Today

1. In the context of (a lack of) National Housing Policy for Older People:Should we be asking older people to move?What do we need to end standoff?International Longevity Centre-UK

2. Today • ….a back-to-front presentation: • Answer question of should we ask older people to move home? • Discuss question of specialist housing for older people • Present recommendations • …before presenting (some) results of ILC-UK study • …and asking how we can influence policy in this area

3. Should we be asking older people to move and downsize? (i) • ‘Unhelpful’ and ‘offensive’ vs‘pensioners will still be living in family homes that are far too big for them’ • Debate of contradictory standpoints • Rhetoric vs fact • Does it depend on the age or the tenure?

4. Should we be asking older people to move and downsize? (ii) • IGF: Hoarding of Housing • “Older people’s overconsumption of housing was the principal cause of the current housing crisis” • At the time of publication, under-occupation rarely in government policy and rebuffed by Housing Minister. • ~Two years later policies around under-occupation emerge (not older people…yet…ageing in place?) • Focus on older people correct? Only older people over-consume?

5. Should we be asking older people to move and downsize? (iii) • Evidence to support: • (EHS) In 2010/11 around 7% of households (16-24) VS <0.5% of households (55+) live in homes where the number of bedrooms needed exceeded the number of bedrooms available. • Around 57% 65-74 under-occupy vs 11% (16-24) • But ILC-UK argue under-occupation an issue regardless of age:

6. Should we be asking older people to move and downsize? (iv)

7. Should we be asking older people to move and downsize? (v) • But ILC-UK argue under-occupation an issue regardless of age • Evidence to support: • Almost twice as many h/h 16-24 under-occupy than over-occupy • In terms of numbers, households 55-64 (pre-retirement?) responsible for largest number of under-occupied households (1.89 million)

8. Should we be asking older people to move and downsize? (vi) So should we be asking older people to move and downsize? • Yes BUT not because they’re old! • Yes BUT only if we’re asking under-occupiers of all ages to consider their housing. • Yes BUTonly if we’re asking both private and public sector housing residents • Yes BUT not only for the ‘public good’ – rational consumers! • Yes BUT only if they have somewhere to go! Need to ensure a diversity of housing options including specialist housing

9. Specialist housing How much is there? HAPPI: 730,000 (incl nursing and residential) in England How much do we need? Good question(!) - Standard SHOP@ reports: 120 S/H; 20 En/S/H; 25 X/C; 65 R/C; 45 N/C per 1000 75+ How much is being built? Housing (excl nursing/resi care): Approx 8,000 pa (prev 30k) Where is it being built? Huge geographic inequalities in availability: e.g. TG region; OO housing v low

10. Why have we stopped building as much specialist housing for older people? -Withdrawal of public sector funding from constructing specialist housing. -Focus on ageing in place in housing policies – why can’t ageing in place include specialist housing?  Lack of demand -No overall mandate on (English) LAs – NPPF mentions older people twice. Wide variety in way Strategic Housing Market Assessment carried out and interpreted etc. -Lack of demand among older people ‘Retirement housing looks depressed, like a care home’ – knowledge + acceptability ‘80 is the new 50’ (get real!) -Lack of clarity of who retirement housing is for – pre-emptive moves?

11. The result: A Mexican standoff! Who shoots first? Policy-makers, but action required from all parties Policy-makers Older People Housing Developers

12. What actions are needed to stimulate specialist housing Policy-makers: 1. Rewrite policies to reflect that ‘ageing in place’ and ‘staying in own home’ includes retirement housing. 2. Incorporate the prevention agenda into policies involving housing, health and social care. 3. Supply specific benchmarks – what is reasonable provision? 4. Help to foster trust in an embattled sector 5. Incorporate housing into financial planning guidance

13. What actions are needed to stimulate specialist housing Providers: 6. Innovation panels 7. Incorporate key learning from other sectors 8. Action on the concerns of potential consumers Older people: 9. Stop denying that we are ageing 10. In addition to having a right to accessing a range of housing options, assume greater responsibilities around housing *ALL UNDERPINNED BY BETTER EVIDENCE

14. Adding to the evidence base – ILC-UK Research on extra care housing (i) - What is it? Little consensus…. • Wide spectrum of self-designated extra care housing; 3 tenets Challenges of extra care problem…wider? • Selection effects into extra care housing – relatively unknown – why do people choose to live in extra care housing? • Establishing a counterfactual • Comparison data – measuring institutional transitions; measuring falls; measuring overnight hospitalisation?; measuring health/care needs • PSM usually for modelling selection process into treatment – used in a more rudimentary fashion here • Represent caveats to the results

15. Adding to the evidence base – ILC-UK Research on extra care housing (ii) • Number of hospital beds available for geriatric medicine declined over recent decades • Innovation? • Difficulties in modelling count data • Overdispersion in Poisson – attempted Negative Binomial • Less than 20% of residents in extra care actually experience overnight hospitalisation in a given year • Vuong test confirmed zero-inflated negative binomial regression model most appropriate for regression modelling

16. Adding to the evidence base – ILC-UK Research on extra care housing (iii)

17. Adding to the evidence base – ILC-UK Research on extra care housing (iv) • Comparison group – characteristics • Inverse care law – evidence in BHPS (or other effect?) • Incidence rate is higher than in overall community sample BUT reflects length of stay • Number of episodes of admission consistently lower in extra care sample i.e. less people go to hospital in the extra care sample, but those that do stay longer • Fiscal benefits? • Mechanism? – Balance of care needs – makes understanding and reconsidering role of spec housing so important

18. How can we influence policy and overcome challenges? (What are policy-makers looking for?) • Why show ILC-UK example – Across whole sector but especially private sector – need to find if it works, how and why? – Private sector needs to fund • Which components – e.g. extra care – restaurant/hairdresser etc • Does it work across groups (if not why) • Engage with policy debates early on – e.g. housing and loneliness • Get people to plan ahead and move earlier – lifestyle choice – evidence for this – can we have SAGA housing as well as holidays (should we?) • Reassure local concerns (e.g. will it bring older people in) • Most important: Is it cheaper; how long to accumulate benefits?

19. Other challenges (opportunities?) • Lack of clarity about theoretical purpose of specialist housing for older people. Providers say lifestyle (pre-emptive) – public say existing care needs only (and policy-makers) – who’s right • Current situation is one characterised by crisis-movement • Linked (?) – lack of understanding around selection into specialist housing – who moves and why • Do we know older people want to move to specialist retirement housing; know enough to make a decision? • Fragmented planning policies and social care policies – opportunity? • Wales, Scotland and Northern Ireland

20. Summary and Conclusions • Should we be asking older people to move to retirement housing? • Yes – but only for the right reasons • Where should they move to? • Specialist retirement housing but as part of a diversity of choices • What needs to be done? • Policy-makers need to reconsider specialist retirement housing alongside other housing (£300 million – no prevention); evidence to support • A role for research • (with better funding) – understand contribution of private sector… among other issues/challenges