Remodelling Sheltered Housing

1
Remodelling Sheltered Housing

• Professor Julienne Hanson
• University College London
• DoH Housing LIN Meeting
• Chelmsford, 5th June 2006

2
Outline of Presentation

• The project, funding body and timing
• The research team
• The importance of the subject policies and
  practice
• What the research is covering
• Some initial findings
• An initial model for extra care housing
• Next steps

3
The Project, Funding Body and Timing

• Remodelling sheltered housing and residential
  care homes to extra care housing
• Funded by the Engineering and Physical Sciences
  Research Council (EPSRC)
• A multi-disciplinary project
• May 1 2005, for 2 years

4
The Research Team

• Professor Julienne Hanson, Hedieh Wojgani and
  Flora Margeti
• University College London
• Professor Anthea Tinker and Dr Fay Wright and an
  OT to be appointed
• Kings College London, Institute of Gerontology
• Dr Ruth Mayagoitia-Hill and Els van Boxstael
• Kings College London, Centre of Rehabilitation
  Engineering
• Dr Alan Holmans, University of Cambridge

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The Importance of the Subject

• Remodelling presents challenges over and above
  those relating to new build schemes
• Perceived problems with inadequate help for older
  people at home and in sheltered housing
• Criticism of residential care and lack of places
• Difficult to let sheltered housing
• Need for closer links between services (e.g.
  Single Assessment Process)
• More funding from DoH
• Previous research on the value of extra care

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Research Remit

• Examining a sample of schemes which have been
  converted from sheltered to extra care housing
• Examining a sample of schemes which have been
  converted from residential care homes to extra
  care housing
• Both these involve considering the role of the
  building conversion itself, changes to service
  (support and care) delivery and any supplementary
  assistive technology at the level of the whole
  scheme.

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Assistive Technology

• An umbrella term for any device or system that
  allows an individual to perform a task they would
  otherwise be unable to do or increases the ease
  and safety with which the task can be performed
  (WHO, November 2004)
• Can be fixed (such as housing adaptations)
• Can be portable (such as bath seats, wheelchairs)
• Can be electronic (such as smoke detectors,
  alarms, passive infra red lighting)

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What the Research is Covering

• Only social housing a sample of schemes which
  have been converted since 2000 to extra care
  (five Local Authorities and five Housing
  Associations)
• Examining what the care, building and AT
  changes were and what is likely to be needed in
  the future
• Investigating the remodelling process itself and
  how it took place
• Obtaining the views of older people and staff
  post-occupancy of the new building, to look at
  the advantages and disadvantages
• Costing the changes to the schemes, and
• Providing guidance based on the findings

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Staying Put / Moving On

• Finding out what are the criteria for admission,
  and also what is the current policy and what
  actually happens in practice in respect of
  providing a home for life.
• An architect, social scientist, OT and a
  rehabilitation engineer will examine each of the
  schemes at the end of the project to decide (on
  agreed criteria) what additional structural,
  engineering and innovatory AT changes will be
  necessary to house the tenants that become
  progressively disabled if the scheme were ever to
  be in a position to offer a home for life.

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Initial Findings 1 Choice of Sample

• It has proved more difficult than we anticipated
  to find examples of LA housing as many seem to
  have transferred schemes to HAs, sometimes in
  order to facilitate the remodelling process
• The variety is immense no 2 schemes are the
  same in how they have remodelled (e.g. all or
  part of the scheme is extra care, some are
  conversions and some extensions, some remodel the
  flats and others the communal facilities, etc.)

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Initial Findings 2 Housing

• The architects, quantity surveyors, building
  contractors and professional clients for the 10
  schemes are being interviewed in order to analyse
  the design process for each conversion.
• Plans of the 10 schemes have been analysed,
  before and after the conversion, to determine how
  the remodelled scheme differs from the original
  building.

