Specialist Housing Research Articles

Advantages and challenges of extra care housing in the UK for people living with dementia: a scoping review

PurposeThe purpose of this paper is to report on a scoping review of the advantages and challenges of extra care housing (ECH) provision in the UK for people living with dementia. Access to suitable housing is a fundamental right for people living with dementia and can enable people to live as well as possible (Twyford and Porteus, 2021). Understanding the advantages and disadvantages of different models of housing with care has been identified as a research priority by people living with dementia (Barrett et al., 2016) but “there is no current consensus on the best model of specialist housing for people with dementia” (Twyford and Porteus, 2021, p. 29).Design/methodology/approachThis scoping review identifies the advantages and disadvantages of living in ECH for people with dementia. It is the preliminary stage of a study that seeks to develop knowledge about different models of ECH for people living with dementia (Atkinson et al., 2021).FindingsAdvantages include the promotion of independence, flexible staffing, safety and security, social inclusion, physical design and integrated service provision. Disadvantages include barriers to entry, tensions between independence and support, managing advanced dementia, resourcing flexible care, managing social exclusion, loneliness and stigma and a disabling environment.Research limitations/implicationsThe scoping review reinforces the need for further research into different models of ECH provision in the UK for people living with dementia. The review provides insight that is of benefit to all stakeholders involved in ECH and contributes to the development of evidence-based provision called for in the recent All Party Parliamentary Group inquiry (Twyford and Porteus, 2021).Originality/valueThis scoping review summarises the current position for people living with dementia in ECH.

Factors influencing care and support for older adults with traumatic injury in Australia: a qualitative study

Purpose To investigate factors influencing provision of care and support to older adults with traumatic injury in Australia, from a health service and policy perspective. Methods Semi-structured interviews were undertaken with 16 clinicians, support providers, researchers, policy makers, and representatives from peak bodies in Australia, who had experience across injury, ageing, and disability sectors. A thematic analysis was performed using a framework approach. Results Themes identified included prolonged injury recovery in older adults, limited accommodation options, restricted access to preventive care, escalating care needs over time, issues with siloed funding schemes and funding availability, and the need for advocacy to coordinate care across different schemes. Certain themes were specific to people who were older when injured. Others related to people who had acquired an injury at a younger age and were ageing with injury. However, most themes had relevance for both groups. Conclusions For older adults, this research has highlighted a range of cross-sector problems which impact upon the potential to recover from injury and to age well with injury. To improve the lives of older adults with injuries, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors, and improved advocacy and case management. Implications for rehabilitation To address the lack of long-term, multi-disciplinary preventive care for age-related conditions and secondary complications in people with injuries, older adults may need more prolonged, or individualised, care following injury, episodic health checks, and a greater focus on long-term health care. Accessible and well-coordinated specialist housing and support responses, that offer timely access to health care professionals and carers trained in both ageing and disability, and enable greater support for “ageing in place”, are required to manage changing care needs of people ageing with injury. There needs to be greater involvement of geriatricians, nurses, and allied health care professionals within the aged care sector in order to care for people with complex needs, including older adults with injury-related disability. To reduce gaps in care and support for injured older adults, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors.

Specialist housing for older people in an era of neoliberal transformation: exploring provision in England

Specialist housing for older people is an important welfare service and integral part of the housing offer in many countries. An extensive evidence base details the relative merits of different modes of provision, but little light has been cast on the forces shaping provision and the interests served. Drawing on a new model of demand and supply of specialist provision in England at the local authority level, this study addresses this lacuna. Two key contributions are made to knowledge and understanding. First, the uneven landscape of specialist housing provision is charted and the extent to which this maps onto need is revealed. Second, this condition is explained by situating specialist housing within wider debates about the reimagining of housing systems driven by the neoliberal transformation of housing politics, and recognising that these processes can have uneven effects embedded in the nature of places.

