The housing and support needs of older people in rural areas

The housing and support needs of

older people in rural areas

Centre for Housing Policy Mark Bevan

Karen Croucher David Rhodes

Peter Fletcher Associates

Peter Fletcher

Riseborough Research Associates Moyra Riseborough

ii

iii

Acknowledgements Our very grateful thanks go to all the people who participated in this study and who generously gave their time to talk to us about their views and experiences on living in the countryside. We would also like to thank all the respondents in the statutory, voluntary and community group sectors who helped us with this work.

This research was funded by the Countryside Agency and the Housing Corporation. We would like to thank the members of the advisory group who provided invaluable advice and support throughout the project. In particular, thanks are due to Sue Adams, John Flower, Paul Lightfoot, Steve Ongeri, Daniel Pearson, Gary Rigby, Tracey Roose and Dave Stewart.

Special thanks are due to Hugh Bates, Jeanette Crookes, Roger Mattingly, Barbara Newbronner, Maureen Parker and Yvonne Rickatson who contributed hugely to the project as members of the Older People’s Reference Group.

iv

v

Contents Acknowledgements iii Contents v List of tables and figures ix Executive summary xi

Consultations with older people xi Policy overview xii National data xii Case studies of housing and support needs in rural areas xiii Conclusions and recommendations xiv

Needs assessment xiv Maximising the potential of the existing housing stock xiv The housing market – future housing provision xiv Resources for housing and care in rural areas xv Low-level and preventative services xv Strategies for older people in rural areas xv Care staff recruitment xvi Linking housing, transport and access to services in the countryside xvi Black and Minority Ethnic groups xvi Mental health services xvi Cost, value for money and sustainability xvi

Listening and responding to older people xvii Chapter one: Introduction and methods 1

Context and background 1 Older people in rural areas 1 Needs in rural areas 2 Patterns of tenure and housing markets in rural areas 3 Recent policy changes affecting older people in rural areas 3

Joint working 4 Organisational change 4 Housing and support 5 The role of sheltered housing 6

Transport and access to services 7 Objectives and methods 7

Consultations with older people 7 Policy and statistical overview 8 Needs profiles 8

Structure of the report 8 Chapter Two: Living in rural areas – the views of older people 10

Introduction 10 Consultations with older people 10

The sample 11 Older people’s reference group 11

Views on living in the countryside 12

vi

Staying put or moving on: housing options for later life 12

Staying put 13 Moving on 15 Affordable warmth 16 Sheltered housing 17 Residential care 18 Planning ahead 18 Knowledge about housing options in rural areas 19

Transport and access 20 Shops and facilities 23 Social isolation and community development 25

Care and support 27 Informal support and low-level preventative services 27 Intensive home care 29 Community alarms 29 Health care 30

Information 31 Summary 33

Chapter Three: Older people in rural areas: a national overview and local perspectives 37 Introduction 37 National overview 37 Profiles of case study areas 40

Five rural districts 40 Scarborough District 41 Waveney 42 Pendle Borough 43 Bromsgrove 44 North Dorset District 46

Illustrating rural diversity 47 House prices in the case study areas 48 Summary 50

Chapter Four: Meeting the housing and support needs of older people: local responses 53 Introduction 53 Rural needs 54 Needs in rural areas 54

Identifying need 57 Housing opportunities in rural areas – affordable housing and suitable properties? 60

Affordability 60 Condition 60 Supply of properties 61

Social capital and volunteering in the countryside 63 How well do services meet the needs of older people in rural areas? 64

Older people with mental health problems 64 Older homeowners 67 Older people from Black and Minority Ethnic communities 68 Preventative services 68

Issues of concern for older people 69 Transport 69 Isolation 69 Decline of facilities and services 70

vii

Security and crime 71 Moving home 72 Attachment to place 72

A voice for older people 72 The challenge of providing services for rural communities 73

Geography 73 Dispersed populations and equity of access 73

Land use and planning requirements 79 Socio-economic factors 80 Recruiting and retaining staff 80 Organisational challenges 82

Older people’s strategies in rural areas 83 Funding 85

Summary 86 Chapter Five: Conclusions and recommendations 89

Introduction 89 Diversity and disadvantage in the rural context 89 The housing market – maximising the potential of existing housing stock 91 The housing market – future housing provision 92 Offering choice for people who want to move 94 Resources for housing and care in rural areas 95 Low-level support and preventative services 96 Older people's strategies for rural areas 97 Care staff recruitment 98 Linking housing, transport and access to services in the countryside 99 Black and Minority Ethnic groups 99 Mental health services 100 Future research 100 Summary of recommendations 101

Needs assessment 101 Maximising the potential of the existing housing stock 101 The housing market – future housing provision 101 Offering choice for people who want to move 101 Resources for housing and care in rural areas 102 Low-level and preventative services 102 Strategies for older people in rural areas 102 Care staff recruitment 103 Linking housing, transport and access to services in the countryside 103 Black and Minority Ethnic groups 103 Mental health services 103 Cost, value for money and sustainability 103 Listening and responding to older people 104

References 105 Appendix 1: Policy overview – The need for housing, care and housing related support

for older people in rural areas 113 Introduction 113 Key policy trends 114

Moves towards a coherent policy for older people 114

viii

Supporting People 116

Supporting Older people 116 Funding Supporting People 117 Administering Supporting People in rural areas 117

Rethinking the role of sheltered housing in rural areas to support ageing in place 119 Joint policies – listening and responding to older people? 120 Broader policies affecting older people – and others 121 Re-organisation, change and regional shifts 122

Implications and impact of policy change 123 Summary 127

Appendix 2: Rethinking the role of sheltered housing in rural areas – case examples 129 Appendix 3: The Housing Corporation’s definitions of housing association supported

housing and housing for older people 133 Appendix 4: Older people in rural areas: national data 139

Introduction 139 Analysis of 2001 Census 139 Survey of English Housing 140

Older people in rural areas – age, health and income 140 Age and gender 140 Self-reported health status 141 Life-limiting illness and disability 143 Household composition 144 Unpaid care 144 Voluntary work 146 Household income 146

Older people in rural areas: tenure and house condition 147 Tenure 147 House condition: How far are non-decent homes located in the countryside? 148 Central heating 151 Satisfaction with home 153

Older people in rural areas: neighbourhood 154 What do people think about the area in which they live? 154

Older people in rural areas: access 162 Availability of a car 162 Access to services 164

Appendix 5: Older people in rural areas: local data 171 Scarborough 173 Waveney 173 Pendle 174 Bromsgrove 175 North Dorset 176

Appendix 6: Pendle Older Persons’ Strategy 179 Appendix 7: Older People’s Interview Schedule 183 Appendix 8: List of participating agencies 187 Appendix 9: Service Providers Interview Schedule 191

ix

List of tables and figures Table 3.1 – Mean dwelling price in urban and rural wards by local authority, 2001 49Table 3.2 – Change in mean dwelling price by local authority, final quarter 2001 – final

quarter2003 50Table A4.1 – England: Older people as a proportion of all people by gender and by age band 141Table A4.2 – England: General health status by age, by rural and urban population 142Table A4.3 – England: Long-term limiting illness by age, by rural and urban population 143Table A4.4 – Any household member with disability? 144Table A4.5 – Is your accommodation suitable for the person with ill health or disability? 144Table A4.6 – England: Provision of unpaid care by age and gender 145Table A4.7 – Any voluntary work in the last year? 146Table A4.8 – Household income (gross) per week (£) 147Table A4.9 – England: Tenure of older people 148Table A4.10 – Costs of repairs to make dwellings decent, 2001 150Table A4.11 – Availability of central heating for older people, by age, by rural and urban areas

in England 151Table A4.12 – Households with central heating 152Table A4.13 – Satisfaction with accommodation 153Table A4.14 – Satisfaction with area 155Table A4.15 – Has the area got better or worse over the last two years? 156Table A4.16 – Problems in area – crime 157Table A4.17 – Problems in area: litter 158Table A4.18 – Problems in area: neighbours 159Table A4.19 – Problems in area: traffic 160Table A4.20 – Problems in area with racial harassment 161Table A4.21 – Problems in area with vandalism 162Table A4.22 – England: Car or van availability of older people 163Table A4.23 – Cars and vans available 165Table A4.24 – How easy is it to get to a corner shop? 166Table A4.25 – How easy is it to get to a medium to large supermarket? 167Table A4.26 – How easy is it to get to a post office? 168Table A4.27 – How easy is it to get to a doctor? 169Table A4.28 – How easy is it to get to a local hospital? 170Table A5.1 – People aged 55+ as proportion of all people by rural/urban wards in case study

counties 171Table A5.2 – People aged 55+ as proportion of all people by rural/urban wards in case study

districts 172Table A5.3 – Older people as a proportion of Scarborough population, by gender and age

band, and rural/urban 173Table A5.4 – Older people as a proportion of Waveney population, by gender and age band,

and rural/urban 174Table A5.5 – Older people as a proportion Pendle population, by gender and age band, and

rural/urban 175

x

Table A5.6 – Older people as a proportion Bromsgrove population,by gender and age band,

and rural/urban 176Table A5.7 – Older people as a proportion North Dorset population, by gender and age band,

and rural/urban 177

xi

Executive summary

This research was commissioned by the Countryside Agency and the Housing Corporation to examine the housing and support needs of older people in rural areas. There were three elements to the study: consultations with older people living in rural areas; a review of national policy and analysis of data from the 2001 Census and Survey of English Housing (SHE); and an exploration of the housing and support needs of older people and local service responses in five rural districts in England. These were Scarborough in North Yorkshire, Bromsgrove in Worcestershire, Waveney in Suffolk, Pendle in Lancashire and North Dorset in Dorset.

Consultations with older people

More than 70 older people living in rural areas took part in a series of interviews and discussion groups. The intention was to explore the needs, concerns and aspirations of older people in relation to housing and accommodation, and other aspects of living in the countryside that impact on older people’s housing choices and decisions.

The diversity of views reflected the heterogeneity of older people. Respondents were clear that enabling choices around meeting housing needs in rural areas was not just about housing, but about making critical linkages with other key features of rural living, such as transport and access to a range of services. Transport was viewed as the most significant issue facing older people in the countryside.

Most respondents intended to stay in their own homes as they got older, emphasising the importance of ensuring existing accommodation arrangements could be sustained as far as was practicable through renovation, maintenance and improvements, and the installation of facilities, such as downstairs toilets and bathrooms, as well as aids and adaptations. Heating was a cause for concern, as many rural areas did not have mains gas supplies and alternatives (such as oil and solid fuel) could be costly.

For those who wanted to move or had moved, there were mixed views about the types of accommodation that should be available within smaller communities. Currently older people’s choices are constrained both in the public and private sector. Some felt that people should be able to live in the communities where they had always lived; others were more circumspect, noting that developments of housing for older people would be more appropriately located in larger settlements. The availability of affordable housing was viewed as important for people of all ages.

xii

Given limited alternative options in terms of accommodation, low-level support services were seen as crucial way of helping people to continue to live in their current homes. When asked about the types of services that made a real difference to older people in the countryside, most usually, people talked about low-level preventative services, such as assistance with small domestic repairs, heavier gardening tasks, lifts to the doctors and hospital appointments, fetching shopping and so forth.

Many respondents remarked on the myth of tight knit rural communities and reflected that the lack of affordable housing and employment in villages, and the growing numbers of commuters and second homeowners, were, in some places, eroding the old sense of community that once existed. They felt that the notion that country people looked out for each other could be damaging, as service providers always assumed that people would have more informal help than was actually the case. Others, however, felt there was still a strong sense of community in rural places and this was due to the activities of older people themselves, who were the driving force for much community activity.

