Over the age limit

For a demographic timebomb is about to explode that could jeopardise government plans to tackle the problem of housing an ageing population.

Consultation on the government Green Paper Shaping the Future of Care Together ends in mid-November. The Department of Health’s ‘big care debate’ has raised important questions about the provision for caring for an increasingly elderly population with growing health problems.

Government plans include the creation of a national care service for England, aimed at ending the postcode lotteries in care services, increasing co-operation between health, housing and social care services.

Cost effective

But the ground has been shifting so rapidly that the government – and local authorities – are struggling to keep pace. Increasingly, the so-called ‘personalisation agenda’ is evoked to emphasise the need for more independent living – the understandable desire of the majority of older people to remain in their homes, with support from the health service or local authority when increasing frailty begins to take its toll. It is also seen as a more cost effective means of caring for older people than shutting them up in retirement homes.

But John Galvin, chief executive of the Elderly Accommodation Council, points out that current plans are failing to get to grips with the timebomb and anticipated big shifts in demand for different types of care. Sheltered housing run by councils, housing associations and charitable trusts are looking increasingly inadequate and out of date, he says.

‘People are living longer with ailments and increasing frailty, including mental frailty. Sheltered housing was never designed to cope with this. The warden historically was a good neighbour, and older people had lower expectations,’ he says.

‘Half a century ago, when sheltered housing started to be built by local authorities, lifespans were 10 or 15 years less than they are now. People muddled by as they aged and became infirm – it was seen as a natural part of life.

‘As everything became professionalised, councils took on responsibility to assess needs and see if they could deliver appropriate services. But sheltered housing schemes have aged and most residents now are in 80s and 90s with increasing dementia and physical frailty. A traditional warden cannot give sufficient response and the move in public sector thinking is to the provision of extra care housing.’

At the moment, we are in the midst of a lurch in government policy, he says. ‘If you ask older people what they want – stay put, move into sheltered housing or a care home, 99 per cent say they want to stay where they are and get services delivered so they can.

‘There has been a brave attempt to disentangle the assessment of needs from an assessment of how we will pay to meet those needs. The personalisation agenda is about that, understanding what your needs would be to maintain a reasonably independent way of living that doesn’t start from the assumption that local authorities will deliver it all for free.’

In the UK, in little more than a decade and a half the population is expected to rise from 61 million to 69 million, but while the 15-29-year-old group will increase by 2.5 per cent, the number of over-75s is expected to rise by 60 per cent from just below five million to 7.5 million.

The fastest growing group is the over-80s, which increased by more than a million between 1981 and 2017 and is currently 4.5 per cent of the population at just below three million.

But the burden of care for this rising population is increasingly falling on health and social services. For while life expectancy has gone up in leaps and bounds, the number of years of healthy living hasn’t kept pace. People are living longer but the extra years are plagued with ill-health. Government figures show life expectancy for a man grew by almost five years between 1981 and 2011 from 71 to 76 years. For a woman the increase was 3.5 years from 77 to 80. But while survival rates have vastly improved, healthy life expectancy only grew by 2.5 years on average.

Feeling the strain

Thirty-eight per cent of 65-74-year-olds have a limiting long-standing illness and this rises to 50 per cent of the over-75s. Dementia now affects one in four people over 85.

Sir Derek Wanless’s review of social care said, even taking into account big strides in improving health, that the number of disabled older people will rise by 57 per cent in little more than a decade and a half and the number of people with a degree of dependency will rise by 1.22 million.

The number of people with dementia will soar from 700,000 to more than a million. These are people with a high level of dependency and the almost 50 per cent increase will put a massive strain on care services.

At present, about 70 per cent of the over-65 households in Great Britain are owner-occupiers, with almost two-thirds owning properties outright, and fewer than 5 per cent still paying a mortgage. More than a fifth (well over 20 per cent) rent from the social sector (the proportion rises with age – with about a third, 32 per cent, of over-85s renting from the social sector) and fewer than 5 per cent renting from private landlords.

House adaptations – handrails, bathroom modifications and alerting devices such as button alarms – mean a greater of older people can remain in their own homes. Adaptations are more common for the over-75s.

Most older people live with spouses or partners – under a fifth of men and under a third of women aged 60 to 75 live alone – but the latest government figures reveal that this rises steeply with age with about a third of men and two thirds of women over the age of 75 living on their own.

Other problems – apart from frailty and loneliness – also increase with age. A big proportion of older people, struggling to get by on pensions, find it hard to cover heating bills or to feed themselves adequately.

