Housing an ageing populationwith social care needs:investigating the role of extracare housingJessica Watson, Internationa...
About ILC-UK The International Longevity Centre-UK is the leading   UK think tank on longevity and demographic change.   ...
Establishing theextra in Extra Care:Perspectives fromthree Extra CareProvidersAvailable fromwww.ilcuk.org.uk  The Internat...
Overview• Housing context• Introducing Extra Care• Research Questions• Data and Methods• Results and conclusions from ILC-...
Health, social care and housing            among the ageing population• Housing:   • Lived in same house for 40+ years (17...
Extra care housingWhat is it? Little consensus….Wide spectrum of self-designated extra care housingSome common principles ...
Extra care housingWhat do we know about extra care housing?What does extra care housing claim to do?   The International L...
Research Questions 1.   What is the social profile of extra care housing residents  and how does this compare with reside...
Data and Methods Data: Longitudinal data from 3 partners on almost 4,000 residents of extra  care housing since 1995; Br...
Characteristics of residents Gender Age Living arrangements Additional care needs Health shocks that may predict entr...
Characteristics of residentsThe International Longevity Centre-UK is an independent, non-partisan think-tank   dedicated t...
Extra care as a home for life I                                                                    Length of time until ex...
Extra care as a home for life II:                   Competing Risks Framework                                             ...
Extra care as a home for life III                          All community match sample                Domiciliary care matc...
Extra care and inferences on costs Social care costs (median community care package and extra care)       The Internation...
Extra care and inferences on costs Initial social care costs of extra care housing may be higher  than if remaining in th...
Summary of conclusionsPressing need for development of older people’s retirement housingExtra care housing:   1. Supports ...
Policy Recommendations I1. Policy-makers need a co-ordinated response to providing   housing, health care and social care ...
Many thanksThe International Longevity Centre-UK is an independent, non-partisan think-tank   dedicated to addressing issu...
Many thanksCopies of the report available:www.ilcuk.org.ukInternational Longevity Centre - UKdylankneale@ilcuk.org.uk or j...
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3 watson-extra care presentation

  1. 1. Housing an ageing populationwith social care needs:investigating the role of extracare housingJessica Watson, International Longevity Centre – UKInternational Federation on Ageing ConferenceMay 30 2012 The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  2. 2. About ILC-UK The International Longevity Centre-UK is the leading UK think tank on longevity and demographic change. It is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. The ILC-UK is one of 14 partners in the International Longevity Centre Global Alliance. The alliance is a multinational research and educational consortium. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  3. 3. Establishing theextra in Extra Care:Perspectives fromthree Extra CareProvidersAvailable fromwww.ilcuk.org.uk The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  4. 4. Overview• Housing context• Introducing Extra Care• Research Questions• Data and Methods• Results and conclusions from ILC-UK research• Policy recommendations The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  5. 5. Health, social care and housing among the ageing population• Housing: • Lived in same house for 40+ years (17% 1993/4; 24% 2007/8) • Rising levels of under occupancy? • Rising levels of housing wealth?.....Rising inequality? (Older people still biggest consumers of social housing) • Less retirement housing being constructed• Health care: • Compression of morbidity? (Zaninotto et al, 2010) • Non communicable diseases (stroke, dementia)• Social Care: • Rising cost • Rates of receipt of domiciliary care at home declining… The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  6. 6. Extra care housingWhat is it? Little consensus….Wide spectrum of self-designated extra care housingSome common principles of extra care housing: Ergonomically designed Flexible and continually adapting care packages delivered onsite Communal facilities Group activities Independent homes within small-medium sized retirement communities Usually age specific Leasehold tenure as well as rental tenure Community balance of care needs The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  7. 7. Extra care housingWhat do we know about extra care housing?What does extra care housing claim to do? The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  8. 8. Research Questions 1. What is the social profile of extra care housing residents and how does this compare with residents in the community setting? 2. Can extra care housing be considered a home for life for older people? 3. Does residence in extra care housing facilitate healthier and more independent life? 4. What impact does residence in extra care housing have on the uptake of overnight hospital beds? 5. What inferences can be made about the costs and benefits of extra care housing? The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  9. 9. Data and Methods Data: Longitudinal data from 3 partners on almost 4,000 residents of extra care housing since 1995; British Household Panel Survey; English Longitudinal Survey of Ageing; Survey of English Housing (descriptive) Limitations/Challenges1. Characteristics of residents Descriptive analysis2. Extra care housing as a home for Event history analysis (Lognormal andlife Competing Risks); Propensity Score Matching3. Extra care housing as a healthy Event history analysis (Competing Risks);home for life Propensity Score Matching4. Extra care housing and hospital Zero inflated negative binomial regression;beds? Propensity Score Matching5.N Inferences on the costs and Descriptive analysisbenefits of extra care housing? The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  10. 10. Characteristics of residents Gender Age Living arrangements Additional care needs Health shocks that may predict entry to extra care housing:  Stroke  Dementia  Parkinson’s disease The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  11. 11. Characteristics of residentsThe International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  12. 12. Extra care as a home for life I Length of time until exit (all exits) First quartile (25%) Median (50%)All residents 3.1 6.5 Male 2.6 6.0Gender Female 3.4 6.7 Proportion of extra care residents remaining 1.00 0.75 0.50 0.25 0.00 0 5 10 15 analysis time (years) No additional care needs on arrival Very low care needs on arrival The International Longevity Centre-UK is an independent, non-partisan needs Low - Moderate care needs Moderate to High care think-tank High care needs on arrival Very high care needs on arrival dedicated to addressing issues of longevity, ageing and population change.
