A place we can call home: A vision and a roadmap for providing more options for housing with care and support for older people

Published: 15 November 2021

This report for commissioners and managers in health and social care develops a vision and roadmap for providing more options for housing with care and support. It is the result of the research undertaken by the Commission on the Role of Housing in the Future of Care and Support.

Executive summary

The Commission on the Role of Housing in the Future of Care and Support was established in October 2020. Composed of a group of leaders of care and support organisations, academics, experts and practitioners related to housing with care and support, and co-chaired by the Rt Hon Paul Burstow, Professor Julienne Meyer CBE and Sir David Pearson CBE, the Commission was tasked with developing a vision and roadmap for providing more options for housing with care and support.

The Commission focused on the needs of people over the age of 65, although it also takes account of examples of promising practice in relation to working age adults (including those with learning disabilities). The Commission also considered the specific needs of diverse communities who often find it more difficult than others to access high-quality housing that facilitates their care and support.

The Commission believes that as much as is feasible, people should be supported to live in their own homes if they choose to, but there will always be some people who need or want to move from their original home.

This Commission has considered a broad spectrum of currently available housing types that provide access to care and support including: care homes, housing with care (an umbrella term for extra care, retirement villages, assisted living), housing with support (an umbrella term for retirement flats, sheltered housing), Shared Lives, and some forms of alternative or community-led housing, such as co-housing schemes, which for simplicity we refer to as ‘housing with care and support’ throughout the report.

Despite many reviews and attempts to address these challenges, insufficient progress has been made in terms of policy and delivery. The voices of older people and their carers are not consistently heard or listened to and there is an urgent need for central and local government to understand what older people want and need in later life and to create the conditions to enable the housing with care and support market to flourish.

The Commission believes that the Social Care Future vision should be our guiding ‘north star’ as we consider where we want to be in the future:

We all want to live in a place we call home with the people and things we love, in communities where we look out for one another, doing the things that matter most.

Moreover, on the specifics of housing with care and support, the Commission further believes that:

In the future, if people are to move into housing with care and support, a good choice of options must be available locally so we are not simply “placed” in a one-size-fits-all approach to care.

The case for change is compelling and urgent. Without far-reaching and sustained change nationally and locally, we will see the gap in the choice worsen, quality decline, inequalities widen and the economic costs grow.

At the heart of the vision is the idea that as far as is possible, people should be supported to live in their own homes. But for many people, this will be neither desirable nor possible. In this situation, the Commission has identified seven key principles of excellence that reflect this vision of the future, as well as existing examples of positive practice that demonstrate that such a vision is entirely achievable. These key principles build on other quality frameworks, such as the:

Think Local Act Personal ‘I statements’
the My Home Life hallmarks of what good looks like and
the Housing LIN HAPPI design principles

The seven principles of excellence for housing with care and support:

Person centred and outcome focused
Community connectedness
Strong leadership culture and workforce
Adopting innovation
Enabling choice and control
Promoting equality
Co-production and shared decision-making

If we are holistic in our thinking and actions, there is the potential to transform whole communities in the future through housing with care and support. The Commission worked with the co-production collective (a steering group of people with lived experience of different aspects of social care) to envision what we wanted a future place to look like, 10 years from now. The result was Brookmore, an imagined but also plausible place, we would all like to see in the future if we are ambitious for change. Through a place-based, integrated and co-produced approach to developing a vision and plan, and with sustained and focused action thereafter, we believe that Brookmore could be winning awards for the quality, choice and diversity of housing with care and support provision, and benefitting immensely from the growing health and wellbeing of its older population.

To realise the vision, and to create many more places like Brookmore in the future, we need to overhaul how we plan, commission, design and deliver housing with care and support. This will require concerted action nationally and locally, for at least 10 years.

This should not happen all at once through a big bang approach. It will need a combination of immediate action and actions over the medium and longer terms. These actions, both national and local, are set out in the Commission’s roadmap.

Key recommendations for National Government Open
- Create a national long-term vision and strategy for housing with care and for older people, co-produced with people with lived experience and other key stakeholders, with the aim of greatly increasing availability, quality and choice of housing with care and support options. This strategy should include targets for dramatically increasing the supply of housing with care and support across the country, with a priority being on ‘levelling up’ supply in areas where there are fewer options and choice.
- Legislate for a new Housing Future Fund (combining both money for capital spend and revenue spending) that obliges local partners including the NHS and local authorities to pool statutory funding and work together to develop a single plan for housing for older people.
- Introduce rights-based legislation, building on the Care Act (2014), which creates legally enforceable standards for housing with care and support, specifying what each person can expect from any housing with care and support provided.
- Increase capital expenditure, expanding the size of existing grants administered by Homes England and the Greater London Authority, to rapidly grow the supply of housing with care and support for those with ‘intermediate’ and lower needs, such as extra care and supported living. This expenditure should be linked to requirements for local authorities to produce a detailed local strategy and plan.
- Publish a national workforce strategy for social care, which includes six priorities, as previously called for by the national social care leaders and applies across all housing with care and support settings.
- Introduce clear definitions of housing with care type housing options – such as extra care and retirement villages – into national planning frameworks. Improve planning guidance so there is clarity on the application of planning use classes, site allocation, and assessment of local needs and demands.
- Strengthen the guidance notes for local authorities on the access requirements contained in the National Model Design Code by referring to older people and also including specific reference to the HAPPI design principles.
- Ringfence national investment in local information, advice and advocacy services for older people seeking housing with care and support options and help to move.
Key recommendations for local authorities and local partners (e.g. NHS, housing associations, voluntary, private and community sector and people who draw on care) Open
- Form local partnerships to produce a single plan for improving housing for older people within a local place, co-produced with people who draw on support. These plans should be developed jointly with the NHS, with budgets pooled to leverage larger capital funding and other inward investments into new developments, and their strategic requirements should be explicitly based on a thorough analysis of needs. The plans should include a long-term strategy for shifting investment into innovative, preventative models of housing with care and support.
- Include the HAPPI design principles along with nationally approved building regulations on accessibility when scoping out the design code.
- Establish and resource local co-production forums made up of, and speaking for, older people from all kinds of backgrounds, to influence planning, commissioning and design of housing.
- Expand the use of Individual Service Funds, a form of personal budget for people who draw on support, to help many more people to access innovative forms of supported living.
- Develop local information, advice and advocacy hubs to give older people better access to information on housing with care and support.
Key recommendations for developers and providers Open
- Provide a diverse range of different housing with care and support options for older people, broadening choice at all levels of affordability. Developers should ensure that all new developments adopt the 10 HAPPI design principles as a minimum which provide guidelines for the production of high-quality housing with care and support.