Sheltered housing and care for older people

Examining Community-Based Housing Models to Support Aging in Place: A Scoping Review

BACKGROUND AND OBJECTIVES

With the global population aging, there is demand for older adults to age in place, that is, to live and age well in their home and community with some level of independence. Community-based housing models exist and may support this process. This scoping review aimed to describe and synthesize the ways in which community-based housing models relate to older adults' aging in place and identify strengths and gaps in the literature.

RESEARCH DESIGN AND METHODS

The housing models explored were: villages; naturally occurring retirement communities; congregate housing and co-housing; sheltered housing; and continuing care retirement communities. This exploratory scoping review examined international peer-reviewed literature published from 2004-2019. Six databases were searched using terms related to housing models and older adults. Forty-six articles met the inclusion criteria. Descriptive numerical summary and thematic analysis were used to synthesize study characteristics and findings.

RESULTS

Our analysis revealed four themes relating to aging in place in the housing models: Social Relations, Health and Well-being, Sense of Self and Autonomy, and Activity Participation. Further analysis identified housing-specific characteristics that appeared to pose barriers to, or enable, aging in place.

DISCUSSION AND IMPLICATIONS

To best support aging in place, the findings of the review suggest multiple characteristics worth considering when developing or relocating to a community-based housing model. Further research is required to understand how facilitating characteristics can promote aging in place for community-dwelling older adults.

Well-being and thriving in sheltered housing versus ageing in place: Results from the U-age sheltered housing study

AIMS

To explore to what extent type of residence (sheltered housing or ageing in place) contributes to thriving and well-being in older adults, when controlling for age, sex, living alone, being a widow and adjusting for functional status, self-rated health, and depressive mood.

DESIGN

A matched cohort study.

METHODS

A self-report survey was sent out to a total population of residents in all sheltered housings in Sweden and a matched control group ageing in place (N = 3,805). The data collection took place between October 2016-January 2017.

RESULTS

The interaction analyses related to thriving showed that with increasing level of depressive mood and decreasing levels of self-rated health and functional status, those residing in sheltered housing generally reported higher levels of thriving, as compared with those ageing in place. Well-being was not found to be significantly associated with type of accommodation.

CONCLUSION

There may be features in sheltered housing that are associated with resident thriving especially among individuals with impairments of function, health or mood, although further studies are required to identify these specific features.

IMPACT

This study informs staff and policymakers about thriving and well-being in sheltered housing accommodations. These findings may be used to further the development of sheltered housing accommodations.

Residing in sheltered housing versus ageing in place - Population characteristics, health status and social participation

Sheltered housing is a housing model that provides accessible apartments with elevated social possibilities for older people, which is expected to increase resident health and independence, reducing the need for care. As previous research on sheltered housing is scarce, the aim of this study was to explore the characteristics, health status and social participation of older people living in sheltered housing, compared to ageing in place. The study utilised baseline data from a matched cohort study survey on a nationally representative total population of residents in all sheltered housings in Sweden, and a matched control group (n = 3,805). The data collection took place between October 2016 and January 2017. The survey assessed functional capability using the Katz ADL and Lawton IADL scale, self-rated health using the EQ5D scale, and depressive mood using the GDS-4 scale. Descriptive statistics, frequencies, mean scores, independent t tests, p-values and effect sizes were utilised to compare the two groups. The results of the study show that older people living in sheltered housing, compared to ageing in place, had lower self-reported health (M = 64.68/70.08, p = <0.001), lower self-reported quality of life (M = 0.73/0.81, p = <0.001), lower functional status concerning activities of daily living (M = 5.19/5.40, p = <0.001), lower functional status concerning instrumental activities of daily living (M = 4.98/5.42 p = <0.001,), and higher probability of depressive mood (M = 0.80/0.58, p = <0.001). The results imply that residents in sheltered housing may have more care needs than those ageing in place. Further longitudinal comparative studies are needed to explore the impact residence in sheltered housing has on resident health and well-being.