Policy overview

The policy context in which older people in rural areas live has seen an increase both in the number of policies and also in the extent to which there is an inter-dependence between them. A key development has been the emergence and growing significance of regional governance and also an expectation of more joined-up working between agencies. At the same time, the way that policies are implemented is subject to growing regulation and inspection.

An opportunity for a local and rural input is not always possible, because the structures of government and systems and processes do not always take account of local plans and hopes. Further, continuing age discrimination also hampers policy outcomes, although there is a recognition of the importance of involving older people in policy development and implementation. There is also a need to take account of new thinking about, and new definitions of, housing and services, such as sheltered housing and the potential role of Extra Care in rural areas.

National data

Census data show that 27.9 per cent of the population of England are aged 55 and over. However, in rural areas this rises to 31.5 per cent of the population. Almost 1 in 3 people in rural areas are aged 55 and over, compared with 1 in 4 people living in urban areas. Self reported health status among rural older people is better than among their urban peers, although the greatest differences are among the younger-old. Older people in rural areas also report less life limiting illness than their urban peers; nevertheless, there is considerable morbidity among the oldest rural residents. Average levels of income fall steadily as people age – just under 1 in 10 households of people aged 50-64 had a household income of less

xiii

than £100 per week, but this roses to almost 3 in 10 households of people aged 75 and over.

A greater proportion of older people are owner-occupiers in the countryside than in urban areas. A total of 81 per cent of people aged over 55 own their own home in the countryside (compared with 73 per cent in urban areas). However, the proportion of people owning their own homes drops with age. The proportion of people aged 55+ in social rented accommodation in rural areas is lower (11 per cent) than in urban areas (21 per cent), although a greater proportion of very old people live in social rented accommodation.

Adequate warmth in the home is crucial for the health and well-being of older people; 93 per cent of people aged 55+ in rural areas have central heating. However, more than 10 per cent of those 85+ have no central heating.

Analysis of the 2001 SEH showed that compared with younger age groups, older people tended to demonstrate considerable satisfaction with both their homes and the areas in which they lived.

Case studies of housing and support needs in rural areas

Agencies in rural areas have clear views about what needs are, but are less able to quantify needs, and thereby, justify the provision of resources for particular groups. Needs assessment methods are lacking, although there is a shared recognition that there are considerable unmet needs for a range of services. Areas of concern for service providers are: older people’s mental health services, particularly services for dementia; older people from Black and Minority Ethnic (BME) groups; and support for older homeowners.

There appears to be a reasonable supply of sheltered housing, but it does not always meet the expectations of many older people. Some existing sheltered housing schemes, particularly those that are older, are already difficult to let. Extra Care Housing schemes were in various stages of development in all the case study areas. There is some evidence that some older people will make trade-offs between the advantages and disadvantages of remaining in a village or remote settlement and moving to larger settlements with easier access to facilities. Many older homeowners are asset rich but income poor, and there are only patchy mechanisms to assist them with the maintenance and upkeep of their properties.

The lack of affordable and suitable homes limits the choices of older people themselves and is also impacting on other sections of the community. This has consequences for older people, notably difficulties in recruitment and retention of care staff and the loss of informal family support networks.

Preventative services were seen to be crucial to maintaining independence, preventing isolation, offering a route into other services and providing opportunities for regular checks

xiv

on health status and general well-being. Usually, these services were provided by voluntary sector agencies with (insecure) funding from statutory sector agencies.

Conclusions and recommendations

Meeting needs in the variety of circumstances found in different rural areas requires specific and tailored approaches which are often more difficult and costly than in urban areas. Older people as a group in society reflect very diverse needs and aspirations. However, the starting point for addressing these needs is one of recognising the aspiration of equity and diversity in the way that policy responds to older people in rural areas. This aspiration prompts the following questions of politicians, councillors, service providers at national, regional and local levels and of older people themselves:

• Have the needs and aspirations of older people in rural areas been acknowledged? • Have the needs and aspirations of older people in rural areas been analysed? • How are these needs being addressed? Do they reflect the circumstances in my rural

area?

Needs assessment

• Needs assessments undertaken as part of surveys by Rural Housing Enablers, parish plans, village appraisals, or local initiatives (such as the Community Investment Prospectus across North Yorkshire) should be widely promoted. Small area housing needs data should be collated at regional level to inform Regional Housing Strategies, and to ensure they have a rural dimension. Needs data could also be more widely shared between agencies that commission and provide services for older people.

Maximising the potential of the existing housing stock

• The potential of the existing housing stock in rural areas should be maximised by:

− greater investment in improving non-decent housing stock in rural areas; − the development of Home Improvement Agencies, including a minimum standard

of service, to achieve a minimum standard of service across all rural areas; − giving particular consideration to the operation of the Disabled Facilities Grant

(DFG) as part of the review currently being undertaken by the Office of the Deputy Prime Minister (ODPM).

The housing market – future housing provision

• Much more attention is needed on the place of older people as a key group in housing market planning at both regional and local authority levels. Older people are important to ensuring the sustainability of rural communities, given the high proportion of older people who live in the countryside, and migration trends.

xv

• It is essential to develop a (rural) stock profile that is, and must be, responsive to the

needs of older people. Greater emphasis needs to be placed on ensuring that new build in the private and public sector can meet the needs and aspirations of older people in the future. In smaller settlements, attention should be more focused on ensuring that all new build in the future, including small developments of affordable housing, maximises the potential to meet the needs and aspirations of older people. Beyond accessibility, consideration needs to be given to space standards to allow opportunities in the future for adaptation and installation of equipment.

• Models of Extra Care Housing that specifically address rural needs, through services such as outreach, links with community transport, etc, should be evaluated and promoted. In addition, new thinking is needed about flexible service models that cross housing support, primary care, social care and other community support services, which can support older people in living in ordinary housing in rural communities. The Housing and Older People’s Development Group could provide a forum for promoting housing models that respond to the needs of older people in rural areas.

Resources for housing and care in rural areas

• In the rural context, the majority of older people are homeowners. Further attention should be given to the potential of equity release schemes and developing schemes with shared-ownership.

• Competing claims on very limited resources is a fact of life, but it may be worth exploring the evidence base behind the decision-making of commissioners and providers. How far is there an awareness of the needs of older people in rural areas amongst key groups such as councillors?

Low-level and preventative services

• Low-level support and preventative services are of particular importance in the rural context. To ensure that low-level support and preventative services are seen to be part of the mainstream, the National Service Framework for Older People, Supporting People Strategies and local Joint Strategies for Older People should place greater emphasis on preventative services.

Strategies for older people in rural areas

• The rural dimension of regional and sub-regional housing strategies need to be further developed: there is evidence of rural proofing, but clearly greater consideration of the needs and aspirations of older people at regional level is required. This should be paralleled by a requirement for integrated strategies for older people – including housing – at a district level, linked to the Local Strategic Partnership and the Community Plan, where these exist.

xvi

Care staff recruitment

• Care staff retention and recruitment difficulties are particularly acute in rural areas. Generic care workers who are able to take on a wide range of tasks may be one way forward, although we do not underestimate the difficulties there may be in terms of training, insurance, health and safety legislation and so forth.

• Staff shortages also highlight the need to support informal carers.

Linking housing, transport and access to services in the countryside

• Most respondents viewed transport as the most significant issue facing older people in the countryside. Indeed, policies and investment aimed at promoting accessibility for older people is likely to have knock-on effects in terms of helping to sustain housing options in rural areas. Strategies in rural areas must make the links between the diverse aspects of daily living as part of a whole system approach. Developments at regional level with regard to transport planning must embrace examples of what works in rural areas up and down the country.

Black and Minority Ethnic groups

• Agencies should consider how the needs of BME households can be met, including elders, both now and in the future, in the rural context as a matter of principle. Joint working, for example, through rural forums, particularly at regional level, can help to coordinate and facilitate these developments.

Mental health services

• A consistent view from service providers and commissioners was that older people with mental health problems were particularly poorly served in rural areas. Again, in reviewing the National Service Framework for Older People, greater emphasis could be placed on services that respond to the mental health needs of older people.

Cost, value for money and sustainability

• It is undeniable that providing housing and services in rural areas can cost more. This is a well-known fact which is always mentioned in any study on the countryside but somehow the fact that things cost more seems to be held against rural areas or is used as an excuse for inaction. Volume savings cannot always be made and it would be inappropriate in many instances to try. However, higher costs can be mediated through achieving good value for money, and they can be justified when the benefits of providing a building or service add to the sustainability of a local community.

xvii

Listening and responding to older people

• Finally, the way that providers and policy-makers engage and work in partnership with older people is a necessary component of any policy or service development, which touches on the concerns of older people themselves. It is essential that the views of older people living in the countryside are part of this process and that the development of engagement models include the potential for incorporating a rural dimension.

xviii

1

Chapter one Introduction and methods

The 2001 Census shows that for the first time there are more people aged 60 and over than there are children in the UK. Alongside this demographic shift, concepts of age and ageing are being redefined. Notions of older people as a homogeneous and needy group that place a ‘burden’ on society are increasingly being rejected in favour of more positive attitudes towards later life that recognise the contribution older people make to society, and the diversity of older people’s aspirations, expectations and needs.

The changing demography has particular implications for rural areas as – compared to urban areas – a greater proportion of rural populations are aged over 55. This report is intended to extend the growing body of evidence relating to housing and support in later life in the countryside (see, for example, Milne et al, 2002, Le Mesurier, 2003a, Oldman, 2002). The research was commissioned by the Countryside Agency and the Housing Corporation with a remit to consider the housing and support needs of older people in rural areas. In this introduction we provide a brief overview of the context and background for the report, and then outline the objectives of the research and the approaches taken by the research team. For the purpose of this project older people were defined as being aged 55 and over.

Context and background

Older people in rural areas

Heywood et al (2002) stated that ‘later life’ described a phase which encapsulated the latter part of life, which could arguably be said to begin around the age of 50 and continues over the next five or so decades. The Housing Corporation document Housing for Older People deliberately left ‘older people’ undefined, noting that different people will need to use similar services at different times in their life (Housing Corporation, 2002). However, for the quantitative analysis in the report it was necessary to impose a clear definition in terms of age, and therefore a pragmatic decision was made to include people from the age of 55 onwards. It was also felt that it was important to be able to draw upon the experiences of people from that age onwards to explore their views on planning for the following decades.

The Oxford-Countryside Agency 1998 ward level classification was used to define rural areas in the report. This classification, developed by the Social Disadvantage Research Centre at Oxford University, used the following variables to indicate rural wards: population density; economically active population; public transport used to travel to work; employment

2

in agriculture/forestry/fishing; employment in primary production; and ethnic background (Chandola et al, 2000).

The 2001 Census shows that almost 1 in 3 people in rural areas are aged 55 and over, compared to 1 in 4 people in urban areas. As younger people leave the countryside in search of work, leisure opportunities and housing, increasing numbers of older people are seeking to move to the countryside when they retire. Research has highlighted the continued process of gentrification in many rural localities, with a significant driver being older households retiring into rural areas, with a particular increase in people aged 75 and over moving into the West Midlands, Welsh Borders, mid-Wales, Lincolnshire, North Yorkshire and Cornwall (Oldman, 2002). A detailed analysis of rural communities in the Lake District has also drawn attention to the impact of retirement migration on the sustainability of villages (Blenkinship, 2004). Recent research in Wales has echoed this trend, highlighting ageing and retirement as key issues which will place significant pressures on the housing stock in rural areas over the next 25 years (Tewdwr-Jones et al, 2002). Although inward migration is not always viewed positively, there is evidence demonstrating the contribution older people make to rural life, be they people moving into an area, or long-term residents (for example, Le Mesurier, 2003a). However there is a considerable diversity in the experience of older households in the countryside and a high proportion of older people live on low incomes. Indeed Shucksmith (2000) suggested that the single most effective measure to address poverty in rural Britain would be an increase in the level of the state benefits.

