Chapter One Introduction
1.1. The Scottish Executive Development Department commissioned Tribal to undertake a scoping review of the existing body of research literature into housing for older people, in order to inform their review of this housing in Scotland. This scoping review will be considered by the Review of Older People's Housing ( ROOPH) working group who will make recommendations to Scottish Ministers based on these findings.
1.2. This project is part of a series of studies that will enable Scottish Ministers to develop policies on medium to long-term need, and will provide local authorities with some of the resources they need to develop responses at the local level. This work builds on research and policy development focusing on older people, by the Scottish Parliament and the Executive since devolution.
1.3. To date this focus has been mainly on health and social care, for example, through the Joint Futures programme. However, the focus is now turning to include housing for older people. Housing is clearly very closely related to the issues of health and social care, and while this review is focused on housing for older people, it will consider the overlaps with health and with social care in particular, where they impact on the provision of housing for older people. This report does not, however, provide an in depth consideration of the provision of care services for older people, as this was beyond the scope and focus of this review.
1.4. The brief for this research notes that the existing specialist (sheltered/ amenity) housing stock may increasingly be unfit for purpose. This literature review considers the reasons for this, including:
- Changes in the population structure, with people living longer, and tenants becoming increasingly frail;
- Higher expectations of living standards and size of accommodation;
- Age and condition of dwellings which has led to low demand for housing in some places;
- The location of accommodation in areas that are no longer appropriately served by local amenities, which means they are no longer appropriate for those with limited mobility.
1.5. Looking to the future, there are several reasons to expect further changes in demand for specialist housing, in particular:
- The impact of increasing owner occupation;
- Older people's aspirations to remain in their home for longer, with support provided at home;
- Increased expectations that older people will have a say in their housing options and solutions;
- The reluctance amongst older people to move into residential or nursing care fuelling demand for extra-care provision.
1.6. All these issues are driving changes in provision, and will mean that facilities developed twenty to thirty years ago may have a limited life-time.
Developing the Research Questions and Issues
1.7. The research questions that have been identified to guide the research, and which this review aims to answer, are as follows:
- What impact will changing demographics and tenure structures have on demand for specialist accommodation?
- Why do people choose sheltered housing as opposed to other forms of housing available to them in retirement?
- What are the range and focus of older people's aspirations for housing?
- What lessons can be learned from models of specialist housing developed abroad?
- What types of housing for older people are likely to meet future needs and aspirations?
- What are the funding implications for options identified?
1.8. There is a wide range of literature that is relevant to this project. While much of this research comes from England, there is also much literature and research specific to Scotland. The review aims to cover the majority of the most recent literature and research in Scotland, as well as some background policy and research since 1980, and a selective review of the literature from England and abroad. It also identifies relevant models of delivery from the UK and abroad, with 1990 being used as a cut-off date for these (other changes in society mean that earlier case studies are unlikely to be comparable with today's circumstances).
1.9. The issues are drawn out from existing literature, and the findings are therefore guided by what previous researchers and practioners have highlighted. Wherever possible we have used the terms as they are used within the literature, though the definitions vary between texts, as they refer to different situations, times and places. For example, Extra Care and Very Sheltered Housing can often mean the same thing; as can Aids and Adaptations and Equipment and Adaptations.
Report Structure
1.10. The structure of this report is as follows:
- Section 2 reviews the policy context for Scotland, with a brief overview of how this compares with England.
- Section 3 looks at the social context of housing for older people. This includes a review of demographic information, evidence relating to the aspirations, expectations and decisions that older people make in relation to their housing, and issues of exclusion and their impact on housing.
- Section 4 provides an overview of the spectrum of housing and support options, from home care through to extra-care.
- Section 5 considers the delivery issues associated with: changes in technology and the opportunities these provide for older people; the impact of efforts to reduce delayed discharge; and the housing options of older people requiring dementia care.
- Section 6 reviews alternative models of delivery, including co-housing and retirement communities, tenure alternatives for older people, and the provision of intermediate and respite care.
- Section 7 reviews the evidence gathered from activity at local authority level. This includes strategies and research that have been done into the housing and support needs of older people.
- Section 8 highlights issues that have been identified in the literature as being worthy of future analysis, and where the existing evidence base is thin.