Housing with care, also referred to as retirement communities or integrated retirement communities is an umbrella term that includes extra care housing, assisted living, retirement villages, independent living, assisted living, close care and very sheltered living. The range of names and definitions within housing with care is complex as reported in 2021 by sector representative ARCO.
Housing with care provides people with the opportunity to live in their own purpose-built, self-contained household, while accessing care and meals on-site. This can enable people to live more independently for longer. Care is provided by staff who are available 24 hours. The term ‘care’ refers to personal care which includes physical assistance, or prompting with supervision, given to a person in connection with:
- eating or drinking
- using the toilet
- washing or bathing
- dressing
- oral care
- the care of skin, hair and nails (with the exception of nail care provided by a chiropodist or podiatrist).
The accommodation is usually a one- or two-bedroom flat or bungalow, which is available for sale, rent or shared ownership, in a community or village of similar accommodation. The dwelling is specifically designed to facilitate the delivery of care if and when it is needed, the level of which can be increased or decreased as required. Typically, domestic services are available and staff are on-site 24 hours. There is also 24-hour emergency help via an alarm system.
Although accommodation is self-contained, a range of communal facilities may be available including a restaurant or café, lounges and gardens. Leisure and wellness facilities such as gyms, hairdressers and activity rooms may also be available. These facilities may be open to the public to encourage and develop community connectedness and reduce isolation and loneliness. Many schemes also run social activities for residents. Schemes have a manager (previously called wardens) who may live on- or off-site. Retirement villages tend to be larger complexes and generally offer more leisure and care facilities than mainstream housing with care schemes.
Key differences between residential care and housing with care are that those living in housing with care have specific tenure rights to occupy their dwelling and the legal agreements for provision of care and accommodation are separate. Those living in housing with care have exclusive possession, over their accommodation, which means they can decide who enters and when; they also have their own ‘front door’ with their own key.
It is a newer form of specialist housing for older people, and is still relatively uncommon in many parts of the country.
Number of units
There are approximately 74,000 housing with care units in UK although figures on this vary. This is a relatively small number of units with only 0.9% of households aged over 65 living in housing with care in England and Wales, compared with 6.5% in the US and 5.7% in Australia. Provision is not uniform across the country, for example around 8% of districts in England lack even one housing with care scheme.
Who lives in housing with care?
Housing with care is predominantly lived in by older adults, but there are schemes for adults of all ages including multi-generational schemes. The housing is designed for older people who are able to live on their own if they have on-site access to assistance with personal care as and when required. The level of care offered can vary from a few hours each week to full-time care. It is hoped that this flexibility will help people to ‘age in place’. There are also schemes specifically designed to support adults living with dementia.
Costs and funding
The cost of housing with care varies depending on whether the resident rents or buys their accommodation, the scheme chosen, the level of care needed, and where they want to live. The cost of renting is made up of rent plus a charge to cover the services and support provided. Rents vary significantly between landlords and around the country. As well as ongoing charges for the care and assistance provided, there is a regular ‘service charge’ to cover the management and upkeep of the scheme. Council tax, water rates and energy bills may also be additional costs. In addition, there may also be one-off fees when a tenancy ends such as administration or event fees (also known as exit or transfer fee).
People may be able to get help with their rent and/or service charges through the housing benefit part of Universal Credit, if renting, or Pension Credit, if they own their own home. Age UK also advises that help with council tax and the cost of some or all of a person’s care and support may be available through the local authority.
Regulation
Personal care is a regulated activity and housing with care schemes in England which offer this service are subject to regulation by, and should be registered with, the Care Quality Commission (CQC).
Commissioning and provision
Nearly all housing with care schemes for rent are provided by local authorities and housing associations, but there are charitable and private sector providers. In contrast, 12,000 out of a total of 14,000 leasehold units are provided by the private sector. Private providers are concentrated in the south of England and are completely absent in many districts in the north of England
Housing with care units by sector and tenure type
| Sector | Total | Private | Public |
|---|---|---|---|
| Leasehold | 14K | 12K | 2K |
| Mixed tenure | 23K | 1K | 22K |
| Rent | 35K | 0K | 35K |
| Other | 1K | 1K | 0K |
Note: Mixed tenure includes a mix of rent and leasehold. Other tenures include shared ownership, for example.