Nicky Hodges Associate - URS Keynote 4 Nicky Hodges Associate - URS

Research on behalf of DCLG into the provision of housing for older people Nicky Hodges, Associate, URS Housing LIN South & South West Conference 08 October 2014

Outline Research context, key questions and approach REA – Benefits and costs of provision Case study - North Somerset Older people’s views Stakeholder views Overall research findings Housing requirements Different types of new housing Demand for adaptations – and bottlenecks Demand for specialist housing – and barriers to supply Questions

Context of study Filkin Report 2013 - Select Committee on Public Service and Demographic Change All Party Parliamentary Group on Housing and Care for Older People Research commissioned by Housing Minister Part-funded by Contestable Policy Fund Parallel DEMOS policy project Findings presented to Housing and Planning Minister ‘We need more designated specialised housing for older people and disabled adults. The level of provision is not keeping pace with our ageing Population’ – government response to Filkin report Contestable Policy Fund – central pot which aims to commission high quality advice from outside the Civil Service on Ministers’ priority policy areas. Initially commissioned by Kris Hopkins MP, taken forward by Brandon Lewis MP, whose brief covers both housing and planning.

Research key questions What types of specialist / adapted housing do older people want and need, and what do they see as the barriers to securing these? What is the nature and extent of the gap between supply of and demand for different specialist/ adapted housing types wanted by older people, both now and projected for the next 20 years? What is the reason for any under supply of specific specialist/ adapted housing types wanted and needed by older people? 5

Policy options development Research approach Rapid Evidence Assessment Assess robustness of research studies Focus on evidence of demand, supply, gap, reasons for under supply. Quantitative research Market assessment – current housing circumstances of older people Model of future demand set against supply Qualitative research National level 2 expert focus groups Expert interviews 3 Study Areas Older people focus groups Local stakeholder interviews DCLG required the research to include the following main elements: (i) a quantitative assessment and/or model of the market for older people’s housing; (ii) a qualitative assessment of the key factors affecting supply and demand with regard to older people’s housing; and (iii) a Rapid Evidence Review of published relevant literature on housing provision for older people. The three research elements and links with the policy options project were united through an overarching research framework, developed jointly by URS and Demos. Quantitative research – based on demographic data plus key policy questions e.g. tenure and dwelling size requirements, requirements for adaptations to existing building stock Policy options development

REA Themes Benefits and costs of ageing in place / specialist provision User and customer perspective Gap between supply and demand and need Sub-themes Information and advice BME older households Equity release Housing and dementia Under-occupation, over-consumption and mobility 7

Benefits and costs of new provision Extra Care v care homes Improving body of evidence Extra care provides a cost-effective solution compared to care homes (PSSRU, 2011) Extra care delivers better services and an improved quality of life (various) But more costly for social care? Increase in short term costs of care – needs identified Health costs decrease – proactive, more immediate response Extra Care v mainstream housing Little robust evidence on cost-effectiveness Beneficial health outcomes compared to mainstream housing (Kneale, 2011) Croucher et al (2006) identified gaps in evidence base PSSRU finding – benefits apply when compared for the same group of people Netten et al, 2011 - an evaluation of 19 schemes that opened between 2006 and 2008 and which received capital funding from the Department’s Extra care housing fund. PSSRU,. Institute of Public Care, 2014, Kneale, 2011 The evidence base on the health and social care costs and benefits is not conclusive. However, it would appear that (i) the short term costs of care increase because of more comprehensive assessments that identify previously unknown and / or unmet needs and (ii) health costs decrease because of a proactive approach and more immediate responses to needs. 8

