Mary GRIFFITHS Sheltered Housing in Britain - An Approach to Managing the Housing Needs of the Elderly št. 28,29/1995 The official statistics which are used by the British government to measure population and housing trends define the elderly population by official age of retirement. This is despite the fact that the age of retirement differs for males and females -being 65 and 60 years respectively. Table 1: Composition of the Population in 1991 (England) (millions) Aged less than 60/65 39.3 Aged 60/65 5.5 Aged 75 + 3.2 Source: OPCS 1989 Pop Proj.: Series PP2 No16 (Quotedin Leather P., Kirk H.: Age File the Facts, Anchor Housing Trust, Oxford, 1991) Hie above table shows information which relates to England only. The elderly population of the UK is distributed across the constituent countries in a proportion which broadly follows the general population as a whole. The number of elderly people has grown steadily throughout Uiis century. But an even more significant trend is the increase in the nuimber ofvery elderly within tlie post-retirement age group. Table 3 shows the change in the make-up ol" the elderly population in age bands from 1901 and projected forward to 2021. As can te seen from the above table there has been a steady increase in the proportion of veiy elderly people within tlie older population; and in particular a significant increase in the 75+ age group. Tlie general population will be 'older' in future yeare. lliis is not Just because people ai-e living to a greater age. It is also a product of declining fertility rates which means that there are proportionately fewer yoimg people in tlie population now than previously (and siili decreasing). Throughout the remaining years of the 1990's it is likely that older people will make up about 18 % of the whole population. In the next cen-tuiy projections suggest that there will be a significant increase in the proportion of elderly people. Fii'stly, because of a continuation in tlie trend towards fewer births per adult female in tlie national population, as identified above; but also because j>eople bom in the post Second World War 'baby boom' will reach retirement age in the fii^st decade of the new centuiy. The numl:>ers in Table 2: People of pensionable age in the Uuiled Kingdom. 1991 Population % of UK Total England 8.796,207 84% Wales 570.932 5% Scotland 908.485 9 % . Northern Ireland 228,000 2% UK Total 10.504.045 100 % Source: OPCS, 1993. 7aò/e 1 Housing Characterislic population groups Elderly people Socicd policy Housiiig policy Great Britain The principal response by providers of puhlic and social rented housing to the housii'y needs qfolderpeople has been to provide "sheltered" housing. Has this emphasis on sheltered housing been the most appropriate housùìg management solution to the housing problems of older people? This paper presents a brief case study illustrating tux> categories of shel-, tered housing scheme. Mary Griffiths Bivališča v Britaniji - pristop k reševanju stanovanjskih potreb starejših občanov Stanovanja Značilne skupine prebivalstva Stari ljudje Socialna politika SLanovanjska politika VelOca Brita-nija Institucije, id skrbijo za oskrbo zJav-ninii in socialninù najemnimi stanovanji. so se ria stanovaiyske potrebe starejših občaiiov odzvale z zagotavljanjem "zatočišč. " AliJe povdarek na 'zatočiščih' bil najbolj ustrezni pristop k reševojiju staiìovojyskih potreb ostarelih? Ta prispevek na kratko predstavlja dve kategoriji zatočišč za starejše občane. no. 28, 29/1995 that age group are likely to increase by 33 % between 2001 and 2027 -from 8.9 million to 11.7 million people. Of greatest significance from the above scenario will be the increase in the numbers of those aged 75 years or more; this suggests that within a generation nearly a quajler of the (()(i il population wUl be in tlie post-retin-iiient age bracket. But within li lis group an increasingly signllicauL proportion will be aged 85 years plus, an increase of 0.2 million by the turn of the century, and a furtlier increase of 0.25 million in the first decade of tlie next centuiy. These are very significant changes in our jxipulation when considered in tlieir own right. They become even more significant when seen alongside parallel changes in tlie make up of tlie population, and when considering tlie problems which increasing frailty brings to older people. Women have a longer life expectancy than men. This means tiiat a large proportion of the ToIdU old - tJiose over 75 years - will be women living alone. Already 75 % of all women over the age of 70 years currently live alone. (Mackintosh et al.: 20). Although the majority of elderfy people retain good health well into their retirement, there are many illnesses and corresponding disabilities which are age related. In particular the 'old' old are likely to suffer increasing mobility problems, affecting how tliey cope with stairs, gardens or every day tasks like dressing themselves and preparing meals. 'i..disability rates start to climb steadily qßer 50 becoming parìicularly steep over 70. The most severe levels of cUsability remain low until aboiä 70 and then rise quickly. FYom about 75 more people have some level of disability than do not Increasing dis-ability witlx age means a growing dependency on otl^ers. Nearly one half of those 85+ are unable to walk down tlie road unakled ajid nearly a third caiviot manage stairs unaided.' (An Joeing Population . Fact Sheet 2. Family Policy Studies Centre. London 1991) Table 3: Changes in the make-up of the elderly population Note: '= includes 90+ pop. Source: Tinker, A. et al, 1994 Table 4: III Health in Old Age Age 1901 1951 1971 1981 1991 2001 2011 2021 % % % % % % % % 60-64 . 