Housing with care as a model for housing with care and support

What is housing with care?

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.

The size of housing with care schemes can vary but usually consist of between 15 and 60 self-contained homes although some schemes have more than 250 units.

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

Note: Mixed tenure includes a mix of rent and leasehold. Other tenures include shared ownership, for example.

Source: British Property Federation (BPF)

Case studies

• Cullingtree Meadows Open

  Model of housing or service: Housing with care

  Principles of excellence: adopting innovation; person centred and outcome focused; community connectedness

  View: Full case study - Cullingtree Meadows

• Charlie Ratchford Court Open

  Model of housing or service: housing with care

  Principles of excellence: community connectedness; person centred and outcome focused; adopting innovation; co-production and shared decision making

  View: Full case study - Charlie Ratchford Court

Promising practice examples

• ExtraCare Charitable Trust Open

  Model of housing or service: housing with care

  Principles of excellence: community connectedness

  The ExtraCare Charitable Trust, a leading not-for-profit developer of housing for over 55s, is based in the English Midlands and was established in 1988. It currently supports older people in 15 retirement villages and five housing schemes, together totaling over 3,900 homes. These homes are available to older people in their local area for affordable rent, shared ownership and leasehold sale.

  The vision of the Trust is ‘better lives for older people’ and its mission is creating sustainable communities that provide homes older people want, lifestyles they can enjoy, and care if it’s needed.

  Each of the villages and schemes has five to 18 social, health and leisure facilities that are accessible to residents, volunteers and people living in surrounding communities. These may include: reading groups, choir singing, wheelchair aerobics, tai chi and abseiling. Every location is supported through their activities teams. ExtraCare also arranges large-scale events, including a Christmas event, craft competitions and talent showcases, where all of the locations meet for a day of activities and entertainment. Residents, friends, relatives and guests are all welcome.

  The Trust also has around 2,300 active volunteers representing all age groups who support administration, hospitality, wellbeing and health, entertainment, skills learning, activities, resident friendship and charity shops.

  Residents report feeling less lonely, more active and ‘a part of things’ in a set of video testimonials.

• Audley Villages Open

  Model of housing or service: housing with care

  Principles of excellence: adopting innovation; person centred and outcome focused

  Audley Villages is part of Audley Group, a private sector specialist retirement housing provider. Audley Villages was founded in 1991 and there are now 19 villages in various locations around the UK. Each Village is aimed at the luxury end of the market. Residents buy their own house, cottage or apartment within an Audley retirement village with a lease of up to 250 years (length of lease varies by village) and a monthly maintenance fee. Residents are free to sell their property at any stage on the open market. This allows people to downsize and be free of maintaining their home but still benefit from a continued investment in a property they own.

  Additional support, known as Audley Care, is available for residents and ranges from light housekeeping to 24-hour care, seven days a week. Knowing that support can be increased when needed can promote independence and help residents feel more secure about their future.

  At the heart of each retirement village is a centre-piece building which houses a restaurant, library and the Audley Club which has facilities similar to those found in Country Clubs. The centre-piece buildings themselves often comprise Tudor Halls, Georgian Mansions and Victorian Villas which have been sensitively developed and restored.

  Audley Group is committed to using green energy. The entire Audley Group portfolio of villages including the 19 Audley Villages, will be powered by green energy by November 2021. Audley Cooper’s Hill in Surrey, opened in late 2019, is Audley’s very first green energy village and all newly completed villages will operate on green energy.

  Owners describe the activities they are involved in as well as practical issues such as moving during the pandemic in a set of ‘owner stories’.

• Guild Living Open

  Model of housing or service: housing with care

  Principles of excellence: community connectedness; adopting innovation; person centred and outcome focused

  Guild Living retirement properties include one, two- or three-bedroom apartments to rent or buy with no ground rent or other hidden costs. Formed with Legal and General, Guild Living is creating innovative ways for older people to live independently in the heart of towns and cities and plan to deliver 3,000 new homes in urban areas by 2026. The location of the communities will provide easy access to the vibrancy, culture and convenience of town and city living thus promoting community connectedness. Guild Living believes that older people should be ‘reinstated in the centre of our lives and the centre our of communities’.

  The design and ethos of the communities has grown out of research carried out through the Guild lab, an ever-evolving research and ideas hub. The homes and environment are designed to help people remain active and independent and offer a variety of health and wellbeing services. From appliance heights to lighting and access to security, everything is ergonomically designed to meet the needs of those who live there. On-site medical advice and assistance for whenever it is needed will also help people to age in place. Guild Assist, its registered care provider, tailors support and care to meet the needs of the individual.