Benefits and costs of adaptations Context Most people want and need to stay put Incomplete evidence Provision of services not as good as it could be Benefits to older people Falls prevention Mental wellbeing Ability to self-care Cost savings Mixed evidence re adaptation costs v. social care savings Stronger positive evidence re health cost savings Few people move home in their later years; 95% live in mainstream housing - Brown, T. (2011) Housing an Ageing Population, London, Housing LIN and Keepmoat 2006 study - Croucher, K., Hicks, L. and Jackson, K. (2006) Housing with Care for Later Life – A Literature Review, York, Joseph Rowntree Foundation PSSRU study on extra care - Darton, R. et al (2011) Improving Housing with Care Choices for Older People: The PSSRU Evaluation of Extra-care Housing, Housing, Care and Support, Vol 14 No 3 pp 77-82 The PSSRU study and other research (e.g. Institute of Public Care, 2014, and Kneale, 2011) show that Extra care provision delivers better services and an improved quality of life but with increased social care costs – though there is contradictory evidence on the latter point (see below). There is a small but expanding evidence base on the benefits of private sector provision (e.g. Institute of Public Care, 2014; and McCarthy and Stone, 2008). The evidence base on the health and social care costs and benefits is not conclusive. However, it would appear that (i) the short term costs of care increase because of more comprehensive assessments that identify previously unknown and / or unmet needs and (ii) health costs decrease because of a proactive approach and more immediate responses to needs. Kneale, D. (2011) Establishing the Extra in Extra Care: Perspectives from Three Extra Care Housing Providers, London, ILC-UK On social care 9

North Somerset - views of older people

Thoughts on planning ahead There isn’t actually much support really if you begin to lose your faculties. ‘It’s like bereavement. You get so used to your house, you invest a lot in it.’ ‘The underlying factor is fear’ Safety and security and having a support network; Fear is associated with feeling lonely and isolated. Some people don’t like moving. ‘I just loathe the thought of it’. ‘It’s like bereavement. You get so used to your house, you invest a lot in it.’ Variety of views over this – some participants discussed idea of life as a journey, and moving on to a new stage. ‘When I retired I needed another horizon.’ ‘When I move again I’ll get rid again. It’s really important to move on to the next stage of life’ ‘We need to plan ahead and think positively’ 11

Views on sheltered / retirement housing ‘It [sheltered housing] worked very well in Bristol until wardens were taken away.’ ‘I don’t think we want to go back to the sheltered housing that we had’ ‘It’s not good to live in this sort of isolation with only people in your age group whose outlook you share.’ Family attitudes - ‘Where are we going to stay when we come and visit?’ 12

Views on Extra Care and retirement villages ‘It’s a living community’ ‘If we are going to move it will be to something like extra care housing, but then, how are we going to get there?’ Money would soon be ‘eaten up’ by service charges ‘You have to be very careful in these closed communities that people are being treated how they deserve to be treated’ Transport links in rural areas Want long-term guarantees for care arrangements ‘It’s a living community’ – reference to a new scheme which includes shared equity options. Considered to be well-integrated with established village. 13

Case Study Area – views of stakeholders

Understanding of context Very high growth in numbers, especially over 85s Oversupply of care home beds Park Homes to Retirement Villages Diversity in ‘older’ age group Elderly frail – extra care housing For younger age groups ‘What is available in the middle that older people would like? Between independent living and extra care?’ ‘We don’t have enough of it that’s affordable and in the right location’ Strong desire for bungalows – high value of those available, View of local authority ‘If only they would build more bungalows, but they’re not so they stay put’ (Older person, Somerset)

Local authority views ‘It has got to be about the private sector and how we persuade them to do more for older people.’ ‘It is about proactive engagement with providers and using the JSNA and market position statement to identify the gaps’ We need alternatives to residential homes. Want Extra Care Housing rather than care homes. One of the most significant things [adult social care commissioning] have done is engage with planning. Quote continues ‘But you then have people who want to remain where they are and aren’t willing to explore different housing options. People want to stay in the home that they are used to, it’s obvious but it’s true.’ 16

Social care On moves ‘By the time my service is involved it’s generally when there has been a hospital admission or there has been a big life event or a crisis.’ On MOTEX centre Provides demo equipment and adaptations centre ‘If they have got the money they might as well get on with it themselves rather than wait for the council.’ Quote continues ‘But you then have people who want to remain where they are and aren’t willing to explore different housing options. People want to stay in the home that they are used to, it’s obvious but it’s true.’ Voluntary sector bodies identify funding constraints as important. West of England Care & Repair; Community Connect services important to identify needs, provide advice, services. 17

