The future of housing with care Claudia Wood, Demos

What do we know about the market? 560,000 retirement units in the UK, 105,000 are OO. This is 2.4% of entire housing stock. 477,500 units of housing with support in England in 2012 (retirement housing), and 55,700 units of housing with care.   85 per cent of this counts as sheltered housing 7 per cent is designated extra care 4 per cent and 2 per cent are very sheltered and close care housing respectively 1 per cent of these homes – 57,000 units – are designated as retirement village.

What do we know about the market? There are around 5,000 nursing homes and 12,000 care homes in the UK 400,000 older people live in these homes – over half with dementia The over 65s population has grown 11% since 2001 – but the care home population has grown by just 0.3%

What do people want? 58% of older people would consider moving in the future 43% say it would be difficult or impossible for them to move 43% want to move due to needing a property better suiting their needs (no stairs, smaller garden) This increases with age to 100% of 81+ 26% say their house is too big for them; 19% say ongoing maintenance is becoming a problem 33% of the over 60s interested in downsizing 25% are interested in a retirement property to buy or lease on assured tenancy Aspirational moves and housing with care are twin demographic trends

If you were frail in later life, where would you needs best be met?

What words do you associate with ‘residential care’? Negatives Positives Old age (76%) Care (41%) Boredom (48%) Safety (22%) Loneliness (42%) Community (19%) Illness (38%) Comfort (16%) Isolation (34%) Friendships (13%) Disability (31%) Respect (9%) Abuse (27%) Modern (9%) Uncaring (26%) Fun (3%)

Need – not demand Housing with care will be in greater demand, a long tail of lifestyle related illness combined with comorbidity, dementia, complex needs This requires a mixed spectrum of provision to cater to different levels of need ‘Residential care’ is conflated with ‘care home’ and as such is related to poor quality, risk of abuse, associated with frailty and loss of independence “extra care” and other terminology distances itself from ‘residential care’ but this in fact represents a diverse spectrum of options – from care home to village settings, supported living, ‘green house’ etc, Currently, people need housing with care, but do not demand it – is a change in terminology needed and to cut through confusion?

The future of ‘housing with care’ Independence, autonomy and choice Personalisation and collective empowerment Aspiration Being embedded in the community Co-locating with community services Learning and working environments Fostering relationships and communities Responding to social and demographic trends Mixed provision for a spectrum of need Dementia specialism Step up, step down, respite, short stay

How do we get there? Separate care needs from housing choices Tackle perceptions of the entire spectrum Take the emotion out of decision, make a positive choice Carrying this through into regulation and commissioning Create a flourishing and flexible market Commissioning, regulating – fewer Chinese walls Planning and building for diversity and innovation Fewer Chinese walls Location location location Change the narrative to reflect (1) and (2) Paying for housing with care A growing split in the market A longer term view of care Affordability of housing

Claudia.wood@demos.co.uk