Independent living: Lessons from Covid-19 and the case for investment
INDEPENDENT LIVING: LESSONS FROM COVID-19 AND THE CASE FOR INVESTMENT
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The benefits of Independent Living Housing (commonly known as extra care) are increasingly well understood. Social connections, choice and independence boost wellbeing, while access to care if and when needed gives peace of mind. Independent Living also saves the public purse millions of pounds every year. A recent Inner Circle study estimated circa £4,475 net per person per year when compared with traditional residential care.
Inner Circle’s latest commission gave me the opportunity to speak to developers and providers of Independent Living Housing. We’ve been discussing the barriers to delivering this type of housing, and partnership approaches that have worked well with local and regional authorities to accelerate the delivery of suitable Independent Living.
The impact of COVID-19 came up in discussions and what was interesting is that none of the developers, landlords and/or care providers said it would negatively affect their investment plans for Independent Living. Instead, it is likely to positively impact Independent Living: from design considerations in terms of increasing personal space standards (particularly private outside space), to a greater focus at board level on considering later-living housing needs, rather than mainly focusing on providing lower risk general needs housing.
There have been 65,000 excess deaths in the UK since the coronavirus outbreak, and care home residents are on course to make up more than half the deaths caused directly or indirectly by the coronavirus crisis in England. The devastating impact of COVID-19 on older people and the vulnerable serves as a stark reminder of both the inadequacy of many traditional care homes and the founding principles of housing associations: not-for-profit organisations set up to provide affordable homes for people who need them and to support local communities, investing all the income they make into delivering on their social purpose.
COVID-19 recovery efforts provide the opportunity to reinvigorate the UK’s house building programme and to ensure housing meets the needs of our ageing population, helping to create more sustainable communities and to increase resilience should we ever face such a crisis again. This is the case for greater investment in this unique part of the housing and healthcare sector.
What is Independent Living Housing?
Independent Living means living in an independent home with your own front door (usually a flat or bungalow) and having a 24/7 peace-of-mind care team based in the development who can respond quickly in the case of emergency, and who can provide further personalised care packages and spot care services when needed. Community connections are encouraged in various ways so that people do not feel socially isolated and have daily opportunities to be sociable and active members of their community. There is often some type of café or restaurant, or at least access to a hot meal service.
Independent Living Housing should be well designed so that moving into this type of housing is seen as a positive and aspirational preventative choice – usually from age 65 onwards – enabling people to continue active and independent lives and have their care needs met if and when they arise. Beyond that core definition, there are varying views on what form Independent Living should take, and the need for flexibility depending on the development, location and partners in question, as well as the intended residents to ensure as much need is met as possible.
An Increasing Focus on Personalised Care and Enabling Independence
Over the last five or six years in particular since the 2014 Care Act, there has been a growing awareness of the need to consider how a personalised approach to someone’s care can be supported – giving people more choice and control over their future and ways to maintain their independence.
As care needs develop, older people are often dependent on carers visiting their homes. This can be extremely costly to both individuals and the public sector. When people get to a point where they can no longer cope at home (often identified through admission to hospital), they are most frequently moved into residential care homes (due to a lack of alternative options), and this institutional setting, by its very nature, cannot offer flexible support that connects people to communities and opens up opportunities for a richer life. Many local authorities also spend large sums of their Adult Social Care budget on residential care, despite them recognising that care homes are not it not being the most suitable option for many people.
Currently many older people are not aware of the options available to them. The Communities and Local Government Committee are calling for a national telephone housing advice service specifically for older people that signposts them to local services. At Inner Circle, as part of wider Independent Living commissions, we’ve worked with a number of authorities on how to increase awareness among housing, planning, commissioning and care teams of how Independent Living housing could better meet many people’s needs, as well as be lower cost for the public purse due to economies of scale (when compared with people receiving domiciliary care in their current homes, or compared with being placed in residential care).
