Practice Implications

A range of housing and support options

Evidence demonstrates that most older people would prefer to remain in their own homes, with the provision of more intensive domiciliary support as required. The housing needs of many in this study at the point of entry were, however, such that this was not an option, endorsing the need for the development of options responding to different needs and preferences.

Design Elements

Space and layout and provision for impairments are essential. There is potential to incorporate elements of assistive technology at the development stage and micro-design elements such as heating controls.

Divesity of provision

No single arrangement was shown to be superior in terms of its provision. Different arrangements impose various eligibility criteria to cater for different support requirements at entry, for a range of income levels, and for other elements of selection. Across the range of provision commissioners need to ensure that some providers will respond to the needs of potentially excluded groups such as those with mental health needs or those on low incomes. Long-term viability for people with dementia remains a challenge.

Ensuring individual needs are met

There was evidence that the wider support needs of some residents beyond immediate personal care could fall into a “service gap”. The principles of independent living for older people, which may require support to access social networks or community activities, need to be carefully reviewed and resources accessed. Volunteer involvement may be of value.

Community engagement

Care needs to be taken around strategies that position housing with support developments within wider plans for community engagement. For example in two schemes that acted as service hubs for wider community provision (eg social services day centre and home care team, NHS chiropody service) this impacted on perceptions of “home” and did not appear to promote significant community integration. Decisions to allow wider community use of residents’ facilities such as restaurants or swimming pools should be considered carefully as this was not always welcomed and raised concerns about security and inconvenience.

Exit criteria

Providers should be clear as to the extent to which they seek to respond to life-long needs or provide for a particular stage. Where the latter, clear criteria for moving on and information and support to enable this should be provided.

User involvement

Although some may welcome active involvement in the management of schemes, this study suggests that many are reluctant to become invovled in committees or formal mechanisms for resident consultation. Individuals express concerns about the time and energy invovled and about being constantly approached. A wider preference was for clear information, for easy access to repairs, and for a greater element of choice or control in respect of equipment in the house itself.