1. Jeremy Porteus Director Housing LIN
Housing for Older Citizens: Improving older people’s choices to reduce social care needs in Wales
ADSS Cymru Conference
Llandudno, 30 June 2016
Jeremy Porteus
Director
Housing LIN

2. About the Housing LIN
Previously responsible for managing the DH’s £227m Extra Care Housing Fund and £80m Telecare in England grant
Member of the PM Challenge on Dementia Health and Social Care Champions’ Group
48,000+ members across housing, health and social services to help improve partnership working and integration on housing and care
Essential online resources on housing with care for older people to support commissioners, funders and providers in market development, innovation and investment
10 regional ‘learning labs’ in England & Wales supporting local information exchange, peer-to-peer shared learning and improvement activities, and exemplar study visits

3. Getting the message across
“The focus for many has purely been on bricks and mortar. If we’re going to create truly aspirational communities for seniors it needs to move beyond design and be about connection and relationships”
Sara McKee, Housing LIN Viewpoint
“The shortage of purpose-built housing for older people is ‘bed-blocking’ the housing market.”
John Pankhurst, Inside Housing

4. An ‘inward orientated home’
“From the viewpoint of many older persons, the housing market for them is lacking in the physical environment but also in the emotional side of contact with the wider community. The segregation of one section of the community in an ‘inward orientated home’ just because of age is a failed proposal and the ‘baby boomers’ are looking for more enlightened prospects for their later lives.”
Ian Hooper, Housing LIN viewpoint (forthcoming)

5. Improving later life Building personal resilience
Detachment from social participation in older age can have negative impacts on health & wellbeing, including depression, physical and cognitive decline, and increased mortality.
Building community resources to resilience
Social mobilisation – providing ways and means to build, enable and support older people’s connections to social networks in the community and to foster their mutual aid
Co-creating lifelong neighbourhoods
Older people are both the beneficiaries of and contributors to all age-friendly activities that span the generations.

6. Happi(er) homes Be as independent as they want to be
Feel part of a community and choose how and when to they want to engage
Have greater autonomy and feel that their lifestyles are met with wider health and wellbeing benefits from living in a ‘care ready’ environment
Stay connected with their social or other support networks, including navigating and interacting with the use of technology, preventing isolation and loneliness

7. Housing for Older People in Wales (1)
The Strategy for Older People in Wales ( ) includes amongst the outcomes it is seeking: “Older people have access to housing and services that supports their needs and promote independence.”
The Social Services and Wellbeing (Wales) Act 2014 requires consideration of an individual’s wellbeing and a focus on prevention and early intervention. The appropriateness of housing and housing related support is seen as an important contributory factor to wellbeing, particularly but not only for older people.

8. Housing for Older People in Wales (2)
Older People’s Commissioner (Sarah Rochira) in a review of care homes has acknowledged the need for other forms of care and support including housing with care: “the potential for further development of other models that combine housing and care, such as extra care, has not been fully explored.”
The National Partnership Forum’s workstream report Housing Issues for Older People and the Housing Role in Health and Social Care recognised extra care housing as “an important element of an overall strategy to increase choice and options for older people and the need to develop more options and choice in all tenures.”

9. Housing for Older People in Wales (3)
The Public Policy Institute for Wales report exploring the housing needs of an ageing population in Wales includes within its recommendations that the Welsh Government develop a housing strategy addressing older people’s housing requirements, review planning policy and require local housing needs assessments, and develop national and local-level knowledge, information and advice training and education activities to promote awareness of housing options for older people.

10. Housing for Older People in Wales (4)
Support the independence of older people: Are councils doing enough? The Wales Audit Office recently highlighted that access to, and availability of, housing and housing based support services for older people has reduced in recent years. In addition, it found that only three councils directly provide extra care housing and 11 councils directly manage sheltered and elderly designated accommodation.

11. Housing for Older People in Wales (5)
Former Minister for Communities and Tackling Poverty, Lesley Griffiths, made an oral statement to the National Assembly for Wales on Housing an Ageing Population on 15 September She stated that she considering establishing an expert group, which will run for a time-limited period to advise the Government in 2016 on its future policy approach to housing an ageing population.
In Spring 2016, commissioned Sheffield Hallam research to:
Explore Local Authorities strategies for meeting the housing needs of older people and where Extra Care fits into this into the future
Calculate the cost-effectiveness of Extra Care in Wales in terms of building and development costs, as well as care costs
Investigate how Extra Care schemes are used by residents and the community