Older UK sheltered housing tenants' perceptions of well-being and their usage of hospital services

The aim of this study was to examine sheltered housing tenants' views of health and well-being, the strategies they adopted to support their well-being, and their use of health and social care services through a Health Needs Assessment. Sheltered housing in the UK is a form of service-integrated housing for people, predominantly over 60. The study used a parallel, three-strand mixed method approach to encompass the tenants' perceptions of health and well-being (n = 96 participants), analysis of the service's health and well-being database, and analysis of emergency and elective hospital admissions (n = 978 tenant data sets for the period January to December 2012). Tenants' perceptions of well-being were seen to reinforce much of the previous work on the subject with strategies required to sustain social, community, physical, economic, environmental, leisure, emotional and spiritual dimensions. Of the tenants' self-reported chronic conditions, arthritis, heart conditions and breathing problems were identified as their most common health concerns. Hospital admission data indicated that 43% of the tenant population was admitted to hospital (886 admissions) with 53% emergency and 47% elective admissions. The potential cost of emergency as opposed to elective admissions was substantial. The mean length of stay for emergency admissions was 8.2 days (median 3.0 days). While elective hospital admission had a mean length of stay of 1.0 day (median 0.0 days). These results suggest the need for multi-professional health, social care and housing services interventions to facilitate sheltered housing tenants' aspirations and support their strategies to live well and independently in their own homes. Equally there is a need to increase tenants' awareness of health conditions and their management, the importance of services which offer facilitation, resources and support, and the key role played by prevention and reablement.

Addressing loneliness and isolation in retirement housing

Loneliness is a significant health risk for older people, linked with bereavement, living alone and declining health. Previous research suggests loneliness is common amongst residents of English retirement housing, who show a relatively high incidence of these factors. This invites the question, what can providers of retirement housing do to help their residents avoid loneliness, thus remaining healthier and less likely to need care services? Through a survey of 326 retirement-estate managers, we investigate the role of staff and residents' groups in developing organised social activities for residents in retirement housing, and the potential of these activities for generating social contacts which may provide a pathway to avoid loneliness. The survey was informed by a literature review with two objectives: firstly, to consider the nature and causes of loneliness amongst older people and how these apply to retirement housing residents; secondly, to identify good practice models of previous interventions designed to widen social interactions for older people or provide emotional support. The sample was drawn from the all-England property portfolio of a major provider of retirement housing for people over 55. The sampled estates, mostly social rented but including some with a mixture of leasehold and rented dwellings, represent a sector also described as sheltered or supported housing, which has over 550,000 dwellings in the United Kingdom. It is characterised by having some form of staff support for people who are frail, immobile or isolated, such that they may occasionally need help available on call. In the literature review, we consider how different kinds of social contact can help develop friendships and meet social support needs, in retirement housing and elsewhere – in particular, organised group activities (clubs, classes, etc.) and specific interventions designed to address loneliness. The fieldwork suggests that organised activities in retirement housing have considerable potential to meet residents' social support needs, but that this potential is often not fully realised. A wider range of activities is needed, which may require the support of housing management staff, volunteers and community organisations.

The rhythm of ageing amongst Chinese elders in sheltered housing

This paper examines how some elderly Chinese tenants in a cluster of housing schemes in the north of England differed in their perception, consciousness and management of time. It examines how there was too much or too little time for some of these tenants and how time played a part in their personal and social identification arising from their experiences of migration. Lefebvre's concept of rhythmanalysis is intended to be a transdisciplinary theory that could be used to theorise ‘everyday life’. The writer superimposes this concept on the activity and disengagement theories of ageing to add meaning to the ethnographic data gathered and argues that ageing is not a simple matter of activity or disengagement. These Chinese elders coped with change through a flexible and ongoing process of adapting to different rhythms of life. This paper aims to contribute to the empirical understanding of ageing for a minority in Britain and to present a novel theoretical perspective on research approaches to ageing.

Housing Concerns of Vulnerable Older Canadians

La préparation pour les besoins futurs de logement des personnes âgées est impérative dans les pays avec des populations vieillissantes, mais peu est connu sur ces questions parmi les adultes plus âgés vulnérables. Cette étude a utilisé une approche qualitative pour identifier les préoccupations majeures au sujet de logement dans ce groupe. Un total de 84 personnes âgées vulnérables, y compris des personnes agées indigènes souffrant de divers handicaps et des minorités ethniques ont participé en 10 groupes de discussion. Les normes de besoins de logement de la Société canadienne d’hypothèques et de logement (SCHL) ont offert un cadre d’analyse de données de base, avec l’identification des thèmes de logement clés supplémentaires entre et au sein de groupes des personnes âgées vulnérables. Les résultats fournissent un aperçu sur les caractéristiques de logement préféré, indépendamment de la forme de logement. En outre, les résultats fournissent un aperçu de comment prendre en charge les adultes âgés vulnérables qui choisissent de rester dans leurs maisons et leurs communautés, et comment garantir que logement approprié est développé qui répond aux besoins de cette population diversifiée.