Costs and Outcomes of an Extra Care Housing Scheme in England

Extra care housing, which provides support and care for people in specially designed accommodations, has now been part of the range of housing and care services available to older people in England for several years. Currently, the United Kingdom evidence base tells us little about the financing, estimation of the costs, or burden to the public purse of housing with care. The United Kingdom has significant state welfare provision in the areas of health and social care. The objective of this in-depth case study was to investigate the cost and outcome consequences for a sample of people who moved into an extra care housing scheme in Bradford, England, and to reflect on the methodological implications for future research in this developing area. The main finding of the study was that the overall cost per person increased after a move to extra care housing, but that this increase was associated with improved social care outcomes and improvements in quality of life.     

Housing Conditions and Risk: Reporting on a European Study of Housing Quality and Risk of Accidents for Older People

The declining capacities in older people often lead to limitations in activities of daily living and a simultaneous rising demand for care services. Many of these limitations in daily activities are to a varying degree caused, enhanced or facilitated by disadvantageous housing and environmental conditions. Home modifications have been credited as an important part of the solution, allowing for an extended and safer use of the home. In order to examine this issue in more detail, this paper provides empirical evidence on the type and extent of risks associated with accidents around the home. It reports on findings from a European case study on the difficulties using the home and risks of accidents which may lead to injury. It is argued that healthy housing conditions for older persons are important to maximize the supportive capacity of one's home, to stimulate an active and healthy lifestyle, and to avoid unnecessary institutionalization.     

Extra Care Housing in the UK: Can it be a Home for Life?

Extra care housing is believed to constitute a home for life, precluding the need for institutional accommodations, but currently there is little substantiating evidence. Longitudinal data show that 8.2% of extra care housing residents will move to institutional accommodations after 5 years. Matching analyses suggest that extra care housing residents aged 80 years and older are approximately half as likely to enter institutional care compared with older people in the community in receipt of domiciliary care, albeit with some caveats. Extra care housing may embody a home for life for the majority of residents, although a substantial minority is likely to require institutional care.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Outsourcing within the Nordic context: Care services for older people in Finland

The early 1990s economic setback brought significant reforms favoring the outsourcing of care in Finnish municipalities. Here, outsourcing refers to the practice of municipalities employing private organizations through different means (e.g., open tendering) to deliver public care services. In this context, this study examines the growth in the outsourcing of service housing and home-help services in 311 municipalities from 2001 to 2015 and investigates the municipal factors associated with outsourcing using four dimensions: care needs, population size, economic situation, and political ideology of the municipality. The findings reveal a steep increase in the outsourcing of home-help and service housing. Care needs of older people are the most influential factor for outsourcing, particularly for service housing. Overall, the findings show a growing trend in private care provision in Finnish municipalities.     

The Meaning of a “Sense of Community” in a Finnish Senior Co-Housing Community

In the foreseeable future, alternative housing options will be needed to meet the needs of and answer to the wishes of older people. Co-housing schemes are developed to fulfill the need for a housing type that provides mutual support and social contacts while alleviating the isolation and loneliness often experienced in ordinary neighborhoods. This study on a senior co-housing community in Finland asked what a “sense of community” meant to the residents and how a sense of community becomes visible in daily life. For these residents, a sense of community meant not only living with like-minded people but also communal activities, doing things together, learning from each other, and having reciprocal support, all of which created a sense of togetherness, belonging, and trust. The findings of this study showed that moving in later life can offer a viable option of having a living environment that one likes, which calls for a broader interpretation of housing policy guided by “aging in place” thinking.     

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.     

The Evolution of Housing Typologies for Older Adults in The Netherlands From 1945 to 2016: An Analysis in the Context of Policy,Societal, and Technological Developments

This study aims to examine housing typologies for older adults in the light of three qualitatively examined exogenous factors: policy, societal developments, and technology. The developments in inpatient and assisted ambulatory housing facilities for older adults have been mapped from 1945 to 2016 using quantitative data. Using these data, five transition periods can be distinguished. Within the first transition periods, policy factors were tremendously important, while within the later ones, societal influence empowered by technological change became the primarily driving factor. This research shows that the classification of inpatient, assisted ambulatory housing, and outpatient housing may no longer be applicable in its current form.     

Promoting reflective practice with older people: Learning and teaching strategies

Social work with older people is often characterised as low status employment and is dominated by medicalised constructions of old age. Consequently, there is a need for educational responses that address students' negative attitudes toward older people and enable the development of practice skills in this area. The present paper evaluates an elective course for third year social work students that challenged their perceptions of their own and others' ageing, and stimulated a reflective approach to practice with older people. Reflective learning techniques were employed in the course, including observations in aged care service settings. Students in the course showed a high degree of interest in working with older people in the future and, although this did not increase much throughout the course, they evaluated it positively, noting greater awareness of issues affecting older people.     

Targeting Services to Those Most at Risk

Abstract

The budget crises facing many state Medicaid programs have increased interest in the goal of linking services and housing as a way to provide more options to people with disabilities at less cost than institutional care. This article examines some of the premises underlying this interest, especially with respect to linking supportive services and federally subsidized housing for older persons. The first section provides a brief history of the activity in this area. The second section examines the risk factors associated with nursing home admission and how those factors match the characteristics of renters receiving subsidies. The third section focuses specifically on the likelihood that subsidized renters will also become eligible for Medicaid. The fourth section explores the capacity of housing programs to meet the challenges associated with service delivery. Finally, the conclusion examines the implications for public policy decision-makers interested in linking services and housing in order to address the long-term care (LTC) needs of older persons with modest incomes.     