Overall research findings DCLG required the research to include the following main elements: (i) a quantitative assessment and/or model of the market for older people’s housing; (ii) a qualitative assessment of the key factors affecting supply and demand with regard to older people’s housing; and (iii) a Rapid Evidence Review of published relevant literature on housing provision for older people. The three research elements and links with the policy options project were united through an overarching research framework, developed jointly by URS and Demos. Quantitative research – based on demographic data plus key policy questions e.g. tenure and dwelling size requirements, requirements for adaptations to existing building stock

Housing requirements Diverse preferences and needs amongst growing population of older people The majority of people will continue to live in mainstream housing Wellbeing preferences Health and wellbeing – public purse savings and individual wellbeing benefits Future considerations for housing options Future generations will be more demanding than post-war generation Reduced pension provision Growing prevalence rates of diabetes, dementia, obesity The older population is projected to grow by 37% up to 2032, those aged 70+ by 73% Individual needs vary by health, wealth, level of activity, lifestyle Staying put - either as a positive choice, or as a ‘forced choice’ due to a lack of immediate alternatives. Space, security, access to services, family/social networks, attractive home and local area matter Adaptations provision achieve preventative health benefits Housing with on site care provision achieves benefits as compared to residential care homes. Housing choice – bungalows still perceived to be a popular option Affordability – about cost of purchase PLUS cost of service charges

Demand for adaptations in existing housing Rented sector demand could grow by 49%, from 1.2 million households in 2012 to 1.8 million households in 2032 Owner occupier demand could grow by 39%, from 677,000 households in 2013 to 941,000 in 2032 Demand could outstrip supply by 292,000 in rented sectors Projected future mismatch (excess supply of 236,000 adaptations) in owner occupier sector where low income households unable to afford adaptations Social rented and private rented – likely to be predominantly in the social sectors. There appear to be particular barriers to adaptations in private rented housing, where equality legislation provisions are not readily accessible to renters as a means of securing adaptations paid for or agreed by landlord. 1st 2 bullets refer to total demand 2nd 2 bullets refer to demand relative to provision The inability to afford is amongst owner ocupier households. Those with an annual income less than £20k are assumed unable to afford major, costly adaptations. Refer to pp 11/12 & p46

Bottlenecks to accessing adaptations Inadequate funding relative to need Complex/ disjointed process Poor user awareness of DFG or suitable options Limited offer / provided too late to maximise effectiveness Need for impartial, independent advice Need for shift from provision on release from hospital to preventative investment to maximise cost-effectiveness and impact on quality of life

Demand for specialist housing Projected Growth in total demand for specialist housing Rented sector demand could increase by 48% over 20 year period, from 44,000 in 2012 to 659,000 units Owner occupier demand could increase by 37%, from 78,000 to 107,000 units (by 2032) Projected Gap between supply and demand in 2032 Combined gap of 135,000 units Rented sector 164,000 units in excess of supply Owner occupier 29,000 units in excess of demand due to affordability barriers The existing shortage most importantly affects the middle market owner occupiers and private renters who cannot afford more costly retirement housing and who fall outside eligibility for social housing. Rates are based on historic rates of provision and assuming current build out rates continue The level of demand for private specialised housing is very sensitive to price threshold and attitudes towards moving/staying put.

Constrained demand These views illustrate, from a variety of perspectives, some of the reasons why there is not more active demand from older people for new housing. People’s attitudes to their own home are also important, as is affordability. Affordability barriers - low awareness and concerns/mistrust about financial products, limitations on availability of mortgage-type products. Limited choice of feasible specialist housing options Poor awareness of newer options that are available Limited customer demand to generate delivery of increased supply of attractive, realistic choices.

What limits supply of specialist housing? Poor consumer demand to drive supply Lack of pro-active planning Competition for suitable sites Higher costs of provision with significant communal space and services Need for stronger business case for developing housing with on site care Issues regarding Use Class Public sector funding constraints

Research delivered by URS Team, led by Doug McNab Philip Leather, PSL Research Ltd Sheila Mackintosh , Mackintosh O’Connor Associates Dr Tim Brown, Centre for Comparative Research at DeMontfort University

Nicky Hodges, URS Nicky.hodges@urs.com 0117 917 1179 Any Questions? Nicky Hodges, URS Nicky.hodges@urs.com 0117 917 1179