Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Village Life:
Independence, Loneliness, and Quality of Life
in Retirement Villages with Extra Care
Brian Beach, Research Fellow
International Longevity Centre – UK
@ilcuk

ILC-UK Planning Tomorrow, Today
 Westminster based think tank
 Evidence based research organisation
 Focussed on policy
 Independent
 Experts in ageing, demography and longevity
 Broad remit in research
 Take a balanced approach to intergenerational fairness
 Well respected
 Well networked – part of an international alliance
www.ilcuk.org.uk

 Explored the experiences among
residents of retirement villages with
extra care support
 Primary data collection through a
survey to residents
 Comparison with similar sample taken
from ELSA

Topics for Today
 Setting the scene
– Housing with care, retirement villages, and extra care
 Why is this important?
 What did we do?
 Findings:
– Independence & Choice
– Isolation & Loneliness
– Quality of Life
 How do the findings compare to other settings?
 Implications & Recommendations

Understanding “Housing with Care”
 Housing with care is one area that has evolved in response to
the expected increase in future care needs resulting from an
ageing population
 A range of definitions cover what the term means, which has
evolved over time
 At its core: a purpose-built, community-based alternative to
residential care for older people that seeks to fill their
housing, care, and support needs simultaneously, while
promoting their independence within private accommodation

Retirement Villages and Extra Care
 The market for retirement villages has grown in recent years
 Retirement villages are designed around a central hub, where
amenities including a health club, swimming pool, GP surgery,
restaurants and cafés are available
 Extra Care – also called very sheltered housing or assisted
living – a particular approach to housing with care, recognised
as more of a concept rather than a specific type of housing
 Housing first, providing private self-contained homes
 Care services are available in a flexible and tailored way, provided on-
site and available 24 hours a day

Why is extra care important?
 Often promoted as providing a “home for life”
 Offers a compromise or third way between residential care
and staying in one’s previous home
 Broadly harmonises with government policy aims in two ways:
 Finding new, innovative ways to manage the financial
implications of the growing demand for care
 Enhancing quality of life through independence and choice in
housing with care

Why is extra care important?
 More recently, three other aims have emerged:
 Promote greater independence by offering on-site
amenities and care services, while also giving greater
choice in planning for later life
 Reduce social isolation by bringing people into a more
communal living environment
 Enhance residents’ quality of life compared to what they
would experience in the general community or a
traditional residential care setting

Conducting the Research
 Anonymised survey questionnaires
 Caution in over-generalising the results
 Non-response bias; Results only apply to this particular type of housing
with care, i.e. retirement villages (with extra care)

The Residents
 Almost two-thirds (62.8%) were women
 Only 14 reported being single, separated, or divorced, and
over half (54.8%) were married or cohabiting
 Over half (51.3%) were aged 75-84, with 17 (8.5%) aged 90+
 Only 11 reported ‘Poor’ or ‘Very poor’ current health
 Over two-thirds (67.5%) reported no change in health since
moving in
 Over a quarter (27.9%) indicated a decline; only around 1 in 10 of
these ended up in ‘Poor’ or ‘Very poor health’

Independence & Choice: Discovering the housing
6.1%
33.8%
19.2%
9.1%
20.7%
9.6%
13.6%
0% 5% 10% 15% 20% 25% 30% 35% 40%
someone living in your current housing at the
time
a friend or relative
(you were) living in the local area
word of mouth
an advertisement (print, radio, TV, etc.)
direct marketing (leaflets in the post)
the internet
Thinking back, did you find out about your current housing from…

Independence & Choice: Discovering the housing
 Many respondents referenced their (grand)children as
bringing the housing option to their attention
 I had been looking for a suitable flat for a long time as my husband
was finding the stairs more and more difficult, and I was finding it
more necessary to call for help. My grandson phoned on a Saturday
afternoon and we drove straight down…and bought that afternoon.
 Advertising
 I was very tempted by the promises…in the marketing literature…I
have no intention of moving house again!... The fact that I could be
completely independent in my own environment and with a small
garden [was] important.
 Living in the local area

Independence & Choice: Deciding to move
1.5%
6.5%
30.2%
13.1%
48.2%
24.6%
52.8%
53.3%
36.7%
0% 10% 20% 30% 40% 50% 60%
you had a sudden need for care
your spouse/partner had a sudden need for care
you expected to have care needs in the future
your spouse/partner expected to have care needs…
you wanted a smaller home (downsizing)
you didn’t want to go into a typical care home
you liked the independence of your current housing
you wanted to maintain an active lifestyle
you wanted to be nearer to your family and/or…
When you decided to move into your current housing, was this because…

 Independence (52.8%), an active lifestyle (53.3%), and the
desire to downsize (48.2%) feature prominently
 But have perceptions changed since moving in?
 Over half of the respondents left responses, with a vast majority
indicating no change or improvement
 Better than anticipated. It provides a lot of feel good factor.
 Negative comments related to concerns around the building (e.g.
fixtures or size) or management
 The flat is suitable for our needs, but I do miss the view (garden)
and larger rooms.