Needs in rural areas

On an individual level, there are a number of features of daily living that can affect all people, in rural or urban areas alike. These include factors such as affordable warmth, an accessible environment in and around the home, the need for practical support and care, and personal mobility.

Cutting across these household factors are other aspects of living such as access to services and facilities. Again, this is not to suggest that this problem is exclusive to rural communities: far from it. Limited access to services caused by the decline of facilities such as shops and banking services has been shown to affect people in inner cities and large urban estates (Speak and Graham, 2000).

Nevertheless, it is possible to identify a number of characteristics of rural areas that make the experience of needs in rural areas distinctive. Commentators have suggested that it is worth separating out these different facets, because the experience of need in rural areas is not only defined by personal wealth and income, but also by these other factors such as accessibility. Thus, Shaw (1979) categorises deprivation in rural areas in terms of three main factors. Resource deprivation encompasses issues such as low income and housing. Opportunity deprivation relates to the availability of services such as health. Mobility deprivation describes transport issues and inaccessibility of employment, services and

3

facilities. It is the way these circumstances can combine at the personal level which can limit and severely constrain opportunities for households.

Patterns of tenure and housing markets in rural areas

A defining characteristic of housing in rural areas is the tenure profile in comparison with urban areas. A greater proportion of older people own their own homes in rural areas than in urban areas. A higher proportion of all households live in the private rented sector than in urban areas. This feature of tenure in rural areas has particular significance for many older people who live in unfurnished accommodation on regulated tenancies.

Collectively, the rural action plans produced at regional level for the Housing Corporation illustrate the diversity of housing markets in rural areas. A key feature of housing markets in many rural areas remains the high demand for housing, and the absolute shortage of affordable housing. However, in some rural areas policy attention is focused upon regeneration. For example, former mining communities in rural areas may have retained significant proportions of affordable housing stock. Instead, there are issues in relation to the poor quality of the housing stock that older people have to deal with, and the consequences of living in locations where there is a low demand for housing, including hard-to-let properties.

A further difficulty relates to the assessment of needs in rural areas. Oldman (2002) suggested that Supporting People (see below) should tap into bottom up assessments of need. There is evidence that some Supporting People teams are doing this (see, for example, Durham and Kent’s 2002/03 Supporting People strategies and needs assessments). This type of assessment is a growing resource as communities take on the development of parish plans or appraisals, boosted by the funding available through the Vital Villages Programme. Moseley and Chater (2002) have illustrated the benefit that practitioners such as Rural Housing Enablers can draw from these types of assessment, and have highlighted how affordable housing development can be attuned to the changing needs of older people.

Recent policy changes affecting older people in rural areas

Recent policy initiatives have emphasised the importance of giving all older people greater choice and control in the way in which their housing, support, personal care and health care needs are met. England has never had an explicit older people’s policy but there are signs that a more coherent policy approach is emerging. Successive governments have placed an increasing emphasis on ensuring that older people are given the services they need in order to live as independently as possible, for as long as possible. From 1999, Government policy has aimed to consistently link in and join-up areas of policy that affect older people. Government policy also reflects an awareness of social and economic change and diversity amongst the older population, and older people’s contributions to society are also increasingly acknowledged.

4

Joint working Most striking is the fact that policy decisions are increasingly being made and announced jointly by key government departments. The joint approach reflects an awareness that housing, health and general ‘well-being’ cannot be confined to one area of policy, and no single department should aim to develop policies on its own. The need to make further links between housing, care, support, health, transport and regeneration is recognised in Quality and Choice for Older People’s Housing: A Strategic Framework (DTLR/DoH, 2001) and in Government guidance to encourage local authorities to take the lead in drawing up linked strategies to benefit all older people and enable them to contribute to local life if they wish (see Preparing Older People’s Strategies: Linking Housing to Health, Social Care and Other Local Strategies (ODPM et al, 2003)). Local authorities were also charged with producing crosscutting Community Strategies or Plans aimed at bringing an increasing number of local plans and strategies together in one vision, and an action plan for a locality (or combining the sum of Community Strategies in the case of two-tier authorities). These are not to be confused with Community Plans, which largely focus on housing and planning. Community Plans are intended to produce the over arching blueprint for a local area and all other strategies are supposed to link in. The broad intentions of, for example, an older people’s strategy in a Community Plan should be clear and will be reflected further down the hierarchy in a housing strategy or Supporting People strategy.

Organisational change

The movement towards a more coherent policy for older people and integrated mechanisms to enable these to be implemented in practice comes at a time when the institutions and agencies that make and deliver policy are changing. Health policy changes reflect a number of things, including the drive to manage public resources better, a determination to tackle medical inequalities and avoidable diseases and, medical advances and improved knowledge. The changes include an almost constant re-organisation of our health services and a gradual re-engineering which has resulted in more services and medical interventions being delivered at a community level or through out patient and day surgery. At the same time, more of the acute and specialist forms of medical intervention are being concentrated in larger hospitals, which serve larger populations, often across a regional area.

Re-organisation in health is only one example of far-reaching changes. Significant changes at a regional level have occurred that affect local arrangements for housing and support in the broadest sense. New regional decision-making structures in England have been introduced that oversee pots of funding and decide on regional priorities. Spending and planning for social housing, land use and regeneration are switching from the present central-local arrangements to regions.

5

The direction policy has taken is probably more inclusive than ever before. Government, as Appendix 1 indicates, makes serious efforts to listen to older people. More older people have the opportunity to benefit and be considered as full citizens as compared to the past, and wide areas of policy are theoretically being brought into play – from how market towns are regenerated, and for whom, to planning permissions for owner-occupied retirement housing in small villages. This kind of broad approach is vital if policy is to reflect older people’s needs and aspirations today and tomorrow, regardless of income or tenure, race or ethnicity or where they live. Certainly in recent year’s economic development, regeneration, transport and infrastructure changes rather than housing have tended to dominate regional agendas. It is possible that housing could be sidelined in some regions. The exceptions are ‘growth areas’, such as the Thames Gateway identified by ODPM as an area with acute housing shortages and high demand. Growth areas will receive huge investment for housing. Furthermore, there are concerns over the extent to which older people will fare in regional agendas. For example, there is a pervasive tendency for older people’s housing and other issues that affect them to be seen as marginal. This is something that Better Government for Older People and the Housing and Older People Development Group have continued to lobby Government on. The Housing and Older People Development Group will also be gathering more information on regional bodies’ efforts to reflect older people’s interests and concerns. At the moment the evidence is that Regional Housing Strategies, in general, have not reflected older people in all their diversity although there are encouraging signs in some areas. Overall then, regional changes are still being bedded in. Awareness is still developing amongst regional bodies of the need to take account of the diverse pressures on different parts of the region, including rural areas, and to make sure these are reflected in, for example, regional housing strategies. The Countryside Agency has produced helpful advice notes on the subject while the Housing and Older People Development Group is in the process of producing regional briefings on older people’s needs and wishes, and the relevance of strategic working in regional settings.

Housing and support Supporting People – announced in 1998 and finally implemented in 2003 – was a key change in policy. The Supporting People Administrative Guidance (DTLR, 2001) specifically comments on and makes suggestions for future housing related support services for older people. Supporting People offers more opportunities to develop services that people require regardless of the kind of housing or tenure they live in. The cost of services is a thorny issue. However, it is clear that costs are likely to be higher in rural as opposed to urban areas for the same reasons that domiciliary care costs and community health services costs are higher. This is a factor that can easily be overlooked in Best Value reviews and should concern all rural areas.

6

The role of sheltered housing

There is a need to ensure that the sheltered housing services and buildings are suitable to support older people who wish to ‘age in place’ and not to have to move on to another setting. For sheltered housing in more rural areas, the new funding flexibility offered by Supporting People provides the opportunity for a sheltered scheme in a town or village to provide a community support role for vulnerable older people in the local area. Particularly where a rural sheltered scheme is the only one available in an area, then it needs to offer as much flexibility in whom it houses, and the services it offers, both to its residents and the wider community.

The Housing Corporation is introducing new definitions of housing for older people and supported housing (Housing Corporation Regulatory Circular No: 03/04) for Registered Social Landlords. The purpose is to enable housing associations to better describe their housing for rent as either general needs housing, supported housing, or housing for older people within the Housing Corporation’s regulatory, data collection and investment systems. The circular is reproduced in Appendix 3. This means that, for the first time, there will be an accurate count of housing associations (Registered Social Landlords) based on clearer descriptions that indicate whether their schemes have special design features suitable for older people or not. There are three types of housing for older people:

• housing for older people (all special design features); • housing for older people (some special design features); • designated supported housing for older people.

Providers are initially going to be asked to re-categorise data provided to the Housing Corporation on their sheltered housing and other stock designated for older people under one of the three definitions. This means that for the first time there will be an accurate count of housing association (Registered Social Landlords) based on clearer descriptions that indicate whether their schemes have special design features suitable for older people or not.

Traditional models of sheltered housing and very sheltered housing are being replaced, and innovative models of housing for older people – such as Extra Care schemes – are emerging. Smaller rural settlements, however, may not be able to sustain conventional sheltered or Extra Care schemes, and older people may need to move to larger settlements and market towns to access this type of housing, perhaps giving up their social networks and place in the former community. An alternative to moving to a ‘scheme’ is to stay put. The Supporting People programme is designed to extend the range of housing options available to older people in rural areas. Supporting People will, for example, seek to improve the quality of services and cover gaps in provision to certain groups. Older people in rural areas have been identified as one of the groups who currently miss out on a number of services that could enable them to continue to live independently for longer. Services include, floating support services, handyperson services, help with shopping and cleaning and community

7

alarm services (see, for example, Cheshire Supporting People Strategy, Durham Supporting People Strategy).

Transport and access to services

Cutting across housing issues are other aspects of need in rural areas. Someone may be adequately housed, but may be isolated in terms of access to services or transport (Housing Corporation, 2002). A study of mobility amongst older people in rural areas of the North Cotswolds noted the limited use of public transport and the reliance upon their own car or upon lifts with relatives, friends or neighbours (Gant, 1997). Research has also highlighted the continued process of decline of services and facilities such as retail outlets, and in particular, a concern about post offices in rural areas and the way that these latter may respond to the loss of over-the-counter payment of benefits (Moseley and Chater, 2002).

Objectives and methods

Against the background described above, this project set out to investigate the housing and support needs of older people in rural areas. There were seven objectives to the research:

• Identify the needs and concerns of older people in rural areas in relation to the full range of housing and housing services.

• Highlight other concerns that impact on the housing needs of older people and the decisions they make about housing in rural areas.

• Identify the care and support needs of older people and how these relate to their housing needs.

• Consider how the availability of informal support networks impact on the housing choices of older people.

• Consider how links to other services (health, shops, social services, transport) impact on the housing choices of older people.

• Identify the amount, quality and type of housing available to older people, and how the supply matches the requirements of older people.

• Consider the provision of housing and information advice services for older people in rural areas.

There were three discrete elements to the project: consultation with older people; policy and statistical overview; and needs profiling in five case-study rural districts.

Consultations with older people

An extensive programme of interviews and discussion groups was conducted in which more than 70 older people living in rural areas participated. The intention was to explore older people’s experience of living in the countryside – both the positive and less positive aspects, and to investigate their preferences and concerns about the type of housing and support

8

services available to them. A fuller description of the methods for this element of the research is presented in Chapter two. The interview schedule is presented in Appendix 7.

This project was supported throughout by an Older People’s Reference Group which met on three occasions with the research team. The members of the group were all resident in rural parts of North Yorkshire. The group commented on the proposed methods, drafts of the report, and discussed in depth with the research team many of the issues that were emerging from the work as it progressed.

