What next for the Extra Care quiet revolution?

The housing market slowdown has stalled the growth of extra care housing. With a general election and public spending cuts just around the corner, the future of this innovative housing and care solution for older people now looks shaky. Paul Coleman reports.

Knock. Knock.
“I’m collecting for the old people’s home,” says the man on the doorstep.
“Wait a minute,” replies the little boy. “I’ll go and get my Mum and Dad.”

One reason why this old gag lags well past its sell-by date is because the growth of extra care housing during the last decade has challenged the traditional ‘old folk’s home’. During the ‘noughties’ thousands of older people sold their private homes to buy or rent apartments in new extra care housing schemes. The Mill Rise Extra Care Village in Newcastle-under-Lyme is typical. Inside one building, Mill Rise provides 60 residents with rented or shared ownership homes alongside three doctors’ surgeries, a pharmacy, restaurant, café, hair salon and a courtyard garden. *

Since 2004 Prime Minister Gordon Brown’s Labour government has stimulated growth of the extra care housing market through the Department of Health’s Extra Care Housing Fund. Local authorities, housing associations and private developers bid to the Department for capital funds that part-funded new extra care schemes. A DH statement, prepared for 24 Housing, says: “The Department will have invested £227 million by 2010 to help kick start the development of extra care housing.”

However, the statement shows the government seems to think it’s done its bit for the extra care housing market. The DH statement adds: “There are no plans at present to extend the Department’s extra care housing fund beyond 2010.”

Funding termination comes at a time when the growth of both private leasehold and social-rented extra care housing has received several setbacks. The broader housing market has discouraged potential extra care residents from selling their homes. Filling mixed tenure extra care schemes is therefore more difficult for housing providers. The credit squeeze has also hit housing associations and developers trying to borrow funds.

The planned halt to government capital funding could further discourage housing providers from financially committing to new schemes. Housing associations and developers aren’t likely to leap into action at the first sight of ‘green shoots’. Extra care, by its very definition, imposes immediate costs. Care teams and kitchen staff have to be in place from day one even if only to cater for a handful of residents. Most providers will wait to measure the quality of any economic recovery. These setbacks come just when a growing extra care sector is needed. The number of older people with cognitive and functional impairments will increase over the next 20 years.

However, a poignant, hopeful moment arose when 83-year-old Queen Elizabeth II, dispassionately delivering the Queen’s Speech on 18 November, read aloud: “My government will introduce a bill to enable the wider provision of free personal care to those in highest care need.” Gordon Brown had earlier revealed this plan during the political cockfight of this autumn’s party conference season.

Health Secretary Andy Burnham duly presented The Personal Care at Home Bill to Parliament on 25 November. Currently, older people can receive care services from local authorities free of charge for up to six weeks. The Bill would remove this time limit in respect of personal care at home and guarantee free personal care for an estimated 400,000 people with significant needs.

Predictably, the Conservatives and Liberal Democrats dismissed the Bill as a Brown wheeze to score political points in advance of an election. The Government claims the measure would help around 130,000 people needing home care for the first time. However, the government hasn’t yet confirmed if the measure includes people who live in extra care schemes.

“Extra care is clustered home care so I think that anything that encourages home care will benefit extra care,” says consultant Philip Mickelborough who has analysed extra care housing for over 15 years. Mickelborough, author of market analyst Laing & Buisson’s regular reports on extra care housing, says: “The Extra Care Housing Fund was the most dramatic market change. Every local authority has taken a stab at getting some of the money. But we’re in the midst of the 2009-10 funding tranche and there’s uncertainty about what happens next.”

However, Mickelborough feels extra care housing demand could rise again as public awareness sharpens, especially when more older people – and their children - realise extra care can protect older people’s capital. “If you go into a care home, you have to sell your house, your capital disappears and your children’s inheritance vanishes,” says Mickelborough. “But buy an extra care flat and your capital is preserved.”

Mickelborough sees local word of mouth further stimulating demand. For instance, Skinners Court, a relatively small 48-flat extra care scheme, developed by the Skinners Charitable Trust and Hanover Housing, has generated awareness in north London. Five older people with low-level learning disabilities were offered Skinners Court tenancies after their existing traditional residential care home closed. Enfield social services funded specialist care and the local Disability Action branch provided further support. This alliance helped the quintet move into co-located flats on one floor in a scheme that even offers a cinema and a health and beauty treatment room.

Mickelborough sees many local authorities anticipating a drop in demand for the traditional residential home. The UK’s estimated 15,000 extra care schemes represent no more than 10% of the total home care sector. “But I do think this will increase as people will be diverted into extra care,” says Mickelborough.

