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Chapter Three Social Context

3.1. There have been significant changes in the social context of housing for older people over the last 25 years, and this chapter provides information on this context. It reviews existing and anticipated changes in population and household structures, with particular reference to older people and pensioner households. It reviews the findings from previous research into the aspirations, expectations and housing decisions of older people, from a range of English and Scottish research. Finally, it identifies the issues that are faced by groups experiencing social exclusion, including older people on low incomes, in rural areas, and from minority groups.

Demography

3.2. Changes in the age and household structure and tenure choices of Scotland's population have had significant impacts on the demand for older people's housing and care services over the past 20 years. Projections for the future indicate that there are further significant changes ahead, which could have a variety of impacts on the delivery of housing for older people. Key statistics for Scotland indicate:

• The number of older people (aged 65 and over) is projected to rise by 46% from 812,000 in 2002 to almost 1.2 million in 2027. The rate of increase is projected to vary between local authority areas, with the City of Edinburgh being the only council area with no projected increase. ( GRO Scotland 2001 Census in Audit Scotland, 2004a)
• The number of 'very old' people (aged 85 and over) in Scotland is projected to increase from 88,000 to 174,000 over the same timeframe. ( GRO Scotland 2001 Census)
• The proportion of the adult population who are 50 or over is projected to increase from 44% in 2002 to 54% in 2027. (Government actuary department's population projections 2002, from Raab and MacDonald, 2004)
• The growth of the older male population (60%) is projected to outstrip the growth of the older female population (38%) between 2002 and 2027. ( GRO Scotland 2001 Census)
• The dependency ratio in Scotland is projected to increase from 6.0:10 (2001) to 6.9:10 (2031); reductions in fertility mean that this increase stems entirely from the increase in the older population. (Wood and Bain, 2001)
• The 2001 Census indicates that at that time only 15.8% of households with a Household Reference Person ( HRP) from a black or minority ethnic group were pensioners, compared with 45.9% of those from white ethnic groups. (Bield et al, 2004)

3.3. Key household statistics for Scotland are:

• Proportion of single pensioner households in Scotland was 15% in 2001, and the number of all households with pensioners was 31%. ( GRO Scotland 2001 Census)
• The proportion of older people is higher in more rural areas, with remote rural areas and small remote towns having particularly high proportions of people aged 85 and over. This trend is set to increase. (Wood and Bain, 2001)
• The increase in the older population will lead to a significant growth in older single male households, particularly in those aged 55-65. Households with 2 or more adults will also increase, particularly in the 65+ age band. The smallest increases will be in single female households, particularly in the 60-75 age band (see Graph 2 below). (Scottish Household Survey ³)
• In 2002, 49% of single pensioners were owner occupiers, compared to 72% of 'older smaller' households (comprising two adults only, of whom at least one was a pensioner). (Raab and MacDonald, 2004)
• In 2004 there were 32,758 sheltered and 2,872 very sheltered housing dwellings within the social rented sector (Scottish Executive 2005a), and an estimated 6,100 private sheltered housing dwellings (Fisk and Prida, 2004). This is equivalent to 7% of households over 65 living in sheltered housing, and 0.5% living in very sheltered housing.

3.4. Some of these facts are illustrated in the graphs below.

Graph 1: Households in Scotland by age of head of household

Source: Scottish Household Survey

Graph 2: Percentage increase in household types by older age groups from 2002-2016

Source: Scottish Household Survey

3.5. These changes in population and household structure have a number of implications for the provision of housing for older people. The increase in older single male households is of significance, as is the increase in older households where both partners are alive (see Graph 2). This suggests that an increased proportion of properties developed for older people will need to be able to accommodate two older people, both of whom may have mobility difficulties.

3.6. The decline in the working age population will lead to reductions in informal caring. This is likely to put increasing pressure on professional services, which is in turn likely to put strain on professional staffing levels (Joseph Rowntree Foundation, 1997; Curtice et al, 2002). This may be exacerbated by predicted increases in the proportion of older people requiring help with domestic or personal care (Pickard et al, 2000). However, there is also some suggestion that concern over the availability of carers may be exaggerated (Appleton, 2002). An issue that will be key, but which is poorly understood at present, is the increase in healthy life expectancy (when little support is required) as compared to the increase in life expectancy (House of Lords, 2005).