Third sector housing in 21st-century Hong Kong: opportunities and challenges

Hong Kong has a large public housing sector that shows strong resilience. Given the approximate half–half public–private housing divide in Hong Kong, officials, housing advocates and the general public envisage housing provision, problems and remedies within the ‘rigid’ framework of private and public housing. Social innovation examples of third sector housing as start-ups in ‘social housing’ have emerged in the early 21st century in Hong Kong, thereby forming a ‘new’ model in housing delivery amidst the public–private binary housing market. This study focuses on the gap filled by third sector housing in Hong Kong through serving as a complement to the private and public housing sectors in meeting unsatisfied general housing needs and as a supplement to both sectors in catering for neglected specialist housing needs. The exact future trajectory of third sector housing development will highly depend on the synergy of different stakeholders in public, private and third sectors as well as the common citizens in its nurturance.

Unpicking the downsizing discourse: understanding the housing moves made by older people in England

The UK’s ageing population has generated contradictory policy responses. On the one hand, facing the lack of specialist housing for the elderly, older people are incentivised to ‘age in place’; on the other, to move to smaller homes to free-up family housing, reducing pressure on housing supply. This ‘downsizing’ discourse is presented as a ‘win-win’ situation which benefits older people and the rest of society. However, a survey and interviews conducted with over 55 s in England reveals more nuanced patterns of residential moves, behaviours and aspirations than suggested by ‘downsizing’. Only a minority of older households choose to downsize. This paper looks into this mismatch between observed housing choices and the construction of downsizing as a policy goal. It suggests that theoretically speaking, the very notion of downsizing is problematic and difficult to define and is an over-simplistic concept which in reality applies to a heterogeneous group of people.

‘It Can’t Really be Answered in an Information Pack…’: A Realist Evaluation of a Telephone Housing Options Service for Older People

Despite calls for better support to empower people when reassessing their housing in later life, two recent literature reviews highlight a paucity of research on the efficacy of such services. This article reports a qualitative realist evaluation on the efficacy of a UK telephone service providing information on specialist housing to older people. The findings of thirty-one realist interviews with sixteen older people are presented. Information-seekers’ existing tenure (social tenant or private owner-occupier/renter) shaped their experience and utilisation of support. Broadly, however, information was considered too ‘light touch’ to empower older people. However, the widely recognised lack of accessible housing options and reports of non-transparent and unresponsive market practices were also key factors. This study underlines the widely acknowledged need to increase the supply of specialist housing, and recommends that housing options support be reflective of market conditions and be more substantive – including discussion, deliberation, education and advocacy.

Bridging the gap between the home and the hospital: a qualitative study of partnership working across housing, health and social care

ABSTRACT Rising demand and financial challenges facing public services have increased the impetus for greater integration across housing, health and social care. To provide insight into the benefits and challenges of partnership, we interviewed 37 housing professionals and held a validation workshop with eight external agencies working within a new, integrated housing service in the United Kingdom. The strength of the initiative rests on the capacity of neighborhood officers to conduct home visits and refer tenants to support agencies. Yet this strength poses problems in partnership building because increased referrals threaten to overwhelm already stretched health services. Despite broadly supporting the initiative, officers expressed concern over losing specialist housing knowledge whilst filling in gaps for services. Tensions over professional role boundaries between officers and social workers, poor communication, lack of capacity in external agencies and difficulties in sharing information were identified as barriers to partnership. Whilst capacity issues were acknowledged, partner agencies welcomed the initiative and called for joint meetings and colocation of services. Lack of capacity of external agencies to respond to referrals threatens integrated housing and health initiatives. Greater interprofessional collaboration and further investment across the system is required to increase capacity and ensure referrals are translated into healthcare outcomes.

