Better Homes Active Lives – Extra care housing scheme in Kent

Why was this example implemented?

Extra care housing schemes are a mix between independent living in the community with home care support and assisted living; i.e. very sheltered housing or housing with care. They are increasing in popularity as policy agendas in the UK try to shift care from traditional residential settings to the community. Tenants of extra care housing schemes can come and go as they please and have friends or family stay over in their apartment if they wish (though not to live permanently) – they have the same housing rights as ‘normal’ adults living in apartment buildings. Extra care housing is able to accommodate people who would otherwise be frequent users of acute services because they are unable to adequately self-care for themselves in their own home (Riseborough and Fletcher, 2008). Those targeted for extra care housing are people who can care for themselves, but whose housing is not suitable for self-care. It can also be used as a setting for intermediate care.

Until recently most extra care housing was developed with public subsidy by housing associations for social rent. Now the market for extra care housing is increasing to include both state and privately funded tenants paying market rates and provided by commercial companies, as in this example.

Description

The Better Homes Active Lives project, initiated by Kent County Council Adult Social Services Directorate, offers 275 extra care apartments for older people across seven newly built sites in Kent (approximately 40 apartments per site) which were developed by teams with occupational therapists and district managers. The accommodation is open to people over the age of 55, single or married, and is an alternative choice to residential care as care staff are available on site 24/7. Thus tenants with a range of needs can be catered for; from those with low needs but who feel isolated and vulnerable in their own homes to those with high personal needs but who can otherwise manage on their own. The apartments have their own front doors and tenants are free to come and go as they please. There is secure access to the apartments and each one is fitted with a pull cord alarm to call staff if they need assistance. The apartments are wheelchair accessible with adjustable kitchens and have been designed to meet the needs of people with dementia; each floor is colour coded and pictures have been used to help people navigate around the apartment block. Tenants have access to communal gardens. There are also heat sensors in flats to detect fires. Telecare systems can be fitted into flats on an individual basis. Other facilities available on-site which are newly built to serve the apartment blocks can include: restaurant, gym, hairdressers, internet cafe, shop, communal lounge, bar, and laundry. Many of these additional leisure facilities are also open to the general public thus allowing more integration between those living in the long term care facility and the wider community.

Each of the seven apartment blocks has a full time onsite manager. Managers have the following responsibilities: ensure tenant wellbeing and safety, offer advice, organise repairs, arrange help with shopping or household chores, and arrange social activities on and off site. Managers also develop support plans with tenants to identify any additional assistance which may be needed. Care packages provided by health or social services can still be received by tenants. Extra care housing is housing first- the laws that apply to tenants are those that underpin housing laws rather than residential care.

The Better Homes Active Lives housing project is a partnership of Kent County Council, district and borough councils in the county and Housing 21, which is a non-profit housing and care provider. The cost of the project is £72 million financed entirely through Government PFI credits. PFI, or Private Finance Initiative, is a scheme whereby the project has been designed, built, financed and operated by the private sector, but is leased by the government and will return to public ownership at the end of the contract period, usually 30 years (For more information on PFI click here).

What are/were the effects?

No evaluations on this scheme have been carried out. However, various types of extra care housing schemes have been implemented elsewhere to good effect.

Extra care housing schemes create suitable physical home environments for older people. Health and social care packages for those in extra care housing are still arranged similarly to those residing in their own homes; i.e. family support is taken into consideration during a needs assessment. However, because of the availability of onsite support, informal family carers will have most if not all of their care burden relieved by paid formal care.

Extra care housing is able to accommodate people who would otherwise be frequent users of acute services because they are unable to adequately self-care for themselves in their own home (Riseborough and Fletcher, 2008). It may also be a better option for older people who have been admitted to hospital who are not able to return home because their accommodation is not suitable for them, but whose needs are not so high as to need care home admission. These situations often result in delayed discharges from hospital and extra care housing might be a more acceptable alternative (Riseborough and Fletcher, 2008). It is yet to be seen whether extra care housing schemes will replace residential care homes.

What are the strengths and limitations?

Strengths

• Extra care housing is housing first- meaning that tenants are primarily consider as independent members of the community, but who also have many of the personal care and safety benefits of residential care.
• Accessibility options within the home (i.e. Telecare) can easily be upgraded as the tenant’s needs increase.
• On site facilities are available to the wider public thus helping tenants to maintain an active social life and connections with their family.
• Extra care housing offers older people an alternative to residential or nursing homes.

Weaknesses

• Though this type of scheme offers tenants independence, it still means older people must leave their own homes which they may be unwilling to do.
• The scheme has not been evaluated so any benefits over other types of residential care or care at home are speculative.

Opportunities

• Extra care housing arrangements could help relieve the burden on family carers as daily care needs can be met by onsite paid carers.

Threats

• Extra care housing is not necessarily more affordable than residential care homes.
• It may not be feasible to care for tenants with very high care needs which may mean that tenants will need to move into residential care at the end of their lives.

Credits

External Links and References

• About the Better Homes Active Lives Accommodation
• Housing 21 – Extra care housing in Kent 
• Office of National Statistics - Mid Year Population Estimates 2009 – Table 8 
• Riseborough M, Fletcher P (2008) Extra Care Housing: What is it? London: Housing Learning & Improvement Network.