3 watson-extra care presentation

Housing an ageing population
with social care needs:
investigating the role of extra
care housing
Jessica Watson, International Longevity Centre – UK
International Federation on Ageing Conference
May 30 2012

The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.

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.


Establishing the
extra in Extra Care:
Perspectives from
three Extra Care
Providers

Available from
www.ilcuk.org.uk


Overview

• Housing context
• Introducing Extra Care
• Research Questions
• Data and Methods
• Results and conclusions from ILC-UK
research
• Policy recommendations

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…

Extra care housing
What is it? Little consensus….

Wide spectrum of self-designated extra care housing
Some 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


Extra care housing

What do we know about extra care housing?
What does extra care housing claim to do?

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?

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/Challenges

1. Characteristics of residents Descriptive analysis

2. Extra care housing as a home for Event history analysis (Lognormal and
life Competing Risks); Propensity Score Matching
3. Extra care housing as a healthy Event history analysis (Competing Risks);
home for life Propensity Score Matching
4. Extra care housing and hospital Zero inflated negative binomial regression;
beds? Propensity Score Matching
5.N Inferences on the costs and Descriptive analysis
benefits of extra care housing?

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


Characteristics of residents


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 6.0
Gender
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

Extra care as a home for life II:
Competing Risks Framework
Risk 1: moving to
Risk 2: death
an institution
All 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)
N 1,189 1,189

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 6

Models adjusted for Sub-hazard Sub-hazard Sub-hazard Sub-hazard Sub-hazard Sub-hazard
Age, Sex, Living ratio of ratio of ratio of ratio of ratio of ratio of
Arrangements, 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


Extra care and inferences on costs
 Social care costs (median community care package and extra care)


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

Summary of conclusions
Pressing need for development of older people’s retirement housing
Extra 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

Policy Recommendations I
1. 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.


Many thanks


Many thanks
Copies of the report available:

www.ilcuk.org.uk

International Longevity Centre - UK

dylankneale@ilcuk.org.uk or jessica.watson@ilcuk.org.uk

Twitter: @ilcuk


3 watson-extra care presentation

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (10)

Similar to 3 watson-extra care presentation

Similar to 3 watson-extra care presentation (20)

More from ifa2012_2

More from ifa2012_2 (20)

Recently uploaded

Recently uploaded (20)

3 watson-extra care presentation