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Executive Summary

Introduction

1. Tribal prepared this literature review for the Scottish Executive Development Department as a scoping review of existing literature and research findings. The review will be used to inform the Department's review of housing for older people in Scotland, which is anticipated to feed into the development of integrated policies and service delivery for older people.

2. Population projections indicate a considerable increase in the number of older people in Scotland, particularly of 'very old' people (aged 85+) and older men. It is anticipated that these demographic changes will lead to further pressure on services for older people. There is also a general acceptance that the existing specialist older people's housing stock is becoming increasingly unfit for purpose.

3. Literature for the review was identified from a range of searches including internet searches of key websites and searches on databases covering academic references, practice and professional journals, national and local government publications and non-governmental research reports. The search considered all literature since 1980, though the focus during the review was on more recent research findings. Consultation was also undertaken with a range of Scottish local authorities to identify any research carried out at a local level for their own policy development and service delivery.

4. A series of research questions were developed to guide the review, and the findings, as they relate to these questions, are presented here.

• What impact will changing demographics and tenure structures have on demand for specialist accommodation?
• The increasing population of older people in Scotland will lead to further pressure on services for older people while changes in gender balance and tenure balance towards owner occupation will impact on older people's housing options and choices. Trends towards high proportions of older people in remote rural areas also seem set to continue.
• Decisions about moving in older age are complex and are highly dependent on individual circumstances. Health related issues are the most common reason for moving, with outcomes being most positive for those that have planned their move for some time. Moves tend to relate to a 'push' from inappropriate existing accommodation, rather than the 'pull' of the new alternative. There is considerable movement within general housing in the owner occupied sector, with older people moving to properties with improved ground floor access or closer to shops and local amenities.
• Why do people choose sheltered housing as opposed to other forms of housing available to them in retirement?
• Sheltered housing provides social contact and a secure environment that appeal to many older people. Extra-care and very sheltered housing have proven to be popular for a minority of people as alternatives to residential care or high intensity care at home. They provide flexible care and accommodation suited to those with mobility problems. Satisfaction levels are high, particularly in relation to access to care and the provision of meals.
• However, the majority of older people stay in general needs housing and may move within this to a property that more closely suits their needs.
• What are the range and focus of older people's aspirations for housing?
• Older people are keen to stay in their own homes. They are guided in their decisions by aspirations for security, accessibility (both internally and externally) and sufficient space, with many considering two bedrooms to be a minimum.
• Provision of care at home services (both high and low intensity) form a vital means of enabling older people to fulfil their desire to stay at home. However, lack of awareness of eligibility to services, particularly for those over 75 years, appears to restrict access. This can also be an issue for older people in rural areas and those from minority ethnic groups.
• Care and repair services and the fitting of equipment and adaptations also enable older people to stay at home.
• What types of housing for older people are likely to meet future needs and aspirations?
• The increase in owner occupation and the desire to stay at home are likely to mean that services that enable older people to remain at home will be of increasing importance.
• Extra-care housing aims to replicate the advantages of living at home, while providing flexible care. Satisfactions levels are high, particularly in relation to access to care and the provision of meals. Present indications suggest that this form of provision will also be of increasing significance in the future.
• What lessons can be learned from models of specialist housing developed abroad?
• Retirement communities and co-housing communities for older people have been introduced into the UK as forms of specialist housing for older people from abroad.
• Retirement communities have proven popular with those able to afford them, though the high costs of living in such communities mean that they are not appropriate for the majority of older people.
• Co-housing for older people has been slow to deliver in the UK so far, but may suit future groups of older people, if housing associations are able to adapt to this form of delivery.
• What are the funding implications for options identified?
• The provision of property based services for older people in their own homes, particularly home adaptations, have been found to provide very good value for money in reducing dependency for older people.
• Evidence relating to the cost-efficiency of extra-care housing compared to residential care is mixed. It is improved by large-scale provision, but this is problematic in rural areas where intensive home care may be more cost effective.

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