  The focus of Guild Living is to empower older people to live better, and creating intergenerational environments is a vital aspect of its offering. This has translated into campus-style communities open to all generations. As well as providing housing for older people, the communities will include a café, gym, pub, cinema and restaurant which is open to the public.

  
  In Property Awards 2020, Guild Living was shortlisted for newcomer of the year.

• The Maples Open

  Model of housing or service: housing with care

  Principles of excellence: adopting innovation; community connectedness; person centred and outcome focused

  The Maples in Kirkby, England, is a three-storey building containing 100 one- and two-bed apartments for people aged 55 and over. Part of not-for-profit housing association group Torus, The Maples was constructed by Lane End Development Construction Ltd on a brownfield site. The development is helping to meet the local need for extra care accommodation as identified in Knowsley Council’s Extra Care strategy.

  The Maples offers extra care and supported living options, as well as state-of-the-art facilities. With the inclusion of a community Bistro and Beauty Salon, it is hoped that The Maples will become a community hub everyone can enjoy, whether they live in the apartments or not. The building is bordered by 48 homes, 16 flats, and six bungalows, which have been made available for affordable rent and rent-to-buy.

  Residents at the Maples have access to intelligent assistive technology, following funding from Knowsley Council. This includes a door entry and video-call system, enabling residents to video call each other and connect with care staff on-site when required. The equipment also enables videoconferencing with GPs and other external health providers, ensuring residents’ health can be monitored without them having to leave their home.

  The Maples provides practical day-to-day tenancy support, including help with benefits, managing money and accessing additional care alongside health and wellbeing activities.

• Battersea Place Open

  Model of housing or service: housing with care

  Principles of excellence: person centred and outcome focused;

  Owned by the private company Lifecare Residences, Battersea Place offers a total of 109 one=, two- or three-bedroom retirement apartments. There is a wide range of hotel-inspired amenities coupled with the reassurance of 24-hour care. Situated on Albert Bridge Road, opposite Battersea Park, Battersea Place marks a new generation of retirement facilities for London. Battersea Place offers those aged 65+ a high-end London residence with a discreet, state-of-the-art care capability, including an on-site 30-bed nursing home, should a resident’s needs change.

  Battersea Place encourages an independent lifestyle along with offering opportunities to socialise with new friends. Activities are planned after finding out the interests of the residents and include individual and group trips to theatres, concerts, and art galleries to suit individual tastes. Battersea Place is home to an array of five-star facilities including chef-led restaurant, concierge, chauffeur service, pool, library and cinema.

  My life has carried on much the same as in my previous home. I still go out every morning to pick up the paper, stretch my legs and do my shopping; my apartment’s only three minutes from the bus stop that takes me up to the King’s Road.

  Sandy, resident

• De Hogeweyk Dementia Village Open

  Model of housing or service: housing with care

  Principles of excellence: adopting innovation; person centred and outcome focused; community connectedness

  De Hogeweyk, just outside Amsterdam, is a village style development consisting of 23 homes, each of which accommodates six people who are living with more advanced dementia. The development was originally funded by the Dutch government and opened in 2009.

  De Hogeweyk provides a ‘village-like’ environment, with facilities like a supermarket, town square, theatre, garden, and post office all available, and is part of the broader society in the town of Weesp. It is considered one of the most cutting-edge elder care facilities in the world. Each of the 23 homes is designed and furnished according to any one of seven lifestyles which will be common to, and familiar for, the six people who live there.

  The focus of De Hogeweyk is that residents can live a normal life. There are over 250 full- and part-time staff who care for the residents. Staff organise the household; shopping, cooking and laundry and include the residents in household duties where possible to help create a feeling of ‘normal life’. As well as supporting residents in their homes, staff also take on roles within the village, like working at the grocery stores, movie theatres or as post office clerks. All caregivers are trained to help those with dementia. The professional, round-the-clock care and support is almost invisible to keep disruption to normal life to an absolute minimum.

  As dealing with money can become confusing for those living with dementia, the costs of doing anything in the village is factored into the overall cost of living there. Cameras are also positioned around the village. This approach provides a world that a person with dementia can understand. It gives them consistency so that they can experience life without having to feel bad about the things they can no longer do.

