Can retirement communities help solve the social care crisis?
Retirement communities are becoming increasingly popular in other countries, but could they work as well in the UK, asks David Brindle.
Supermarkets and online retailers have done well during the coronavirus pandemic. So too, it seems, have manufacturers and installers of ‘care pods’. One company reports a threefold increase in inquiries from families anxious to avoid their loved ones going into residential care – even if it means building an annexe for them in the garden.
For upwards of £65,000 – more like £100,000 for a fully fitted-out version – you can acquire a self-contained living space for mum or dad with walk-in wet room, kitchen with eye-level grill and safe induction hob and doorways wide enough for a wheelchair. Going deeper into six figures, you could add a second bedroom for a live-in carer. Costly, for sure, but with care home fees averaging £700 a week, the theory is that you could recoup much of the outlay in a couple of years.
Of course, few families will have the money or space to contemplate such a solution. But aversion to residential care is being reported across the income scale in the wake of the deaths of almost 40,000 care home residents in England and Wales involving Covid-19. Occupancy rates of homes have typically fallen by some 10 percentage points to below 80%, an uneconomic level for most operators, with analysts forecasting it will be at least late next year before pre-pandemic numbers return.
But should they return? There is a growing view that part of the long overdue reform of social care should be a planned shift away from the traditional residential home model to bring the UK closer in line with other countries that offer much more housing with care – usually an apartment, leasehold or rental, in a purpose-built development with on-site facilities such as restaurants and gyms, 24-hour staffing and care services on tap that flex with your individual needs.
Providers of these so-called ‘retirement communities’ sense that this is their moment. The Associated Retirement Community Operators (ARCO), which represents them, has recently launched a high-profile campaign to persuade ministers to foster expansion and has secured the backing of political big beasts Ken Clarke and David Blunkett, now both members of the House of Lords, who say that ‘the UK needs to follow international trends and create more options that sit between care in people’s own homes and care homes’.
Only 0.6% of older people in the UK live in retirement communities, according to ARCO, compared to 5% or 6% in the US, Australia and New Zealand. Matching that kind of level of provision would create 40,000 jobs, free up 100,000 family homes and save ‘billions’ of NHS and social care costs because people would be better supported. In the short term, ARCO aims to raise the numbers living in its communities from the current 75,000 to 250,000 by 2030.
It’s a compelling case, but not an open and shut one. There’s a lack of clarity about what constitutes a retirement community – ARCO is at pains to distance its offer from ‘retirement housing’, which it portrays as having a part-time warden and emergency call system – and confusingly there are various descriptors in use in addition to housing with care, including ‘extra-care’, ‘assisted living’ and ‘very sheltered housing’. McCarthy Stone, perhaps the best-known brand in the older people’s housing sector, calls itself the leading developer of retirement communities but is not an ARCO member.
The leasehold market is also dogged by a poor past reputation for hidden costs and difficulty selling-on apartments. While providers have taken steps to address these concerns, alarming individual stories continue to surface: in one recent case, a 68-year-old woman was reportedly facing £2,200 service charges and penalty fees for her late mother’s unsold flat, having dropped the asking price to £25,000 below a 2013 valuation.
But the retirement community operators’ biggest challenge is finding purchase for their case in government. And this flags up a wider question of whether housing for older and disabled people is going to be taken properly into account in ministers’ promised plans for social care reform. As a recent report by the All-Party Parliamentary Group (APPG) on Housing and Care for Older People puts it: ‘Every decision about care is also a decision about housing.’
Yet with care the responsibility of the Department of Health and Social Care, and housing sitting with the Ministry of Housing, Communities and Local Government, it’s hard to see where the buck stops in Whitehall.
That APPG report calls on the Cabinet Office to bring together the two departments, the Treasury and NHS England to forge an overarching strategy for housing and care for older people. If the drift that’s blighting this critical issue is really to be arrested, that’s the kind of collaborative model that will have to be replicated at local level under the emerging NHS integrated care systems.
In truth, we will need our care homes as well as a greatly expanded supply of housing with care. In 1998, one in six of us was 65 or older. By 2018, it was one in five. By 2050, according to official projections, it will be one in four. Many of us will be able to live independently in our later years, perhaps with a little support, but some of us will need much more care: the numbers living with dementia are forecast to rise over the next 20 years from 850,000 now to 1.6 million.
About three in four current residents of care homes have some form of dementia. That proportion, and the severity of the condition, can only rise. Residential homes will increasingly be places of specialist care with nursing. Meanwhile, housing with care must play a far bigger role for those of us not planning to have our own care pods next to the potting shed.
David Brindle is a care sector commentator and former public services editor of the Guardian. He is chair of Ambient Support.
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