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SECTION 9: THE CHANGING ROLE OF SHELTERED HOUSING
9.1 Reflecting on the different elements of this review, it is clear that sheltered housing has undergone a number of changes. Perhaps the most notable and far reaching are the changes to warden services (including reductions in hours worked by wardens, and changes to the role of the warden), and increases in services charges to residents. These changes however are not uniform across all providers. It appears that some providers are still determined to provide 24 hour on-site cover. Others however have implemented significant reductions to the hours of warden cover provided in their schemes. Moreover, increasing numbers of providers are beginning to develop very sheltered housing schemes either as entirely new schemes or as re-developed existing sheltered provision. Again, these developments are not taking place uniformly across Scotland, and the responses to the provider survey indicate that there is no single blueprint for very sheltered housing.
9.2 Responses to the provider survey identified a number of different factors that, in combination, are driving changes to sheltered housing. These fall into four broad inter-related groups - new regulation, funding issues, new and alternative service developments, and supply and demand factors. In this section we reflect on the drivers for those changes, how provider organisations have responded, and how these changes have been received by residents.
New Regulation
9.3 Providers noted new regulatory requirements which had led to changes in sheltered housing provision and were presenting particular challenges. These were:
- Impact of the European Working Time Directive and UK Minimum Wage Legislation on warden services;
- Scottish Social Services Council requirements for qualifications for housing support staff, including wardens, with their potential impact on recruitment and the additional costs associated with training, particularly for staff replacement/cover;
- Requirements to meet Care Commission standards, and annual inspections;
- Administrative pressures and the extensive effort associated with performance reporting to Supporting People, the Care Commission and Communities Scotland;
9.4 Of these, the European Working Time Directive (and, to a lesser extent, the Minimum Wage Legislation) had generated the most profound changes to sheltered housing. As a result warden services had been reviewed, and most providers had decided it was no longer possible to provide 24 hour on-site warden cover, as it would be too costly. Consequently, warden cover is now most usually provided at given hours through the day, and in some cases there is no on-site cover at weekends. Community alarms provide the links to out-of-hours cover. In conjunction, the requirements of Supporting People to clarify sheltered housing services had meant that the role of warden was more clearly defined. Although some providers were uncomfortable with the changes, most were not, and indeed welcomed the opportunities to review services. It has already been noted in Sections 6 and 7 that residents of sheltered housing have not welcomed the changes to the warden services.
9.5 Many providers also noted that the Scottish Social Services Council requirements for housing support staff to be qualified were creating difficulties. Many reported the difficulties in finding a suitable training course, as most focused on skills required by home care staff rather than housing support staff. Moreover, the numbers of staff that needed to be trained created funding difficulties as well as problems in providing cover while staff were away.
9.6 Care Commission inspections, and what were generally perceived as the onerous requirements of performance reporting for Supporting People, were also generating additional pressures for providers. This was felt at all levels in provider organisations. Many wardens we met were frustrated by the increasing levels of paper work which reduced their capacity to spend time with residents. In addition, housing associations operating in a number of local authority areas noted that requirements for inspection were different in most local authority areas - as one noted, "they ask the same set of questions in six different ways". Many also felt that Care Commission inspectors appeared to unclear about the role of sheltered housing, and how sheltered housing could be "inspected" in a meaningful way.
Funding Issues
9.7 Most providers reported shortfalls in funding for sheltered housing. These were due to:
- Falls in (and uncertainty about) levels of Supporting People funding and the implications for housing support services for older people;
- Lack of financial resources including capital resources for investment and remodelling and revenue funding for service development.
9.8 Although the Supporting People programme has had profound effects on sheltered housing, it is important to note that it was only one of a number of factors that providers felt were driving changes. In some areas, local authorities were reported to be more supportive of sheltered housing than in others, and consequently they were more willing to fund services. Some key informants also felt that estimates of the costs of services made in preparation for the introduction of Supporting People ("sizing the pot" or the period of Transitional Housing Benefit) had been hurried and proved inaccurate; consequently there had been winners and losers in terms of Supporting People funding allocations. The expected falls in levels of Supporting People funding nationally, along with local uncertainties about future levels of funding, are undoubtedly creating considerable difficulties for providers. Some providers questioned whether current and already reduced levels of housing support could be maintained in the future, although given uncertainties about funding, they were unclear about what further changes would be required. Nevertheless, some organisations had welcomed the opportunities that Supporting People had provided for developing tenure-neutral services and for reviewing sheltered housing provision in the wider context of older people's service more generally.
New Service Developments
9.9 Alongside changing regulations and funding issues, new service developments were raising questions about the future role of sheltered housing. These included:
- Promotion of independent living and the associated move away from care homes;
- Increasing opportunities to provide home support, thus reducing demand/need for sheltered housing;
- Improving technology and availability of aids/adaptations to enable people to remain in their current home;
- Introduction of Free Personal Care;
- Need to provide support on a peripatetic basis rather than linked to a housing scheme;
- Development of extra care housing.