37 30.7 30.3 25.7 24.2 23.5 27.5 25.3 65-69 25.9 26.2 25.7 24.5 23,2 21 21.9 21 70-74 18.6 20.5 19.1 21 19 18.9 17 20.4 75-79 10.9 13.3 12.8 15 15.5 16 13.5 14.6 80-84 5.5 6.4 7.5 8.5 10.6 10.9 10.2 9.5 85-89 2.1* 2.8* 3.4 3.7 5.3 6.4 6.4 5.7 90+ 0 0 1.2 1.5 2.2 3.3 3.5 3.4 Toteis 100 -100 100 100 100 100 100 100 AGE GROUP 65-74 75+ All ages Long standing illness % 40 53 19 GP consultation in last 14 days % 16 20 14 Outpatient in last 3 months % 18 20 14 Source: OPCS General Household Survey, 1988; quoted in: Age File the Facts (op cit). Hie most common disabilities suffered by old people are mobility, hearing and personal care difficulties; 75 % of people aged 80 or more have some fonn of disability. Ttie problems of ill health also occur witli more frequency after the age of 75. liiere is a strong correlation between disability, ill health and low income. So the statistics quoted above have a bearing not only upon elderly people's ability to cope with tlieir day to day personal and practical care, there is also a link with poor quality housing. Indeed single elderly ill or disabled people have tlie lowest income levels of all disability groups in Britain, which suggests they may have more limited choices about their accommodation in an increasingly market orientated housing economy. Elderly people with mobility and health problems often depend he- avily upon the support given to them by infonnal cai-ers ~ who are often female relatives, usually daughters. In future the supply of informal carers may well decline as the proportion of women of working age who are actually in full-time employment increases. Interestingly the elderly population is not evenly distributed throughout the country, so the pressures upon agencies providing housing and care are also different The highest concentrations of older people are to be found: '...along theSoidh Coast oJEnglajid; Coastal areas of North Wales. Lancashire. Yorkshire. Uncdnshire and East Anglia: inlojid areas siich as Hie Cotswolds. Mid Wales and the Welsh Borders. Yorkshire Dales and southern Lake District; and in Scot-laivi: Dwiifiies. Boixiers. Tayside, arid parts of the Western Isles and HigMands' (MacMntosh. 1990 op cit) Št. 28,29/1995 Some areas have acted as a magnet for retirement purposes, putting a strain on housing and care services. For contrasting reasons, ai-eas which experienced expansion 40 years ago - die new towns and the post war suburbs - are also experiencing an ageing population profile - reflecting the migration pattern of young families to areas where employment prospects are better. Data about household composition is crucial when planning new dwellings and services, and also when trj^ng to make best use of existing stock by minimising Lmder-occupa-tion of family dwellings. Tlie majority of elderly people live in one or two person households, requiring one or two bedroomed acconunoda-tion. Aswesawalx)ve, in 1991 there were 6.3 million older households - equivalent to neai-Iy 34 % of all households. The number of lone person older households is projected to increase to 3.5 million by 2011. Yet the largest proportion of the full range of housing stock is still family sized dwellings. Elderly people ai-e also disproportionately aflected by housing disrepair within the housing stock; the 1986 English House Condition Survey found that older people were more likely to occupy hoLises which were in need of repair or lacked basic amenities. TTiis is partly explained by tlie tendency of people to age with their property, but also illustrates Uie coirelation between low income and old age - which limits tlie capacity of older people to caiTy out repaii-s and maintenance to their homes when increasingly needed. Tlie type of housing older people occupy {tlie tenure pattern) is changing, as a result of shifts in the general tenure pattern in the last 15 years when owner occupation has been vigorously promoted by government as tlie 'natural* tenure of choice. So in future yeai-s tliere will be growing nunibei-s of elderly people living in dwellings which they own - either with a mortgage or outright (mortgages having been paid up). At present most providei-s of social rented housing expect people who own their own houses to be able to solve their own housing problem by buying sometliing smaller and more suitable; in practice few can gain access to the social rented sector becaLise of these access mies. 'iliis may have to change unless private developers respond to tlie potential growing mai-ket for small easy to maintain housing for this group. Table 5: Hoiismg Tenure by age ojhead of household. Great Britain, 1991 Under 25 25-29 30-44 45-59 60-64 65-69 70-79 80+ 'Owned 36 59 75 75 69 62 56 52 Rented: local authority 31 27 17 18 23 32 32 36 housing association 5 3 2 2 2 2 4 5 private " 25 10 4 3 4 3 7 6 other 3 2 2 2 2 0 0 0 total 100% 100% 100% 100% 100 % 100% 100% 100% includes outright ownership and ownership with a mortgage includes furnished and unfurnished lettings Source: adapted from OPCS, 1993, Table 3.32b. no. 28, 29/1995 Sheltered Housing TTie principle response by providers of public and social rented housing lo the housing needs of older people has been to provide TshelteredU housing, liiere are now more than 460.000 sheltered housing units in England, 300,000 of which are owned by local authorities. Hie rate of provision has declined considerably in the 1990's arid the reduction in new-build has only partially been filled by housing associations and the private sector, 'llie number of completions by sector are shown in tlie following figure: In Scotland, too, there was a big increase in the construction of sheltered housing in tlie 1980's. The size of the stock of sheltered housing increased from 8,487 units in 1980. to 31,632 in 1991. (ScotUsh Office Social Work Services Group, 1993). Tliis rate of production is impressive. Tmker (et al) point out that... •in the ten years to 1989, England's total housing stock rose by 10 %, but tlie number of sheltered units by 69%.'