This need for more awareness of the benefits of Independent Living Housing is all the more acute, given the impact of COVID-19 in care homes where people live in closer proximity to each other. The experience of those developers and registered providers I spoke to is that people in Independent Living Housing have been affected far less than those in care home settings. This likely highlights the inadequacy and limitations of a lot of care homes – older converted properties lacking space to adequately isolate people.
Increasing Demand for Age-Friendly Housing
Older people currently occupy over a third of UK housing stock. The number of people aged over 65 is forecast to rise to 14.3 million by 2025 (a 22 per cent rise), with the highest levels of population growth being among the over 85s. This means one in five people will be over 65 by 2025, and one in four by 2050.
As a result, there is an anticipated increasing demand for suitable purpose-built affordable rent accommodation for older people, as well as shared ownership (possibly with a nil rent proportion) – and for a significant proportion of this to be Independent Living Housing. This demand is from both the privately-rented and privately-owned sectors, due to the increasing costs of rent and care (and the related need to free up equity), and also from social housing due to the lack of suitability of existing stock and limited supply.
A focus on meeting the needs of our older population will not only be better for individuals in later life and enable public funds to go further but will also encourage people to downsize into more suitable homes and to free-up larger homes for others.
Learning from COVID-19 to better meet the needs of UK’s ageing population
In the last few years there has been a step change in thinking about age-friendly housing. Increasingly, Independent Living Housing is beautifully designed, well-considered and well-integrated in the community, having independently run cafes within developments for example and sometimes using the on-site care service as a central hub from which domiciliary care can be provided in the wider community. There is also a move towards intergenerational housing and exploring how age-friendly housing can be better mixed with other types of housing and community uses aimed at different age groups, such as nurseries.
The devastating impact of COVID-19 on people in care homes should only help to accelerate this focus on better meeting the needs of the UK’s ageing population and providing more suitable Independent Living Housing that people want and choose to live in. As university is to a teenager, Independent Living should be to someone approaching their later years – an attractive option that will create opportunities for an independent and fulfilling life.
Now is an opportune time for both local and central government and developer/providers to do all they can to prioritise increasing the supply of Independent Living and to improve understanding of what it is, and why it is so important to: an individual’s quality of life, enabling a sustainable public sector, and contributing to a society that has sufficient, suitable and affordable housing for all ages.
 The Health Foundation (2020) What has been the impact of Covid-19 on care homes and the social care workforce? :https://www.health.org.uk/news-and-comment/charts-and-infographics/what-has-been-the-impact-of-covid-19-on-care-homes-and-social-care-workforce
 National Housing Federation (2020) What housing associations do: https://www.housing.org.uk/about-housing-associations/what-housing-associations-do/
 National policy drivers and guidance set out the government’s vision for older people, including those with disabilities: Valuing People Now (Department of Health, 2009), Transforming Care: A national response to Winterbourne View hospital (Department of Health, 2012), the Care Act 2014 and Fixing Our Broken Housing Market (Department for Communities and Local Government, 2017). All advocate greater choice and control for people over the support they receive, the lives they lead and place a strong emphasis on wellbeing and individual outcomes.
 Housing for Older People (2017) House of Commons: Communities and Local Government Committee: https://publications.parliament.uk/pa/cm201719/cmselect/cmcomloc/370/370.pdf
 Local Government Association (2017) Housing Our Ageing Population: https://www.local.gov.uk/sites/default/files/documents/5.17%20-%20Housing%20our%20ageing%20population_07_0.pdf
 Rental Housing for an Ageing Population (2019) Housing Lin: https://www.housinglin.org.uk/_assets/Resources/Housing/Support_materials/Other_reports_and_guidance/HAPPI-5-Rental-Housing.pdf
 In 2018 Matter Architecture were commissioned to develop a pilot intergenerational housing scheme in the borough: http://www.matterarchitecture.uk/wp-content/uploads/2019/11/442_Matter-intergen-Nov19.pdf