Housing options for older people in a reimagined housing system: a case study from England

The housing options of older people now extend far beyond the traditional choice between staying put and making do, or moving to specialist housing or residential care. A flexible suite of options has emerged, centred on promoting independence and well-being. Valuable insights have been provided into the development, delivery, costs and benefits of these options. Light has also been cast on the experiences and preferences of older people. However, little is known about who gets what housing, where and why. This reflects a tendency within analysis to consider these different housing options in isolation. This study responds by situating the housing options of older people within wider debates about the reimagining of the housing system driven by the neoliberal transformation in housing politics. Taking a case study approach, it explores the gap between the ambitions of policy and realities of provision at the local level, relates this to the particular intersection of state practices and market mechanisms manifest within the case study and, in doing so, rises to the challenge of extending analysis of the impacts of the neoliberal approach on the right to housing to new groups and different settings.

Housing options for the future: Older people's preferences and views on villages with care and support.

A growing older population worldwide means there is a need to ensure there are sufficient housing options to meet a broad spectrum of need and aspiration. There is little understanding of the relative importance of the "pull factors" that might attract older people to relocate to a new environment. Older people's views of the relative level of attractiveness of potential features of a specialist housing development offering care and support were investigated using Q methodology. Forty-one participants aged 53-89 living in a locality in Northern England rank-ordered 70 statements from April to August 2016. The analysis revealed four viewpoints: adaptation and care seekers, comprising prioritisation of care provision, specialist accommodation and accessibility; care-indifferent luxurians, which encompasses attraction to some "luxury" features and less emphasis on care provision; connected separatists, emphasising a distinct environment with good public transport connections; and independent engagers, comprising attraction towards social opportunities and remaining independent. Broad agreement was found on some topics, such as the generally high prioritisation of safety and security. The research provides a deeper understanding of differences in views towards housing options among older people which developers, planners and funders will need to recognise. While providing high-quality care may be a key objective for some organisations, this may not be the most important concern for some older people contemplating relocation, with many other features considered more attractive.

Challenging times: building a health, housing and social care local workforce strategy

Purpose The purpose of this paper is to stimulate a wider debate around the coordination of workforce planning in non-statutory services (in this case, specialist housing for older people or those with long-term health and social care needs, such as learning disabilities). The authors argue that current NHS reforms do not go far enough in that they fail to include specialist housing and its workforce in integration, and by doing so, will be unable to optimise the potential efficiencies and streamlining of service delivery to this group. Design/methodology/approach The paper used exploratory study using existing research and data, enhanced by documentary analysis from industry bodies, regulators and policy think tanks. Findings That to achieve the greatest operational and fiscal impact upon the health care services, priority must be given to improving the efficiency and coordination of services to older people and those requiring nursing homes or registered care across the public and third sectors through the integration of service delivery and workforce planning. Research limitations/implications Whilst generalisable and achievable, the model proposed within the paper cannot be fully tested theoretically and requires further testing the in real health and social care market to evidence its practicality, improved quality of care and financial benefits. Originality/value The paper highlights some potential limitations to the current NHS reforms: by integrating non-statutory services, planned efficiency savings may be optimised and service delivery improved.

Empowering local government or just passing the austerity buck? The changing balance of central and local government in welfare provision in England 2008–2015

ABSTRACTThis paper asks two questions: first, how did the balance of decision-making between central and local government in welfare policy in England change between 2010 and 2015? Second, to what extent has that led to divergence in the extent and manner of such provision? It finds significant areas of policy where local flexibility has been increased (such as council tax benefit, crisis loans, and funding for specialist housing), either through a change in the tier of government responsible, or ‘unringfencing’ of grants allowing local authorities greater discretion in whether to deliver particular services, although in other important areas decisions on welfare remain firmly centralized. It also concludes that in areas where responsibility has been localized, divergence has been immediate and substantial. Localization may well reduce entitlements where local authorities enjoy a financial reward for so doing and political costs are low.

