1. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Housing an ageing population with social care needs: investigating the role of extra care housing Jessica Watson, International Longevity Centre – UK International Federation on Ageing Conference May 30 2012

2. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. About ILC-UK  The International Longevity Centre-UK is the leading UK think tank on longevity and demographic change. It is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.  The ILC-UK is one of 14 partners in the International Longevity Centre Global Alliance. The alliance is a multinational research and educational consortium.

3. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Establishing the extra in Extra Care: Perspectives from three Extra Care Providers Available from www.ilcuk.org.uk

4. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Overview Housing context Introducing Extra Care Research Questions Data and Methods Results and conclusions from ILC-UK research Policy recommendations

5. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Housing: Lived in same house for 40+ years (17% 1993/4; 24% 2007/8) Rising levels of under occupancy? Rising levels of housing wealth?.....Rising inequality? (Older people still biggest consumers of social housing) Less retirement housing being constructed Health care: Compression of morbidity? (Zaninotto et al, 2010) Non communicable diseases (stroke, dementia) Social Care: Rising cost Rates of receipt of domiciliary care at home declining… Health, social care and housing among the ageing population

6. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. What is it? Little consensus…. Wide spectrum of self-designated extra care housing Some common principles of extra care housing:  Ergonomically designed  Flexible and continually adapting care packages delivered onsite  Communal facilities  Group activities  Independent homes within small-medium sized retirement communities  Usually age specific  Leasehold tenure as well as rental tenure  Community balance of care needs Extra care housing

7. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Extra care housing What do we know about extra care housing? What does extra care housing claim to do?

8. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Research Questions  1.What is the social profile of extra care housing residents and how does this compare with residents in the community setting?  2.Can extra care housing be considered a home for life for older people?  3.Does residence in extra care housing facilitate healthier and more independent life?  4.What impact does residence in extra care housing have on the uptake of overnight hospital beds?  5.What inferences can be made about the costs and benefits of extra care housing?

9. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Data and Methods  Data: Longitudinal data from 3 partners on almost 4,000 residents of extra care housing since 1995;  British Household Panel Survey; English Longitudinal Survey of Ageing; Survey of English Housing (descriptive)  Limitations/Challenges 1. Characteristics of residentsDescriptive analysis 2. Extra care housing as a home for life Event history analysis (Lognormal and Competing Risks); Propensity Score Matching 3. Extra care housing as a healthy home for life Event history analysis (Competing Risks); Propensity Score Matching 4. Extra care housing and hospital beds? Zero inflated negative binomial regression; Propensity Score Matching 5.N Inferences on the costs and benefits of extra care housing? Descriptive analysis

10. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.  Gender  Age  Living arrangements  Additional care needs  Health shocks that may predict entry to extra care housing:  Stroke  Dementia  Parkinson’s disease Characteristics of residents

11. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Characteristics of residents

12. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Extra care as a home for life I Length of time until exit (all exits) First quartile (25%)Median (50%) All residents3.16.5 Gender Male2.66.0 Female3.46.7

13. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Extra care as a home for life II: Competing Risks Framework Risk 1: moving to an institution Risk 2: death All residents8.2% (6.7-9.9)25.0% (22.4-27.5) Gender Male6.4% (4.3-9.1)30.6% (26.0-35.3) Female9.1% (7.2-11.3)22.0% (19.2-25.1) Health Status/Care Needs on Arrival No additional support package 5.5% (4.0-7.3)16.8% (14.2-19.6) Level 1 (very low package needs) 12.8% (6.8-20.8)29.6% (20.0-39.7) Level 2 (low support package) 17.5% (11.7-24.4)39.8% (31.6-47.6) Level 3 (moderate support package) 11.9% (5.2-21.5)41.0% (28.3-53,1) Level 4 & 5 (high or very high support package) 9.9% (4.9-17.1)56.9% (46.1-66.3) Age Group 50-646.8% (2.8-10.9)10.2% (5.8-16.3) 65-69 6.2% (3.1-11.0)13.0% (8.2-19.1) 70-74 6.0% (3.4-9.8)18.2% (13.3-23.7) 75-79 9.0% (5.8-13.0)24.6% (19.4-30.2) 80-84 8.0% (4.8-12.3)27.2% (21.3-33.5) 85+ 12.7% (8.5-17.7)49.0% (41.8-55.8) N 1,189

14. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Extra care as a home for life III All community match sampleDomiciliary care match sample Age 65+ Model 1 Age 75+ Model 2 Age 80+ Model 3 Age 65+ Model 4 Age 75+ Model 5 Age 80+ Model 6 Models adjusted for Age, Sex, Living Arrangements, Year Sub-hazard ratio of moving to an institution Extra care housing 1.7761.2160.9050.6940.532*0.316** (0.659)(0.471)(0.463)(0.207)(0.167)(0.121) N1714103462416301028634

15. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Extra care and inferences on costs  Social care costs (median community care package and extra care)

16. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Extra care and inferences on costs  Initial social care costs of extra care housing may be higher than if remaining in the community  But, because of higher probability of transition to institutional accommodation, long-term costs lower –Planning for retirement  Cost of lower rate of hospitalisation  Cost of reduction in social care package  Cost of falls

17. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Pressing need for development of older people’s retirement housing Extra care housing: 1.Supports some of the most vulnerable in society 2.Appears to be a home for life for the vast majority Compared to those with similar characteristics appears to be lower rate of transition to institution; plausible mechanism (age, living arrangements, gender, in receipt of care at home) 3. Associated with fewer inpatient stays 4. Associated with fewer falls 5. Is a healthy home for life Extra care not a panacea for all older people’s housing issues, but evidence suggests benefits for a sizable majority of residents Summary of conclusions

18. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Policy Recommendations I 1.Policy-makers need a co-ordinated response to providing housing, health care and social care for our ageing population. 2.Policy-makers should recognise and encourage private sector development of extra care housing. 3.Policy-makers should enhance and sustain programmes of education and information for those who are retired and newly retired to plan their housing and financial futures. Furthermore, consumers need reassurance that policy changes will not negatively impact their retirement decisions.

19. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Many thanks

20. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Copies of the report available: www.ilcuk.org.uk International Longevity Centre - UK dylankneale@ilcuk.org.uk or jessica.watson@ilcuk.org.uk Twitter: @ilcuk Many thanks