3.7. The increase in the older male population may have implications for housing and care services for two reasons:

• male carers are more likely than female carers to seek assistance (Curtice et al, 2002);
• couples are less likely to move into sheltered or residential care, and are therefore more likely to require assistance in their own home.

3.8. The increase in owner occupation over the last twenty years is likely to have a significant impact on the housing choices of older people over the next twenty to thirty years. The present pattern is for a relatively high proportion of older people to live in social rented accommodation, particularly single households. As the younger generation of owner occupiers move towards retirement, their capital assets will lead to very different patterns of decision making. The evidence as to what impact this may have on housing provision is discussed later in this chapter.

3.9. While the proportion of pensioners from black and minority ethnic groups is small, they often have particular needs, and the expansions in these populations and changes in these communities are likely to lead to an increase in demand for provision for their specific needs. This will be discussed in further detail later in this chapter.

Aspirations, expectations and decisions in older age

3.10. The literature relating to what older people seek from their housing, and how and when they make decisions about whether to move, mostly comes from England. However, given the social similarities between Scotland and England, much of this research is considered to be applicable to Scotland. This comparability may be considered to have increased over the last twenty years, as owner occupation levels in Scotland have risen to 62% (2001 Census) compared to 69% in England (Survey of English Housing, 2000). Having said that, the review of the evidence will be restricted to those findings which are most transferable to Scotland, in order to avoid spurious comparisons.

Housing Preferences

3.11. Research indicates that there are a few key criteria that most people look for in their housing. However, within this there is wide variation between individuals. In general, housing needs are closely associated with health and age, though preferences vary through time as well as between individuals.

3.12. Some research (Clough et al, 2003) found that older people were in general fairly well satisfied with their present housing. However in comparing people across this older age group, other research found that increasing age had no association with changes in levels of satisfaction with their housing (Wilson et al, 1005). Where all researchers are agreed is that older people are keen to live in their own homes, and maintain independence for as long as possible ( e.g. Fletcher et al, 1999; Tanner, 2001; Levenson et al, 2005).

3.13. Issues of key concern to older people have been identified from a range of research (Neville, 1983; Wilson et al, 1995; Appleton, 2002; Clough et al, 2003; Clough et al, 2004) as:

• Bungalows are popular, as are houses; while ground floor access is preferred for mobility reasons, some research found this had disadvantages in terms of security, so ground floor properties are considered least satisfactory. For those who could manage stairs, upper floor flats are sometimes preferred for security and quiet.
• Fuel poverty and poor insulation still emerge as significant issues in much research.
• Space is considered important; this includes space for hobbies, to have family and friends to stay, and for couples to have space independent from each other. A large property was not considered problematic in itself, though the ability to heat or maintain it may be an issue. This is particularly important, given the increased time spent on home based leisure activities by those over 65 (Brook Lyndhurst, 2004).
• Safety and security are important, and while this may relate to fear rather than reality, it should be taken into account during the design of new developments
• Well designed kitchens and bathrooms, are important, and should have space for wheel chairs or mobility equipment.
• Shops, services and public transport should be within easy access.
• Good neighbours are important, and their age was only found to be a slight concern.
• An open outlook is also popular, to watch others come and go.

3.14. It is also interesting to note from research that there is a reluctance to move into sheltered housing or accommodation with other older people (Clough et al, 2003). Nonetheless, other research found that those in sheltered accommodation were the most satisfied with their housing (Wilson et al, 1995). Some commentators suggest that some older people do want to live in age-segregated communities, and argues that these people should not be seen as 'failing', because they choose to reduce their independence in exchange for other benefits (Dalley, 2002; Clapham, 2005). In a similar way, some suggest that residential care is the most appropriate solution for some older people, and others choose it above other supported housing options (Leason, 2005).

3.15. English policies are shifting towards increased choice for older people's housing options ( DETR, 2001). However, research suggests that the availability of housing options in later life is to a large extent determined by housing decisions earlier in life, for example, decisions relating to owner occupation. These decisions indicate differences in people's willingness to take on risk, with the suggestion that those unwilling to take such risks are more likely to choose to enter residential care later in life (Clapham, 2005).