Policy and statistical overview

Current national policy and recommendations for good practice with regard to older people were reviewed in the context of rurality. This review is presented in Appendix 1. In addition two principal national data sources – the 2001 Census and the SEH – were interrogated to provide a statistical overview of the housing circumstances of older people in rural areas. A summary of these findings is presented in Chapter three, whilst the full analysis, along with a fuller description of the methods adopted, can be found in Appendix 4.

Needs profiles

There is considerable diversity among rural communities. To better understand how different socio-economic, geographic and demographic factors impact on the housing and support needs of older people, five districts in different counties were selected for closer examination. These were: Scarborough Borough Council in North Yorkshire, Bromsgrove District Council in Worcestershire, North Dorset District Council in Dorset, Pendle Borough Council in Lancashire, and Waveney District Council in Suffolk. Apart from providing a regional spread, these districts provided good coverage and variation on a number of key features including: presence of a National Park; remote/deep rural area; coastal area; retirement area; mixed urban/rural area; and areas where major industry has declined. Relevant strategy and needs documents were collated and key informants interviewed from a range of statutory and voluntary sector agencies across the five case study districts. Fuller methodological explanation is presented in Chapter three. An example of an interview schedule is presented in Appendix 9.

Structure of the report

The report is structured in the following way. Chapter two sets out the views of older people, and reports on their experiences, exploring the outcome of a series of interviews and discussion groups undertaken in the early part of 2004. Chapter three presents data from the 2001 Census and SEH, providing an overview of the housing circumstances and attitudes of older people in the countryside, and also describes the five case study districts. Chapter four profiles older people’s housing and support needs in the case study areas, highlighting service providers’ responses to older people’s needs in these rural areas. Drawing on the evidence presented in the previous chapters, Chapter five makes a series of policy, practice

9

and research recommendations. Appendix 1 presents a detailed overview of national policies relating to older people in later life with particular reference to housing and support in the rural context.

10

Chapter two Living in rural areas – the views of older people

Introduction

This chapter draws on the views of older people in rural areas to examine a range of topics about housing choices and living in the countryside. The first section addresses the needs, concerns and aspirations of older people in relation to housing, and the types of properties and accommodation that older people felt were needed in the countryside. The second section addresses the aspects of rural life and access to other non-housing services that impact on older people’s housing choices and decisions. As will be seen, transport was the primary concern of older people, and is integrally linked to older people’s housing choices, their ability to access other essential services and facilities, and to maintain social networks and to participate in their communities. The third section addresses older people’s views on access to care and support in rural areas. Finally, the chapter examines older people’s views on the role of information and advice.

Consultations with older people

Face-to-face interviews, telephone interviews and discussion groups with older people living in rural areas were undertaken between February and April 2004. Contacts were made with potential interviewees via a number of different agencies and organisations in the five case study counties including: Home Improvement Agencies; voluntary sector groups; housing associations; local church groups; Older People’s Forums; day centres; lunch clubs; and other rural networks.

Although efforts were made to identify people from within BME groups, it was extremely difficult to identify any areas where people from these communities lived in a rural setting. In Lancashire there is a large Pakistani community, however, these communities are located in the old mill towns rather than in surrounding rural districts. A discussion group was held with a group of older women from the Pakistani community in Nelson. In Worcestershire there is a diverse BME community. However, these communities tend to be located in the city of Worcester and other urban centres rather than in the rural districts. Work is currently being undertaken in Worcester to understand the housing needs of older people in the Asian community, but it is still very much in its early stages. We also made contact with Gypsy Services in Worcestershire and were able to speak to a very small number of travellers about the housing needs of older travellers.

11

The sample

A total of 78 people agreed to be interviewed, take part in a discussion group, or allowed the interviewers to sit in on groups discussing living in rural areas arranged by other agencies (interviews n=35; discussion groups n=4, workshops arranged by other agencies n=2, total participants n=78). Their ages ranged from mid-50s to early 90s. Most interviews took place in the interviewee’s own home, with a small number conducted on the telephone. One discussion group was composed of people in their 50s; another was held with a Pakistani Welfare Association Asian Women’s Lunch Club; the remaining two were conducted at a day centre.

Interviewees and discussion group participants included people living in the private and social rented sectors, as well as homeowners. The properties they occupied varied in age and size from modern flats, houses or bungalows to older, listed properties. Some were residents in sheltered housing schemes (although none were resident in residential or nursing homes). We were also able to interview one older member of the travelling community who lived in a trailer on a gypsy site. All interviewees lived in rural locations – some in villages or smaller settlements and others in relative isolation. Some had lived in the same village or settlement all their lives, others were local to their area of residence, and others had retired or moved in later life to live in the countryside. Many – although not all – of this latter group had previous connections with the area to which they had moved. Most of the older participants lived alone, and many of these had cared for a partner who had since died. Others lived with their partners or other family members. Some people enjoyed good health, and others did not. The younger participants were usually in paid employment. Many respondents undertook some type of voluntary activity.

The intention was to explore older people’s experiences of living in the countryside – both the positive and less positive aspects, and to identify their preferences and concerns about the type of housing and support services available to them. With the younger participants we also explored the kinds of preparations, if any, they were making for later life in the countryside. It is hardly surprising that people in their 50s and 60s rarely considered themselves to be ‘older people’, and some were highly amused to find themselves categorised as old. The full topic guide is presented in Appendix 7.

Older people’s reference group

The research team was assisted throughout the project by an Older People’s Reference Group (see Chapter one). The members of the group commented on aspects of the work, questions to be covered in interviews, draft reports and so forth, and also discussed their attitudes towards, and experiences of, living in the countryside. In addition to the interviews and discussion groups described above, this chapter has also been informed by the conversations and discussions held with the reference group.

12

Views on living in the countryside

Respondents were asked what were the good and bad aspects about living in the countryside. For most, the best things were the peace and quiet, the space, not feeling ‘hemmed in’, the closeness with the natural environment and the wildlife and livestock that they saw around them, the cleaner air and less noise and pollution than in urban areas. Others also noted they felt safer in the countryside as crime rates were lower than in towns, and this enhanced their quality of life, although this is not to say that people were not concerned about crime and anti-social behaviour. Some people liked the relative isolation of where they lived. Many spoke about the sense of community they felt. Most of those who had moved to the countryside, either pre-retirement or on retiring, felt they had been able to join in with the community and make new friends, although they recognised that some communities might not be so friendly. For most of those who had always lived in the countryside there was nowhere else they wanted to be, or felt they would fit.

“It’s country, and we are country boys. I couldn’t live in the town, or I wouldn’t want to. I like all the green of the countryside, not concrete and brickwork. And the peace and quiet. And the birds.”

These views illustrated the importance of the attachment that many respondents felt to the neighbourhood where they lived, and the contribution that these respondents made to the vitality of their communities.

Among our respondents, the biggest disadvantage of living in the countryside was seen to be transport and the lack of alternatives to private car ownership. This underpinned almost all other concerns regarding access to health, shopping, education and leisure services, and influenced housing choices. This theme is considered in some detail below.

Staying put or moving on: housing options for later life

We asked our respondents if they could envisage a time when they would move from their current home, and – if they thought that it was likely that they would move – what type of housing or accommodation they would look for, and what would influence their choices. Respondents were very conscious of potential changes in their circumstances that might alter their ability to remain living in their current homes. Whilst the ideal for many respondents was to stay where they were, many recognised that declining health may lead to a staged process of changing accommodation requirements throughout later life. A couple of respondents commented on negative attitudes of some practitioners towards age and health, illustrated by one of our respondents who commented:

“When my husband was in hospital, they kept saying ‘his age is against him’. But he was 69. Is that old? I’m seventy and I don’t feel old. Are you getting less thought of because you’re getting old?”

13

Health, however, was not the only factor at play. Respondents were asked to reflect on the key issues for older people about housing in rural areas. However, even though housing was intended as the primary topic of these interviews, time and again these discussions turned to the importance of transport and access to services as the determinants of successful ageing in the countryside. Certainly in policy terms, investment in accessibility is likely to have positive knock-on effects in terms of sustaining housing options for older people.

Different respondents also expressed different levels of attachment to the places where they lived. Usually those who had always lived in the same village – sometimes the same house – all their lives, were clearly intending to stay in their current homes for as long as possible, ideally only leaving “in a box”. Others were more circumspect. This latter group of respondents wanted to remain in the local area, perhaps moving to a smaller, more manageable home in a larger settlement with easier access to facilities. They reflected that it would probably be too difficult to remain where they were currently living as they got older, or more importantly if their health started to fail or they could no longer drive. Many thought that there were not the local facilities and support services in place in rural areas to enable them to stay put. As one respondent noted:

“I don’t believe that the statutory services have the staff, the resources, the financial resources, to provide the services that are needed to support people in rural areas. And that can be through no fault of their own, just to start off with the people are not there who want to work for social services and do paid care work and that sort of thing, they can get better paid jobs, better conditions elsewhere.”

Q: “So you’re not optimistic about later life in the countryside?”

“No, I think I’m realistic.”

Others shared similar views, noting that it would be impractical and unrealistic to expect the same levels of service delivery or facilities in rural areas as in larger settlements. Others however, felt that services should be ‘different’ in rural areas, and could be moulded to better meet the needs of older people. In exploring what could be ‘different’, respondents frequently referred to low-level preventative services (see below).

Staying put

A number of respondents had planned ahead to sustain living in their present home. They commented on ‘getting the house right’ for the future while they had the financial means by undertaking larger scale repairs and maintenance to their properties. One respondent, for example, commented on getting his roof repaired and the house into a good condition, not only whilst he had the funding available, but also the energy to follow through the ‘hassle’ of organising the repairs. This respondent’s views illustrated the role that services such as

14

Home Improvement Agencies can play not only in providing information about possible financial arrangements, but also in facilitating repairs and improvements to people’s homes.

In a similar vein, another group of respondents discussed the installation of design features within the home, or steps they had taken to improve access around their home. In particular, these respondents commented that they had planned ahead in case their personal mobility deteriorated. These respondents noted that they had thought about converting a downstairs room into a bedroom, installing a downstairs toilet and shower, improving access to a bathroom or toilet, or ensuring that their stairs could take a stair lift. For example, one respondent noted that:

“I’ve already worked out that I can move a bed downstairs. Because the bathroom is downstairs. And one part of my family is moving to about 50 yards away. They’ve built a house on the land. So I’m very lucky.”

A couple of other respondents were not so lucky. They commented that their current homes were virtually unadaptable, and that a move was the only real option open to them. The limitations of the existing housing stock place a greater onus on any new build to meet lifetime homes standards to help facilitate successful ‘ageing in place’.

However, a couple of respondents expressed frustration at planning restrictions which had turned down applications for planning permission to convert their homes or build an extension to allow them to accommodate their changing health status. One of these respondents commented that if the Government has the aim of allowing older people to maintain their independence, then why is it so difficult for older people to get the permission they need to make the changes to their homes that would allow this to happen? A key issue is achieving a balance between how the planning system can have a positive role in helping to facilitate housing solutions tailored to the needs of older people in rural areas, against conserving the aesthetic quality of the rural built form. Strict limits on the ability of people to transform their homes, in addition to limits on the mix of types of new properties being built, puts greater pressure on other housing alternatives in the countryside, as more people are compelled to move to meet their changing needs.

For the large proportion of respondents who wanted to stay where they were, there is the crucial role of renovations, equipment and adaptations in helping older people to continue living in their own place, along with key organisations such as Home Improvement Agencies. The few respondents who had been in contact with Care and Repair agencies valued their services highly. Many people however did not know what a Care and Repair agency was, and were not aware that this type of service might be available.

