Fay Wright

Some social consequences of remodelling English sheltered housing and care homes to ‘extra care’

ABSTRACT Across the United Kingdom, new build and remodelled ‘extra care’ schemes are being developed in many areas on the assumption that they offer older people with care needs an alternative to residential care. This paper reports an evaluation by a multi-disciplinary team of 10 extra-care schemes remodelled from sheltered housing or residential care units. The evaluation audited buildings and identified social and architectural problems. No two schemes in the sample were alike; some aimed for a dependency balance and others set a dependency threshold for admission. The three criteria used for assessing eligibility were the number of paid care hours the older person had at home, their property status and the type of disability. This article focuses on the wide variation in assessing eligibility for an extra-care place and on some social consequences of remodelling. A number of tenants remained in situ during the remodelling process in six of the schemes. Building professionals were unanimous that retaining some tenants on site caused significant development delays and increased the remodelling costs. There was also a social price to pay. ‘Old’ tenants resented their scheme changing into extra care and were hostile towards ‘new’ tenants who had obvious needs for support. In some extra-care schemes, ‘old’ tenants were refusing to participate in meals and all social activities.

Discrimination against self-funding residents in long-term residential care in England

This paper reports the findings of research funded by The Nuffield Foundation on older people paying the full cost of their long-term residential or nursing home care in England. The research had three stages; a national postal survey directed at the senior finance officer in social services departments, follow-up telephone interviews with a sample of them, and interviews in five case study areas. Those interviewed included social services staff (including a legal adviser), care home providers, self-funding residents and relatives. These self-funding residents were commonly relatively physically independent on admission to the care home. Despite central government directives that needs assessments should be available regardless of a persons means, it is a common policy to encourage older people in this situation to admit themselves directly to care homes without a needs assessment. Wide variation was found in local authority practice in respect to being prepared to make a contract with a care-home provider for older people able to meet the full costs of care.

Remodelling to extra care housing: some implications for policy and practice

Extra care housing is seen as a popular option for older people by families, some older people, policy‐makers and practitioners. Some new build is being provided but another option, for which grants are available, is to remodel existing outmoded buildings. This research reports on recent attempts from 10 case‐study areas in England to remodel sheltered housing and residential care homes to extra care housing. The results are mixed, with satisfaction reported by many new tenants, anger by some existing ones, challenges at every stage of the project for design and construction teams, and issues over the provision of assistive technology and care. Nearly all the schemes experienced unexpected problems during the course of construction. Remodelling is not necessarily faster or cheaper than commissioning a purpose‐designed new building. Nevertheless, remodelling may be the only viable option for some unpopular or outdated schemes. The research showed that remodelling is not a quick fix, but that it did have considerable advantages for many of the older people and support staff who were living and working in the remodelled buildings. The research concluded that remodelling should only be undertaken when other options have been carefully examined. Drawing on the research findings, advice to policy‐makers and practitioners who are considering this course of action is outlined in the discussion.

Extra care housing: a concept without a consensus

Extra care housing has developed from sheltered housing and has increasingly been seen as a popular option by policy‐makers for a number of reasons. These include the inability of conventional sheltered housing to be an adequate solution for a growing population of very old people, the decline in popularity and high costs of residential care and perceived problems with older people staying in mainstream housing. There is, however, no agreed definition of extra care housing, even though a growing number of government grants are becoming available for this type of housing. This is causing confusion for providers and for older people and their families who are not sure exactly what is provided. This lack of clarity means that this form of housing has become an erratic and piecemeal form of provision.

Improving the provision of information about assistive technology for older people

The importance of assistive technology (AT) in helping older people maintain independence is increasingly recognised in policy. The article reports on a modest piece of research, funded by the Helen Hamlyn Foundation, that looked at an important corollary of this development — the provision of relevant and appropriate information about AT. The research involved mapping both AT and information sources, focus groups with 28 users aged 75 and over and 12 carers, interviews with 40 professionals and information providers and a postal questionnaire to 131 care home managers (response rate of 45%). The findings point to the large volume of available information, but suggest that there are problems in identifying needs and in accessing all necessary information. Professionals share these problems and organisational issues impact on professional capacity to provide satisfactory information. The situation in care homes appears ambiguous in terms of responsibility for AT provision for residents and hence for information. The researchers concluded that there is considerable scope for improving both access to information and the design of that information. They also concluded that there are terminology issues that need addressing in further research.

Is extra care housing in England care-neutral?

Purpose – Extra care housing (ECH) is housing for older people that aims to provide flexible care while fostering independence. The purpose of this paper is to examine the impact that some of the successes and failures in improving accessibility during remodelling had on care provision, in order to offer advice to social housing providers planning to remodel existing properties into ECH. Design/methodology/approach – The data consisted of an inventory of accessibility features and assistive technology (AT) items in flats and common areas. The data were drawn from ten ECH schemes in different regions of England. Findings – Most of the AT found was low-technology supporting independence, such as grabbers; some was specific to care provision, such as hoists. Even after remodelling, the design and layout of most buildings did not fully comply with accessibility standards, leading to increased provision of care for some tenants: a care-negative situation. Research limitations/implications – This multidisciplin...

Is Remodelled Extra Care Housing in England an Inclusive and ‘Care-neutral’ Solution?

This paper reports findings from a two-year EPSRC-funded study that examined how sheltered housing and residential care homes in England had been remodelled to Extra Care Housing (ECH). ECH is a relatively new type of housing for older people, which aims to provide flexible care while fostering independence, though no agreed definition of ECH exists. Ten case studies of social housing schemes that had been remodelled into ECH were chosen from different regions of England. Access and assistive technology in flats and communal areas were audited by a multidisciplinary team. The aim of this paper is to examine the impact that some of the successes and failures in improving accessibility during remodelling had on care provision. Even after remodelling, the design and layout of most buildings did not fully satisfy current accessibility standards, leading to an increased need for care for some tenants once the building was reoccupied. Successful examples of accessibility, assistive technology and care integration required both active tenant involvement and creative design input from care staff, architects and builders who were assistive technology and accessibility aware. It will be argued that for new and remodelled ECH buildings to be care-neutral, designers need to work towards the most inclusive model of ECH.