Deciding to Move

3.16. As with housing expectations, decisions as to whether to move, where to move to, and when to move, vary considerably between individuals. The decision-making process is complicated, and involves a range of factors including previous and existing tenure, income and savings, age and physical ability, and the timescale available for the decision-making and moving process.

3.17. Around half of older people over 60 have never thought about whether they may need to move in order to meet their future housing needs (Clough et al, 2003). In contrast, around a third have given the decision some thought, and of these, a quarter have given the matter considerable thought. Similarly, research with owner-occupiers found that half have no intention of leaving their present home (Askham et al, 1999).

3.18. As might be expected, the disabling effects of aging are the over-riding reason for moving (Clough et al, 2003). For those whose move was the result of a gradual process of increasing frailty, giving more time to make decisions about moving, views about their eventual move were generally more satisfactory. For those whose move was brought about by an abrupt change in health, the decision process tended to be considerably for-shortened; the older person therefore often had less control over the process, and was less satisfied with the outcomes. Other research has also identified health issues as being important precursors to a move (Oldman, 1990a), with critical health events often leading to admission to a care home (Stilwell & Kerslake, 2004).

3.19. The decision to move, and where to move, is based on the balance of circumstances at that time. Many older people, particularly owner occupiers, choose to move within the general housing stock (Appleton, 2002). This decision may relate to anticipated future needs, such as more ground floor space, or an aspiration to be nearer to shops, post office and social facilities.

3.20. Financial concerns play a major role in decision making. Research into the financial implications of home ownership for older people (Hancock, 1999) found that for many older people the costs of repairs, and their ineligibility for housing benefit to help with housing costs, meant that those in smaller properties were worse off as owners than as renters. However, those in owner occupation have the advantage of being able to increase their income though equity release schemes. This is a particularly significant factor for those aged 80+ and those in larger properties.

3.21. Other financial concerns for owner occupiers also impact on their decision making. Research into older owner-occupiers' perceptions of owner occupation (Askham et al, 1999) indicates that many owners feel considerable pride in their property, and are resistant to losing this. Furthermore, many would like to be able to leave the proceeds of their home to their children, and resent the idea that this asset may have to be spent on residential care. This is likely to become an increasing issue as the cost of buying a property rises for two reasons:

• There will be an added incentive to pass on funds to children and grandchildren, to help them with the costs of buying a home.
• The increased equity in their property will increase the potential for equity release schemes to be a viable source of additional income (Sumner, 2002). However, this is unlikely to be sufficient to pay for long term care costs (Dalley, 2001).

3.22. These issues may partly explain the finding that many owner-occupiers who do move, tend to move into other general housing, rather than specialist or rented accommodation (Clough et al, 2004).

3.23. Maintenance concerns are a considerable issue for home owners (Askham et al, 1999; Oldman, 1990a), particularly widows. The difficulties of identifying trustworthy tradesmen and the unpredictable costs mean that this ranks highly on the list of reasons why older people choose to move to sheltered or residential care.

3.24. All these factors suggest that the decision to move is based more around push factors associated with their present property than the pull of features associated with sheltered or extra-care housing, such as scheme managers, alarms or age segregated living (Oldman, 1990a). However, once the move has been made, the majority of residents of extra-care schemes were generally pragmatic about balancing the choices and freedoms they lost by moving with the security and reduced responsibilities they gained (Fletcher et al, 1999). In many cases the professionals and family involved become concerned about the risk of the older person staying at home before they themselves feel the risk to be problematic. They often, however, capitulate in order to reduce the burden of concern from those around them (Stilwell and Kerslake, 2004).

3.25. A lack of clear, independent information and advice or an understanding of where to find information, on the housing options available to older people is an issue that has been identified in several pieces of research ( e.g. Care and Repair England, 2003;Clough et al, 2003; Oldman, 1990a; Watson, 1997). This has now been identified as a focus for government in England ( ODPM, 2002). This was identified as a particular difficulty for older people from black and minority ethnic groups (Age Concern Scotland, 1998; ODPM, 2002), for older home owners (Wright, 2002), and those in rural areas ( ODPM, 2002). Specific topics include the availability of care and repair schemes, and equipment and adaptations that could enable people to stay in their original home (Heywood, 2001; Clough et al, 2003).

