housing vulnerable older people: lessons from europe and ... · flexible on site care and support,...

Housing vulnerable older people:

lessons from Europe and Australia

Perth, seminar 19. 5. 15

Professor Anthea Tinker, Institute of Gerontology, Department of

Social Science, Health and Medicine, King’s College London

[email protected]

Outline of presentation

1. A similar background of an ageing population

2. General lessons from Europe

3. Long term care: based on the research for the

Technology Strategy Board

a. The main study

b. The case study of the Netherlands

4. Lessons from Australia compared with Europe over

some issues including research on housing,

homelessness and supported housing

1. Background on an ageing population: growth

of percentages of old people (60+)

UK Europe Australia

2012 23 22 20

2050* 30 34 29

* Projected

Source: United Nations 2012

1. Background on an ageing population: growth

of percentages of very old people (80+as % of

those aged 60+)

2012 2050*

UK 21 30

Europe 20 28

Australia 20 29

* Projected

Source: UN Population Ageing 2012

2. General lessons from Europe The link between housing and health is increasingly being recognised.

WHO/Europe 2010 Housing and Health.

‘Housing conditions influence people's health in positive and negative

ways’ ‘In some countries, accidents in the home kill more people

than do road accidents. Poor design or construction of homes is the

cause of many of these accidents’. 6 prioritised areas were

addressed: thermal comfort and energy, housing and mental health,

the challenges of ageing populations, home safety and accidents,

indoor air quality, residential environments and physical activity’


More attention being paid to related issues such as the

environment such as:

‘An Age City Friendly City – how far has London come? ’

(Tinker and Ginn, 2015)

New Cross Council research project ‘Mobility, Mood and

Place’ (AT a PI). This explores how places can be

designed collaboratively to make mobility easy,

enjoyable and meaningful for older people. It builds on

evidence that how we experience environments

influences our mood and, in turn, our willingness to be

active.


Growing emphasis on housing as a crucial

ingredient in enabling older people to remain in

a home of their own:

- Research on staying at home options

- Research on extra care housing

3. Long term care: based on the research

for the Technology Strategy Board

The Technology Strategy Board have a

research programme ‘Assisted Living’ and

as part of this have developed an ambitious

programme called ‘Revolutionising Long

Term Care’. Our research was part of the

scoping for this initiative

Background

Our report was based on an analysis of the literature

and policy documents. As a result the

Netherlands was identified as having a similar

demographic profile to the UK and appeared to

have examples of care provision that the UK

could learn from. Concentrating on extra care

here but others include the use of technology

a. The main study: Methods

Desk based research or reports and peer

reviewed articles from the UK and

elsewhere (mainly Europe). Findings are

based on evaluated initiatives although

some other promising developments are

mentioned

The main study: Findings

The need to put older people at the heart of

provision (not just lip service) – older

people and their carers have clear views

about the type of services they want and

need. Central to this is the desire to remain

in a home of their own

The main study: Findings

The importance and key role of housing

Appropriate housing can have a preventive

role. Of key importance are home

modifications and research shows that

these are cost effective. Extra care housing

is especially valuable for frail older people

but some schemes are outdated.

3. Findings - Extra Care

Generally thought the UK leads the way

Early evaluations e.g. Tinker, 1989 showed that it was

popular with management, older people and staff but that

it was generally more expensive than staying at home

with an innovatory service although generally cheaper

than hospital or residential care.

Extra care housing is especially valuable for frail older people

but some schemes are outdated.


Recent evaluations (e.g. Netten et al, 2012) very positive but

important to note that less than 10% of older people live

in this form of housing.

Key findings were that ‘People had generally made a positive

choice to move into extra care housing , with high

expectations often focussed on an improved social life.

After they had moved in, most people reported a good

quality of life, enjoyed a good social life and valued the

social activities and events on offer’.


This study also found that the most important attractions of

extra care housing were having their own front door,

flexible on site care and support, security, accessible

living arrangements and bathrooms and the size of the

accommodation.


Recent research (Best and Porteus, 2012) suggests that it may

not be economic for all schemes to have a range of

communal facilities which may have to contract and on

site staff. They also put the case for the provision of 2

bedroom flats which might encourage older people to

downsize


Findings from across the world are tending to focus on small

clusters of housing with varying degrees of support. This

has a long history in Scandinavian countries. Some have

a proportion of the flats for people with high needs.