  The living environment created also helps family members and volunteers participate in activities with the residents. Family members can return to a normal role in the life of their family member who now lives with dementia.

  This is one of a number of innovative developments in the Netherlands.

• Sydenham Court Open

  Model of housing or service: housing with care

  Principles of excellence: adopting innovation; co-production and shared decision making; person centred and outcome focused; community connectedness

  Sydenham Court, is a modern housing with care scheme for people living with dementia. Located in Belfast, Northern Ireland, it is a partnership between Belfast Health and Social Care Trust and Clanmil Housing Group. The facility provides 25 high-quality, self-contained, one- and two-bedroom apartments with a living room, kitchen, and en-suite bedroom. Each apartment is decorated as the tenant has requested. There are homely communal areas and a garden where people can socialise and relax.

  Belfast Trust staff provides 24-hour care and support according to each person’s assessed needs. A range of assistive technology is available to maintain the tenant’s safety within each flat. Family and carers are encouraged to continue to be as involved in the support and care of their relative as they had been before they moved to Sydenham Court.

  At Sydenham Court, each tenant is encouraged to remain independent and stay actively involved in all decisions about their health and wellbeing. In consultation with tenants and their families, Sydenham Court offers a range of social activities that provide opportunities for engagement and interaction with other tenants and the local community. Activities are available on a regular basis, from shopping trips to gardening or arts and crafts. These activities aim to promote quality of life, give tenants a chance to enjoy each other’s company and help to keep them connected with the local community.

  Sydenham Court has been involved in a project with Northern Visions, which focuses on reminiscence therapy, with the aim of helping people see beyond a diagnosis of dementia.

  I was not even allowed to go out on my own before I came to live here. Look at me now. I am out every day and up and down to that Thrift shop and coffee shop.

  Tenant

  We are delighted with dad living here and can’t believe that he has joined in so many things and so quickly. He asked us to bring his suit so that he could get dressed up to go out to dinner. Before Sydenham Court my dad lived alone and had stopped going out.

  Family member

• Bournville Gardens Open

  Model of housing or service: housing with care

  Principles of excellence: strong leadership, culture and workforce; improving outcomes; innovation; community connectedness

  Bournville Gardens retirement village which provides 212 apartments for those aged 55 years and over, is a close partnership between The ExtraCare Charitable Trust, Bournville Village Trust and Birmingham City Council. Located in Birmingham, ExtraCare staff are available 24/7 and provide care to residents according to their need. This includes a wellbeing service and specialist, award-winning support for those who might develop dementia.

  The design of the village is underpinned by the10 HAPPI principles for older adults. Each home has its own front door, kitchen, living room and one or two bedrooms. All homes have a spacious shower room with basin and toilet and some have their own balcony. Village homes have been carefully designed, combining traditional style with modern technology. The technology is designed to support independence, safety, and mobility in the home without being obtrusive.

  The leadership of Bournville Gardens promote a culture which places a substantial mix of social facilities at the heart of the village. These facilities benefit over 300 older people and encourage social and active participation among all age groups within the local neighbourhood. Residents, visitors and volunteers can take part in a variety of hobbies, including choir singing, Tai Chi, writing, drama, wheelchair aerobics and woodwork, all designed to support independence and improved social opportunities.

• Village 135 Open

  Model of housing or service: housing with care

  Principles of excellence: adopting innovation; community connectedness

  Village 135, Manchester, comprising 135 two-bedroom apartments, has been developed by Wythenshawe Community Housing Group, a not-for-profit provider of social housing. It is built over two sites, featuring a glazed footbridge crossing a busy road that connects two existing, remodeled residential tower blocks. The apartments have the flexibility to use the second bedroom as a study, dining room or extra space for the living room if so desired. The Village offers bespoke care packages providing residents with tailored services for existing and emerging needs

  Village 135 has been designed to HAPPI principles, Lifetime Home standards, Secure by Design requirements as outlined in a Housing LIN case study. It has achieved a BREEAM Very Good rating for its environmental, social and economic sustainability performance.

  To maximise natural light and ventilation, the scheme has been designed with the use of sun path analysis to ensure overshadowing is limited and apartments are orientated to capture the optimum natural light that the layout allows for. Communal areas have been planned to enable direct access to south-facing gardens and large areas of glazing have been designed to maximise the influx of natural daylight. All windows have opening lights to allow for natural ventilation, both in the communal areas and apartments.