3.26. Lack of availability of appropriate accommodation was also identified as a concern for those intending to move in early old age, most of whom either sought specialist housing or ordinary housing that was easy to live in and maintain (Clough et al, 2003).

Social Inclusion Issues and Their Impact on Housing

3.27. Older people can experience social exclusion in terms of access to services, mobility and health issues. However, this section focuses on social inclusion issues that are limited to particular sections of the older community.

Poverty

3.28. The substantial drop in income experienced on retirement is well known, and despite increases in state pensions, this remains a key issue for many older people (Clough et al, 2003). For many, their financial situation is a major contribution in their decision to move, particularly for owner-occupiers who still have a mortgage (Hancock, 1999). There is increasing disparity in incomes and affluence in the older population (Sumner, 2002; Dalley, 2001). This means that for some older people, choices are likely to be limited by their financial situation.

3.29. There are two key areas where poverty interacts with housing for older people:

• Fuel poverty
• Home maintenance

3.30. Both these areas have been targeted by the Scottish Executive over the last decade, and much investment has been put into reducing these problems so older people can remain in their own homes (Scottish Executive, 2005g; Scottish Executive 2004a; see Chapter 2 for details). There has been significant progress in this area, with many thousands of households being provided central heating, insulation, and improvements in property repair. However, the research suggests that these schemes are restricted by older people's awareness and capacity to access them. There are several examples in the literature where this has been identified as a significant issue ( e.g. Craigforth Consultancy, 2001; ODPM, 2002; Clough et al, 2003).

3.31. Some critics in England suggest that poverty can also reduce access to lower levels of support which may not be identified through needs assessments, and this can impact on housing choices (Clapham, 2005). However, the provision of free personal care in Scotland, along with Supporting People funding, should restrict this issue north of the border. Issues relating to the provision of these forms of support are discussed further in Chapter 4.

Older People in Rural Areas

3.32. There are a number of housing issues that are particularly problematic for older people in rural areas in Scotland. Many of these issues have been clearly identified in the research conducted at Aberdeen University in 2003 (Philip et al, 2003). Their analysis of the Scottish Household Survey and other sources of information have been combined here with findings from other research (Rural Poverty and Inclusion Working Group, 2001; Tanner, 2001; Williams et al, 1998; Shucksmith et al, 1996; HOPDEV, 2005; Phillip, 1999) to identify the key issues relating to older people's housing in rural Scotland:

• Higher proportion of older people than in urban areas, particularly in more remote rural communities, where services are particularly difficult to provide.
• Rates of owner occupation among older households are higher in rural areas of Scotland than in urban areas. The highest rates of owner occupation are for those between 65 and 75, and as these people become older, it is likely that rates of owner occupation will increase further. 'Other' housing tenures are also more prevalent among older rural households, particularly for those up to the age of 65, suggestive of higher levels of tied accommodation.
• Poor housing conditions are particularly acute in rural areas, and the need for effective dissemination of information about care and repair and fuel poverty schemes is therefore particularly important in these areas.
• Higher rates of private payments for home help (this could be the result of higher incomes in accessible rural areas, or a reflection of lack of awareness or willingness to apply for state assistance).
• Higher than average levels of poverty among older people in remote rural areas exacerbate other forms of disadvantage, particularly in relation to buying in low levels of support to reduce social isolation.
• All forms of home care, from low level home help that reduces social isolation to intensive home care, as well as 'handyperson' schemes, have been found to be particularly important in rural areas, as they enable people to remain not only in their own home, but also in their own community; scarcity of specialist housing provision and clustering often means that a move of significant distance is required to access sheltered, extra-care or residential care.
• There are significant housing management issues in rural areas, with a shortage of affordable properties putting strain on the provision of housing for families. This then has consequences for older people who wish to stay in their family home. The shortage of affordable accommodation is also a significant issue for those leaving tied accommodation on retirement.
• An under provision of sheltered housing in many rural areas, and very limited provision of extra-care housing in all rural areas have been identified through research by Communities Scotland. The closure of residential and nursing homes due to lack of economies of scale is also an issue in some rural areas, as there are rarely any alternative forms of provision locally.
• Studies of migration suggest that people migrate from urban areas to rural areas in their early-retirement years. While this does have positive consequences, in terms of housing provision, tends to push up property prices, and will ultimately put additional pressures on rural services for older people. In later years (70+) this is often followed by a move to small towns, to be closer to services.
• The particular needs of older people in rural areas, and the difficulties in delivering services, create significant challenges for future policy development.

