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

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On the 19th August, the ILC-UK held a launch event of a new research report “Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care” which considers the impact of retirement villages on independence, loneliness and quality of life of residents.

The report incorporates a survey of residents and compares the sample with a comparable group of non-residents living in private housing.

The report has been produced with the support of Bupa and Audley. Anchor provided additional survey respondents.

During the launch, Brian Beach, Research Fellow at ILC-UK, presented the findings of the research. Nick Sanderson, CEO of Audley, and Jeremy Porteus, Founder and Director or Housing LIN (Learning and Improvement Network), responded.

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

  1. 1. 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
  2. 2. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  3. 3. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change.  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
  4. 4. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  5. 5. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  6. 6. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  7. 7. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  8. 8. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  9. 9. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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)
  10. 10. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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’
  11. 11. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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…
  12. 12. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  13. 13. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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…
  14. 14. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Independence & Choice: Deciding to move  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.
  15. 15. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Independence & Choice: Deciding to move  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
  16. 16. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  17. 17. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  18. 18. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  19. 19. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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)
  20. 20. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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.
  21. 21. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  22. 22. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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.”
  23. 23. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  24. 24. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  25. 25. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  26. 26. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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%)
  27. 27. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  28. 28. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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
  29. 29. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. 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)
  30. 30. The International Longevity Centre-UK is an independent, non-partisan think-tank dedicated to addressing issues of longevity, ageing and population change. Many thanks Brian Beach Research Fellow International Longevity Centre – UK (ILC-UK) brianbeach@ilcuk.org.uk +44 (0)20 7340 0440 Twitter: @ilcuk

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