Elixir of life

    Miriam Bernard is professor of social gerontology and
    director of postgraduate studies at the School of Social Relations,
    Keele University. For the past 20 years, her research interests
    have mainly been in developing new and healthy lifestyles in later
    life, and she has a long-standing interest in women’s lives as they
    age. 

    Retirement communities are increasingly promoted as a positive
    alternative to traditional forms of residential and nursing home
    care and the Supporting People programme regards them as suitable
    for fit and frail older people. However, although the number of
    British retirement communities is growing, we know comparatively
    little about how they function.

    Between 2000 and 2003, a team at Keele University explored what
    it was like to live and work in the new Berryhill Retirement
    Village in Stoke on Trent.(1)  A multi-method, participatory action
    research approach was adopted in which the close involvement of
    participants was key.

    The village is in a working-class area that is below the
    national average for health and well-being. The building has 148
    rented flats along a series of internal “streets”. Residents either
    live independently or receive one of four levels of support, which
    stop short of full-time nursing care. There is a social club,
    activities, a range of on-site facilities, monthly street meetings,
    a monthly village news-sheet and an in-house television service.
    Residents also volunteer their services in various roles within and
    beyond the village.

    At the start of the study, the village accommodated 159 people
    older than 55. The population was all white and women outnumbered
    men by two to one. Eight in 10 women lived alone, three in five
    were widowed and one in four were married. Half the men were
    married or cohabiting and half were widowed and living alone. Nine
    in 10 respondents had left school at or before they were 15.
    Three-quarters had been employed in manual occupations. Staff work
    variable hours but cover the village 24 hours a day, 365 days a
    year. A key worker system operates for all residents.

    Concerns about one’s own or one’s partner’s health were the main
    reasons for moving to Berryhill. Three out of four residents had a
    limiting long-standing illness but they functioned better
    physically than their peers with such a condition outside the
    village. And levels of functioning were maintained over the study
    period. More respondents expected their physical, rather than their
    mental health to worsen, and one in five was worried that their
    health might affect whether the village would be a home for
    life.

    Residents spoke positively about opportunities for maintaining
    health within the village, but those with significant physical or
    mental health problems felt they were more limited. About one-third
    of residents receive support and most rate it very highly. Nine in
    10 respondents were confident that support would be available at
    Berryhill if they needed it, but some expressed concern over its
    affordability both now and in the future.

    Opportunities for participation and involvement were key to
    developing a new kind of lifestyle at the village. For women in
    particular, and for people who needed staff support to attend
    activities, the safety and security offered by having them on-site
    was particularly valued. Keeping fit was the most important
    activity and organised trips were popular. Volunteering played a
    big part in village life and regular street meetings offered
    opportunities for involvement in decision-making, which helped
    improve self-esteem and self-confidence.

    Residents said they felt younger inside and thought they looked
    younger. There were no differences on this between men and women,
    and physical appearance and the use of aids such as wheelchairs
    were often poor indicators of how people felt on the inside.

    The mixing of generations could lead to tensions around, for
    example, different tastes in music. There were also fears about how
    the outside world saw Berryhill. Some stakeholders viewed it as
    exclusively for “old” people or for those who had “given up” and
    could no longer cope. But family and professionals perceived it as
    a safe environment and remarked on how residents seemed to have a
    greater sense of self-confidence.

    The study suggests that retirement communities do not have to be
    planned and developed just with middle class professional retired
    people in mind. But we highlight a number of challenges.
    First, the word “retirement” sits uneasily with an ethos of active
    participation. Residents pointed out that using the phrase
    “retirement community” or “retirement village” often meant that
    they and their families had certain expectations of Berryhill: that
    people would be “looked after” as if they were in a retirement
    home. It can also affect the perceptions of people outside who may
    see these communities as places for (frail) old people.

    Second, with an age span of 40 years, what most seems to
    characterise these developments is the diversity of the people who
    are attracted to live there. Three factors are important: the
    different age groups and generations within such a community; the
    gender dimension whereby women’s needs seem to be well catered for
    in contrast to older men’s needs; and the spectrum of “wellness”
    that exists and how this is viewed and handled by residents
    themselves, staff and helping professionals. Developers,
    policymakers and practitioners need to embrace a more nuanced
    approach that takes account of people’s histories, personalities
    and expectations.

    Third, although Berryhill staff (except the newest recruits) are
    trained to NVQ Level 2 as a minimum, staff in similar environments
    are often not especially well qualified or well trained. Our study
    reinforced the need for training and support, including about how
    one relates to older people, communication and information-giving
    skills. Dealing with mental health needs, death and bereavement,
    group motivation and facilitation skills, and conflict management
    techniques were also identified. If they are to work, retirement
    communities require a considerable investment in training and staff
    time beyond the instrumental, task-oriented activities of their
    daily jobs.

    Finally, a particular challenge is to articulate the extent to
    which such communities should encourage people to join them; and
    how far they should be self-contained and security conscious.
    Although residents at Berryhill were keen to maintain links with
    family and friends, at the same time they emphasised how living in
    such an environment was important in lifting the emotional and
    physical burden from families.

    This study suggests that retirement communities can provide
    environments in which to age well and develop a new lifestyle. Yet
    there remain many challenges to all involved: to residents
    themselves, whose values, attitudes and beliefs can lead to
    tensions; to staff, who may struggle to respond to the changing
    needs of the individual and the community as a whole; to developers
    and managers, who have to balance the benefits of increased
    facilities and activities offered through larger communities with
    the needs of more vulnerable individuals; and, of course, to
    policymakers, who must judge how best to incorporate such
    developments into strategies that promote health and well-being in
    older age.

    Abstract:

    This article reports on the findings of a three-year
    participatory action research study exploring what it was like to
    live and work in the Berryhill Retirement Village in Stoke on
    Trent, which was developed by The ExtraCare Charitable Trust and
    Touchstone Housing Association. Funded by the Community Fund (now
    the Big Lottery Fund), the study suggests that Berryhill works well
    for many. However, there were persistent challenges for all
    involved.

    Reference:

    (1) Miriam Bernard, Bernadette Bartlam, Simon
    Biggs and Julius Sim, New Lifestyles in Old Age: Health, Identity
    and Well-being in Berryhill Retirement Village, The Policy Press,
    2004, price £14.99, ISBN 1 86134620 4. E-mail: direct.orders@marston.co.uk

    Further Reading:

    • K Croucher, N Please and M Bevan, Living at Hartrigg Oaks:
      Residents’ Views of the UK’s First Continuing Care Retirement
      Community, Joseph Rowntree Foundation, 2003.
    • Office of the Deputy Prime Minister, Supporting People, ODPM,
      2003.
    • S Peace and C Holland (eds), Inclusive Housing in an Ageing
      Society: Innovative Approaches, The Policy Press, 2001.
    • K Sumner (ed), Our Homes, Our Lives: Choice in Later Life
      Living Arrangements, Centre for Policy on Ageing, 2002.

    contact the author:

    m.bernard@appsoc.keele.ac.uk

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