. Has Ulis emphasis on sheltered housing been the most appropriate housing management solution to the housing proWems of older people? There has been little research canied out as to why sheltered housing was the prefeiTed option for local authorities in Uiis period - bLit Table 6: ConipMioiis ofiiew specialised dwellaigsjor elderly people: by Number of dwellings 1981 1986 1991 1992 'Sheltered housing Private enterprise 130 850 1,501 1,266 Housing Association 1,929 1,916 1,243 1,535 Local authorities/new towns 5,558 3,722 1,569 677 Other housing Private enterprise 62 193 279 409 Housing Association 261 597 598 535 Local authorities/new towns 4,636 1,778 289 92 All new specialised dweilingsior elderly people 12,576 9,056 5,479 4,514 Note: 'figures for 4th quarter not complete Source: Tinker, A. et al.,1994:21. in tlie 1970's it was a solution which was promoted by oflicial government policy. What is Sheltered Honsmg? Government encouragement of specialist housing provision for elderly people really began shortly after the Second World War. with the intro-dLicüon of the Welfare Stale. The 1948 National Assistance Act gave local authorities a statutoiy duty to provide care for the elderly. A grant was made available, through the local auUiorities. to develop or convert accommodation specifically for elderly people. Indeed it is tiirough this legislation Qiat local authority residential care homes in particular, were provided by social services departments -within the upper tier of the two-tier local authority system in Britain. Hiese caine to be known colloquially as 'Pai-t III accommodation'. This type of accommodation was generally provided and managed by Social Sei-vices Departments because of the high level of care provided to residents. People accommodated were assessed as being unable to live independently in their own homes. as tliey needed personal care and support. Tlie residential care homes provided all meals and had staff available for 24 hours a day. However, the regimes within these schemes were often dictated more by the management needs to organise staff teams to provide round-the-clock care witliin shift systems, as Uiey were to meet the actual support needs of tlie residents. By Uie 1960's there was a shift of opinion against residential and institutional caie in all settings because problems of resident insti-tutionalisation were emerging, and at tlie same time it was recognised that people in such schemes were vulnerable to exploitation and even abuse by staff. For example Peter Townsend in 'Hie Last Refuge' (1962) argued tliat: - residents of Part III accommodation had a low quality of life. - routines of care were designed to suit staff rather tlian residents, - lile was loo heavily regimented. št. 28,29/1995 - there was a lack of stimulating activity for residents - many residents had both the physical and mental ability to care for themselves. Elderly people themselves often feared being accommodated in residential 'Part Iir accommodation because of tlie loss of dignity and independence which it involved. It was the nonn for bedrooms to be shared by residents who were not previously known to each oUier and of course there was little room for people to bring witli them their own furniture and possessions, still less to continue with their own life style. Residential care had imposed communal life on people who would not noiinally have chosen this life style, but who, because of tlieir inadequate housing or inability to cope with some every day tasks imaided, could no longer cope in their own home. This exposure of the problems of institutional care brought about a shift in emphasis in social policy away from such facilities towai-ds systems designed to enable tlie elderly to remain in the community wherever possible. This led to innovations in housing witli the aim of safeguarding peopleUs independence for as long as possible. The emerging design ideas which were shaping specialist housing for the elderly were given greater clarity as the result of new goveminent guidance in the late 1960's. The concept of Sheltered Hotising was dellned and developed by guidance produced by the tlien Ministry of Housing and Local Government (later to become tlie Depaat-ment of the Emaronment). Their advice was disseminated to local authorities in England and Wales througli publications known as 'circulars'. At that time local authorities provided much of the fimding to housing associations for new developments. and so the design ideas for sheltered housing were also transmitted to tliese housing providers too. There are two types of sheltered housing designed speciflcally for elderly people described by the fli st Circular (No. 82/69) on the subject, entitled 'Housing Standai'ds and Costs: accommodation specially designed for old people' 1969. It is the 'Categories' of scheme iypes described in Ulis oiTicial guidance which soon entered the language and are still embedded in housing parlance. Tliey have become shorthand names to describe sheltered housing. Tliey ai^e as follows: Category 1: Mandatoiy Staj-idards: 1. hand rails 2. special locks 3. fridge or vented food storage 4. high standai'ds of heating Otlier optional featm-es which did not attract subsidy Category 2: 1. mandatory