Care and Repair England has developed two rural pilots of the ‘Should I stay or should I go’ project. These pilots are intended to test the practicality of providing specialist housing advice services to older people whose current accommodation may have become unsuitable and who, therefore, may need advice in finding alternative accommodation. Alternatively

15

they may need support in continuing to live in their own homes. The two pilots aim to develop good practice in providing these services to older people in rural areas. One pilot is hosted by Age Concern Derbyshire, and the other by East Riding of Yorkshire Council’s Staying Put Scheme.

Often simple equipment and adaptations are all that is required to enable people to stay put. Our respondents had mixed experiences of the installation of equipment and adaptations. When installed, quite simple things could make all the difference. However, when difficulties were reported these were often with the process, and the time it had taken to get adaptations fitted.

As noted above we were able to speak to a very small number of travellers about the housing and support needs of older members of the travelling community. It is difficult to generalise from such a small sample. Nevertheless, there are some useful points that can be made that would be worthy of further investigation. In the first instance, many older travellers who have lived in trailers all their lives would be reluctant to move to a house or bungalow in later life, in much the same way as an older person who had lived in a conventional house all their life would be reluctant to move to a trailer. Staying put for the older traveller means staying in their trailer, often on the same site for a number of years. Equipment and adaptations can be provided to assist older travellers in their homes, and the design of any new travellers’ sites should take into account the needs of the older people who will live there, for example, providing connections to mains drainage to allow the installation of a toilet inside the trailer. Many older travellers are supported and cared for by their families; however, these family networks are strained as there is a shortage of places on sites, and difficulties in obtaining planning permission for new sites.

Moving on

Independent living is not just about staying put; it is also about being able to make choices about moving to other forms of accommodation, in both the public and private sectors. Respondents reflected on the range of housing options that could ideally be available in rural areas. For those respondents who felt that they would move at some point, most felt they would want to stay somewhere near where they currently lived to maintain their social networks, but closer to local facilities where a car was not so necessary, and in accommodation that was ‘easier’ in a number of ways – size, age and maintenance, heating, car parking, and so forth.

Bungalows were often seen as a key option that should be available for people, and a couple of respondents had made the decision to move into bungalows to ensure an accessible environment later in life. However, this was a view that was not always subscribed to. One respondent commented that:

“I have an upstairs conversion. I sleep upstairs but I have a stair lift. So there’s no reason why you just have to think of bungalows in terms of older

16

people. You could use up less ground space if you’ve got an upstairs….I feel safer sleeping upstairs, and I think a lot of people would enjoy that. You can see a bit further from an upstairs window. It isn’t necessary to build on just ground floor accommodation as long as some thought goes into how you can get upstairs without having to climb up and down the stairs, with risks of falling.”

This is an important point because fundamentally older people want to live in the kind of housing they have always lived in, and it is important for policy responses not to equate the housing needs of older people with certain types of accommodation, such as sheltered housing, or small properties.

Properties that were in a good state of repair and easy to maintain were also attractive to older homeowners. Many were very concerned about the costs of significant repairs, and the difficulties in getting reputable tradesmen to undertake repair work, and the general upheaval and worry. Those who lived in public sector or sheltered housing were appreciative that any worries or concerns about maintenance were not their responsibility.

Affordable warmth

Some respondents discussed the heating arrangements in their homes and how these could be affected by living in the countryside. A particular concern was that these respondents used solid fuel or oil for their heating, which could be expensive, or difficult to manage if personal mobility became a problem. One respondent commented that she was lucky, because she had access to mains gas, which meant that she could take advantage of special deals by utilities companies for cheaper fuel combining electricity and gas payments, which were unavailable to other people in the surrounding rural areas. Another respondent who lived in sheltered accommodation felt that her ability to reduce her fuel bills by switching suppliers was compromised by the fact that the bills were paid centrally by the housing association, and individual residents had no control over their payments.

Smaller properties were generally attractive as they offered opportunities to save money on the Council Tax and heating bills; however, people also wanted to be able to accommodate guests and visitors, especially when family lived far away, as well as keep precious possessions. A couple of respondents noted that they had childcare responsibilities for their grandchildren or other relatives, or had needed space to help other family members at times of crisis in their lives such as a relationship breakdown. The notion that a ‘nice little bungalow’ will suffice in later life also underestimates the requirements that older people have for space – for hobbies, pets, for work, to spend time apart from a partner, to accommodate visitors both for social purposes or if someone needed to come and stay to care for someone, and so forth (see Heywood et al 2002, also Hanson, 2001). Outdoor space was also important. Although people did not necessarily want a large garden, many enjoyed gardening and sitting outside, and wanted some private outdoor space.

17

Sheltered housing

There was considerable diversity of views about sheltered accommodation as an option for older people, reflecting the variety of aspirations and choices that respondents wanted or hoped for. A number of respondents were living in sheltered accommodation and, having made this decision, tended to speak favourably about the positive aspects of this type of accommodation. In particular, respondents reflected upon things such as the companionship and sociability afforded by this form of accommodation, or the security it offered in relation to support on hand, if required. However, for other respondents, the notion of living in sheltered accommodation was entirely unappealing. These latter respondents felt that they would have to give up their sense of independence, and a couple of respondents noted that having tried living in sheltered accommodation, they had found that it was not really for them, and had either moved, or were in the process of looking elsewhere.

One issue that respondents were asked to reflect on was the type of accommodation that should be available in villages, including sheltered accommodation. There were mixed views on where sheltered accommodation should ideally be located in rural areas. One factor that mitigated against the development of some types of accommodation for older people in rural areas was the loss of economies of scale that accrue to developments in urban areas, and also the lower demand in any single location because of the dispersed nature of the population. As the population of older people grows in many rural areas over the next few decades, then this balance is likely to alter quite substantially. Thus, villages may not necessarily alter in size, but the fundamental shift in demography will alter the demand for types of accommodation in villages. A couple of respondents discussed the changing needs of their villages, noting that whilst there may well be insufficient current demand for sheltered housing, this situation was likely to change in future years.

Whilst it was clear that some respondents welcomed the idea of sheltered accommodation in villages for older people in general in their area, it was clear that they did not feel it was an option that would be attractive to them personally. Other respondents, particularly those respondents living in scattered or isolated communities, felt that the scale of development, and access to services and facilities meant that local towns or large villages were the most appropriate location for developments of this nature.

The role of the warden in sheltered accommodation was felt to be limited. Many schemes have moved away from having a warden on site. This was felt to be a disadvantage to some as the warden had been a valued source of support. Indeed, one respondent had specifically moved into sheltered housing because there was an on-site warden, only to see this service cut, which defeated the object of moving in the first place. This example illustrates the point that on-site wardens with a generic support role were seen by some respondents as a pull factor, making sheltered accommodation an attractive option for them. The absence of a warden usually meant increased security measures, so access to the sheltered complex was restricted even for those who had legitimate reason to call, such as the postman. This reduced informal contact, and could increase people’s sense of isolation. However, the

18

move towards reducing on-site wardens needs to be set against positive developments in the role of mobile wardens in rural areas, able to develop a role in delivering services to people who want this kind of service in whatever tenure they happen to live in. When given the choice of whether to have a regular visit from a warden, many older people may decide not to bother, sometimes on the grounds of cost, or sometimes because they feel they do not need a regular visit. Some of our interviewees felt that regular visits should be made to older people, particularly those on their own whether in sheltered accommodation or not.

“They need a check. They need essential checks on all these old people, them that don’t call through, they need to be checked, but they aren’t.

And there are the people that need seeking out and checking on periodically. We do get rather a high ratio of carers going in and finding people dead in these parts, in the rural areas, whereas perhaps you don’t get that so much in the towns and cities. Mostly because if they don’t feel well, they won’t want to bother the doctor and there’s nobody there to push for them.”

Residential care

Although there was a sense of residential care as a ‘last resort’, a small number of respondents commented on investigations they had made, or knowledge they could draw on from visiting friends or family in care homes, about the quality of accommodation on offer, and the option of choosing this kind of place to live. One concern was the quality of homes. As one respondent commented:

“If they are good they are wonderful. If they are bad, they are hell on earth.”

Others were very concerned about the insecurity of residential care, and many spoke of local homes that had closed, and residents being forced to move on – often at short notice – to a new place. It was this factor that was of great concern to respondents that although older people could make decisions about their housing needs, there were too many examples of situations where people were vulnerable to decisions made by agencies or individuals and over which they had very limited say or control. Another concern was that if people needed residential care, local placements were important to allow people to receive regular visitors and maintain their social networks. Thus, underlying many respondents’ views was a concern about placing their future in the hands of agencies, both public and private sector, whose priorities may not necessarily always coincide with the interests of service users.

Planning ahead

We asked respondents how ‘young old’ people might be persuaded to think about and prepare for their housing needs in later life. Our ‘young old’ respondents found it difficult to think of themselves as ‘old people’. They thought that any house moves were more likely to be driven by factors such as a change of job, a new relationship, the need to release the

19

equity from the family home to enable their children to gain entry to the housing market, the need to provide a home for older relatives, rather than directly preparing for old age. One group of longstanding friends remarked that they had talked light heartedly of buying a large house together “so we could look after each other like we’ve always done…”. Other respondents reflected that it is not in their nature to plan ahead, and that they would be more likely to respond to events as they occurred. Some of these respondents noted that in later life, planning ahead often means thinking about negative issues such as poor health or limited mobility and it was hard to come to terms with these emotive issues. Others, however, remarked on the importance of not leaving a move too late, reflecting on the experiences of older friends or family who were struggling with large, dilapidated properties, often living in some discomfort in the only part of the house that was accessible to them, but completely overwhelmed by the prospect of moving.

“I’ll have to leave someday. There will come a time when we really would not feel that we wanted to continue putting the effort that it needs to keep somewhere of this size going. I think we’d have to be a good deal more indigent than we are now, but you’ve got to be sensible and the day will come…for instance, I have a very dear and now very old and frail friend and her husband is even smaller and frailer, and they have stayed in their big house far too long, and now they can’t really move – other than a move to a residential home possibly at some time – but it’s beyond their capabilities to get out and move….I wouldn’t be prepared to get into that position, I don’t think it’s fair on your children.”

Knowledge about housing options in rural areas

A theme running though all these views in terms of policy responses is the role of advice and information to help people to make an informed choice about the range of options available. Where respondents had been in contact with agencies such as Care and Repair, Age Concern or Help the Aged, either as recipients of services, or as part of user groups, there was a strong sense of the critical role of these agencies in linking people to what is available, or raising awareness of the help that can be out there. It was clear, for example, from talking to our respondents that many people had not heard of Extra Care Housing and what it offered. Most people equated housing for older people as either sheltered housing or residential care.

Whilst talking about the housing options of older people in the countryside, a number of respondents commented on the overall sustainability of rural communities in terms of the affordability of housing for all people, whatever their age. A small number of respondents had experience of working on parish councils and commented on the types of property coming forward for development via planning applications, and the struggle to secure new affordable housing for their communities. There was a sense of considerable frustration that the most common form of housing that was being developed in villages seemed to be the archetypal large, detached executive home. Respondents were concerned about the

20

diversity of accommodation available, to meet the variety of needs that exist in rural communities. As one respondent commented:

“We’ll look at the enormous new houses there. People were just moving in, so I went across the road to say ‘hello, welcome to [village]. If you need anything like knowing when the dustmen come…’ and they said ‘Well, we won’t be here much so we don’t need to bother’. Well, what a waste. There could have been two or three little houses there. It’s just money. There’s loads of places where they could build smaller houses. It’s getting to be a second home village.”

There was also some resentment about the siting of new developments, with some respondents commenting that the most choice locations seemed to go for upmarket housing, whilst affordable housing was sometimes pushed out to edges of villages, which are not necessarily very accessible for older people.

