IPC

Measuring Extra Care Housing

Outcomes

Purpose of this session

To describe literature review of whether there is evidence to support the beneficial outcomes that have been claimed for Extra Care Housing

To consider the findings so far of the review

To invite discussion on these

To invite participation in the next stage in testing out these claimed and what are the critical success factors in delivering them.

Institute of Public Care

Review undertaken on behalf of the ‘Raising the Stakes’ project group by IPC

Centre of Oxford Brookes University Applied research and knowledge transfer Work with central and local government, health

service, private and voluntary sector Projects cover housing, social and health care Housing examples:

- ECH Toolkit and other work for Housing LIN

- Evaluation of ECH schemes for RSLs

- Development of accommodation and support strategies for LAs

Purpose of work

We all want to ‘raise the stakes’ in the promotion of Extra Care Housing

To ensure that older people are aware of it as a housing option and what it might deliver for them

To encourage providers to invest in such schemes

To encourage local authorities to commission new schemes

Purpose of the work

One of the key contributions to this has to be to demonstrate that ECH ‘works’

That it offers a range of older people good accommodation, that contributes to their well being and within which they will be able to receive care and support according to their needs

That it offers providers a means of achieving those outcomes for occupants and a good investment.

That it offers commissioners a means of achieving those outcomes for occupants, and value for money

Literature review

The review looked across the literature at research, service evaluations, learning papers relating to ECH, and at what older people say that they want from housing, care and support

Also referred to other related work such as the review recently published by Karen Croucher and colleagues for the Joseph Rowntree Trust, the CSIP ECH Toolkit and the review of housing options undertaken as part of the Wanless review

This Literature review is work in progress and the presentation is of findings so far

Main questions being asked

For occupiers, can ECH offer: A balanced and mixed community A home for life for all, including for people with specialist

needs Improvements in health or the capacity to sustain health Opportunities to mix with others and join in the local

community Opportunities to sustain friendships/connections Improved quality of life overall Continued involvement of family carers Genuine alternatives to residential or nursing care An environment that supports diversity, including older

people from black and minority ethnic communities

Main questions being asked

For commissioners, can ECH offer: Reduced or maintained levels of need for formal care

and support packages Reduced likelihood of admission to care homes and

nursing homes Reduced hospital admission and re-admission An environment that can support other older people

(non occupants) in the local community An environment and model in which one can

commission a quality service to promote quality of life, health and well-being, and sustain older people in a housing setting

Main questions being asked

For providers, can ECH offer: Properties that are marketable and sustainable

whether for rent or sale – housing providers Improved staff recruitment and retention– support

and care providers. More effective use of staff resources – support and

care providers An environment and model in which one can deliver

a quality service to promote quality of life, health and well-being, and sustain older people in a housing setting – all providers

For investors, can ECH offer a sustainable return on investment

Main questions being asked

Additionally, where ECH was deemed to be successful, to begin to identify what made it so eg:

Philosophy and outcome aims Type of scheme – tenure mix; user group mix;

dependency mix; assessment and lettings system Design Service delivery model – including assistive

technology Community role Partnership approach – strategic and operational Funding (capital and revenue) and value for money

Summary of findings

Reasonable support seems to be available for the following outcomes

- Improved well being

- Continued involvement of family carers

- Quality of life

- Realistic alternative to residential care

Summary of findings

‘Jury’s out’ on the following outcomes

- home for life

- promote active engagement and involvement

- reduce need for health services

Summary of findings

Insufficient sources were identified on the following outcomes:

- Improved care staff recruitment and retention

- sustainable return on investment for occupants, providers and commissioners

Findings so far

Extra Care Housing is able to provide a ‘home for life’ to its occupants

and ECH provides a realistic alternative to care home

admission

- Does seem that many ECH occupants do age in place and do not need to move on into care

- Where people have moved on, it is mainly to care homes with nursing or specialist EMH care homes

- studies of care home residents suggest many could have moved into ECH instead

Findings so far

So for many people does seem a home for life Does offer a realistic alternative to ‘standard’

residential care Less able to support people with high level needs,

particularly severe dementia Therefore probably does not represent an alternative

to specialist and care homes with nursing

Findings so far

ECH improves health and well being, reduces or maintains need for formal health and social care input

- Self reported feelings of improved well being are well documented

- Fewer objective measures of improved functioning

- Some evidence of shorter hospital stays

- Some evidence of reduced need for care hours from those received in previous accommodation

Findings so far

Support for claim of improved well being

This can relate to a cluster of factors, better housing, more social contact

Less evidence for specific measured health gain

Some evidence for reduced need for health and social care intervention

Findings so far

ECH reduces social isolation, encourages involvement and can provide support to other local older people

- Opportunity is certainly there and active elders can benefit

- Some evidence of isolation of those with dementia and potentially BME elders

- Insufficient information about value to local community.

Findings so far

ECH enables continued involvement of family carers

- Clear value of enabling carer and supported person to remain together

- Higher proportion of families retain contact than in care homes

- Less evidence available of direct impact on carer themselves

Findings so far

ECH improves quality of life of its occupants

- Partly a summation of the previous questions

- Seems clear that for most people it does offer a good quality of life, particularly in terms of independence and security

- Also seems to apply to many with dementia

- ‘Improvement’ has to be seen in the context of possible losses associated with moving, aging, reduced abilities etc

Findings so far

ECH improves staff recruitment and retention compared to equivalent jobs in other sectors

- Anecdotal evidence only so far

Findings so far

ECH offers a sustainable return on investment for occupants, providers and commissioners

- For owner occupiers offers a shield for equity

- No research seen so far on investment returns to developers but examples of demand outstripping supply suggest a saleable product

- Commissioner value has to be seen in ‘whole system’ terms, can move costs from one statutory agency to another and overall savings are unclear

- probably need a better cost model to answer this question

Findings so far

What factors seem to lead to success in achieving these outcomes?

- Only so far some very broad indications from the literature

- For people with dementia – admission at earliest stage, maintaining a mix of abilities within a scheme, staff training and expertise

- Design – space in scheme and each unit

- Support and care – continuity, positive attitude, flexibility of response to need, effective use of assistive technology

- No one size fits all ‘right’ approach, but some basic principles

Next steps

Further work on the literature review to help contribute to the planned online evidence base for commissioners and providers on the demonstrated achievements of ECH

Associated interviews with a sample of commissioners and providers who claim they are successfully delivering the outcomes explored in the literature review - what measures are they using and how they are they achieving the outcomes.

Discussion

How far do these interim findings on outcomes match your experience?

Can you point us in the direction of more evidence around

- returns on investment?

- improved staff recruitment and retention? What in your experience are the critical success

factors in delivering positive outcomes? Proposals for/interest in being part of the next

steps?