12. Extra care: Meeting the needs of fit or frail older people
A change in social ethos is required through public education/awareness raising
Produce a clear definition of what constitutes extra care housing
Deinstitutionalization of older people
Develop a more integrated health and social care services, include extra care
Allocate resources for specialist housing to aid wider housing market
Support professional development and training
(Burholt V et al, University of Swansea, 2011)

13. What do we know about the current position?
An increasing older population
Significant numbers of older people living alone
Increasing numbers of people living with limiting long term illness
Increasing number of people living with dementia
Significant numbers of older people provide unpaid care

14. What do we know about the current position?
A significant proportion of older people live in owner occupied housing in Wales (76%)
A significant supply of social rented sheltered housing (c26,800 units)
A limited supply of social rented extra care housing (98.5% social rented)
A small mixed provider market and very little extra care housing aimed at owner occupiers
Demand for extra care housing in Wales

15. What do we know about the current position?
Supporting People: 80% of people receiving housing related support are older people
A significant number of older people are supported in care homes (c11,300 residential care home beds across Wales)
A significant number of older people are receiving home care (c18, over age of 65)
Pressure on revenue and capital funding, rent reform, LHA, seeking alternative sources of inward investment eg grant, borrowing, other?

16. What’s the nature of the ECH market in Wales?
Total ECH units currently = 2,005
1,965 units of ECH owned and managed by housing associations
Shortfall of ECH by 2030 = 10,500 or c530 per annum
New build unit costs = £90k-£130k
Total new build = c£65-70million pa
Scheme sizes (rural/urban, support “hub & spoke”, villages?)
Tenure Mix: Affordable rents, Market rents, Shared ownership/leasehold
Viability
Commissioner: implications for procurement and commissioning
Provider: implications for development and/or managing

17. Evidencing funding applications
Understanding demand & capacity
Housing LIN / ADASS SHOP analysis tool
Draws on the IPC POPPI data from ONS, plus the
EAC care & housing data

18. Imaginative solutions
NHS and others back partnerships with housing associations that offer long-term health, care and housing benefits = estimated £1b
Smith Institute research found billions could be saved by admissions avoidance and reduced length of stay if NHS land and assets were used for step-down facilities or supported housing
On-going revenue stream for NHS from its estate through development of affordable housing
Work with housing associations, local authorities and others to develop:
Reablement/intermediate care/hospital at home
Supported housing – eg mental health
Specialist housing – eg extra care
General needs housing

19. A healthy relationship
Step down/intermediate care or rehab facilities with move on: NHS organisations and/or LAs release land in partnerships with housing associations eg Gwalia in Neath Port Talbot
Supporting people with dementia: Developing dementia-friendly Extra Care Housing eg Wales & West HA in Mold, Flintshire

20. More healthy partnerships
NHS can pay for building supported units, recouping savings by more efficient care pathway to meet continuing health care for people with a learning disability eg In One Place, Monmouthshire
Housing provider can both develop the units and provide care and support service that offer both independent living options but also develop ABCD approaches to inclusion and community resilience eg Cartrefi Conwy and their ‘Passion for Life’ programme

21. What outcomes can extra care deliver?
Extra Care Housing can offer a home for life
Living in Extra Care Housing can improve health and wellbeing
Extra Care Housing can provide added value to the local community
Extra Care Housing can contribute to the local housing market

22. What’s the evidence?

23. Opportunities or Challenge?
What scope is there for better planning, commissioning and/or access capital funding to promote innovation in lifestyle choices for older people or stimulate a housing with care market as an alternative to institutional provision?
Asset Based Community Development where partners such as not-for-profit, churches and statutory health and social care services support more people in the community, meet growing demands for care and support, any targets / cost-benefits?
Is there the case for new forms of co-housing housing for maximising independence or is the future more speclialist housing and home based care and support?
Are there other market opportunities to link co-housing with homesharing, care coops/mutuals?
What strategies and policies are in place to engage, involve and listen to the housing with care needs of people, and their carers, and the wider community?
Join the Housing LIN Cymru to stay connected with latest ideas

24. Recommendations
Need a better strategic understanding of the role of extra care housing
Enhancing the extra care housing offer, especially to older people and the need for advice & information
Look at extra care in its capacity: an ability to deliver care and support at home
Need for further Invest in extra care housing in Wales
Produce a Welsh version of the HAPPI design criteria to promote good practice and stimulate innovation

25. THANK YOU www.housinglin.org.uk/Wales/ Jeremy Porteus Housing LIN
Director c/o EAC, 3rd Floor
89 Albert Embankment
London, SE1 7TP
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