Unless subsidised, housing providers need extra care housing schemes with at least 40 apartments to make a profit. Mickelborough doesn’t expect UK ‘village’ schemes to go beyond 350 units. Schemes in the United States have 3,000 apartments, turning them effectively into older people’s ghettos. Older people in Britain don’t want to be isolated from their local community. They want to see people, use local shops and meet and entertain family and friends.

Extra care housing research by the Joseph Rowntree Foundation and the Personal Social Services Research Unit at the University of Kent shows that older people are most attracted to extra care schemes located in the heart of neighbourhoods rather than those built on town fringes. Schemes running cafés, gyms and hair salons that can be used by local people are even more attractive to older people looking to buy or rent. Healthier schemes are also where residents are actively organise social activities.

Once a surer recovery begins, housing associations can resume making money from privately sold flats in mixed tenure schemes. Promising evidence suggests older people are happy to buy apartments in mixed tenure schemes.

However, the looming General Election promises little. Strenuous enquiries by 24 Housing found neither Conservative nor Labour have specific policies on extra care. A Liberal Democrats housing spokeswoman seemed unsure of extra care’s existence. A broader Conservative proposal, where everyone at retirement contributes £8,000 in return for £25,000 of care home accommodation could lead to older people opting for inferior care home accommodation ten years later simply because it’s free. “This proposal could be modified so the £25,000 could be used to fund extra care accommodation,” says Mickelborough.

The Homes and Communities Agency continues to fund individual county council schemes, such as those successfully bid for by Cornwall and Shropshire. Between 2004-08, £228m came from the Housing Corporation (now the HCA) but the rosy days of the Extra Care Housing Fund are now over.

This growing uncertainty has led to some voices insisting government must carry on stimulating the market. Helen Williams, assistant director at the National Housing Federation, told 24 Housing: “Extra care housing can offer a more cost effective and flexible alternative to residential care. It is vital that Government continues to encourage the growth of extra care housing that enables people to self-care for longer and helps them to retain their independence in their own apartment.”

DEFINING MOMENT
No set definition of extra care housing exists but this might run close.
Extra care housing offers more than traditional sheltered or residential homes by meeting the housing, care and support needs of older people, while helping them to maintain their independence in their own self-contained privately owned, rented, part-owned or leasehold apartments. Support and care is available 24-hours each day. Meals, domestic support, leisure and recreation facilities are provided alongside other facilities in small 40-plus units or larger 200-plus unit ‘village’ schemes.

LANDLORDS AND THE SOCIAL CARE AGENDA
Social housing landlords are at the forefront of the fight to provide quality social care, standing shoulder to shoulder alongside health and social services.

That claim comes from the Association of Directors of Adult Social Services (ADASS), which last year set up its own housing network within the organisation in recognition of the important role played by the sector.

“Having a decent, affordable home is often the key to independent living,” says Bill Hodson, joint chair of the ADASS’s housing network and director of adult social services at York City Council.

Adult social services departments know from the profile of people living in social housing that many tenants have limited incomes, he says, and that can make some adults vulnerable.

“Because of that, there’s a crucial partnership role to play with social services and health to provide a safe and supportive environment and to collaborate to enable people to maintain their tenancies in the community when problems arise” he says.

And he scotches any still lingering claims that ALMOs took tenants further away from core social care, saying: “There is no inherent reason why partnerships with ALMOs should not work effectively, although it can be easier to plan work across housing and social care within the same management structure.”

He also stresses that more than half of the directors of adult social services are also responsible for housing in their areas, although in most cases this is as the strategic lead rather than being the landlord.

“Effective partnerships with housing are more prominent in many directors' minds these days than they were when ALMOs first came into being. The formation of a housing network in ADASS in 2008, and the prominence of housing in discussion about the delivery of effective social care, shows that there is a strong motivation in most areas to make this relationship work.”

One area in which the ADASS says there could be improvement is in planning joint strategies. Mr Hodson says: “There will always be operational issues that need to work effectively at the local level. Partners need to keep these under review, particularly in terms of sharing information appropriately to manage risk. More could be done at the strategic level in some areas to take forward major issues that would improve tenants lives.”

But, those concerns aside, the ADASS believes social policy has moved on significantly in the past ten years and social housing providers have played a major part. Mr Hodson’s organisation is now working with a number of housing organisations to provide a practical guide to what personalisation of services means for housing providers.

“Much has been done in recent years,” he says, “and housing has played an important role. The Supporting People programme has had a big influence in many areas in terms of re-commissioning or reshaping housing support geared around measurable outcomes for tenants. A great deal has been achieved and for that the social housing sector should be applauded.”
Paul Humphries