‘If you ask older people what they want, 99 per cent say they want to stay where they are. Understanding what an older person needs to maintain this independence starts from the assumption that local authorities will not deliver it for free’

According to the Anchor Trust, the biggest provider of housing, care and support for older people in England, about 2.2 million older people are living in poverty, with about half of these well below official poverty levels. Around 1.2 million single people and couples over 60 are living in fuel poverty – they cannot afford to keep their home warm in the winter months. Over-60s make up nearly half of all households in fuel poverty.

Anchor points out that by 2020 the UK will have almost three million more people over the age of 65 and many of them will be increasingly frail. The rise will be accompanied by an increase in dementia, obesity and diabetes.

At the moment, three levels of care accommodation exist – independent (where care is provided in the home), sheltered (bedsits and flats, but with a warden or manager on site, although these are increasingly being withdrawn) and residential care homes.

Residential care homes offer the highest medical and nursing support. There are about 16,000 care homes in the UK with places for 420,000 older and physically disabled people.

The level of care increases with age – sheltered accommodation, which provides a level of independence in a self-contained bedsit or flat, has 19 per cent of over-85s and 13 per cent of 80-84-year-olds compared to 4 per cent of 65-69-year-olds. Up to 600,000 people are resident in sheltered accommodation in England, and more than 700,000 in the UK as a whole. Some sheltered accommodation includes extra care provision for older clients.

Private sector

Anchor residents are private payers and people who are state-supported by their local council and/or the health service. The housing association has 24,000 sheltered housing properties. Forty per cent of the properties are older bedsits, which Anchor admits are increasingly undesirable. Recent developments are being built around the supply of one-bedroom and two-bedroom flats.

Most sheltered housing is run by councils, housing associations and charities, but about a fifth is privately run. In the private sector, lead provider McCarthy and Stone, which had announced plans to build 20,000 new sheltered homes for sale in the next 10 years, has recently had to scale back its operations and lay off staff. Like other developers, the company has been hit by the recession and, earlier this year the threat of administration became very real. It was rescued by a consortium including Lloyds Banking Group, which is now 43 per cent owned by the taxpayer.

Guardian Management Services, Anchor’s leasehold business, also builds sheltered housing for sale in England. It provides housing management services to leaseholders at 6,700 properties. Anchor also manages 1,000 extra care properties and is moving in a new direction with schemes such as the Denham Garden Village in Buckinghamshire, and three new developments in Coventry for people with dementia.

Anchor chief executive John Belcher believes the demand for sheltered housing will remain strong, but he accepts that older developments don’t fit current demands. ‘Our sheltered housing is popular,’ he says. ‘But a lot of sheltered housing stock of the past 30 years is outdated and needs modernisation. Bedsit-type accommodation built in the 1960s and 1970s is no longer attractive to this generation of older people, so we’re looking at different models – communities like Denham which provide sheltered housing for rent and for sale with a range of support services available.’

Denham is a mixed-tenure development with 323 properties combining bungalows, houses and flats split into 60 per cent for rent and 40 per cent for sale. The site has a GP surgery, small supermarket, post office, bar, restaurant and gymnasium.

Nationally, a majority of Anchor tenants are state-funded – housing benefit pays weekly rents that average about £62 nationally – but 30 per cent of tenants pay the full rent and service charge themselves. Most of them are owner-occupiers who have sold up and moved into rented accommodation.

Older residents and those needing extra care are charged an hourly rate between £10 and £20 an hour. ‘Where we’re commissioned by a local authority to provide care, it will pay between £10 and £15 an hour. Where individuals pay for themselves – self-funders – it can be up to £20 an hour.’

Dealing with private payers is straightforward, but the state-funded component of other tenants is unnecessarily complex and ‘an absolute bloody nightmare’, John Belcher says.

‘In the past housing benefit used to pick up all of the support service cost that went into sheltered housing. When the Supporting People regime was introduced, care was split off so that the support component not directly related to housing got funded through Supporting People.

Means testing

‘It’s a fine line how you distinguish between a housing service and a non-housing service. You’re still means-tested in terms of whether you can receive housing benefit and the support service that goes with that, and you’re also assessed about your level of dependency to determine whether you’re entitled to receive Supporting People funding or not.

‘If you’re in receipt of state support, your rent and that element of the service charge that relates to housing is picked up through housing benefit, and your care needs are assessed by a Supporting People team and that service is commissioned for you.