  13. 13. Extra care as a home for life II: Competing Risks Framework Risk 1: moving to Risk 2: death an institutionAll residents 8.2% (6.7-9.9) 25.0% (22.4-27.5) Male 6.4% (4.3-9.1) 30.6% (26.0-35.3)Gender Female 9.1% (7.2-11.3) 22.0% (19.2-25.1) No additional support 5.5% (4.0-7.3) 16.8% (14.2-19.6) package Level 1 (very low package 12.8% (6.8-20.8) 29.6% (20.0-39.7) needs)Health Status/Care Needs Level 2 (low support 17.5% (11.7-24.4) 39.8% (31.6-47.6)on Arrival package) Level 3 (moderate support 11.9% (5.2-21.5) 41.0% (28.3-53,1) package) Level 4 & 5 (high or very 9.9% (4.9-17.1) 56.9% (46.1-66.3) high support package) 50-64 6.8% (2.8-10.9) 10.2% (5.8-16.3) 65-69 6.2% (3.1-11.0) 13.0% (8.2-19.1) 70-74 6.0% (3.4-9.8) 18.2% (13.3-23.7)Age Group 75-79 9.0% (5.8-13.0) 24.6% (19.4-30.2) The International Longevity Centre-UK is an independent, non-partisan think-tank (21.3-33.5) 80-84 8.0% (4.8-12.3) 27.2% 85+ 12.7% (8.5-17.7) 49.0% (41.8-55.8) dedicated to addressing issues of longevity, ageing and population change.N 1,189 1,189
  14. 14. Extra care as a home for life III All community match sample Domiciliary care match sample Age 65+ Age 75+ Age 80+ Age 65+ Age 75+ Age 80+ Model 1 Model 2 Model 3 Model 4 Model 5 Model 6Models adjusted for Sub-hazard Sub-hazard Sub-hazard Sub-hazard Sub-hazard Sub-hazardAge, Sex, Living ratio of ratio of ratio of ratio of ratio of ratio ofArrangements, Year moving to moving to moving to moving to moving to moving to an an an an an an institution institution institution institution institution institution 1.776 1.216 0.905 0.694 0.532* 0.316**Extra care housing (0.659) (0.471) (0.463) (0.207) (0.167) (0.121)N 1714 1034 624 1630 1028 634 The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  15. 15. Extra care and inferences on costs Social care costs (median community care package and extra care) The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  16. 16. Extra care and inferences on costs Initial social care costs of extra care housing may be higher than if remaining in the community But, because of higher probability of transition to institutional accommodation, long-term costs lower – Planning for retirement Cost of lower rate of hospitalisation Cost of reduction in social care package Cost of falls The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  17. 17. Summary of conclusionsPressing need for development of older people’s retirement housingExtra care housing: 1. Supports some of the most vulnerable in society 2. Appears to be a home for life for the vast majority • Compared to those with similar characteristics appears to be lower rate of transition to institution; plausible mechanism (age, living arrangements, gender, in receipt of care at home) 3. Associated with fewer inpatient stays 4. Associated with fewer falls 5. Is a healthy home for life Extra care not a panacea for all older people’s housing issues, but evidence suggests benefits for a sizable majority of residents The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  18. 18. Policy Recommendations I1. Policy-makers need a co-ordinated response to providing housing, health care and social care for our ageing population.2. Policy-makers should recognise and encourage private sector development of extra care housing.3. Policy-makers should enhance and sustain programmes of education and information for those who are retired and newly retired to plan their housing and financial futures. Furthermore, consumers need reassurance that policy changes will not negatively impact their retirement decisions. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  19. 19. Many thanksThe International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.
  20. 20. Many thanksCopies of the report available:www.ilcuk.org.ukInternational Longevity Centre - UKdylankneale@ilcuk.org.uk or jessica.watson@ilcuk.org.ukTwitter: @ilcuk The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.

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