floor areas which are less Uian in Catl. oITset by the Inclusion of communal areas within schemes 2. communal provision 3. individual cookers 4. emergency alann system 5. self-contained wardens accommodation Schemes had to comply with these mandatoiy standaj'ds in order to qualily for the enhanced housing subsidy which sheltered housing attracted from 1969 onwaicls. However the Ia)cal Government Planning and Land Act, 1980. abolished tliese standards and led to Circular 82/69 l^eing witlidrawn. Local au-tliorities subsequently set their own standards whilst housing associations followed the design and contract criteria published by the Housing Coi-poration - tlie funding agency to which housing associations apply for financial support for new development. But tlie advice contained in tlie cii-cular had become deeply ingiained, and still has a strong influence upon the design of sheltered housing. In addition to these design features sheltered housing usually also includes some or all of the following : a resident warden or a responsible person who acts as a 'good neighbour'; an alarm system to each dwelling which when activated alerts tlie warden/good neighbour that a resident needs no. 28,29/1995 help. Usually schemes are purpose built though some schemes have been provided through convei-sion of existing buildings. In addition, most schemes have dwellings which are usually grouped together on one site - sometimes as a mixture of Categoiy 1 and Categoiy 2 accommodation units. All have an occupancy which is confined excki^ively to elderly people. Occasionally younger people who have a need for a comparable level of supporl. because they are physically disal^led for example, may be housed vviüiin a sheltered housing scheme. The day to clay costs of mnning schemes in the local authority sector, including tlie Wardens costs, are usually borne by the Housing Revenue Account which is the financial account into which all income from renting out L.A. property is paid. Occasionally the non-housing costs (Üiat is anyUiing which would more accurately be defined as TcareU) ai'e met by the Social Services Depail-ments, from their own revenue budget; usually only where a scheme has been jointly planned by both housing and social services departments. Some housing associations have specialised exclusively in providing sheltered housing for tlie elderly e.g. Hanover Housing Association and Anchor Housing Association. E>/en housing associations with a more mixed stock profile have significant levels of sheltered housing. nie following brief case study provides an illustration of the two categories of sheltered housing scheme. Both have been developed by a national housing association; about 25 % of their stock is specialist housing for the elderly, tlie rest being largely mainstream family housing. Case Study Examples A. Tjrpical Category One Scheme: • Scheme was built in 1979. • Consists of 28 units. • Good Neighlx)urU helper. • Alarms: Pull cords are situated in flats, and connected through to Good Neighbour. There is no speech facility. • The rents levied range from £ 36.00 for a secure tenancy to £ 47.00 per week for an assured tenancy. • Other services include caretaker, grounds maintenance, communal lighting and cleaning and external window cleaning, see attached schedule. • The Good Neighbour works Monday - Friday. 9.00am-U.00am and priority is given to checking on all residents to ensure they are in good healUi. Should they be found to be in need of medical assistance Uiis is done immediately. • Once all residents are visited other duties can be attended to eg reporting repairs. • The Cat I properties are on the ground and fust floor with general purpose properties on the second floor. There are no lifts on site. • There are no communal facilities on site. B. Typical Category Two Scheme: • Scheme was buflt in 1986. • Consists of 46 units. • Resident Warden. • Alanns: The system is connected through to a Centi-al Control based in an adjacent town, who cover whilst tlie Warden is off duty. The Tunstall Telecom Piper Group sjTstem benefits from a two-way speech facility which enables tlie Wazxlen to speak to the tenant. • The rent levied range from #45 for secure and £ 67 for assured per week depending on the type of tenancy. Along with the residential warden, there are other services which are listed on the attached schedule. • The Warden works Monday-Friday. 9.00am to 5.00pm and priority is given to checking on afl residents to ensure they are in good health. • Once all residents are visited other duties can be attended to eg. reporting repairs, lamidry tokens, coffee mornings. Communal facilities include common room, laundry and guest room. • The scheme is built on 3 floors with a lift. št. 28. 29/1995 Despite tlie withdrawal of Circular 82/69 in 1980, the standards within sheltered housing continued to evolve so that sheltered schemes developed in the 1980's and to date include guest rooms in which friends and relatives can stay for a small charge - the idea is to facilitate continuing contact and support from relatives who may live some way away from the scheme. Rési-dents usually have use of a laundry room containing washing machines and tumble dryers, irons and ironing boards: and activities or hobbies room(s) where all manner of activities can be continued - such as carpentiy, arts and crafts, gardening etc. In addition to self contained accommodation the warden in charge of a scheme will usually also have an oflice where the residents personal records will be stored, where private interviews can be held and where the hub of the alarm system will be housed. In the 1980's the