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The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
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.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Establishing the
extra in Extra Care:
Perspectives from
three Extra Care
Providers
Available from
www.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.
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.
• 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…
Health, social care and housing
among the ageing population
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
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
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Extra care housing
What 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.
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.
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
life
Event history analysis (Lognormal and
Competing Risks); Propensity Score Matching
3. Extra care housing as a healthy
home for life
Event history analysis (Competing Risks);
Propensity Score Matching
4. Extra care housing and hospital
beds?
Zero inflated negative binomial regression;
Propensity Score Matching
5.N Inferences on the costs and
benefits of extra care housing?
Descriptive analysis
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
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
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Characteristics of residents
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
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
Gender Male 2.6 6.0
Female 3.4 6.7
0.0
00.2
50.5
00.7
51.0
0
Pro
port
ion s
till r
esi
dent
0 5 10 15analysis time (years)
No additional care needs on arrival Very low care needs on arrival
Low - Moderate care needs Moderate to High care needs
High care needs on arrival Very high care needs on arrival
Proportion of extra care residents remaining
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Extra care as a home for life II:
Competing Risks Framework
Risk 1: moving to
an institution Risk 2: death
All residents 8.2% (6.7-9.9) 25.0% (22.4-27.5)
Gender Male 6.4% (4.3-9.1) 30.6% (26.0-35.3)
Female 9.1% (7.2-11.3) 22.0% (19.2-25.1)
Health Status/Care Needs
on Arrival
No additional support
package 5.5% (4.0-7.3) 16.8% (14.2-19.6)
Level 1 (very low package
needs) 12.8% (6.8-20.8) 29.6% (20.0-39.7)
Level 2 (low support
package) 17.5% (11.7-24.4) 39.8% (31.6-47.6)
Level 3 (moderate support
package) 11.9% (5.2-21.5) 41.0% (28.3-53,1)
Level 4 & 5 (high or very
high support package) 9.9% (4.9-17.1) 56.9% (46.1-66.3)
Age Group
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)
75-79 9.0% (5.8-13.0) 24.6% (19.4-30.2)
80-84 8.0% (4.8-12.3) 27.2% (21.3-33.5)
85+ 12.7% (8.5-17.7) 49.0% (41.8-55.8)
N 1,189 1,189
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Extra care as a home for life III All community match sample Domiciliary care match sample
Age 65+
Model 1
Age 75+
Model 2
Age 80+
Model 3
Age 65+
Model 4
Age 75+
Model 5
Age 80+
Model 6
Models adjusted for
Age, Sex, Living
Arrangements, Year
Sub-hazard
ratio of
moving to
an
institution
Sub-hazard
ratio of
moving to
an
institution
Sub-hazard
ratio of
moving to
an
institution
Sub-hazard
ratio of
moving to
an
institution
Sub-hazard
ratio of
moving to
an
institution
Sub-hazard
ratio of
moving to
an
institution
Extra care housing
1.776 1.216 0.905 0.694 0.532* 0.316**
(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.
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.
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.
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
Summary of conclusions
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
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.
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Many thanks
The International Longevity Centre-UK is an independent, non-partisan think-tank
dedicated to addressing issues of longevity, ageing and population change.
Copies of the report available:
www.ilcuk.org.uk
International Longevity Centre - UK
[email protected] or [email protected]
Twitter: @ilcuk
Many thanks