9.10 New service developments, particularly those designed to enable people to stay in their own homes, were seen to be changing the profile of applicants to sheltered housing. It was felt that sheltered housing was no longer such an attractive option to older people when there were greater opportunities to receive services (for example community alarms) or have aids and adaptations that could support independence at home, along with community services to reduce social isolation (for example, via day centres). Alongside increasing numbers of services delivered at home, there was a new emphasis on promoting independent living for older people who previously might have entered residential care. Consequently many providers noted that the profile of applicants was changing, and applicants had more complex needs and were generally older than had previously been the case. These observations, as well as the growing numbers of sheltered housing residents who were getting older and needing more assistance, were generating the interest in the development of very sheltered housing.
9.11 Many respondents highlighted the need for a national strategy to guide local decision making and planning, and the coordination of strategies across older people's services generally to provide clarity about the role of 'traditional' sheltered housing and how it relates to other types of service provision, particularly the new enhanced models of housing with care and home care services.
Supply and Demand Factors
9.12 In addition, historic patterns of supply of sheltered housing did not meet current and changing patterns of demand.
- Changing expectations and perceptions of older people were leading to voids in some schemes;
- Need for new developments - especially for very sheltered/extra care provision to meet needs of the increasing numbers of frail older people;
- Mismatch between supply and demand - some respondents reported lack of demand; others reported the lack of suitable housing including sheltered housing for older people.
- Increasing numbers of existing tenants with high levels of frailty, and the increasing age and complex needs of new applicants;
- Older people wanting to retain housing equity rather than rent;
- Older home owners with insufficient housing equity to purchase private sector provision.
9.13 Levels of demand have been considered in some detail Section 4, however it is also important to emphasise that most providers felt that the types of demand and needs of residents and prospective residents were changing. As noted above, opportunities to receive services at home were influencing the choices made by older people. Also many noted that new and future generations of older people were used to higher living standards, and had different attitudes toward service provision.
9.14 Despite shared perceptions about the need for sheltered housing to change, respondents had differing views about the future of sheltered housing, as illustrated by the comments below, indicating a lack of consensus regarding how sheltered housing should change, and its position on the spectrum of care services for older people.
"I don't think sheltered housing has a future. When it was developed in the 60s/70s the idea of a good neighbour to help out in emergencies was relevant and appropriate. Now with changes in expectations about service, changes in legislative requirements and our greater ability to support people in their own homes for longer I think that it has had its day."
Local authority provider
"The most significant national challenges relate to the balance of care changing from long term care homes back into the community and older people having more say about remaining in the community for as long as possible. Resourcing is an issue and more funding is required for community care services and housing costs, especially the provision of more sheltered housing, more very sheltered housing and more extra care housing. Due to current perceptions this should take the form of new build rather than conversion of existing properties."
Local authority provider
9.15 It was also clear that different provider organisations were at different points in their strategic thinking and service development. For example, one respondent reported an on-going strategic review of sheltered housing that would inform the future direction of local services. Others, however, were much further on in their thinking, and were already transforming and developing services in what they felt were innovative ways to meet changing needs.
"We believed that the demand for the current model of sheltered housing is in longer term decline. In [Local Authority] we are developing a "core and cluster" approach for existing schemes in which "warden", community alarm and communal facilities will be shared between residents and the other older people living in the vicinity in their own homes irrespective of tenure. We are also developing a "virtual" sheltered scheme using peripatetic "warden" services, enhanced community alarm services with videophone communications to facilitate social interaction, and transport to a central community facility for communal activities. However, we believe the future lies in developing services which will bring many of the benefits of sheltered housing to people in their own homes."
Local authority provider
9.16 Given the relatively small market in private retirement housing is Scotland, it is useful to note that the main private sector provider had no doubt that the market for private sector developments would continue to grow. The main difficulty for private developers was the difficulties in finding suitable sites for development. There was little evidence of lack of demand for this type of property. There is also a growing interest within the private sector in providing extra care or retirement housing with enhanced levels of care as it was felt that it would be extremely difficult to remodel existing private sector provision, and that private sector housing with enhanced care would require new sites and new developments.
Summary
9.17 Most providers felt that recent changes to sheltered housing had been driving by a number of compelling and inter-related factors. Of primary significance were: the new regulations and legislation, particularly the European Working Time Directive; reductions and changes in funding and uncertainties around the future levels of Supporting People funding; new and alternative service developments that allowed older people the opportunity to remain in their own homes for longer; and changes in both levels and type of demand for services. Although there was general agreement about the drivers for change, the types of changes made by providers to services were varied.
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