Older Adults’ Use of Adaptable Design Features in Housing Units: An Exploratory Study

In 1997, the city of North Vancouver, British Columbia developed Adaptable Design Guidelines for housing to support aging-in-place for older tenants. This article reports the first qualitative evaluation of those adaptable design features since those guidelines were implemented. The study used a qualitative methodology to explore the elderly tenants’ use and satisfaction of the adaptable design features in the housing units and environmental changes made by those tenants. Key qualitative categories that emerged from the interviews were design preferences and environmental modifications. Findings from this study can inform future revisions of the guidelines and demonstrate what needs to be done in environmental design of seniors’ housing that can foster functional independence.     

Housing Implications of Individual Budget Home Care Models for Older Renters: An Australian Case Study

Policies and programs relating to successful aging in place are premised on the fact that older people's housing is stable and suitable. Home-based aged care delivery models such as individual budgets aim to deliver increased service flexibility, choice, and control for consumers. Little attention has been paid to the consequences of such models for older renters, who often have less stable housing and restricted rights to modify their accommodation. This article reports on a project in Australia that explored the delivery and receipt of individual budget style models of home-based aged care services to older renters.     

The influence of the economic crisis on quality of care for older people: system readiness for innovation in Europe

The aim of this study is to examine the influence of the recent economic crisis on the quality of long-term care for older people in Belgium and the Netherlands. A mixed-method approach was applied, primarily focused on conducting semi-structured qualitative interviews with health professionals working in a management role in organizations providing long-term care for older people. The results show that Dutch organizations seem to be prepared for the influences of the economic crisis on the quality of its care provision primarily in terms of a sound system readiness. At the same time, Belgian organizations seem to be prepared for the influences of the economic crisis on the quality of its care provision primarily in terms of a favorable sociopolitical context. Comparing two countries allows for reciprocal lesson-drawing. The conclusion drawn in this study is that a sustainable long-term care system requires above all stability and structure.     

Designing a “Think-Along Dwelling” for People With Dementia: A Co-Creation Project Between Health Care and the Building Services Sector

Ageing-in-place is the preferred way of living for older individuals in an ageing society. It can be facilitated through architectural and technological solutions in the home environment. Dementia poses additional challenges when designing, constructing, or retrofitting housing facilities that support ageing-in-place. Older adults with dementia and their partners ask for living environments that support independence, compensate for declining and vitality, and lower the burden of family care. This study reports the design process of a demonstration home for people with dementia through performing a literature review and focus group sessions. This design incorporates modifications in terms of architecture, interior design, the indoor environment, and technological solutions. Current design guidelines are frequently based on small-scale studies, and, therefore, more systematic field research should be performed to provide further evidence for the efficacy of solutions. The dwellings of people with dementia are used to investigate the many aspects of supportive living environments for older adults with dementia and as educational and training settings for professionals from the fields of nursing, construction, and building services engineering.     

A Hitchhiker's Guide to caring for an older person before and during coronavirus‐19

Coronavirus‐19 (COVID‐19) has reconfigured working lives with astonishing velocity. Older people have suffered the worst effects of the pandemic, with governments marginalizing or overlooking their needs. Women perform the majority of care for older people, often compromising their working lives and health. Yet in academic articles their voices are often filtered or aggregated in quantitative studies. Based on a weave of personal experiences and secondary research, the article traces a path through UK forms of care and shows how the inadequate response to COVID‐19 stemmed from existing policies embedded in health and social care. COVID‐19 has severed important informal care work, rendering the vulnerable yet more exposed and carers anxious and bereft. Longitudinal research capturing the trajectory of care from the perspective of older people and their carers would lead to improved support hence gender equality.     

In the Best Interest of the (Adult) Child: Ideas About Kinship Care of Older Adults

This article uses a qualitative, ethnographic approach to examine the experiences of older adults and their kin, as the older adult engages in relocation. Studies looking at caregiving by kin for older adults highlight burdens for the adult child. This study offers a life course perspective on kinship care, analyzing older adults’ decisions to move. It was found that many older adults are strongly influenced by the desire to not be solely cared for by their kin, as well as to select housing near their existing social network, which might exclude kin. In conclusion, policy implications are discussed.     

Functional Ability,Neighborhood Resources and Housing Satisfaction among Older Adults in the U.S.

The purpose of this study was to explore neighborhood resources that influence the housing satisfaction of older adults. The study included 10,146 participants from the 2009 panel of the American Housing Survey who were 65 years and older. Hierarchical regression modeling was performed to examine older adults’ perceptions of neighborhood resources and consequently the role these resources play in predicting housing satisfaction among community dwelling and residents of assisted living, controlling for age, sex, ethnicity, education, and housing maintenance. In addition, three levels of physical functioning among residents of assisted living were examined. Results showed that there were differences in housing satisfaction by residences and levels of physical functioning. Subjective evaluations of neighborhoods and the near surrounds were significant predictors of housing satisfaction. Results of the study suggest that policy makers and housing professionals need to continue to consider the role of supportive neighborhoods and social environments in promoting successful aging particularly for frail older adults.     

Decisions About the “If,” “When,” and “How” of Moving Home: Can a Relocation Service Help? A Welsh Case Study

This small-scale, Welsh qualitative study explores how a new “moving on” service empowered older people to move voluntarily from their home to an extra-care facility. Eighteen older people were interviewed about their experiences of the service, which offered in-person, bespoke information, advice, financial, practical, brokerage, and emotional support about moving. Findings indicate three service use patterns: continuous, partial, and discontinued. It was instrumental in empowering clients to exercise decisional, executional, delegated, and/or consumer autonomies. Recommendations for future developments of a prototype “moving on” service include a multipartner approach and caseworker case management training modeled on social work practice.     

Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.