An Urban Partnership for Inner Sydney Social Inclusion, Health and Well-being

Inner City Sydney, the catchment area of St Vincent's Health Networks (SVHN) Inner City Health Programme, is populated by people who represent the highest and lowest social deciles in Australia. In common with other inner city environments around the world, the latter are characterised by high levels of homelessness, addictions and mental illness. Challenges for health and social services to coordinate care and meet the needs of vulnerable people of this demographic is complicated by surges of population relating to the central business district, tourists, backpackers, thrill seekers and those with nefarious intent. The catchment area is well served by a number of excellent general practices and non-government organisations. However as a result of the interweaving psychosocial factors and a lack of formal service coordination between community managed organisations and SVHNs Specialist Services, Housing and Family and Community Services, the SVHN Emergency Department has the highest number of mental health and drug and alcohol presentations, the highest throughput of patients through the lowest number of mental health beds and the lowest average length of stay in the state of New South Wales. Given these presentations are increasing at between 2-4% per year and the health and social care resource base is being reduced, a situation is evolving which is unsustainable in terms of consumer safety and quality of life. To address these issues an initiative to establish an integrated care network, the Inner Sydney Urban Partnership for Health and Well-being (UP) is being developed to jointly assess need, plan and integrate service delivery (especially physical health with psychosocial care), share and increase the resource base, research and evaluate developments and promote person centred, recovery oriented care. The process and challenges of developing the Partnership is described and explored referencing the engagement of providers, consumers and carers, a radical vision for transforming the ethos and practical realities of the existing system, the contextual challenges extant in Australia's and NSW policy and funding framework (including the Roadmap for Mental Health Reform, National Disability Insurance Scheme and Activity Based Funding) and progress made to date with developments. Finally consideration is given to how the Urban Partnership is positioned with regard to other international integrated care initiatives and the 4th wave of deinstitutionalisation.

Designing for an imagined user: Provision for thermal comfort in energy-efficient extra-care housing

Regarded as one solution to the problem of how to enable older people to retain their independence, extra-care housing, where each resident has their own self-contained dwelling and access to communal facilities and to care, has received extensive funding in recent years. Implicit in the concept of specialist housing is the notion of ‘special’ occupants, imagined older people. Adopting a socio-technical approach, this paper considers how ideas about ageing inform those aspects of extra-care-housing-design that relate to thermal comfort. The paper draws on semi-structured interviews with 13 people involved in the design, development and management of UK-based extra-care housing. Participants characterised imagined occupants as vulnerable to cold, at risk from fuel poverty and liable to be burned by hot surfaces or fall from high windows. These user representations were reportedly inscribed into the design of extra-care housing schemes through the inclusion of building features such as communal heating, under-floor heating, restricted window opening and heated corridors. The utilisation of stereotypical user representations of older people raises questions, given that older people's thermal comfort needs can be highly diverse. The paper explores the implications for energy demand.

An evaluation of the effect of housing provision on re‐offending

PurposeEstablished in 2007, Vision Housing is a small London‐based specialist housing provider working primarily with ex‐offenders. This study seeks to evaluate the impact of Vision Housing's provision of housing and support on re‐offending rates.Design/methodology/approachThe evaluation design compared expected re‐offending rates after one year calculated using offender group reconviction scale (OGRS3) with actual reoffending rates after one year based on data from the police national computer (PNC). “Re‐offending” was defined in line with the current Ministry of Justice definition based on “proven re‐offending”.FindingsThe predicted rate of proven re‐offending for 400 clients referred to Vision over 12 months was 40.7 per cent. Their actual proven re‐offending rate over 12 months was 37.0 per cent. This is 3.7 percentage points less than the predicted proven re‐offending rate, equivalent to a 9.1 per cent reduction in proven re‐offending. This result was statistically significant. Analysis also suggested that Vision Housing is more successful with women; offenders under the age of 35; offenders referred by the Prison and Probation Service; offenders with a higher predicted risk of proven re‐offending; and offenders who had committed more serious offences.Research limitations/implicationsThe evaluation conducted to date does not include a comparison group and therefore has relatively low levels of internal validity.Practical implicationsThe authors are not aware of any UK studies of the impact of housing on re‐offending that have successfully used a more methodologically robust evaluation design. Until such studies are carried out, the results of the current study should be of great interest to policy‐makers and those delivering rehabilitative services to ex‐offenders in partnership with third sector organisations.Originality/valueThis study has produced evidence of the impact of housing on recidivism and quantified that impact.