Respondents made clear that enabling choices around meeting housing needs in rural areas was not just about housing itself, but about making critical linkages with other key features of rural living such as transport and access to services. An imperative for the development of ‘whole system’ approaches in rural areas is links between agencies and services which help people to draw together these diverse aspects of daily living.

Transport and access

In all the interviews and discussion groups a dominant theme was the lack of transport services in rural areas. The importance of transport and means of access to services for older people cannot be underestimated. The availability of transport and the location of their home in relation to services and facilities were often of greater concern to people than the type of accommodation they were living in. The cost of transport – whether private car ownership, or other means of getting about – was seen to make living in the countryside relatively more expensive. As one respondent remarked, whatever service or activity was being planned or provided, transport has to be built in from day one.

The ability to drive was seen to be a key factor to living in the countryside. Those people who could drive recognised that once they were no longer able to drive, their lives would be completely transformed as there were few transport alternatives to the private car.

“We all dread the day we aren’t allowed to drive anymore. Hang on to that as long as possible.”

In some cases people felt that once they were no longer able to drive they would have little choice but to move as there were no local facilities that they could easily access, and they would be dependent on family, friends and neighbours for lifts. Other people accepted that they would simply have to make do with the services and facilities that were available locally

21

and organise their lives differently without a car. For those who could no longer drive or who had lost their driver partner, the lack of transport had been a factor in their housing choice, and certainly had hugely influenced their lifestyle. Previous work carried out by the Centre for Housing Policy (Croucher et al, 2003) investigated the reasons why older people had chosen to move to Hartrigg Oaks, a retirement village in York. Many residents, particularly those who had previously lived in rural locations, reported that their decision to move had been greatly influenced by their concerns about their ability to drive in the future.

Parking and the location of parking spaces was a concern to some respondents. For those who could drive, adequate parking near to their home was sometimes lacking. For those who did not have their own garage or driveway, parking on the road could sometimes be difficult and the parking spaces were not always near their homes. Some sheltered housing schemes had very few parking spaces and these were not always designated as disabled spaces or for residents only. Given the crucial role of access to private transport in the countryside, more emphasis needs to be given to facilitating adequate and accessible parking in developments. This factor may well cut across broader environmental priorities about limiting car use by restricting parking availability, but these broader concerns may not necessarily be appropriate in the context of ensuring adequate access for older people to their homes.

A minority of those interviewed thought they were reasonably well served by public transport, but most did not. For those in remote locations or smaller villages there was often no bus service at all, or a very infrequent service. Those who did not have access to a car were either dependent on neighbours and friend for lifts, or made use of community transport services such as Dial-A-Ride, or the various voluntary transport schemes that were available. Inevitably opportunities to go out were limited. However, many people remarked on the willingness of neighbours to assist them, particularly at difficult times, and many regularly offered lifts to others.

“Well, we give people lifts. I have three people on Mondays, Wednesdays and Saturdays. I am their bus.”

Public transport, usually bus services, was thought to be improving in some places, but was still inadequate to meet the needs of older people. This was in part because of the infrequency of services, or timetabling of services that left people with either too little or too much time in their destination, but most often because people were unable to walk to a bus stop because of frailty or physical or sensory impairment. There were few bus shelters and services were thought to be unreliable, so a long wait in the cold and wet without shelter was not an attractive prospect. People acknowledged that there was little profit to be made in providing rural bus services as most people used their cars when they needed to travel.

“More buses should be provided. My life was absolutely ruined ‘cos of the buses not running. I lost my chance to get up and go, you have to swallow

22

your pride and ask people for a lift. The parish council are trying to get a shelter for the buses otherwise you have to stand in the rain.”

Private taxis were considered to be very expensive, beyond the budget of most older people, and often inaccessible unless there was a local taxi service. Taxis from nearby towns were often reluctant to travel long distances to collect a fare, especially if the fare was only going a short distance. It was also reported that some taxis were reluctant to take travel vouchers given to older people by social services in payment for fares as they could not be readily cashed in.

Community transport services were highly valued and often provided the only means of travel, but could in some instances be quite limited. Quite understandably, journeys usually had to be booked in advance. Some services were only intended to take people for specific reasons such as hospital or doctors’ appointments, and would not take people to or from home to social events. Where services were dependent on volunteer drivers, this usually constrained outings to weekdays and daytime as volunteers are less likely to be available at weekends and evenings. There was little room for spontaneity. Most voluntary services only covered limited, fairly local destinations. Some people also remarked on the patchy nature of voluntary sector services – they could be excellent in some places, and non-existent in others.

Personal mobility was also a concern. For those who were unable to walk or unable to walk far, the only transport services that were of much use to them were door-to-door services such as taxis, lifts from friends and neighbours or voluntary transport schemes, which picked people up from their homes. For this group, transport was essential for even the shortest journeys. In one village, the local GP surgery had moved to the next village, and in recognition of the difficulties this might cause, the Primary Care Trust (PCT) had contracted with a local voluntary transport service to bring older and disabled patients to appointments at the surgery. This system was preferred by older people, even though the surgery was further away, because they had not been able to walk to the old surgery although it was nearer. One respondent suggested that there should be schemes to enable older people to hire electric disability scooters in villages, as these provided an excellent means of getting out and about. Many villages and rural settlements do not have pavements or adequate street lighting, and the absence of these features was not helpful to older and infirm residents.

In most areas there is usually a scheme that enables older people to travel more cheaply, sometimes even free, on buses and trains. Our rural respondents welcomed this type of assistance, although they noted that such subsidies were not all that helpful if there was only one bus a week. Some respondents felt that all older people should be able to travel free on public transport. In one area when a county council planned to reduce its transport subsidies to older people, the police had to be called to the council meeting due to the vociferous protests of older people’s groups who had attended to voice their concerns from across the county. The role of Older People’s Forums in raising the issue of transport was also

23

highlighted. The members of the Droitwich Older People’s Forum had been engaged in discussion with the local bus company regarding improvement to routes and services.

Developing strategies in rural areas to enable successful ageing in place needs to address the key issue of access to transport. There are many examples up and down the country of flexible and responsive services at local level that operate in the countryside. The Countryside Agency has highlighted the importance of linking local development with national and regional transport policy. A recent development here is that it is intended that Regional Development Agencies will have a stronger role to play, since central Government is setting out proposals to establish regional transport funding allocations for the first time, and to supplement the regional transport, economic development and housing funding allocations set over the 2004 Spending Review period.

Shops and facilities

As noted above, many older people would prefer to stay in their own homes, or at least in their own village or community rather than move to larger settlements. Clearly, limited transport services and the numbers of older people who do not drive or have access to a car, increase the necessity for accessible local services and facilities located in rural settlements, and will be key factors in enabling them to stay put in their home or community of choice. People did not expect to find a Marks and Spencer in every village. However, a post office and small village store were highly valued amenities. Some of those interviewed did not have easy access to even basic services. The demise of the village post office and small shops has been noted by other commentators. Our interviewees also remarked on the reduction in numbers of local shops and services that had once been in place. However, in some instances it was felt that more recently there had been some improvements, and it was noted that new businesses had been opened with support from grants from a number of government bodies, including the Countryside Agency. This was widely supported. Parish councils were also active in encouraging local businesses to widen the stock they carried.

Apart from enabling people to do basic shopping, a trip to the post office or local shop offers the opportunity to meet neighbours, exchange a few words, and pick up information about events and services. A trusted post office worker was often the point of inquiry about benefits or problems with pension payments. There is the possibility that someone will notice if a regular customer does not appear to collect a pension or regular newspaper, and make inquiries about their well-being.

Some respondents were well-served by a number of mobile shops that called on regular days and times, offering a reasonable range of produce, including fresh fish, meat and vegetables. Some local shops would also deliver orders. Doorstep milk deliveries were also valued, and often milkmen will deliver other basic groceries and produce. Again door-to-door services such as milk and post delivery allowed for informal surveillance of the well-being of older people. Mobile libraries were also a highly valued local service.

24

Internet shopping did not seem to be a facility that many of our respondents made use of, although many had observed the increasing number of delivery vans from the large supermarket chains that were servicing rural areas. Indeed most of those we interviewed were not connected to the internet and had no intention of becoming connected, usually because it was seen to be very expensive. People felt that internet shopping was fine if you had a big order, or consistently ordered the same provisions, otherwise it was not all that practical. One member of our Reference Group was visually impaired, and remarked that the time it took to for the computer to read out the many items it was possible to buy made internet shopping extremely time-consuming and rather dull. Many older people felt that the town-based supermarkets had been instrumental in the closure of smaller shops and businesses in villages. Although ostensibly consumers were being offered more choice in a supermarket, that choice was only available to those who could travel to them. Even for those older people who could get a bus to a supermarket (and some supermarkets provide their own bus service), carrying a week’s supply of shopping could be too much for them. Again many were dependent on door-to-door transport (usually lifts from family and friends) to access retail facilities in town. Having a door-to-door service was a particularly valued aspect of flexible transport schemes such as Dial a Ride or voluntary transport schemes in rural areas.

Apart from shopping for day-to-day needs, people also need access to larger, specialist shops for one-off purchases such as a new coat, shoes, electrical goods, or special presents. A scheme in rural Northumberland run by Age Concern has been set up to enable isolated older people to access a wider range of retail outlets. Our Reference Group thought such schemes were very valuable.

This project covers the most isolated aConcern, and funded by the Countrysishopping, socialise, and take part in culocal shops and market towns, and givchoices and interact economically withparticipants being able to buy their ownto visit the 'new' supermarket which haChristmas presents for her grandchildr To make the service as effective as po- Targeting: the service targets only thoopportunity to go shopping or travel to might be made even worse by mobility- Client involvement: the project startedservices they would like. Now that it is to choose the destination of each outin- Community involvement: apart from tsteering groups in each area. These aworkers, and many key decisions suchresponsive to local needs. Again, it muThe project is approaching its first birthstay independent and in their own hom

NORTHUMBERLAND RURAL SHOPPING PROJECT reas of England's most rural county, Northumberland. The scheme is operated by Age de Agency. It aims to maintain independence in older people by providing opportunities to go ltural and arts activities. Clients of the service are taken out in small groups to local and not-so-

en support to help them choose food, clothes and other items, enabling them to make their own the wider community. The outcomes of the project have been quite startling, with some goods for the first time in years. One woman was overcome with emotion at finally being able

d been built in her nearest town 12 years ago. Another client was delighted at being able to buy en for the first time in many years.

ssible, there are three key elements: se older people in the most rural parts of the county, for whom there is practically no the nearest market town due to lack of appropriate transport services. Their circumstances problems or financial issues. out following discussions with older people in the north of the county about what kind of

up and running, clients' views are evaluated after each and every trip and they are encouraged g. The project has to be as flexible as possible to cope with this. he contribution of local volunteers to provide support on the trips, the project is guided by local re made up of representatives from local community groups, transport partnerships and social as eligibility for the service are decided on by the steering groups. This makes the service very st be as flexible as possible to make the most of this. day and can celebrate being a national award winner as well as helping over 200 older people es

25

Other services that were frequently mentioned by older people as problematic were banking and financial services. The decline of local post offices and closure of smaller banks left many older people in rural areas without ready access to financial services. Telephone and internet banking were not viewed very favourably. Currently many older people do not have access to the internet (see above). Call centres, with answering systems offering menus of options and requests to press different numbers were thought to be poor replacements for contact with a known person at the bank.

Social isolation and community development

Many respondents remarked on the relative social isolation that many older people in the countryside have to endure. Some felt that older people in urban or suburban areas could just as easily become isolated and ‘stuck in four walls’. Nevertheless for older people in the countryside, geographical isolation, the changing nature of rural populations, and lack of opportunities for informal social contact – for example, a walk to the shop, or difficulties in attending social events due to lack of transport – were all felt to contribute to social isolation.

