IPC

1. IPC Measuring Extra Care Housing Outcomes

2. Purpose of this session • To describe literature review of whether there is evidence to support the beneficial outcomes that have been claimed for Extra Care Housing • To consider the findings so far of the review • To invite discussion on these • To invite participation in the next stage in testing out these claimed and what are the critical success factors in delivering them.

3. Institute of Public Care • Review undertaken on behalf of the ‘Raising the Stakes’ project group by IPC • Centre of Oxford Brookes University • Applied research and knowledge transfer • Work with central and local government, health service, private and voluntary sector • Projects cover housing, social and health care • Housing examples: - ECH Toolkit and other work for Housing LIN - Evaluation of ECH schemes for RSLs - Development of accommodation and support strategies for LAs

4. We all want to ‘raise the stakes’ in the promotion of Extra Care Housing To ensure that older people are aware of it as a housing option and what it might deliver for them To encourage providers to invest in such schemes To encourage local authorities to commission new schemes Purpose of work

5. Purpose of the work • One of the key contributions to this has to be to demonstrate that ECH ‘works’ • That it offers a range of older people good accommodation, that contributes to their well being and within which they will be able to receive care and support according to their needs • That it offers providers a means of achieving those outcomes for occupants and a good investment. • That it offers commissioners a means of achieving those outcomes for occupants, and value for money

6. Literature review • The review looked across the literature at research, service evaluations, learning papers relating to ECH, and at what older people say that they want from housing, care and support • Also referred to other related work such as the review recently published by Karen Croucher and colleagues for the Joseph Rowntree Trust, the CSIP ECH Toolkit and the review of housing options undertaken as part of the Wanless review • This Literature review is work in progress and the presentation is of findings so far

7. Main questions being asked For occupiers, can ECH offer: • A balanced and mixed community • A home for life for all, including for people with specialist needs • Improvements in health or the capacity to sustain health • Opportunities to mix with others and join in the local community • Opportunities to sustain friendships/connections • Improved quality of life overall • Continued involvement of family carers • Genuine alternatives to residential or nursing care • An environment that supports diversity, including older people from black and minority ethnic communities

8. Main questions being asked For commissioners, can ECH offer: • Reduced or maintained levels of need for formal care and support packages • Reduced likelihood of admission to care homes and nursing homes • Reduced hospital admission and re-admission • An environment that can support other older people (non occupants) in the local community • An environment and model in which one can commission a quality service to promote quality of life, health and well-being, and sustain older people in a housing setting

9. Main questions being asked For providers, can ECH offer: • Properties that are marketable and sustainable whether for rent or sale – housing providers • Improved staff recruitment and retention– support and care providers. • More effective use of staff resources – support and care providers • An environment and model in which one can deliver a quality service to promote quality of life, health and well-being, and sustain older people in a housing setting – all providers For investors, can ECH offer a sustainable return on investment

10. Main questions being asked Additionally, where ECH was deemed to be successful, to begin to identify what made it so eg: • Philosophy and outcome aims • Type of scheme – tenure mix; user group mix; dependency mix; assessment and lettings system • Design • Service delivery model – including assistive technology • Community role • Partnership approach – strategic and operational • Funding (capital and revenue) and value for money

11. Summary of findings • Reasonable support seems to be available for the following outcomes - Improved well being - Continued involvement of family carers - Quality of life - Realistic alternative to residential care

12. Summary of findings • ‘Jury’s out’ on the following outcomes - home for life - promote active engagement and involvement - reduce need for health services

13. Summary of findings • Insufficient sources were identified on the following outcomes: - Improved care staff recruitment and retention - sustainable return on investment for occupants, providers and commissioners

14. Findings so far • Extra Care Housing is able to provide a ‘home for life’ to its occupants and • ECH provides a realistic alternative to care home admission - Does seem that many ECH occupants do age in place and do not need to move on into care - Where people have moved on, it is mainly to care homes with nursing or specialist EMH care homes - studies of care home residents suggest many could have moved into ECH instead

15. Findings so far • So for many people does seem a home for life • Does offer a realistic alternative to ‘standard’ residential care • Less able to support people with high level needs, particularly severe dementia • Therefore probably does not represent an alternative to specialist and care homes with nursing

16. Findings so far • ECH improves health and well being, reduces or maintains need for formal health and social care input - Self reported feelings of improved well being are well documented - Fewer objective measures of improved functioning - Some evidence of shorter hospital stays - Some evidence of reduced need for care hours from those received in previous accommodation

17. Findings so far • Support for claim of improved well being • This can relate to a cluster of factors, better housing, more social contact • Less evidence for specific measured health gain • Some evidence for reduced need for health and social care intervention

18. Findings so far • ECH reduces social isolation, encourages involvement and can provide support to other local older people - Opportunity is certainly there and active elders can benefit - Some evidence of isolation of those with dementia and potentially BME elders - Insufficient information about value to local community.

19. Findings so far • ECH enables continued involvement of family carers - Clear value of enabling carer and supported person to remain together - Higher proportion of families retain contact than in care homes - Less evidence available of direct impact on carer themselves

20. Findings so far • ECH improves quality of life of its occupants - Partly a summation of the previous questions - Seems clear that for most people it does offer a good quality of life, particularly in terms of independence and security - Also seems to apply to many with dementia - ‘Improvement’ has to be seen in the context of possible losses associated with moving, aging, reduced abilities etc

21. Findings so far • ECH improves staff recruitment and retention compared to equivalent jobs in other sectors - Anecdotal evidence only so far

22. Findings so far • ECH offers a sustainable return on investment for occupants, providers and commissioners - For owner occupiers offers a shield for equity - No research seen so far on investment returns to developers but examples of demand outstripping supply suggest a saleable product - Commissioner value has to be seen in ‘whole system’ terms, can move costs from one statutory agency to another and overall savings are unclear - probably need a better cost model to answer this question

23. Findings so far • What factors seem to lead to success in achieving these outcomes? - Only so far some very broad indications from the literature - For people with dementia – admission at earliest stage, maintaining a mix of abilities within a scheme, staff training and expertise - Design – space in scheme and each unit - Support and care – continuity, positive attitude, flexibility of response to need, effective use of assistive technology - No one size fits all ‘right’ approach, but some basic principles

24. Next steps • Further work on the literature review to help contribute to the planned online evidence base for commissioners and providers on the demonstrated achievements of ECH • Associated interviews with a sample of commissioners and providers who claim they are successfully delivering the outcomes explored in the literature review - what measures are they using and how they are they achieving the outcomes.

25. Discussion • How far do these interim findings on outcomes match your experience? • Can you point us in the direction of more evidence around - returns on investment? - improved staff recruitment and retention? • What in your experience are the critical success factors in delivering positive outcomes? • Proposals for/interest in being part of the next steps?