Chartered Institute of Housing and the Royal Institute of British Architects produced a 'Housing Design Brief: Housing for Elderly People', that aimed to ensure that the following features were designed into schemes in order to: ♦ Facilitate independence - e.g. locate power points at waist height; ensure that windows can be easily opened: ♦ Maximise pei-sonal space and privacy - this therefore precludes shared facilities: • Provide safetyaids e.g. handrails, but ensure that Uiey do not l>e-come overly obtrusive: ♦ Ensure that taps etc. can be easily manipulated allowing for reduced grip; • Provide a stimulating environment within tJie dwelling in order to olTset as far as possible Uie reduced contact witli tlie outside world which frailty brings e.g. an interesting aspect and windows which provide a view when seated; • Avoid potential disorientation of tenants by avoiding overly complex layouts - with long conldors which may quickly become rabbit warrens; • Maximise the possibility of contact between tenants whilst preserving private space e.g. by grouping flats or btmgalows into small groups of four: • Pi-ovide small or easily managed dwellings; • Efllcient and cheap heating; • Locate near to amenities and community seivices; • Locate on a site with good access to public transport: • Provide level access to the site with no steep gradients; • Pi'ivacy; • Oi'ovide manageable garden - or no garden; • Provide pleasant environment; • Physical security; • Minimal concentration of specialist dwellings. There is now greater effort to minimise the institutional feel of sheltered housing with a view to maximising independence and privacy of tenants and nonnalising ' theirU housing - tliat is maldng it as near to TordinaryU housing as possible. It shoLiId be bome in mind that the figures ai'e likely to be imder rather than overstatecl as not all local authorities will have precise data for schemes in their area. The uneven distribution of schemes reflects the ad-hoc nature of planning at the local level and tlie total lac k of strategic regional and national planning for specialist housing for this group. Table 7: Regional Distrihuiiai of Sheltered Housing REGION local authority housing assoc'n private total units per 1,000 pop'n north 23,631 8,040 397 31,798 12.3 yorks and humberside 39,776 10,598 1,093 51,467 10.4 east midlands 35,110 7,364 1,098 43,572 10.9 eastern 37,944 13,387 5,078 56,509 9.9 greater london 26,068 16,114 4,248 46,430 6.9 south east 34,955 19,475 15,154 69,584 10.0 south west 33,639 12,192 6,255 52,086 11.2 west midlands 29,713 10,649 2,194 42,556 8.6 north west 42,495 22,981 3,281 68,757 10.0 total 303,061 120,800 38,798 462,659 9.7 (Scotland 31,632 4) Source: Age File the Facts. 1994:21 (Information for Scotland, Tinker, 1994, opcit). no. 28, 29/1995 PeterTowiisend in "Ilie LastRefuge' in the 1960's recommended that 50 sheltered dwellings shoLild be provided for every 1,000 elderly people in the population. Tliis benchmark has not been adopted as the above illustrates. AnÜieaTinker (et al) ix)ints out tliat: There is very Utile national guidance in Englajid and Wales on how much housing is needed by elcledy jjeople. and what form it should lake . However. the Departniejit of fiie Enuiwn-nient started research on housing needs and provision ... and hopes to issue guidance after the completion of tiv2 study ... 'llie Scottish OlTice issued national guidance for Scotland in 1991 suggesting 20 units of vety sheltered housing, 46 units of sheltered housing and 80 units of medium dependency housing per 1,000 people aged 65 and over (Tinker, 1994:22). In 'Sheltered Housing for Uie Elderly", by A Butler. C Oldman and J Greve, published in 1983, the au-tlioi-s criticised the over- emphasis placed upon sheltered housing as a cure-all for the housing problems experienced by older people. They acknowledged that sheltered housing represented a substantial improvement in accommodation standards for those who were re-housed from unfit, un-moclemised or unsuitable housing. But Uiey did not find, in their national study of provision, that all or most tenants either needed or wanted the wai"-denUs services or even tlie alaiin scheme. 'What is not altogether clear is why somebody living inpoorhousvig conditions should be seen as a candidate for a form of specialised housing, when apparenäy their require-nv2nts could have been met in oUier ways - either by home improvements or a move to better quality housing. ' Indeed some veiy real problems with sheltered housing were iclen-üfied by this study in the 1980's: - sheltered hotising had been provided to the virtual exclusion of other alternatives; - afudgingofobjectives-especially as iDetween the 'housing* as opposed to the Tcare' elements: - they created age-based ghettos -and as a result tenants became separated from the wider community; - they tend to increase dependency - not all tenants need supervision - or care; - not all tenants had actively chosen the sheltered option. They had become sheltered tenants because of a) the lack of oüier housing options, or b) because their local autliority was seeking to reduce under-occupation ofL.A. family sized housing: - many tenants would have pre-feired to have remained in tlieir fonner home. Even where tenants had been appropriately re-housed Uiey sometimes became too freiil to cope on Üieir own, but had dilBculty securing tlie additional care they needed. On Uie oUier hand this kind of'housing with care' is cheaper than other fomis of Tcare and support' provided in other settings. This was shown by figures produced in the 1980's: Table 8:77ae cost per person (in £ 's) per annum, biclusive of