Introducing Daily Living Products to Older People with Sight Loss: Practice Implications of an Innovative Demonstration Programme

This article describes an assistive technology demonstration programme for older people with sight loss and their support workers. Ninety-four participants across four specialist housing schemes and one resource centre attended demonstration sessions, co-led by occupational therapists and lead staff. Twenty-eight daily living devices were demonstrated and discussed. A review revealed that although participants had some knowledge of generic and low vision devices, they valued the opportunity to learn more about technological solutions to routine difficulties. Implications for practice are considered and suggestions made as to how occupational therapists may facilitate appropriate awareness of, and access to, daily living devices.

Choice and control in specialist housing: starting conversations between commissioners and providers

In July 2007, Housing 21 began an exploration of how changes to the system of social care called personalisation might impact on specialist housing provision in England. Personalisation now forms the basis of English social care policy focusing the delivery of public services on what people might want or choose, in the context of eligibility criteria and means testing. It is designed to promote greater choice and control of the support that people receive.However, there have been concerns that the views of older people living in extra care housing settings have not been heard in the implementation of personalisation. In 2008‐09 Housing 21 engaged older people and other groups with an interest in sheltered and extra care housing to debate the implications of personalisation for current and future housing, care and support services. This article discusses what arose from this consultation and its relevance to housing providers and commissioners.

The delivery of end-of-life care within extra-care housing

This article explores the means by which the end-of-life care (EoLC) provided for people living in extra-care housing may be improved. Extra-care housing is a form of specialist housing that enhances people’s ability to remain self-caring by providing access to services that promote independent living. With the expansion of the extra-care housing sector, the NHS National End of Life Care Programme and Housing 21 felt it was important to investigate EoLC in extra-care housing schemes. Staff and tenants from three Housing 21 extra-care schemes were consulted regarding current practice in the planning and delivery of EoLC and their experiences of local NHS services. The resulting report, Is it That Time Already? Extra Care Housing at the End of Life: A Policy-into-Practice Evaluation, summarised in this article, calls on health and social care workers to cooperate with housing schemes to improve understanding and support of each other’s work, in order to enable tenants to die at home if that is what they desire. Conflicts of interest: The employing organisations of both authors were involved in this project and the resulting report

Older patients with chronic heart failure within Swedish community health care: a record review of nursing assessments and interventions.

Nursing records can provide a valuable source of information for the researcher. In this study, community nursing records for two periods of two years were reviewed retrospectively in order to locate and analyse statements relating to the monitoring of patients with chronic heart failure. The older people being studied were drawn from nursing homes, specialist housing for older people, and those living in their own homes. The total number of records included in the sample was 161, and appropriate instruments were used to collect the data in a systematic manner. However, the records were found to be largely ordered in a chronological sequence, and written in a narrative form, but without a shared format or structure. Drug administration was the most commonly recorded nursing intervention, while only 12 per cent of records indicated that patients were being weighed, and 3 per cent recorded health promotion activities.

Social work and older people with dementia: Meeting their housing needs

This paper looks at the potential contribution of both home improvement agencies (HIAs) and assistive technology to social work with older people with dementia. It presents some of the main findings of research funded by the Nuffield Foundation on how HIAs are helping to meet both the home improvement and home adaptations needs of such people. Two case studies are presented of such work in practice as well as a third example which looks at the potential role of assistive technology. It is argued that social workers have much to gain through working closely with such specialist housing agencies and that this is most likely to happen if staff'on the ground' map the availability of such support in their locality.

Extra care: Assessing the need and location

The two previous articles set out a typology of extra care housing and support for older people, and outlined funding. The last in the series describes how to decide if a frail elderly scheme is required, what model is most needed and in which location.The process of reaching a decision on the need for some form of extra care provision is essentially, first, an analysis of the supply of specialist housing and support provision and services, and second, an assessment of demand and trends for these services in a defined locality.