Extra Care and older people: Jill Manthorpe reviews two pieces of research

THE RESEARCH: 

Title: Remodelling sheltered housing and residential care homes to extra care housing: advice to housing and care providers
Authors: Anthea Tinker, Julienne Hanson, Fay Wright, Ruth Mayagoitia, Hedieh Wojgani, Alan Holmans
Publisher: Institute of Gerontology, King’s College London, 2007
Available: aciog@kcl.ac.uk

Title: Social well-being in extra care housing
Authors: Simon Evans and Sarah Vallelly
Publisher: Joseph Rowntree Foundation, 2007
Available at: www.jrf.org.uk/bookshop

OBJECTIVES

These two studies provide information about two important areas of policy and service development for older people in the main. The first report contains advice to planners and funders of existing housing schemes who may be considering the future of their services and housing stock. The second report looks at the social well-being of older people living in extra care housing with the aim of ensuring that designers and managers of extra care schemes take well-being into account as well as “bricks and mortar” or care-oriented features of extra care housing.

FINDINGS

The Remodelling Sheltered Housing and Residential Care Homes to Extra Care Housing research took place during 2005-7 in 10 case study areas. Its key findings are that the option of remodelling sheltered housing or care homes needs to be carefully considered and is not easy. It may be attractive and may seem to provide the solution to several problems. It links to government objectives of promoting choice and independence, but it is not without its own challenges. This summary from the study identifies some of the social and architectural problems that may emerge during remodelling by analysing the views of those who had been involved in the process, from existing tenants to staff, and architects and scheme managers.

Remodelling seemed fraught with problems that were unseen. Costings were generally much higher than envisaged and some schemes did not appear to meet the space standards and design quality that new build homes have to meet. This may mean that today’s problems of not being popular with older people or suitable for increasing disability are not resolved by remodelling. No matter how good the remodelling, it will not turn an inaccessible or unpopular location into a desirable one.

Thought also needs to be given to residents’ or tenants’ safety and security, both while the upheavals of remodelling are going on but also afterwards. Schemes should be “future-proofed” and the researchers suggest that it might be worth waiting for the next generation of telecare systems that will be wireless and that designers should give greater thought to systems that are increasingly used by people in their own homes. They caution that all such technology needs to have staff who are willing to work with it.

The decision to remodel a care home or sheltered housing needs a full cost-benefit analysis. This needs to consider what demand might be now and in the future, and the capacity for any remodelled schemes to have economies of scale that will justify the range of facilities that are valued by tenants. Any remodelling should have a 30-year life expectancy, taking into account the repairs and renewals that are likely to arise.

The importance of many of these matters arose in the interviews with tenants of existing extra care housing in Evans and Vallelly’s Social Well-being in Extra Care Housing study. While most tenants were satisfied with their homes and care, there was a minority who was at risk of social exclusion, particularly people who had mobility problems and impaired cognition, such as confusion or dementia. Others who sometimes found extra care not so supportive were newcomers to schemes, and people who did not have strong support from their family or friends. They may particularly benefit from organised activities and care over the design of extra care schemes so that social interaction is easy and natural.

Extra-care schemes are also able to pay attention to building design matters that also impact on tenants who are frail. These include making arrangements for people’s mobility aids and equipment, such as walking frames and electric scooters. Guest rooms for visitors can be important in enabling tenants to maintain links with family and friends. Facilities in a scheme that attract other local residents can also encourage social links. But tenants value getting out and about, so local public transport and specialist transport are important considerations for any extra care provider. This may be particularly so in isolated and rural areas. Schemes may have to fund-raise to provide a good range of activities and external visits.

Evans and Vallelly recommend that a personal profile should be developed for each tenant but found that referral forms and care plans did not often provide comprehensive information about current or new tenants and few had been written in conjunction with older people, their family or referring agencies. Once resident, they suggest that each tenant has a key worker, as this is likely to reduce the risk of social isolation. Expectations about the role of staff to help tenants may vary between providers of extra care and so their role needs to be made explicit in the contract between the provider and the prospective tenant. What is paid for and what is provided can vary between schemes.

Both reports are written for people who are faced with decisions about housing and care services. They are good examples of research that has its stakeholders’ needs in mind, and material is clearly presented and relates to practice and policy. While both focus on older people’s well-being, the researchers look at wider constituencies, including the staff who work in extra care, and families and supporters of older tenants who play important roles.

CONCLUSIONS

Those planning remodelling changes should learn from the lessons of the early pioneers. The area of extra care is rapidly changing and anyone considering its development should ensure they are up to date with good practice, developments in assistive technology and information technology, as well as rising expectations among older people. Besides current or potential tenants and purchasers, extra care schemes need to take a realistic view of the local context. The location of a scheme seems to be vitally important, and this will affect demand and community use of the resource.

It may be surprising that this study of remodelling is cautious about the social impact of doing this as well as the economics. Both areas need to be considered since remodelling results in a lot of upheaval and may affect relationships between current tenants or residents and newcomers. On both counts, the option of remodelling people’s own homes might be worth considering. Living in one’s own home is what many older people want, especially if it can meet their needs better. Any commitment to the great costs of remodelling should not be undertaken without a careful analysis of other options. This also applies to taking a good look at what is meant by sheltered housing, since, despite its popularity in policy circles, it can have a range of definitions and there may not be agreement about what it will provide or resolve.

Nonetheless, as the research project undertaken by Evans and Vallelly shows, extra care housing has the potential to fulfil many policy objectives at central government and local levels. As well as being able to support older people as owners or tenants, it can play an important part in the wider community. Their study interviewed 30 frail older people living in six extra care housing schemes and six managers. The schemes were selected as being examples of extra care schemes that were thought to be good practice examples of promoting well-being among the tenants. Factors that seemed to promote well-being included: friendship and social interaction, the involvement of family members, engagement with the wider community, having good facilities on-site (such as a shop, restaurant, communal areas, gardens and beauty salons), design and location, and the culture of care and support provided by staff.

Most older people were very satisfied with their well-being and overall quality of life. This seemed to relate to the factors above. This is an important addition to the evidence base for extra care housing, but more needs to be known about care provision, what couples need, gender issues, and specific facilities. Social well-being should also be flagged up when commissioning extra care housing, as well as being central to more long-term quality assurance processes.

Jill Manthorpe is professor of social work and director of the Social Care Workforce Research Unit, King’s College London

This article appeared in the 10 January issue under the headline “Extra-care and older people”