all supportive services (figures 1981-2): 1981-2 1. Hospital: acute 20,319 long stay 15,347 geriatric 14,8142 2. Part III 5,9533 3. Sheltered Housing local authority 4,940 housing assoc'n 4,971 Source: Tinker, A., 1984. Hie group included in these costings were people of high dependency who were in receipt of state benefits. More recent figures published by the DoE compare sheltered housing costs with those of support services provided to people in their own št. 28, 29/1995 homes. This comparison was rather less favourable to sheltered housing - but institutional/residential care is not included in this comparison (Table 9). Irrespective of all Uie arguments about costs, and the relative merits of people moving as opposed to staying in their own homes. - all the research into tenants attitudes have tmcovered very high levels of satisfaction with this fonn of housing. The aspects of schemes which are most highly valued by tenants ai-e the warden's service, tlie physical security provided by schemes and the social contact which is made possible. Recent surveys of sheltered housing tenants are also finding that new residents are older and more frail Uian existing tenants, and are certainly more frail than were new tenants 10 years ago.'Iliis is not only because of demographic trends, it also mai'ks a change in the management of schemes. Tlie concept of sheltered housing with a warden originally included tlie idea of housing people with a range of different abilities so as not to overburden tlie warden with an over dependent population witliin any one scheme, and also so tliat the more able tenants could help the more frail. A further development of the concept has also taken plače in response to an increasing need for provision to meet the needs of the fi-ail elderly. iTiis is known as Very Sheltered Housing or Extra Care schemes. 'Very Sheltered Housing' or 'Extra Care Schemes' In response to Uie increasing cai^e needs of sheltered housing tenants, many local auUioriUes and hoLising associations developed schemes which were designed to provide a higher level of care and support These were known as Very Sheltered Housing' or 'Extra care Schemes', or even - because of Uieir interim status between sheltered housing and Pait III accommoda-üon-Part2 1/2 schemes (Table 10). The main reasons for providing this type of housing were Uiat: - tenants were becoming more fi-ail in sheltered housing, Part 111 accommodation was increasingly seen as inappropriate, - to provide care yet independence, - the wish to widen choices available to older people, - an attempt to prevent hospita-lisžition. The čidditional features provided within extra care housing are usual-some meals; 24 hour cover by a warden or otlier help; and enhanced communal facilities such as a dining room. 'Ilie Very Sheltered Housing Schemes built had often resulted from close inter-agency cooperation esjjecially between housing and social services depailments - this was usually co-ordinated by the housing depaitment. 'Tl\ere was evidence U\at some authorities were coming towards an iiiter-agency approach, which included Vie volwitary sector, to solve all the needs of elderly people. Oi\e District HealUi Authority said 'we are getting acceptance tliat we arejouUly (DHS, LA and volimtary sector) ca-ri]ig for the elderly'. A housing department agreed beccaise without such co-operaüo7i 'District Councils are probaloly not keeii to talee the Table 9: Comparative Costs ofprovision of care and support low dependency medium dependency high dependency stay at home 4565 4409 4429 specially designed housing 5699 5830 5840 sheltered with warden 6519 7053 7377 very sheltered 11,299 11,902 12,564 Table 10: ADVANTAGES PROBLEMS Cheaper than Part III residential care High degree of tenant satisfaction More expensive than care in the home 25 % residents said they would have preferred not to move Provide frail elderly with greater independence than Part ill Schemes varied in the frailty of their residents.ie. selection methods were ill defined More likely to have self contained accommodation than in Part III Self contained accommodation was not universally provided A higher level of care than in more independent accommodation Too much care provided 'in-house' rather than involving Health and Social Services Departments no. 28, 29/1995 initiative on Very Sheltered Honsing, as they might he landed iväh people who need permaneiU care'. A social services department reported 'moving towards a JoitU strategy for l/ie elderly wilh health and honsii^g departments in U\e county'. Joint strategies were being developed in sonie areas, hx East Sujfolk for exainple the Joint care plannij\g team of IxealUx, hoiisijig and social services produced a joint strategy in 19S5 including pilot schemes which were to be evaluated' CTinker. 