Minority Groups in Society

3.33. Analysis of 2001 Census data indicates that black and minority ethnic (' BME') people make up around 2% of Scotland's total population (Equality Scotland, 2004). That 2% can be further analysed as follows:

Figure 1 - Population by Ethnic Origin, BME only, 2001

Source: Equality Scotland (2004) p2

3.34. The research also indicates that in 2001, there were 6,488 people from BME communities aged over 60 in Scotland. Most were living in the Glasgow City Council area, followed by East Dunbartonshire, East Renfrewshire, Edinburgh, and Dundee City. Groups from the Indian sub-continent are more concentrated in these areas, particularly in Glasgow. Older Chinese people tend to be dispersed throughout Scotland. Pakistani and South Asian people recorded the highest levels of 'limiting long term illness' and the Chinese population recorded the highest levels of good health (ibid.).

3.35. The research also showed a marked preference among black and minority ethnic groups for home ownership, as opposed to renting from the local council, other social rented accommodation, and private rented accommodation (ibid.).

3.36. Research undertaken on behalf of the Scottish Executive in 2000 indicated that the home support needs of majority and minority groups in Scotland were very similar despite differences in the sex and age profile of the study samples. However, use of services varied markedly between the two groups, with 27% of the majority ethnic group saying they were receiving services compared with only 7% of the minority ethnic group. There was little evidence found that community based 'day centres' were helping minority groups access mainstream services, due to a perception on the part of providers that mainstream services were inappropriate for minority groups. The minority group also noted that while in NHS care they often had to have food brought in by friends or relatives since the hospital did not cater for their dietary needs (Bowes & MacDonald, 2000).

3.37. Research by the Joseph Rowntree Foundation in 2004 highlighted that service responses to the needs of older black and minority ethnic people in the UK have historically been poor, resulting often in the need to turn to community and voluntary organisations for support. This is particularly relevant given that numbers and proportions of older people from black and minority ethnic groups in the population are rising (Joseph Rowntree Foundation, 2004).

3.38. The research also indicated that the impact of ageing in terms of health and associated care needs occurs at an age relatively younger than the rest of the population for many minority ethnic groups, and that older people from black and minority ethnic groups are more likely to face greater poverty and live in poorer quality housing than white older people. The notion of extended family support is often a myth, and even within minority ethnic groups, the circumstances faced by Chinese older people will often differ from those faced by Afro-Caribbean older people (ibid.).

3.39. Particular issues relevant to housing choices made by minority groups noted in that report include language barriers in services preventing older people from finding out what their options were or what services were available; issues of culture, belief and value systems in care settings (ranging from food options to lack of respect for religious beliefs or practices); money matters (although the issue of misleading pension advice is not restricted to minority groups); and relationships and well being (particularly in relation to care provision, and mental health where an older person was isolated, or where the issue was taboo in their culture) (ibid.).

3.40. More general research has been undertaken into minority issues from a 'race' perspective (Arshad et al, 2001). In relation to housing, this report noted a number of key issues in relation to housing for BME communities:

• the need for greater sensitivity on the part of housing providers in relation to the housing needs of minority ethnic people
• lack of understanding among minority ethnic people of the procedures involved in obtaining accommodation, transfer and relocation in local authority housing
• lack of knowledge of the range of accommodation available in other parts of the social rented sector
• the need for a wide range of house type and size which takes into account the demand for larger accommodation, particularly for Pakistani households, as well as possible changes in the family structure
• the importance of living in an area which is safe from racial harassment
• the importance of access to local amenities and shops catering for their needs and proximity to places of work (for those of working age, or older people who are still working)
• increasing levels of demand for specialised forms of housing for older people in the future