‘The organisations involved in how the money gets carved up are the local authority housing department, the social services department and the health service, commissioned by the local primary care trust.’

But the Anchor chief executive does not believe changes in the funding regime will have a big impact on older people’s services. ‘Older people only receive small amounts of Supporting People funding. For Anchor tenants it’s about £5 a week.’

The row about the removal of the ringfence from Supporting People budgets rages on, but it distracts attention from the main issue, which is about the ‘relentless’ demographics – and the government has not fully got to grips with the issue, John Belcher says.

‘We’ve now got fewer 16-year-olds than people over 60. The workforce is in decline, and with it the number of people to support an ageing population, so we are facing very difficult times ahead. More and more of the onus will be placed on individuals to pick up and meet the cost of their care.

‘The state will provide a basic safety net, but that will be constrained and anybody who needs care over and above that will have to meet the cost themselves.’

At the moment, the majority of disabled people over 65 in the UK – almost two million – rely on informal care with no state-funded care. Anchor predicts that by 2022 this number will have risen to 2.6 million. But the number of informal carers – mainly close family members – and the amount of time they can spend looking after others is also falling as a result of changing family structure. The effects of smaller families, and generations no longer living together as young people move away to follow a career, are already being felt.

‘Children are less inclined to look after parents than in the days when it was considered a duty’

The number of informal carers has received a blow from both partners in most couples now working – which means fewer people are on hand to take on the role – and more second marriages. Children are less inclined to look after parents than in the days when responsibility for ageing parents was looked on as a duty.

As a result, the burden on local authorities is steadily increasing. But the Commission for Social Care found the response from councils was that three-quarters of them were attempting to trim social care budgets for people with ‘substantial’ or ‘critical’ needs – and that people with lesser or ‘moderate’ needs – such as older people who needed help getting up in the morning, with bathing or the washing up would be left to fend for themselves.

Next year, the Supporting People budget is being cut by £60 million and as the ringfence is removed, councils could withdraw support for older people’s services and spend the cash elsewhere. The BBC’s Panorama found that councils up and down the country were axeing wardens in sheltered accommodation as part of a bid to trim budgets. Barnet council in north London said it would save £400,000 by scrapping wardens and introducing coordinators covering several estates.

But John Belcher points out that wardens are a main reason for older people choosing to live in sheltered accommodation. They move in because it’s a protective environment – the manager service provides a sense of security.

‘We’re extremely opposed to the removal of wardens. If you speak to older people who’ve moved into our sheltered housing, the one overriding component in the decision they made to move in was that there was an onsite scheme manager who was available if they needed help.

‘So where local authorities are moving to floating support or said they are not prepared to continue funding a scheme manager through the service charge, we’ve explained that to our tenants and said if you want us to continue the scheme manager service, this is how much the service charge will go up.

National campaign

‘In every case, people have been prepared to meet the additional cost out of their own pockets – on average about £5 or £6 a week. We are not withdrawing any scheme managers whatsoever.’

Two years ago, Northampton council did away with wardens on sheltered housing estates and replaced them with ‘floating support’. The council claimed it had consulted residents and they were broadly in favour. But Panorama found little support for the move – the majority acquiesced because they believed their objections would not be heard. Many said there had been no real consultation and they felt that they had been fobbed off with decisions already taken. Opposition has been growing and it has developed into a national campaign, with Northampton pensioners, supported by Joan Bakewell, the government’s ‘voice for older people’, spearheading the fight against the removal of wardens.

It is a pattern that has been repeated in other parts of the country. But while critics see such moves as being dictated by a cost-cutting agenda, councils (and the government) argue that sheltered housing needs to change.

But one of the costs of the shift towards greater independence, while it may be welcome, could be that it puts people’s lives at risk. One service manager said that this was a price worth paying – it is inevitable that older people will die whatever the circumstances, whether there was a warden on site or not.

Local authority calculation	£
Total weekly income (£95.50 state pension plus £34.50 PG)	130.00
Less personal expenses allowance	21.90
Resident’s weekly contribution	108.10
Cost of the home	500.00
Less contribution	108.10
Local authority’s contribution	391.90

Local authority calculation	£
State pension	95.50
50% private pension	90.00
Tariff income from capital	4.00
Calculated income	189.50
Less personal expenses allowance	21.90
Less disregard income	5.65
Resident’s weekly contribution	161.95
Cost of the home	550.00
Less contribution	161.95
Local authority’s contribution	388.05

*source Age Concern 2019-10 figures