1984:59). On the other hand: 'where tJ-iere was not a gerxerally agreed strategy about for whom very sheltered housing was suitable, this could lead to cortjlict. For example, if patieiUs were discharged early (from hospital) with little forewamirig. on t}xe assumptior-i that an iiitensive level of care would be provided' (ibid). nie availability of punip priming finance tliroiigh the system mentioned above - Joint Funding - provided encouragement to tlie development of very sheltered housing. This finance was available to schemes which could l^e shown to help avoid or delay elderly people having to enter more expensive hospital or residential cai'e. Also, such schemes often attracted revenue funding for suppKDil posts within the scheme, in addition to resident wardens. Veiy Sheltered housing can provide flexible care acconding to need, perhaps for short periods to individual tenants; Uiere may also be economies of scale by providing support services within this environment. This makes them the potential focus of wider community care and support seivices, which in turn would establish pivotal resources in tlie context of Community Care. Before moving on to discuss tlie impact of Community Care legislation and the role of Uie warden, it is woilli pointing out tliat some local auüiorities have been able to enhance their provision of sheltered housing by utilising existing dwelling stock. Ulis has been a particularly attractive option open to local autliorities who have housing estates which contain large numbers of high rise tower blocks; tliese have become unpopular with families and consequentially hard to let. Whole tower blocks can be converted to specialist sheltered housing relatively cheaply by the creation of communal facilities, attractive common ai"eas, elTiclent lift systems, and with the installation of secured entiy systems, even TconciergeU services, 'ilie addition of two-way speech alarm systems linked to a stair team of wardens completes the conversion. The tenants are then charged a sei-vice charge in addition to their weekly rent to cover tlie enhanced services, just as in ordi-naiy low rise sheltered housing. A further development of warden support services has been made possible through Üie new technology now available for alann systems. Illese are now so sophisticated tliat some housing authorities no longer employ resident wardens; instead Uie alann system when activated in the tenants flat is channelled tlirough to a central control ofllce where all participating tenants have their records kept on computer. The central control officer can call up the details of the caller to check for any known medical conditions and depending on tlie resulting two way conversation with the caller can eitlier call out a nonresident warden, a relative or other support seivices including emergency medical aid. These systems have Üie potential to give a similar level of support to elderly people who are still living in tlieir own homes. In short, Uie central control plus non resident warden support can be provided across all tenures and house types; and as such can con-tiibute towards keeping people in tlieirown homes despite increasing frailty. Local auUioriUes now n.m tlieir own schemes or they cari purchase into schemes run on a regional basis by private companies. It is a nati.iral progression that, with the support and consent of existing tenants, tlie communal aspects of ordinary sheltered housing could be opened up to elderly dependent people living in their own homes within the locality - perhaps to provide day care services or meals, or just for social gatherings. št. 28, 29/1995 The Role of the Warden Recent research carried out by Sa-nctuaiy Housing Association illustrates the lack of clarity in this area. It was found that warden job descriptions varied widely tliroug-hout their organisation even where schemes were similar in size and design. This is mainly due to schemes being planned and built at different times. Nonetheless the result was that the expectations by tenants and relatives of the role of the warden, could be very differenL- Service levels are not related to tenants' actual support needs but usually represent how the scheme services were set up ai the time the scheme came into operation. Local management iintiatives iii some areas are attempting to ùUrodiice a more rational, planned service, but this is not uniform more a nvitter of whatpriority ithas beengiven by the local management team. Sanctuary Housing Association have defined the role of Üie warden as covering three main ai-eas of work as follows: • Scheme Manager • Service co-ordinator and facilitator • Tenant Advocate The following is a fairly typical job description provided to wardens of sheltered housing: Sanctuary Housing Association Job Description Job Title: Wanden at 46 Unit Categoiy I and II Scheme for the Elderly Responsible To: Housing Ollicer Responsible For: Cleaner Hours of Duty: 9.00 am-1.00 pm & 2.00 pm -5.00 pm 5 days per week- 35 hours per week To Be Responsible For: Managing the scheme on a day to day basis, to act as a good neighbour to residents and to be tlie Association's representative at tlie scheme. Specific Duties: Welfare of Residents 1. To be alert to the state of health and dependence of each resident and to take appropriate action by contacting relatives friends or relevant sei-vices as required. 2. To establish the well being of each resident before 10.00 am witli follow up visits/ calls as required. 3. To respond immediately to emergency calls made by residents and summon whatever medical or other assistance may be required. 4. To liaise with local agencies and sei-vlces to ensure tliat any assistance available to meet tlie specific needs of residents is uU-lised, eg. Social Services, nursing, medical, home help, meals on wheels, social activities. 5. To offer assistance of a neighbourly nature to tenants who may be ill for short periods, eg. collecting prescriptions. 6. To maintain a record of the doctors and nearestrelatives of each resident and any emergency telephone numbers. 7. Where tlie emergency alann is linked to an off site agency/ authority, to ensure that such details supplied to that agency, authority are kept up to date. 8. To keep Uie Housing Ollicer in-fomed of any cause for concern with regard to the welfai-e of any resident, in particulai-Iy if any resident appears to be refusing help or is becoming incapable of managing Uieir own affairs. Building, Equipment and Communal Areas 9. To be responsible for the security of the building. 