APPENDIX E: OVERVIEW OF RECENT DEVELOPMENTS IN SHELTERED AND EXTRA CARE HOUSING IN SCOTLAND
1 At present sheltered housing provides a way of meeting older people's accommodation requirements and support needs by combining the two into a single package. Although there are a number of definitions of sheltered housing, the term is generally used to describe a cluster of flats (studio and/or one bedroom) and/or bungalows, sometimes with communal facilities, to which a dedicated warden is attached.
2 Sheltered housing therefore falls part way along a spectrum of accommodation and support packages for older people. This spectrum ranges from amenity housing ( e.g. in accommodation designed to be suitable for older people, but with no additional support provision) to extra care housing, which is designed to enable care and support to be provided within the person's home. Extra care housing may be an alternative to long-term care in a residential or nursing home for some frail, older people.
3 To better understand some of the issues currently surrounding sheltered housing, it is useful to provide a quick overview of its development over the last 50 or so years.
4 In recent years there has been a great deal of debate about the role of sheltered housing in Scotland in the early years of the 21st century. This is driven partly by demographic factors, but also by political aspects. For example, it is widely recognised and accepted that older people want to live as independently as they can in community settings for as long as possible. Technological advances, such as those leading to the development of sophisticated monitoring devices that are nevertheless simple to use and trigger a response from a call centre if an adverse event occurs, have the potential to enable far more people to live safely in their own homes for longer. There is also a strong national policy drive to reduce the use of residential and nursing homes by older people where possible (partly due to their high costs).
5 Sheltered housing was originally established in the 1950s and 1960s as a housing option for relatively healthy and fit older people with limited (or no) support needs and a wish to downsize from their under-occupied family homes. The provision of sheltered housing significantly increased in the 1960s and 1970s, as a greater proportion of "special needs" accommodation was built. Much of this sheltered housing was built and managed by local authorities, although in some areas voluntary and religious organisations played a role. The 1980s saw the further development of a considerable number of sheltered housing units, many of which were built and managed by housing associations. Sheltered housing residents rented their accommodation from their landlord. Development has been somewhat more sporadic since the 1980s, although the 1990s and early 2000s have seen increased provision by private sector providers of sheltered housing schemes for owner-occupiers. Currently over 5% of older people in the UK live in sheltered housing, which is more people than in residential and nursing care combined. 19
6 The two main Scottish providers of rented sheltered housing - local authorities and housing associations - faced different sets of political and financial pressures. Local authorities, for example, tend to be highly politicised, resulting in some areas giving higher priority to, say, housing for young people and families, than to warden-supported sheltered housing. Section 89 of the Housing (Scotland) Act 2001 requires councils take the needs of persons with special needs into account when drawing up local housing strategies.
7 Different financial requirements meant that housing associations could build up funds ( e.g. from rental payments) for maintaining and upgrading the capital stock ( e.g. installing double glazing; replacing kitchens and bathrooms), whilst local authorities have to rely on annual capital allocations, which were always subject to many competing pressures. However, annual capital allocations are no longer issued in Scotland as, with the introduction of the prudential borrowing regime for housing in April 2004, councils are now able to borrow prudentially.
8 These differences were exacerbated by changes in the local authority boundaries in 1996/97 (resulting in some authorities "inheriting" decisions made by bodies that no longer existed). Furthermore, the introduction of Right to Buy (RtB) legislation in Scotland in 1980, whilst considerably widening access to owner-occupation, also tended to reduce the amount of new build undertaken by local authorities. The Housing (Scotland) Act 2001 made some fundamental changes to the RtB legislation, including enabling councils to suspend RtB sales for up to five years in areas of high housing stress. However, although tenants of sheltered housing are unable to buy their properties, the overall impact of the RtB legislation was to reduce council's willingness to build new housing stock (at least during the 1980s and 1990s) as respective governments imposed spending limits on local authority capital allocations, which actively discouraged new build. In Scotland, RtB receipts were retained by the landlord and could be used to improve the remaining council stock and, or, pay off outstanding capital debt. These capital consents were gradually withdrawn from 1996 following growing concern about rising debt on Housing Revenue Accounts, the interest on which had to be serviced from rents - the principal source of income for housing providers. Housing associations with charitable status were outwith the RtB legislation, meaning that many housing associations have continued to build sheltered (and other) housing stock.
9 During the 1970s and 1980s attempts were made to try to determine an appropriate prevalence rate for sheltered housing provision in Scotland. The Scottish Office initially recommended 40 dwellings per 1,000 population. This was updated in the 1990s but subsequently dropped, as it was found not to be robust in towns with populations of less than 10,000. Nevertheless, these decisions are likely to have had an impact on investment in new sheltered accommodation during the 1970s, 1980s and early 1990s.