  Special attention has been given to the interior design of all circulation spaces to ensure they are both pleasant areas to be, but also to make sure wayfinding is clear and simple. Corridors are wide enough for scooters to pass but not too wide so they feel uncomfortable.

  The scheme also responds positively to the needs of the local and wider neighbourhood, creating a popular and well-used community hub.

  Village 135 is featured on the Housing LIN website

• Hare Hill Open

  Model of housing or service: housing with care

  Principles of excellence: co-production and shared decision making; community connectedness; person centred and outcome focused

  Hare Hill extra care housing scheme in Rochdale, Lancashire, comprises 41 two-bed and two one-bed apartments. The scheme is a partnership between Rochdale Boroughwide Housing (RBH) and Rochdale Council which has appointed a care provider. The planning and development of Hare Hill was informed by visiting other extra care facilities in the North West and consulting with residents and the wider community. One notable feature that resulted from these consultations is the inclusion of two-bedroom apartments which allows for the flexibility of a carer or family member staying overnight.

  A dedicated care team, together with a range of assistive technology tailored to individual needs, enable residents to live more independently with the reassurance that help is available whenever needed. The extra care scheme also has a café and hair salon, which are open to the local community, a garden, facilities for residents to pursue hobbies and interests and a comfortable lounge area. In addition, it offers easy access to local amenities such as Hare Hill Park, the library and local shops.

  RBH is the UK’s first tenant and employee co-owned mutual housing society, with over 13,500 homes throughout the local area. Hare Hill opened in the summer of 2015 as Rochdale borough’s first purpose-built extra care scheme.

  Hare Hill is featured on the Housing LIN website

• New Larchwood Open

  Model of housing or service: housing with care

  Principles of excellence: promoting equality; co-production and shared decision making

  New Larchwood in Brighton, East Sussex, offers 38 one- and two-bed extra care retirement apartments for over 55s and is part of Anchor, a not-for-profit provider of housing and care to older people. On-site facilities include a residents' lounge, community café, hair salon, cinema, guest room and patio garden, as well as a restaurant where hot lunches are provided.

  Anchor recognises that older LGBTQ+ people’s housing and care needs aren’t always met, with the result being that they may refrain from disclosing their sexual orientation and/or gender identity when accessing services due to a fear of discrimination, stigma, and harassment. To try to address some of the issues, Anchor initiated a pilot LGBTQ+ affirmative scheme at New Larchwood. The idea was to develop a scheme that would be LGBTQ+ inclusive, not exclusive – with the aim of seeing an increase in the proportion of LGBTQ+ people living at New Larchwood.

  A coordinated comprehensive programme of communication, marketing and learning and development was undertaken. The intervention has seen the percentage of residents identifying as LGBTQ+ at New Larchwood double (5% to 10%), with the expectation of continued increase. Clear connections have also been established with local LGBTQ+ organisations to enable improved signposting for LGBTQ+ residents who are seeking specific support.

  Anchor believes that for changes to become embedded, they need to be designed and delivered in partnership with residents. This has been done though a Tenant Advisory Panel which represents a diverse group of housing association residents, all bringing with them a wealth of experience and skills.

• Spey House Open

  Model of housing or service: housing with care

  Principles of excellence: adopting innovation; person centred and outcome focused

  Spey House, managed by Johnnie Johnson Housing (JJH), provides age- and dementia-friendly extra care housing for people aged over 55 in Reddish, near Stockport. Spey House offers 61 one-bedroom flats, and two two-bedroom flats. Residents have their own independent apartments, with access to a range of support services on site.

  The use of technology at Spey House has been part of the Hubble Project which was developed by the National Care Forum with funding from NHS Digital’s Digital Pathfinders Programme. The technology includes pendants that operate within a person’s home and a pendent that operates outside the home. This gives increased peace of mind to residents as they continue to live independently and visit local shops and attractions. Their whereabouts can be traced or they can call for assistance if needed. There is also smart home monitoring within each apartment which involves sensors monitoring movement inside with each resident having a base unit in their home linked to the Wi-Fi system. This allows for a picture of the resident’s usual pattern of movement to be built up, and any unusual activity or inactivity alerts Astraline, a telecare and response service.

  Spey House has found this use of technology has many benefits. It helps tenants to maintain their independence for as long as possible, reassures tenants and families and allows staff to focus on tenants with the highest level of needs. As the sensors detect changes in mobility, tenants can be supported sooner, reducing the risk of falls and in turn reducing the need for emergency services and hospital admittance due to falls.