Download - Village life: Independence, Loneliness, and Quality of Life in Retirement Villages with Extra Care
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
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
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
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
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
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
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
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
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)
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’
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 thetime
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…
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
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…
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.
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
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 subjectiveexperiences may be more useful
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 peoplearound you?
How often do you feel lonely?
Hardly ever or never Some of the time Often
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
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)
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.
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
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.”
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
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CASP-19 Score
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)
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Control
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
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OPQOL Score
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%)
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
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
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)
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)
+44 (0)20 7340 0440
Twitter: @ilcuk