 Sudden needs for care were the least reported options
 Expectations of future care needs influenced around a third of
the respondents
 Including the desire to avoid a care home (24.6%), over half
(51.0%) mentioned at least one care-related reason
Perhaps people are not ‘leaving it too late’ to move into
this kind of extra care housing

Isolation & Loneliness
 Social isolation refers to the absence of contact with others
 Loneliness reflects one’s feelings
 Reducing social isolation may be one stated aim of good
housing with care, but understanding their subjective
experiences may be more useful

Experiences of Isolation & Loneliness
73.6%
79.1%
81.7%
5.7%
78.4%
(54.7%)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
How often do you feel you lack companionship?
How often do you feel left out?
How often do you feel isolated from others?
How often do you feel in tune with the people
around you?
How often do you feel lonely?
Hardly ever or never Some of the time Often

Experiences of Isolation & Loneliness
 The vast majority of respondents (81.7%) ‘hardly ever or
never’ feel isolated from others
 Only around 1% ‘often’ do
 A large proportion (78.4%) ‘hardly ever or never’ feel lonely
 3.6% ‘often’ do

Looking More Closely at Loneliness
 We used the three-item score for loneliness
 Ranges from 3 to 9, with 9 being the loneliest
64.2%
15.0%
10.2%
7.0%
2.7%
0.0%
1.1%
3 (not lonely) 4 5 6 7 8 9 (loneliest)

Looking More Closely at Loneliness
 Responses resemble those for the single-item question
 Must consider impact of widowhood on feelings of
companionship (e.g. look at scores 3 and 4 – 79.2%)
 The highest levels of loneliness (7-9) represent 3.8%,
similar to the 3.6% of ‘often’ feeling lonely
 Around 1 in 5 respondents do feel lonely at least some of the
time
But overall, a large proportion of respondents avoid the
negative subjective experiences of both isolation and
loneliness.

Measuring Quality of Life
 While existing research on extra care housing suggests it does
confer enhanced quality of life, many have drawn on
expressions of satisfaction and contentment rather than a
more robust or detailed measure of quality of life
 CASP-19: 19 questions, each score 0-3; full scale 0-57
 OPQOL: 35-item covering range of topics; reliable and valid
short form of 13 items
 Home and neighbourhood domain

Quality of Life: CASP-19
 Control: “I feel free to plan for the future.”
 Never (0), Not Often (1), Sometimes (2), Often (3)
 Autonomy: “I look forward to each day.”
 Self-realisation: “I enjoy the things that I do.”
 Pleasure: “I feel that life is full of opportunities.”

Quality of Life: CASP-19
 Average score: 43.73 (76.7% of the full scale)
 Median score: 45
0
2
4
6
8
10
12
14
13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57
NumberofRespondents
CASP-19 Score

Domains of CASP-19: A focus on control
 Offering control has been an important objective in the
context of health and social care services
 On the CASP-19 domain, the average score for Control was
13.37 (Scale 0-18)
0
5
10
15
20
25
30
35
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Control

Another Quality of Life Measure: OPQOL
 Measured on a scale of 13-65
 Average score: 55.9 – Median score: 56
 82.5% of the scale
0
5
10
15
20
25
23 -/ /- 35 37 38 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
NumberofRespondents
OPQOL Score

Another Quality of Life Measure: OPQOL
 97.0% agree or strongly agree with “I feel safe where I live”
 Two items referring to health had the largest proportions
disagreeing or strongly disagreeing
 “I am healthy enough to have my independence.” (6.2%)
 “I am healthy enough to get out and about.” (11.7%)

Comparing Our Sample with People in the Community
 Using Wave 6 of the English Longitudinal Study of Ageing (ELSA)
 Propensity Score Matching: gender, age group, marital status,
self-reported health (but not care), and home values ≥£200,000
 Identifies a sample similar to our respondents based on
these characteristics and outcome(s) of interest
 Allows identification of “treatment” effects

Comparing Our Sample with People in the Community
 Quality of Life (CASP-19): higher among our residents, but
significant only at p<0.1
 43.73 versus 41.23
 Control was the only different domain, higher among residents
 13.37 versus 11.59
 On the 0-18 scale, reflects an idea of 74.3% v 64.4% of total
possible Control
 Residents scored lower on the loneliness scale (3-9)
 0.64 points lower (3.73 v 4.37)
 Akin to 12.2% v 22.8% of total possible loneliness

Implications and Recommendations
 For Government:
 Central and local government should identify ways of
working with the private sector to stimulate the building of
new good quality retirement housing
 For Providers:
 Marketing strategies: include aspects of indepdence and
control, think about younger groups (potential residents’
children)
 For Researchers:
 More extensive data collection, greater attention to
subpopulations in care settings (dementia, multiple
conditions)

Many thanks
Brian Beach
Research Fellow
International Longevity Centre – UK (ILC-UK)
brianbeach@ilcuk.org.uk
+44 (0)20 7340 0440
Twitter: @ilcuk

Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care

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