10.To notify the office of any repairs or defects in the building which require attention. 1 l.To oversee the general condition of communal areas relating to the properties and report to the Housing Officer on the standard of any gardening, cleaning or general work undertaken by con-tractoj-s or other employees. no. 28.29/1995 12.To instixict residents on Uie proper use of heating systems and alann equipment. 13.To liaise with tlie local Fire Prevention Officer and ensure Uiat fire drills, regular checks on Uie fire alarm system and maintenance of a Fire Book are cairied out in accordance with regulations and recommendations. 14.To lie genreally responsible for the Guest Room, its cleanliness, lx)oking. etc. 15.To collect, record and pass monies to the Housing Officer for Uie Guest Room tise and communal telephone. 16. To keep an inventoiy of all furniture and equipment provided within tlie scheme which is in the ownership of the Association. General 17.To promote Uie use of the communal facilities and to help organise communal activities. 18.To keep a daily log. Any other duties consistent wiUi Uie post as directed by Uie Housing Manager. Some housing organisations have produced detailed Wardens Manuals which define Uie detailed day to day roles and responsibilities for Üieir employees, and also provide infonnation about Uie departments and agencies to which waixlens may need to refer problems, as well as detailing in-house management pracUces and procedures. 'nie Centre for Sheltered Housing Studies has also proposed a Code of I^actice for wardens which is supported by the professional bodies aiid is being adopted by an increasing number of housing agencies. Code of Practice 1. To offer equal opportunity and fair U-eatment to all residents wiUiout discrimination on account of race, gender, disability, religion, age, or sexual orientation 2. To recognise, respect and safeguard tlie individuality and per- sonal rights of each resident whilst acknowledging the res-ponsibiliUes to oUiers 3. To understand and respect the confidentiality of knowledge and information relaUng to individual residents an Uie employer 4. To facilitate indef)endence and Uie well being of residents both as individuals and within Üie group as a whole 5. To be sensitive and impartial in the delivery of services 6. To act always wiUi honesty and integrity 7. To ensure Uiat professional responsibility is never sacrificed for personal interest 8. To establish and maintain high standards of personal conduct and professional relationships 9. To acknowledge the need for conUnuing professional training and self-development 10.To ensure that internal procedures relating to statutory obligations of the employer are un- . derstood and implemented 11.To underetand the roles of other service provider and significant people in the lives of residents and be committed to working effecUvely with Uiem 12.To be aware of and to accept a responsibility to contribute to Uie setUng of objectives, policies and procedures of the employer. The Commimily Cai-e legislaUon which caiiie into force in 1993 has changed the responsibilities given to statutory agencies for the care and support of elderly people, and other need groups. The principal aim is to retain people in Uieir own homes, living as independenUy as possible for as long as possible. Social Services departments have been given Uie responsibility for drawing up community cai'e plans for their areas, consulting as widely as possible wiUi otlier providers of services, and wiUi users and potential users, 'llieir role as providers of services is to greaUy diminish and the residenUal cai^ homes they still have in management are being trans-fen-ed to outside agencies wherever possible. Rather than acting as direct providers, social seivices are to play the strategic role for planning these services, assessing individual št. 28,29/1995 clients needs for care and support, and purchasing 'packages' of care and support from independent suppliers of services, to meet these needs. People living in residential care homes will only receive financial support from the State for Uieir accommodation. If the Social Services department agrees that tliey are in genuine need of Uie level of care being provided Uiere. The Social Services departments are Uiere-fore the 'enablere' of Community Care but are not the main providei-s. The advantages and potential pitfalls in this re-aiTangement will be explored in the annex to Ulis paper. Thus the way has been opened up for housing associations, in particular, to become major providers of accommodation where mediiun to high levels of care and support are required. Some housing associations already have experience of providing these types of scheme and have already received funding to develop innovative projects including residential cai*e homes for elderly people who have severe mental im-painiient due to Alzheimers and other age related diseases. It is likely that this trend will increase in tlie future: buit that tliis will happen alongside tlie extension of seivices such as domiciliaiy caj'e to people remaining in their own homes, where this is more appropriate. Dr. Mary Griffiths, Senior Lecturer, Course Director, Post-Graduate Diploma in Housing Bibliography and Sources 'nnker. A.: Staying at Mome: Helping Elderly People, UMSO. London 1984. linker. A.; MeCrcadic. C.; Wright. F.; Salvage. A.: 'llie Care of Fnvil Elderly People in the United Kingdom. UMBO, Ivondon 1994. An Ageing Population. Faet Sheet 2. Family Poliey Studies Centre. loindon 1991. Age File tJie Facts. Anchor Mousing Trusl, 1994.