Many respondents remarked on the extent to which perceptions of tight knit rural communities did not accurately reflect what was really happening in the countryside. It was felt that the lack of affordable housing and employment in villages, and the growing number of commuters and second homeowners who were moving into villages, were in some places eroding the old sense of community that once existed. They felt that the rather romantic notion that country people looked out for each could be damaging as service providers always assumed that people would have more informal help than was actually the case. Others, however, felt that there still a strong sense of community in rural places, and much of this was due in no small part to the activities of older people themselves, particularly the younger-old, who were the driving force for much community activity, both organised and informal.

“We enter a best kept village competition every year and they ask ‘Are the elderly involved?’ and we say ‘well, they run most of the clubs in the village’. The WI and gardeners’ clubs, they are all retired people that run them.

It’s a close knit community, so you know everybody. Also people don’t interfere, but are there if you need them. But a lot of villages are commuter villages, so you tend to lose that closeness when you’ve got that. Our village hasn’t quite got to that stage yet, and I hope it never does…..”

Only one respondent remarked on the increasing numbers of older people who were retiring to the countryside in a negative way as she felt this was increasing pressure on existing services. Frequently it was noted how the recently retired made a substantial contribution to community life, and were the main stay of many community activities and informal support

26

networks. Other studies have not always reported such positive attitudes to older people retiring to the countryside (see, for example, Blenkinship, 2004).

Some of those interviewed were people who had retired to the countryside, often to a place where they already had connections. They had been determined to make new friends, and many had made considerable efforts to become part of the existing community. Over time they had successfully built up new social networks and were actively engaged in community and voluntary activities.

“There is a strong sense of community in the village….there are regular events that are well-supported because there is quite a large population in this village of quite well-to-do retired people who have got time on their hands, energy….so there is quite a lot of talent and vigour goes to fund raising and supporting the village, but it’s mostly what one would call ‘incomers’. There is a community of indigenous villagers who are mostly farmers, some of whom are falling on hard times, and I think they don’t take kindly to these more affluent incomers.”

Some of our interviewees were very active volunteers. They enjoyed the sense of purpose, interest, and opportunity for meeting people that regular volunteering gave them. A number had been assisted by voluntary services themselves and were eager to give something back and support organisations that had helped them when they themselves were in need. Being part of the volunteering network also enabled them to find out about services and activities that they themselves could benefit from. They noted that volunteering could sometimes be onerous, and there were some situations when they had been uncomfortable or felt they had taken on too much. Nevertheless, volunteering was very rewarding. Some questioned whether the younger-old would be so willing to take on voluntary activity in the future.

Despite the recognition that older people made a large contribution to community life, many also remarked on the ageing of village populations, again due in part to the lack of affordable housing and employment for younger people. There were concerns about how sustainable communities would be in future when there may well be a much greater number of very old people who might be less able to help each other or take a very active role in volunteering. Activities that engaged both the young and old were seen to be crucial, and these were frequently focused on local schools and churches, or other community activities that bought different age groups together.

“It’s about people caring about what is going on in their community. ’Cos if the community doesn’t care about what is going on you’re fighting a losing battle. The elderly then end up being forgotten.”

Venues are needed where social groups can meet and activities take place. The value of a village hall, or other community resource, where meetings or clubs can be held cannot be

27

underestimated. These need to be accessible to the disabled or less mobile, and with adequate parking facilities, but many existing facilities are old and in some state of disrepair.

Some people have never been socially active and prefer to spend time alone. Nevertheless policy measures can help support facilities and schemes that can go some way to help reduce isolation and loneliness. Good neighbour and befriending schemes can go some way to promoting social contact and social interaction.

“There are clubs that arrange pick ups, but not everybody wants to go to clubs. My husband didn’t. What they really want is a buddy scheme, someone to pop in for a cup of tea and a chat. It’s worth its weight in gold. And someone to say ‘I’m going to the shops, do you want anything, or would you like to come?’ Even better.”

Care and support

Informal support and low-level preventative services

Informal help from neighbours, friends and family was frequently reported as the main form of support that people could rely on. For those who needed assistance with small household tasks, shopping or transport, this came mainly from friends and neighbours as family were usually too far away to be able to offer much in the way of day-to-day support.

“There’s a lot of support for people, to look after people who are living in their own house alone. They either pay, or there’s volunteers who pop in one day a week, or do their shopping. There’s one person whose husband has gone to a care home, and people take her every day up to the care home so she can see her husband. That kind of thing goes on voluntarily without any kind or organisation. You get that in a village which is closely-knit. Not necessarily family, but friends or neighbours.”

Many remarked on the preference of older people in rural areas, particularly those who had always lived in relatively isolated communities where self-sufficiency was the norm, to accept informal assistance rather than engage with outside organisations, which were perceived as bureaucratic and interfering (see below).

“There’s a feeling that it’s OK if it’s a friend or a neighbour, and a feeling of not wanting to engage with authority and to go through all the bureaucracy…”

In addition to informal support, much of the ‘formal’ low-level preventative services in the case study areas were provided by voluntary sector agencies (with funding from statutory sector agencies), and many of the volunteers were people above retirement age. A variety of schemes addressing many different needs were operating in the case study areas, including befriending, handyman schemes, shopping, social/lunch clubs and day centres, exercise

28

and activity groups (such as Walk Out Well in North Yorkshire). There does appear to be an element of the post-code lottery about many of these services. If a local voluntary sector group is very active in a particular location, then services will be in place. However, in another village, district or county there will be not be the same level of activity. Similarly, different local authorities will have different attitudes towards the voluntary sector, and some will be more supportive than others of voluntary sector activity. There does appear to be patchwork of voluntary sector services, even within the five case study areas under investigation in this project. Some areas are less well served than others. Among those we spoke to, voluntary sector schemes were valued, but were clearly only one element of people’s support networks.

In addition, many people paid for assistance with odd jobs, gardening and cleaning when they could afford such services, and indeed find people who would do them.

“My daughter said to me, ‘Have you thought about getting a woman to come and clean once a week?’, but I said ‘Who would I get? The days are done when your mum used to do this. Up and coming generation – you wouldn’t do a Mrs Mop, would you?’ No, it’s a changing world.”

Finding reputable tradesmen was consistently noted as a difficulty. Various organisations were producing local directories listing local tradesmen and businesses to assist (older) people find someone they knew they could trust.

Assistance with such things as small domestic repairs, heavier gardening tasks, lifts to doctor and hospital appointments, fetching shopping were all greatly valued, indeed essential for many older people, reinforcing findings from other research that indicate the great value placed by older people on the low-level preventative services whether informally or formally provided. Such services are usually not within the scope of statutory sector resources, but nevertheless provide crucial support. Indeed when asked what types of services or support could be provided that would make a real difference to older people in the countryside and enable them to remain independent, most usually people talked about low-level preventative services.

Q: “What kinds of things would make a real difference to enable people to stay in the countryside?”

A: “Support in the terms of someone to do your shopping, your cleaning, to post your letters, someone to walk to the post office to get your pension, to go to a cash dispenser to get money, to keep your garden going – if you still have a garden, to prepare meals for you, to take you out so you’re not imprisoned in four walls.

29

Everybody knows that if money can be put into prevention, money can be saved later on, but the world doesn’t work like that and so the resources that are there tend to go into crisis and end of the scale needs.”

This report can only endorse the findings of other earlier research, and stress the essential nature of low-level preventative services, and the great value placed on these services by older people in rural areas.

Intensive home care

Few respondents were in receipt of intensive home care packages from social services, although some did receive some care assistance from social services, and knew that more intensive services were available but only to people in dire need. As one respondent remarked:

“A lot of people wouldn’t be eligible for statutory sector services, they’ve still got needs, but would not be eligible, their needs are not sufficiently severe to be eligible, they need help with cleaning, some help with preparing food, probably still just about mobile. The statutory sector are likely to say that if you have people nearby you won’t get anything.”

Night services generally were thought to be lacking for those who were living alone. Even if people had assistance with getting up, getting meals and so forth during the day, there was little support through the night, when people feel very vulnerable.

Others remarked on the limited tasks that personal carers were allowed carry out, and their adherence to the care plan which left little room for older people to direct their carers themselves, and required them to seek and organise additional help from a number of different sources – whether from the voluntary sector, informally or paid help.

“To get sufficient help you have to have a good income. You have to pay separately for someone to come in and clean up, somebody to come in and check you’re alright, someone to come in and do your shopping. It just mounts up so it’s insurmountable. What you really want – one person per person. That would be the ideal. People don’t like a different person coming in every day. You need the same faces you can form a relationship with.”

Community alarms

Perhaps the most widely used service among our interviewees was the community call alarms, usually necklace-type alarms that are connected to a call centre. Many of those living in sheltered accommodation had alarm chords installed in their homes. These systems gave many a sense of security. Some people were paying for their alarms and felt that they could be expensive for those who were not in receipt of income support. Some felt that

30

although these alarm systems were useful, they were not enough of a safety net for older people living alone. Examples were given of people who did not how to use their necklace alarm, certainly never wore it all the time usually leaving it one place in the house, and did not know how to check whether or not it was still in working order.

“We have one [community alarm] and most have this, but many forget to have it to hand, and some are frightened of it. Not everybody understands…”

Health care

Most people felt that the health care they received was good, but of crucial importance was transport and access to GP surgeries and hospitals. This was perhaps of most concern to those who lived in more isolated settlements.

“It’s [transport] certainly something that has to be factored in, integrated with health care because you see even to get to a surgery you might be anywhere from two to five miles away.”

Community hospitals were greatly valued, as they were local and more accessible for appointments and visits. Again voluntary transport services, and lifts from friends were often the means of attending appointments or visiting friends and family in hospital. Services that collected and delivered filled prescriptions were also valued.

People felt that certain primary care services – and chiropody was particularly mentioned a number of times in this context – should be locally available or ideally come to people in their own homes. One respondent noted that the cost of transporting 20 people – often by ambulance – to the district hospital for regular chiropody appointments must surely be more than having the chiropodist visit people in their own homes. Other examples of apparent inefficiencies in transporting numbers of old and frail people long distances to centralised services were also noted. The preference was for services that come to older people, particularly the very old and frail.

Out-of-hours GP services and emergency ambulance services were a concern to some. Most people would prefer to be able to call on their own doctor out of hours, and felt that the changes towards more centralised out-of-hours services had disadvantages in rural areas. For those in remote locations, it was difficult for visiting health care professionals who did not know the area to find cottages and farms that were on unmarked roads or tracks. Similarly it was felt there may be a reluctance to give out-of-hours visits because of the distance the on-call doctor needed to travel. One interviewee described calling for the emergency doctor, being put through to a call centre in a town some 40 miles away, then being asked to describe his symptoms, and then being told to wait for someone to phone him back. Finally, he was advised by telephone to visit his doctor the next day when it was discovered that his condition was serious.

31

“Being on my own, although I had described my condition, until they’d checked me they didn’t know how bad it was…a lot of people into their eighties living on their own, some of them might not be able to eloquently describe their problems, or think they are not as bad as they are, they really should be seen….”

Another respondent suffering from angina reported that previously her GP would come out to her in the night if she suffered an angina attack, and ‘sort me out’. However now the out-of-hours GP service calls an ambulance and she has to spend the night in hospital, which she thought was a waste of health service money.

There were also similar concerns about ambulance services, their response times in rural areas, and their ability to find a remote village or house particularly at night and when weather conditions were difficult.

“Health is a major problem in an area like this. In these outlying districts it’s very easy to lose a life that may not be necessary to lose.”

