extra care housing (ctd)

  • Mixed views on independence from tenants and staff

  • Quality of life – little evidence either way

  • Does it reduce isolation? Mixed results

  • A home for life? Not always

  • Can they cope with demented tenants? Now some special schemes


5 research on remodelling sheltered housing and residential care to extra care schemes

5. Research on remodelling sheltered housing and residential care to extra care schemes


The project funder and timing

The project, funder and timing

Remodelling sheltered housing and residential care homes to extra care housing

  • Funded by the Engineering and Physical Sciences Research Council (EPSRC – EP/C5329451)

  • A multi-disciplinary project

  • May 1 2005, for 2 years (extended to 31.7.07)


A multidisciplinary research team

A multidisciplinary research team

  • Professor Anthea Tinker and Dr Fay Wright, King’s College London, Social Gerontologists

  • Professor Julienne Hanson and Hede Wojgani, University College London, Architects

  • Dr Ruth Mayagoitia-Hill (Engineer) and Els Van Boxtel (OT), King’s College London

  • Dr Alan Holmans, Cambridge University, economist

  • 3 student projects


The importance of the subject

The importance of the subject

All the reasons already given for extra care +

  • The desire to keep tenants in place

  • Growing attention to poor spatial standards in sheltered housing and residential care homes

  • The challenge of remodelling compared with new build

  • Incentives in policy and funding (grants)


What the research has covered

What the research has covered

  • 10 social housing schemes in different parts of England

  • 8 housing associations and 2 local authorities

  • 8 sheltered housing schemes and 2 residential care homes

  • In all cases examined the role of assistive technology


What the research has covered1

What the research has covered

• A sample of schemes which have been converted since 2000 to extra care

• Examined what the care, building and AT changes were and what is likely to be needed in the future

• Obtained the views of older people and staff to look at the advantages and disadvantages

•Costed the changes to the schemes

  • Providing guidance based on the findings


Some findings a mixed picture with no scheme the same

Some findings: A mixed picture with no scheme the same

In some cases:

  • The whole scheme was remodelled

  • Only the individual flats were remodelled

  • Part of the building was remodelled

  • A wing was added

  • Older people stayed but in others they were decanted


Some findings from the architectural perspective

Some findings from the architectural perspective

  • Remodelling was far from straightforward and there were numerous delays

  • Unforeseen problems were found in all the schemes

  • There were problems when tenants remained in situ

  • 9 out of 10 projects overspent the original budget


Some findings from the architectural perspective ctd

Some findings from the architectural perspective (ctd)

  • Most flats and facilities (for tenants and staff) were bigger and better but there was variation within schemes

  • Often the grounds/gardens were better

  • Problems over lifts in most schemes


Some findings from the social aspect

Some findings from the social aspect

  • Tenants admitted after remodelling were generally enthusiastic (especially those who had moved from care homes – glad of privacy, removal of worry, glad not care home)

  • Tenants who remained in situ were generally hostile to people with high levels of dependency who had come in.

  • Not all schemes provided a hot meal and this needs review


Some findings from the social aspect1

Some findings from the social aspect

  • Levels of care were arbitrary and some tenants needed less care after entry and some new ones more than was provided

  • There was a rapid turnover of staff

  • The considerable input from relatives continued


Some findings from the assistive technology perspective

Some findings from the assistive technology perspective

  • Little incorporation of AT

  • Compliance with accessibility standards was patchy and this could result in more input from staff

  • No wheelchair accessible kitchen was found

  • Little knowledge about AT


Some findings from the financial perspective

Some findings from the financial perspective

  • There was variation between costs in schemes

  • It cannot be assumed that remodelling is a cheaper option than new build

  • The lowest cost/flat was £20K (a refurbishment); the highest was £110,230 (a heritage building). The average was £64,300


Some conclusions about remodelling

Some conclusions about remodelling

  • General satisfaction by tenants with their flats

  • Remodelling needs to be a careful choice when other alternatives, including rebuilding, have been examined

  • Some good examples of good practice were found and need disseminating


What can be learned from this research and how far is it applicable to other countries

What can be learned from this research and how far is it applicable to other countries?

  • The need for a real discussion about the options of new build and remodelling for each scheme

  • In some cases, e.g. lack of land/historic building, there may be little option but to remodel

  • How far are the findings about social housing applicable to the private sector?

  • Will these standards be acceptable to the next generation of older people?


What is happening now

What is happening now?

  • A hard copy summary is being provided

  • Detailed advice for local authorities and housing associations is being put on the web

  • Articles and presentations are being done


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