3 watson-extra care presentation

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



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



• 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



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



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

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



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



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

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



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



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



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



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



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



Copies of the report available:

www.ilcuk.org.uk

International Longevity Centre - UK

[email protected] or [email protected]

Twitter: @ilcuk

Many thanks

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