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Case Study 1
Case Study 2
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Case Study 1

Remodelled
Existing
Total area added 60 sq m, more than 55 of
which is for circulation.
Case Study 2
Total area added 1283 sq m, about 64 of which
is for new flats.
Communal Facilities
Staff Facilities
Flats
Circulation
Other
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Case Study 1 - Typical Flat Conversions
Existing Type A
2X Existing Type D
Existing Type D
Remodelled Type A
Remodelled Type D
Remodelled 2 x Type D
Remodelled Flats Type A (49 m ²)
One-bedroom Type D (33 m ²) One-bedroom 2 x
Type D (67 m ²) Two-Bedroom
Existing Flats Type A (49 m ²) One-Bedroom
Type D (33 m ²) Bed-sit
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Case Study 2 - Typical Flat Types
Existing Type C
Existing Type A
Existing Type E
Remodelled Type A
Remodelled Type E
New Build Type F
Remodelled Flats Type A (67 m ²) Two-Bedroom
Type E (91 m ²) Two Bedroom Type F (50 m ²)
One-Bedroom
Existing Flats Type A (34 m ²) Bed-sit Type C
(31 m ²) Bed-sit Type E (40 m ²) Bed-sit
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Emerging Issues interviews with professionals
involved in the remodelling process

• Dealing with the constraints of the site
• Decanting residents vs. moving them all out of
  the building
• Cutting and carving the building
• Dealing with the unknown
• Sustainability
• Long term costs Are care costs building
  neutral?

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Initial Findings 3Care and Facilities

• For each case study, interviews are being carried
  out
• with a sample of older people in each scheme to
  find out the advantages and disadvantages (some
  will be new to the scheme and others will be
  existing tenants)
• with appropriate staff to see why remodelling was
  done, what problems occurred and how they were
  overcome, how and why new tenants were chosen and
  from what source

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Differences in meal provision, care and community
facilities

• No communal meal in four schemes and an optional
  cooked lunch in six schemes
• Private agency carers in six schemes and carers
  employed by housing association in four schemes
• Three schemes offered nothing, four schemes had a
  day centre for outsiders, two schemes opened the
  restaurant to outsiders (after booking) and two
  schemes housed a community care support team

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What Constitutes Extra Care?

• No agreed definition, and most experts have given
  up trying. Taken a step back to say it is a
  concept or a philosophy.
• Is this good enough for the customers? We think
  not! Older people are confused and do not know
  what to expect from extra care housing.
• Literature review of 40 publications, including
  both web-based and library resources, published
  within the last ten years, that are written in
  English and relate primarily to UK policy or
  practice.
• Listing the elements of extra care mentioned in
  several publications, indicating that a consensus
  had been established. Came up with a list of 25
  such elements, generally agreed on.

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Ingredients of Extra Care

• 24-hour support
• Activity coordinator
• Activity room
• Assisted bathrooms
• Balanced community
• Communal dinning space
• Communal Kitchen
• Communal lounge
• Consulting room
• Culturally sensitive service
• Day Centre
• Flexible care
• Flexible design

• Guest room
• Laundry room
• Lifts
• Lively locality
• Living at home, not in a home
• On-site support staff
• Rebuild skill for independent living
• Scheme manager
• Self-contained dwellings
• Smart technology
• Wellbeing facilities
• Wheel-chair accessibility

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Interrelation of the Design Components of Extra
Care Housing
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Interrelation of Core Values Underpinning Extra
Care Housing
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Matrix of Elements and Variables
An element can score a minimum of 2 and a maximum
of 6 dimensions on the horizontal axis. Each of
the 6 design components / core values is impacted
by a different set of the list of 25 essential
elements identified in the literature. Dual and
multi-faceted elements. Some elements considered
optional have an impact on all the components and
values of the extra care concept.
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Next Steps

• Plotting the elements that are actually provided
  in each of our 10 case studies on the matrix, to
  see exactly what is present and what is absent in
  each scheme
• Delphi Technique. Survey currently under way
  with the Housing LIN (see Newsletter 14) to
  weight each of the 25 variables on a 5 point
  scale from very important to very unimportant.
  Space for other so that we can identify where
  ingredients are missing from the list.
• Up to mid May, we have had about 150 responses,
  many adding helpful comments to flesh out their
  responses.
• Closing date of June 5th. We will then analyse
  the results and write a paper with the LIN - a
  good example of research / practice
  collaboration.