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Better together: Working to deliver housing to meet care needs

The Social Care Institute for Excellence (SCIE) is leading a new commission to develop an evidence-based vision and roadmap for housing in the future of care and support. Here, Kathryn Smith, CEO of SCIE, delves into some of the gaps surrounding housing provision and shares case study examples of best practice.

In a way, our latest discussion paper is a ‘housing report about older people’.

However, I want to stress that the message we’re conveying is that the communities where people live don’t always provide the choice and availability for people who need to draw on care and support services. You see, if you call it merely a ‘housing report’, then people are likely to conclude that it’s all about care homes.

Clearly care homes are an important part of the care system; but they’re not the only aspect. So, our report highlights that in many communities across England, there are a limited range of places that older people can live which provide access to the care and support they need, when they need it; places which suit people who can no longer live at home and who want and need a more supportive environment.

A place called home

There are so many places where older people may choose to live. It could be a care home, or a retirement community, supported living, or retirement housing. But there is all too often little information and limited choice and availability.

And it gets worse: there’s a big imbalance when it comes to supply and demand. There aren’t enough supported living homes and Shared Lives placements for example (Shared Lives is a care and support service for adults who want to live independently in their community, with the support of a family and community network). There are only 70,000 extra care units in England and we need at least 260,000 retirement community units to be developed by 2029.

One of our Commission members, the Associated Retirement Community Operators (ARCO), for example, has identified a significant ‘provision gap’ and has called for an increase in the level of provision of retirement communities. Also called ‘Extra Care’, these have been shown to be especially effective at supporting people with intermediate care needs.

So, now is the time to sort this out. Getting this right is critical. The Association of Directors of Adult Social Services said, ‘Every decision about care is a decision about housing’. We at the Social Care Institute for Excellence are leading on a Commission on the Role of Housing in the Future of Care and Support. We have recently published an early discussion paper. The Commission is listening to a wide range of views and is building a roadmap for the sector, to ensure more older adults have choice and control in accessing forms of housing that support their needs and at the time they need it.

Shared decision-making

Involving people in decisions about their housing should be part of wider conversations. This has been a clear priority identified by all groups involved in the discussions so far. The need for this co-production means we must see greater levels of involvement of people in the commissioning, planning and design of new housing developments; as well as the increased involvement of people who live in supported accommodation. This is so that they can shape their own care and support plans. In a survey we will publish shortly, 31% of respondents say that being involved in decision-making is one of the most important considerations when thinking about care and support in older age. Our Commission has a Co-production Panel – so that this issue is high on the agenda. Here’s two examples of how co-production can work well.

 Case study: Flowers House – Consultation with people using services

 Flowers House is a supported living scheme for people who have dementia, situated next to Bletchley Park. There are 30 one-bedroom flats and four two-bed flats specifically designed for adults with dementia. It is supported living accommodation with 24-hour care delivered by the on-site staff, tailored to meet individual needs. Flowers House provides the opportunity for couples to remain living together with care available as required.

The scheme was built in partnership with Milton Keynes Council and the Grand Union Housing Group – it opened up in 2012. Prior to the scheme opening, people with dementia in Milton Keynes were likely to be supported at home by domiciliary care services until their needs could no longer be met, at which point they would often move into a care home. One of these care homes was dated and required extensive work or a rebuild. Following consultation with people who were using services, staff and the wider public, the preferred option was to build a new scheme to provide a flexible model of accommodation alongside a range of care and support needs.

Case study: Tree Top Village, Newcastle

Residents have been fully involved in shaping the design of the scheme through research and co-production. The scheme is a flagship development for Your Homes Newcastle and Newcastle City Council, combining high-quality accommodation with leisure facilities for residents and local people alike to enjoy. Tree Top Village consists of a main building, offering 75 sheltered housing apartments, bordered by 36 one- and two-bedroom homes and eight bungalows with gardens.

With a hotel-like feel, the main building is centred around an impressive glass atrium with a lobby, reminiscence library, Italian restaurant, hair and beauty salon, mobility shop and card/gift shop. These amenities are open to the public, to support the integration of older people with the wider community, as well as bring investment to the local area. Residents report feeling safe and settled in their new homes and enjoy the different village amenities.

Call on the Government

Housing, for people who draw on care and health services, is something that’s increasingly in the news. ARCO has recently written to the Government. It says there is now a need to highlight an emerging new consensus: that the 2020s needs to be the decade of housing-with-care and an expanded supply of housing and care options in the UK.

ARCO said – and this is underlined in our discussion paper based on the research we have carried out with older people – that by announcing a commitment on this and by setting up the mechanisms for growth, it would be a profoundly positive statement of the Government’s intent to improve choices which are focused on independence and prevention; and to provide a safety net of care and consumer protection for the ageing population.

Fundamental connections

Everything about care and support and where people live should be outcomes-based. Housing needs to be in the right place, it needs to promote independence, resilience and social connection. These fundamental connections between care homes, housing, health and social care aren’t always fully recognised or reflected in policy, building incentives, regulation or practice. Our report provides an overview of the key issues facing the sector and outlines a vision for the future.

So, yes, call it ‘housing’ if you wish – but let’s all remember that our Commission wants to have this discussion about how people can draw on care and support and how that links to their wellbeing in the places that they live.

The discussion paper provides an overview of some of the critical issues that need to be considered and describes the principles on which future provision should be based. It is meant to pose the judicious questions on which we need to work during the coming months; and to spark discussion. Your input is warmly welcomed. Please do send us your thoughts, creative ideas and examples of the great practice we know are out there. We look forward to hearing from you. Please get in touch with the Commission’s secretariat via to share any thoughts on this paper and examples of good practice.

The Commission on the Role of Housing in the Future of Care is funded by the Dunhill Medical Trust and led by SCIE.

Kathryn Smith is Chief Executive of Social Care Institute for Excellence (SCIE). Email: Twitter: @SCIE_socialcare

What improvements, creative ideas and great practice do you have to improve housing options for older people? Share your comments and ideas below.

About Kathryn Smith

Kathryn Smith has thirty years’ experience working in health and social care. She is Chief Executive of Social Care Institute for Excellence (SCIE). Prior to this, her roles included Chief Operating Officer at Alzheimer’s Society, and Director of Services at Scope.

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