3.41. There is some recent evidence of Local Authorities and Housing Associations paying particular heed to the specific housing choices of minority groups in society. For example, in conjunction with Kirk Care Housing, Hanover Scotland, and Bield, Glasgow City Council, have produced an information booklet specifically targeted at the housing options available to black and ethnic minority tenants (Glasgow City Council, 2005), and Equality Scotland have been publishing newsletters on the subject in English, Hindi, Punjabi, Urdu and Chinese since January 2001 ⁴. They have also produced a 'Housing Options for Older People' DVD/Video, which presents a comprehensive overview of the benefits of Sheltered Housing and other services from the perspective of older people, specifically the Black and Minority Ethnic community.

3.42. There is also wider evidence of some local authorities delivering specialised housing for BME older people's groups. In Middlesbrough, for example, a local community development partnership between a housing association and a Chinese community association has resulted in the development (with the support of Middlesbrough Council) of a 'mini-Chinatown' for Chinese older people, comprising housing, a multi-purpose community centre, and space for commercial development. However, the project has not been evaluated yet so it is not possible to provide information on the benefits and costs of such a programme (Stephenson, 2005).

3.43. Widening the net even further, the Policy Research Institute for Ageing and Ethnicity ( PRIAE), based in Leeds, has produced research covering good practice in providing health and social care services to elders from ethnic minorities in Europe, including research undertaken in the UK. This found that in the UK there is still a gap in information relating to health and social care, which may be causing gaps between expectations of services and what is delivered. Availability of information about services in different languages was noted as problematic, and South Asian and Chinese / Vietnamese elders indicated a strong preference for having staff of the same ethnic group, and South Asians placed more importance than other groups on the availability of places of worship, the ability to talk freely about religious issues, and having staff of the same gender ( PRIAE, 2004).

3.44. Also undertaken by the PRIAE, the SEEM project has identified some key priority areas for service development for minority ethnic elders. For example, it has identified a "pressing need to develop a clear policy framework for service development for minority ethnic elders at all levels of government" since existing policies cover, for example, ageing or poverty, but not the combination of issues that face minority ethnic elders ( PRIAE, 2005, p3). It has also identified "a pressing need for local authorities to develop a better relationship with minority ethnic communities and their representative organisations at the local level" (ibid. p3). This needs to involve networking between different agencies that deal with minority ethnic elders, involving service users in planning their own care, improving information and communication (for example, by providing information in different languages), and taking action to help minority ethnic elders overcome barriers that prevent them accessing services (ibid. p4). The provision of ongoing resources by government for staff development, training, planning, and funding partnership working was noted as fundamental to the sustainability of schemes (ibid. p5).

3.45. As noted elsewhere in this report, the need to provide culturally aware services for BME people with dementia has been touched upon in some research (Kerr et al, 2005), since the confusion experienced by dementia sufferers is exacerbated by the lack of cultural awareness in services dealing with minority ethnic groups.

3.46. Another minority group, whose needs may not be being met by existing provision in care homes or sheltered housing, are lesbian, gay, bisexual and transgender (' LGBT') older people. One piece of research notes that while this group may make up as much as 10% of the total population, their needs are relatively unresearched in sheltered housing (Brooks et al, 2003).

3.47. In Scotland, research has been undertaken recently by ODS in partnership with Stonewall Scotland (Communities Scotland, 2005) in relation to this minority group. This research indicated a number of findings relevant to older LGBT peoples' housing options in Scotland. While the majority of participants in the study felt they were content with their current housing circumstances, they raised issues of harassment and of quality of service provision. The latter in particular was felt to be due to assumptions of service providers and a lack of awareness and training. They did not feel that they experienced barriers to accessing services because of their sexuality. Interviewees indicated a clear preference for care to be provided in their own home for as long as possible, but that lack of finance would restrict choice for those relying on local authority or voluntary services. There was also a clear feeling that services to this group should be delivered as part of mainstream services rather than by specialist organisations, with the exception of residential or sheltered accommodation for lesbians or LGBT tenants only (Communities Scotland, 2005).

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