In Spain Barcelona has developed large blocks of purpose

built flats with telecare and round the clock staff

assistance

3.b. Findings - Extra Care (The

Netherlands)

In the Netherlands an initiative called ‘Appartments for life’

started in 1995 by the Humanitas Foundation and these

offer a wide choice of care. They can be bought or

rented.

3. Findings - Extra Care (The Netherlands)

Also in the Netherlands there is an emphasis on making

residential care homes more home like and in one there is

interaction with the neighbourhood including older

schoolchildren coming in after school to work with staff.

In Weidervogelhof there are a variety of buildings and

support allowing for transitions of care so that a greater

amount of support can be offered. For example a ‘care

hotel’ has 6 rooms for rehab and transitions

3. Findings - Extra Care (The Netherlands)

Also in the Netherlands is Hogeweyk village which is

designed for people with dementia. There are 7 different

‘homes within homes’ to reflect different lifestyles such

as for practicing Christians, former city dwellers, those

with a skilled trade etc.

3. Findings - Extra Care – conclusions

There is growing interest across the world in the use of extra

care housing for older people both at the end of life and with

dementia. The importance of training for staff is emphasised

and for commissioners of services to be aware of the pros and

cons of such schemes.

6.

4. Lessons from Australia compared with Europe

over some issues

a. Research on housing

b. Homelessness

c. Supported housing?

d. What else?

4. a Research on housing

A strong record in both countries especially over housing for

older people

4. b. Homelessness

Australia have a good record of research and

provision as assessed by some in the UK. See next

slides for a recent evaluation at King’s College

London

Maureen Crane, Louise Joly & Jill Manthorpe

Social Care Workforce Research Unit,

King’s College London

The Rebuilding Lives study:

Outcomes over five years for

homeless people who are

rehoused

Study’s aims

To examine the longer-term outcomes for

formerly homeless people who were

resettled

To identify the characteristics of those

who receive or need longer-term support

To explore the roles of different

practitioners in providing this support

Study design

Built on FOR-HOME study

Sample: 297 participants who were in

FOR-HOME study & housed at 18 months

Interviews with 224 participants

FIVE YEARS post-resettlement (26% 50+)

Interviews with workers providing

housing related support to participants

Characteristics of older participants

56 participants (51 men & 5 women)

41 people aged 50-59 years; 15 people aged 60+

53% mental health, 54% alcohol & 29% drug problems

18% literacy difficulties

44% homeless more than 5 years

28

The housing needs of older homeless people

Most older homeless people want permanent and stable accommodation.

Some are able to live independently; many require supported

accommodation that takes into account their particular needs (mental

health and alcohol problems).

The support needs of older homeless people can fluctuate once they are

rehoused. Some do not ask for help when experiencing difficulties and

become homeless again.

In England, only a few permanent housing projects for older homeless

people with complex needs. In USA and Australia, various types of

supported housing have been developed for older homeless people.

29

Changes in housing status

18% of older participants became homeless at some

time during the first five years after being resettled.

Some of these were rehoused again. Often related to

mental health and alcohol problems.

Many of the moves by older people were into more

supported accommodation or extra care housing.

30

Housing outcomes after 5 years

of older participants (n = 56)

Still in resettlement accommodation 36

In other accommodation 22

Homeless 9

Died 14

Left tenancy, whereabouts unknown 8

Unknown if in tenancy 11

Total % 100

31

In supported / extra care housing

Aged 50-59 Aged 60+

When resettled 6% 83%

After five years 32% 100%

Compared to the general population, the older

participants who moved to supported / extra care

housing were of a relatively young age.

32

Implications for practice

33

The need for support Planned resettlement for homeless people

works, but many are vulnerable when

rehoused and require long-term support

either regularly or at times of difficulties.

Current tenancy support services are

effectively targeting many with complex

needs.

Support services should also be offered to

young people and others who have little

experience of independent living.

Tackling financial problems More advice and coaching on managing

finances and avoiding debts should be

available to homeless people both before

and after they are resettled

Formerly homeless people should be

encouraged and assisted to access regular

jobs, rather than relying on casual work

4. d. What else?

Co-housing

Use of technology

Home modifications

Conclusions

- While Europe and Australia have much to learn

comparisons are difficult to make when many conditions are

different

- Research obviously helps but needs a robust methodology

- Visits can help to give a flavour of schemes and

developments but not a systematic picture

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