1. A National Strategy for Housing in an Ageing Society

2. 2 1.Older people focus – the offer for older people, better outcomes: Better information, better houses, more choice, that bit of help with your house and services that come to you Innovative service models (HIAs, Link-age plus, IB) Outcomes we are working towards Inclusion 2.Housing revolution for older people. Design revolution. LTHs. Buildings for people. Neighbourhoods. futures. 3.Health, housing and care – ‘the triangle of independence’ 4.The future of specialist housing 5.Making change happen - drivers, strategies, implementation and delivery – stakeholders, LA, PCT, CLG, planners… 6.Detailed action plan 7.Evidence section/annex. Research, economics, best practice and references. Killer graphs. Aspirations. Supply & demand. (key stats in relevant sections too)

3. 3 Who we need to convince? Core audience are people who are not engaged - media, mainstream housing and planning, architects, policy makers, the public etc. Top line messages for those who will not read past page 3. Primary purpose is to raise awareness, engage and champion. Must be highly engaging visual style. Pictures, graphics, killer graphs, quotes. Headline action plan to show way forward. Not geared towards specialists who will read on.

4. 4 Some key features? 1.The hidden story in housing – ageing and growth 2.The economic opportunities of ageing 3.The great challenge for housing health and care 4.Why the story is hidden – projections and perceptions 5.Avoiding a housing crisis

5. 5 The hidden story in housing - older households are driving growth 48% of all new households will be older to 2024. This may turn out to be the most significant driver of the housing market over the next 20 years. Unprecedented demographic change is the great hidden story in housing. Map of growth. The economic opportunities of an ageing society Older people now work more, spend more, own more houses. Business needs to respond to this growth market. From 1970 to 2000, gains in life expectancy added about $3.2 trillion per year to US wealth. In the UK the figures are proportionally similar ( Tsai et al). These new consumers are a huge new market for businesses, such as builders and bathroom/kitchen manufacturers and service providers. Older consumers will buy housing and services that promote health and independent living if businesses see this new opportunity. Prevention… kings fund. [We also ignore the economic contribution of millions of older people characterised as ‘economically inactive’. These powerful consumers are also delivering £XB of informal care and £XB childcare and without them we could simply not maintain employment rates or maintain local economies. Planners, businesses and others must recognise the economic contribution of older people. If we assume dependency it may become a self fulfilling prophecy.]

6. 6 The great challenge for housing, health and care? We face a shortage of appropriate housing for older people and rising demand for care. We plan to build much more housing and we will ensure it meets the needs of older people. Poor housing dramatically impacts on health and care, as a key driver for hospital and care home admissions (PSSRU). The major costs are projected to multiply and housing can be the source of problems or solution. We will need many more inclusive, adapted and specialist houses. Map of housing per 1000 over 65s? The numbers of disabled older people in England are projected to double from approximately 2.3 million in 2002 to approximately 4.6 million in 2041 (PSSRU 2006). Graph. Dementia projections – 683,597 to 1,735,087 in 2051 154%. Where will they live? Graph. Housing, health and care services will face increasing demand. [20,000 older people die each winter as a result of poor housing, which is why we have invested £XB Warmfront and decent homes. Falls from poor housing cost over £700m. A large proportion of people over age 60 suffer from chronic illnesses or disabilities.[3,4]. ]34

7. 7 Why the story is hidden – projections and perceptions These remarkable projections and consequences are easily ignored by those who need to act. Age discrimination, the most prevalent form of discrimination (Abrams 2005), means many struggle to empathise with a growing group of older people. Older people news, one commentator explains, prompts “yawns on the news desks”. Even our own view of when we become old shifts away as we grow older (Abrams 2005). Negative images of housing for older people reinforce our fears and mean we individually and collectively avoid planning (Espejo et al., 1999; Oldman and Quilgars, 1999; Nolan and Dellasega, 2000). One in four of us can expect to live in a care home on a long term basis in, but few plan before its happens. This is about what we want for our future selves and we need a public debate. Equality, Diversity and Prejudice in Britain Results from the 2005 National Survey Dominic Abrams & Diane M. Houston Malcolm Dean, Guardian, Wednesday February 8, 2006. Espejo, A., Goudie, F. and Turpin, G. (1999) Hospital discharge into nursing home care: psychological reactions and contributing factors, Aging and Mental Health, 3, 1, 69-78. Oldman, C. and Quilgars, D. (1999) The last resort? Revisiting ideas about older people's living arrangements, Ageing and Society, 19, 3, 363-384. Nolan, M., Walker, G., Nolan, J., Williams, S., Poland, F., Curran, M. and C, K.B. (1996b) Entry to care: positive choice or fait accompli? developing a more proactive nursing response to the needs of older people and their carers, Journal of Advanced Nursing, 24, 2, 265-74.

8. 8 Avoiding a housing and care crisis What happens if we fail to manage the challenges and miss the economic opportunities? The human and financial costs to shortage of housing and services are great. There are costs to failing to deliver a step change in prevention, as demand for housing and services becomes unmanageable. If we do nothing occupied places in care homes and hospitals would need to rise from around 450,000 to around 1,130,000 in 2051 (151%). Long-term care expenditure would need to rise by around 325% in real terms between 2002 and 2041. Increasing falls. Increasing number of people. We would not want to find that our experience of housing and care is worse than our parents as limited housing and services are stretched over many more people. Wittenberg, R., Comas-Herrera, A., King, D., Malley, J., Pickard, L. and Darton, R. (2006) Future demand for long-term care, 2002 to 2041: Projections of demand for older people in England, PSSRU Discussion Paper 2330.