10 Other influences have been the changes in space standards since the 1980s and the introduction of Scottish Housing Quality Standard ( SHQS) in 2004. The latter sets out the minimum quality standards for housing in the social rented sector. During the 1980s homes had to be a minimum of 30m2, which was subsequently increased to 38m2 and then to 52m2. Therefore many properties built in the 1980s ( e.g. studio flats) fail to meet current space requirements. All accommodation in Scotland will have to meet the SQHS by 2015. It is likely that this will be less of a problem for sheltered housing managed by housing associations, as they face fewer pressures on accessing funds for remodelling than local authorities (although this may be alleviated by the prudential regime for local authorities), as well as tending to have more recently-built stock. It may well be more appropriate to demolish some existing sheltered housing and replace it with new build than to try to remodel it. In many instances former sheltered housing schemes are being replaced with extra care accommodation. Some funding for services provided to residents of such accommodation will be covered by free personal care entitlements.
11 More recent changes at a national level include the introduction of Supporting People funding in April 2003 to replace a number of funding streams 20 for housing support services. Supporting People funds are managed by local authorities. Their use is linked into local plans and strategies for aspects such as housing, community care, health improvement and social inclusion. Furthermore, although annual allocations have not always matched inflation, councils are nevertheless receiving considerably greater sums of money for housing support services than they were prior to the introduction of Supporting People. During the 1990s, funding wardens could be problematic for councils if there was no local pooling of rents for such services. Furthermore, local authorities experienced a form of planning blight until Transitional Housing Benefit was introduced, which further restricted their investment in sheltered housing schemes during much of the 1990s.
12 A number of legislative developments have already been mentioned. Another important one is the European Working Time Directive, which has effectively altered the hours that can be worked (including the number on call) by Wardens. Thus even if a Warden lives within a sheltered housing scheme, they can only be available to residents at pre-determined times. In addition, the introduction of Supporting People funding means that sheltered housing schemes and their staff have to meet the inspection requirements of the Scottish Commission for the Regulation of Care. This places an additional burden on providers of sheltered housing.
13 Another relatively recent development ( i.e. since the mid 1980s) has been the transfer by councils of some or all of their housing stock to one or more Registered Social Landlords. Whole stock transfers have taken place in Dumfries & Galloway, Glasgow, the Scottish Borders, Argyll & Bute and the Western Isles. Inverclyde Council is due to transfer its stock later this year. However, council tenants in Edinburgh, Renfrewshire, Stirling and Highland have voted against transfer. Stock transfer does not mark the end of a council's involvement in local housing as it will retain its strategic housing role and its statutory responsibilities to the homeless.
14 In recent years the age and needs profiles of sheltered housing residents have tended to change. Some residents, for example, have no support needs when they move in initially (although they may expect these to increase over time as they get older). However, a charge for the warden support is generally included within the rent or as a compulsory support charge, irrespective of whether or not the resident wants to receive it. This can cause some resentment, especially if the tenant is self funding, and may affect demand for such housing.
15 The final recent development that is likely to contribute to the future development of sheltered and extra care housing is the increase in home ownership over the last thirty or so years. This is partly due to Right to Buy (RtB) legislation. Research suggests that since 1980 around half of homeowners have bought through RtB. 21.As many people approaching retirement age now hold equity in property, it is likely that the provision of sheltered housing will have to change to reflect this. Whilst private sector providers ( e.g. McCarthy & Stone) may meet the needs of many "traditional" home owners, some owner occupiers ( e.g. those who bought their council house through RtB) may only have limited equity in their property. This may exclude them from buying into private sector provision, but may open up opportunities for housing associations and other sheltered housing providers to develop a wider range of tenure-related options in the future.
16 It has been suggested 22 that the key question facing sheltered housing at present is whether it should move towards being "retirement housing" with a property-based caretaking service or a more highly supported type of provision which can be a housing-based alternative to residential care. Although developments in telecare mean that many more people can be supported to continue living in their current homes, sheltered housing has tended to be popular for several reasons. These include:
- Providing easy-to-manage housing with a high degree of security;
- Offering the option of social integration and engagement with others living in the scheme (especially if there are communal facilities);
- The reassurance provided by a dedicated warden (many of who were resident on-site until relatively recently);
- Being generally affordable (especially for those in receipt of income-related benefits).
17 The challenge for the future for providers is how to maintain these benefits whilst providing suitable accommodation ( e.g. with barrier-free access) that enables recent legislative changes affecting support provision to be met. Furthermore, housing and support providers need to recognise the changing financial circumstances ( e.g. property ownership; occupational pensions) and expectations of older people ( e.g. regarding space). These changes then need to be considered alongside political moves, such as the increasing emphasis on enabling older people to live independently for as long as possible in community settings.