9. 9 1.Starting the Public Debate. Sign up now. This is not a marginal issue to ignore. Accept that this is about all of our futures. Mainstream issue for builders, planners, LAs, PCTs, etc. ageing is important to business and will age proof approach. Inclusive design society. Internet sign up. Kite mark for companies. 2.A new housing offer for older people. That bit of help, Better information, options… More choice.. Design, repairs, adaptations, prevention, equity release. 3.A revolution in housing for older people. The best way to predict your housing future is to shape it now. We need lifetime homes in lifetime communities. Inclusive design. Planning system. Will need inclusive homes in inclusive communities. Olympic village, eco-towns… we need.… 4.A new future for specialist housing. We will see growing demand for specialist housing. However, we must not repeat past mistakes. We need aspirational housing that people actively choose, smash negative image… 5.Making change happen. Govt. Leadership. PSA. Local levers. Joining up health housing and care, Public debate and demand. Implementation.

10. 10 Way forward There is a clear future and positive role for specialist housing. Demand and potential growth. Major costs if don’t plan and embrace reform Must be more strategic. Mismatch of supply and demand in many places. Historical reasons for stock, not often planned. Clarity about evidence of what works, outcomes, cost effectiveness and demand. Must promote choice and innovation. No single model suits all scenarios. Must improve. Not repeat failures. Dos and Don’ts. Design. Image overhaul. Clear shared vision for sector. Actions – government and sector. Strategic use of resources…

11. 11 Is there a future for specialist housing? Yes and its bigger than we think. Major projected growth in older households and particularly older single households (demand for one/two beds). Holmans research. Some areas have little supply. Housing with high levels of care from 450,000 places to around 1,130,000 in 2051 (151%). Are not seeing the predicted end of care homes and sheltered housing. Availability and economics of paying for high levels of care in mainstream housing vs care home? Projections of dementia x2.5, LLI, x2 Dis, housing stock, less people getting home care? ¼ of us projected to enter long term care (PSSRU) But it must change. We must not repeat mistakes. Must improve. Must be strategic.

12. 12 Evidence – despite growth building of retirement housing has slowed

13. 13 Location is the most important factor in the success of specialist housing. Even more important than model. (insert graph) Other valued factors (include amenities, security, specification, ownership and opportunities for social life). High levels of satisfaction with many models. However many fail to get basics right, such as location. Demand high. Outcomes evidence important but limited. Cost effectiveness evidence limited, but we do know that no single model is cost effective for all people. Evidence suggests need more choice and innovation. Use evidence of criteria and values people demand.

14. 14 There is little demand for poor specialist housing badly located. This is why we have hard to let stock. It is a myth that there is no demand for sheltered housing. Private sheltered housing is profitable because of clarity about the product and the local market. In the past we failed to ask basic questions about product and market and did not locate stock strategically. Push/pull factors: Local demand? Competition? Branding/marketing? location? Neighbours? Build specification? Size trading down from? Aesthetics? Inclusive design? Quiet? Secure? Tenure? Values? Communal facilities? Customers? Care? Integration with community? User tested? (Audit Comm/ Peter/ york/ gary etc).

15. 15 We need to smash the negative image of some specialist housing. Better information. Renewed focus on values, brand, promoting lifestyles and not housing of last resort. Learning from other sectors. What assumptions underlie our fears of specialist housing as a brand? Ageing, poor standards of care (Nolan et al., 1996a), lack of privacy, place to die, (Davies and Baines, 1994) lack of control, lack of respect (Biedenharn and Normoyle, 1991 )… One feature of this negative image is the way in which care homes are contrasted unfavourably with living at home (Oldman and Quilgars, 1999). First impressions count – Hospital, Hotel or home? Interviews have indicated that some resort to relatively superficial criteria, such as appearance or décor, to choose a home because they lack advice about what they should be looking for, 'I mainly went on how they looked from the outside.' (Nolan and Dellasega, 2000). Market research on aesthetics here. Décor, furnishings and the 'feel' of a home have also been identified in another study (Davies and Nolan, 2003).

16. 16 We must change flawed branding to reflect core values. Think what will people pay premium for? If Mercedes built specialist housing what would they look like? Most care homes and some sheltered housing brands are not very popular. Retirement housing brands are more popular. Hotel brands more so. Branding must reflect values - anti-ageing, improve your health, great staff who work for you, customer focus, good privacy, place to socialise, respect, social responsibility… Must change design and image to reflect values Aspirational, inclusive. Aesthetics do matter to people. Communal space to hotel standards. Personal space to luxury home standards. Lifetime Communities

17. 17 Radical overhaul of design – inclusive & aspirational

18. 18 a vision for specialist housing Vision for UK specialist housing to be leading the world, outcome focused and evidence based. Promote aspirational specialist housing. Not just for high dependency but for all. Promote private sector and private ownership. Pull factors increased. Better geographic locations (near friends, relatives, shops, services), amenities, security, excellent accommodation specification, wider tenure options and opportunities for social life, employment & learning. Guarantee ageing in place and long term security by inclusive design, ease of maintenance and options of full spectrum of care needs built in but with genuine choice & control. Evidence on philosophy valued by behind models is promotion of active ageing, quality of life, independence & inclusion. Tenure revolution of private ownership. Radical response? Key opportunities of local authorities assessing needs and stock.

19. 19 Local actions Managing stock Really understand supply demand Dos and Don’ts Capacity to repair and adapt Remodelling Sale of poor stock Provision of support services Joint working Third sector and private sector Planning for the future National Actions – national strategic approach, York research, tenure, new build and identify hard to let, kitemark, growth, planning, research/evidence, sites, LA partnership between housing and care, local housing strategies…? Regional Actions – ongoing work and support of the Housing LIN