Information

One of the questions put to interviewees asked where people would go for advice and information across a range of health and social care services, benefits, education and training. Most people felt they would know where to go for information and advice. Many cited informal sources such as people or service providers directly known to them as their first point of contact – friends, family, people they volunteered with, the warden of their sheltered housing scheme, a care worker known to them, their GP, colleagues in the Older People’s Forum or on the parish council. Word of mouth was seen as the most important means of letting people know what was available, and what was going on.

As a second point of contact, most usually the local Citizens Advice Bureau or the local council, and frequently the local Age Concern office, were mentioned. Perhaps of interest is that people usually said they would phone an organisation rather than call in, partly because opportunities to call into town-based offices were limited, and often appointments were necessary. Only one respondent, a woman in her 50s, said she would search the internet for information. This raises the question of how useful websites are to many older people, particularly the very old who do not always have the skills and means to access the internet themselves.

Day centres and social clubs are often seen by service providers as a means of getting information to people. Many of the service providers we interviewed spoke about giving presentations to groups of older people at social clubs or meetings. Those of our respondents who regularly attended social clubs or centres also spoke about such events. They found them helpful on a range of different issues, and also useful in allowing older

32

people to raise their own concerns, for example, with their local councillor. However, not all of our respondents were convinced of their usefulness.

“I think some people are just going along for the free lunch, but aren’t really taking in the jargon that is sometimes given in talks about tax of whatever. Sometimes it’s a bit above their heads. I’m not knocking it…”

This is not to say these events are not valuable – they can have a snowball effect where if one person follows up the information and gets something new, whether an aid or adaptation, a new benefit allowance, others will follow suit (see, for example, Croucher et al, 2003).

Members of an Older People’s Forum found they were frequently asked for information about a range of topics. The Forum’s office was located in the local Council Shop, alongside both council and other agencies’ information workers, so Forum workers were well-placed to seek out information to pass on to others.

Although people felt that they would be able to find out what they needed to know, most people felt that generally there was a lack of knowledge about the range of services that were available, and it was difficult to inform older people living in rural communities about the services, benefit entitlements, various activities and opportunities that were available to them. If people do not know what is available to them, then they do not ask for information about it. As one respondent remarked:

“If you don’t know what you don’t know….there isn’t an enormous clamour for information services to be made available, people don’t access information because it isn’t easily available…..

I think that people have got to know that they want to know something first. So, I’m not sure it’s a case of making information accessible – if you don’t want to know about whatever that area is then you won’t read any information that’s pushed through your door anyway, you’ll just put it in the bin because you think it doesn’t apply to you.”

Some respondents felt information leaflets were “a bit of a cop out”, as they allowed agencies to say they had informed everyone, but not everyone took notice or took in the information.

When asked what could be done to improve access to information about services, a range of suggestions were made indicating that any information strategy (indeed where these are in place) should be wide reaching, and not necessarily focus on venues or services that are most usually associated with older people, as younger family members or friends often passed on information to older people that they thought would be of use to them.

33

A range of possible sources of information were suggested by respondents: village magazines, church newsletters, local radio and television, notice boards in community venues or shops and post offices, mobile libraries, were all cited as means of promoting the awareness of older people’s services in rural areas. Doctors’ surgeries were frequently mentioned as a key information point. It was felt that care workers going into people’s homes should also be aware of the types of services that were available and assist people in accessing them. Thus different organisations – whether health services, voluntary sector, housing, Home Improvement Agencies – should have some knowledge of what other agencies offer and how services can be accessed.

The telephone was also a key means of getting information. As noted above, automated telephone answering systems were not well liked.

A further concern was with ‘form filling’. The complexities of application forms and processes were felt to be off-putting to a lot of older people. Assistance with completing forms was felt to be needed by some people, especially those with a visual or other impairment.

“Sometimes people don’t use all the services that there are. It’s getting people to know what’s out there, isn’t it? I know people keep advertising saying the money’s there for you, but when you come to ask for it the forms are so complicated that I think an older person finds it extremely difficult to follow and get rebates of help. There have been a lot of advertisements on the television saying ‘it’s yours, pick it up’, or something, well I am sure a lot of older people do qualify, but when they start going into it and the questions are so difficult and so complicated, I think they give up quite frankly.”

Many people also spoke of the reluctance of some older people to take what they saw as ‘charity’. There was a feeling that country people are proud and are less likely to ask for things than ‘town’ people.

Summary

The diversity of views reflected the heterogeneity of older people and reinforces the point that it is not possible to be prescriptive about what older people as a single group may or may not want or need. Instead, respondents reflected on their own housing circumstances and their views on living in the countryside. The key to these discussions was to examine how services could or should respond to these diverse needs and aspirations in the distinctive context of the countryside. What became clear from the analysis was that the concerns of older people in the countryside were similar across the different case study areas.

Respondents made clear that enabling choices around meeting housing needs in rural areas was not just about housing itself, but about making critical linkages with other key features of

34

rural living such as transport and access to services. Transport was viewed as the most significant issue facing older people in the countryside.

One feature of living in rural areas was the limited housing options available for older people and a key concern was the range of properties available for people. There is danger in being prescriptive here about the type of housing that older people want or need – most respondents wanted to live in a similar type of housing that they’ve always lived in, whatever that happened to be.

Most respondents were keen to stress that they intended to stay in their own homes. Broadening the housing choices available for older people was not just about increasing the availability of alternatives in the countryside such as a greater diversity of types of dwelling, such as bungalows or sheltered housing, but making sure that people’s existing accommodation arrangements can be sustained as far as is practicable.

For those respondents who had moved, or felt that they would want to move in the future, there were mixed views about the extent to which a range of choices of different types of accommodation should be available within villages. Some respondents felt that people should be able to remain in the communities where they had lived, often for a considerable period of time. Even if smaller communities could not sustain developments of a diverse range of accommodation, including sheltered accommodation, at the present time, changing demographics in future years might well mean that developments may become viable in the future. Other respondents were more circumspect and noted that developments in villages would be very costly, or would be more appropriately located in larger settlements.

New properties could make a valuable contribution to the variety of accommodation available for people who live in rural communities, in terms of both type and price, but there was considerable frustration amongst respondents that too much new development failed to offer meaningful choices. The availability of affordable housing was viewed by many respondents as important not only for older people, but for people of all ages in helping to sustain mixed communities.

The majority of respondents commented on the desirability of low-level support as a crucial way of helping people to continue living in their current home, either provided formally by services, or, as was more likely, informally by friends, family and neighbours. Some respondents noted that this kind of support would be helpful for them, whereas others felt that they did not need this kind of help, but that the idea in principle for older people who needed it in rural areas was important. A number of respondents stated that they were providing help for other people in the locality. Given limited alternative options in terms of accommodation, low-level support was viewed as a crucial way of helping people to maintain their independence in the countryside.

An implication for policy is that spending on features such as transport and low-level support may well indirectly help to facilitate and support the housing choices and preferences of

35

older people in the countryside. An imperative for the development of ‘whole system’ approaches to the development of strategies in rural areas is the links between agencies and services which help people to draw together these diverse aspects of daily living.

Various studies have investigated older people’s preferences for housing in later life (see, for example: Appleton, 2002; Clough et al, 2003; Croucher et al, 2003; Wilson et al, 1995). The outcomes of many of these studies endorse the findings of our work with older people in rural areas. The concerns that older people have about their housing are not just limited to the home itself (although heating, security, size and quality of accommodation, aids and adaptations, and level access are consistently raised as issues within the home) but are closely linked to location, access to a range of services, and particularly transport. Research has also demonstrated the high value placed by older people on low-level preventative services that assist them with small tasks in the home, and enable them to socialise and get out of their homes (see, for example: Clark et al, 1998; Raynes et al, 2001). Previous studies have not had a primarily rural focus. However, work recently carried out with older people by Care and Repair England in rural Devon at a series of Listening Events1 also clearly echoes our findings, that people do not see their housing in isolation, but are also concerned about transport, support services and other types of infrastructure that facilitate independence.

1 Further information available from Care and Repair England www.careandrepair-england.org.uk

36

37

Chapter three Older people in rural areas: a national overview and local perspectives

Introduction

The aim of this chapter is to examine the housing circumstances of older people in rural areas by drawing upon an analysis of two national databases – the 2001 Census and the Survey of English Housing (SEH). The first part of the chapter provides an overview of England. This part of the chapter presents a summary of the main findings of this analysis. A fuller discussion of these results and supporting tables can be found in Appendix 4.

The second part of the chapter focuses on five case study districts (Scarborough in North Yorkshire, North Dorset in Dorset, Bromsgrove in Worcestershire, Waveney in Suffolk, and Pendle in Lancashire). This part of the chapter illustrates the housing and support needs of older people in differing rural areas, drawing on data from the 2001 Census (see Appendix 5 for a further discussion of the five case study areas).

National overview

The rural age profile is significantly different to the urban age profile: almost 1 in 3 people in rural areas are aged 55 and over, compared to 1 in 4 people living in urban areas (see Table A4.1, Appendix 4). The 2001 Census indicated that the population of England stands at just over 48,000,000; with 25 per cent of the population living in a rural area (just over 12,000,000 people). Of the population of England, 27.9 per cent are aged 55+, however, in rural areas this rises to 31.5 per cent of the population compared to 25.2 per cent of the population in urban areas. If the population aged 55+ is split into 5-year age bands, it seems that the differences between the rural and urban populations in terms of age, are largely accounted for by people aged 55-74.

The 2001 Census asked respondents to rate their own health status, asking: ‘Over the last 12 months would you say your health has on the whole been: good/fairly good/not good?’. It also asked whether people had any long-term illness, health problem or disability which limited daily activities or work, including problems due to old age.

These data seem to indicate that more older people in rural areas feel well in themselves. A greater proportion, almost 1 in 2 reported good health, and 1 in 6 rated their health as not

38

good. In urban areas, however, more older people, 1 in 5 rated their health as not good (Table A4.2).

This trend was also reflected in older people who reported a life-limiting illness, and 35.5 per cent of people aged over 55 in rural areas reported a life-limiting illness, compared to 42.5 per cent of people aged over 55 in urban areas (Table A4.3). Again there are large differences between different age bands, and as might be expected the younger-old report less life-limiting illnesses. For all age bands, older people in rural areas report less life-limiting illness than their urban peers. Nevertheless, there is considerable morbidity among older rural residents. The proportions of men and women aged 55+ giving unpaid care are very similar (14.9 per cent of men, and 15.4 per cent of women). It is to be noted, however, that there are very different patterns of care giving between the genders at different ages, and this is true for people in rural and urban areas. A greater proportion of men aged 75+ and above give unpaid care compared to women aged 75+. Conversely a greater proportion of women aged 55-64 give unpaid care compared to their male contemporaries (Table A4.6).

Research has highlighted the significant contribution that older people make to the economic and social vitality of rural communities and that too often older people are represented as a problem (Le Mesurier, 2003b). Households with people aged between 50 and 75 were more likely to undertake voluntary work than other (both younger and older) age groups (Table A4.7). Almost 1 in 4 of those aged between 50 and 74 reported that they had undertaken voluntary work in the last year.

A greater proportion of older people are owner-occupiers in the countryside than in urban areas. In total, 81 per cent of people aged over 55 own their own home compared with 73 per cent in urban areas. However, the proportion of people who own their own home drops with age. In total, 86 per cent of people aged between 55 and 59 are homeowners in rural areas compared with 69 per cent of people aged 85 and over (Table A4.9).

Conversely, a smaller proportion of people over 55 live in social rented housing in rural areas (11.3 per cent) compared to urban areas (21 per cent), and a slightly bigger proportion of people over 55 in rural areas live in privately rented accommodation (7.9 per cent) than in urban areas (6.1 per cent).

However, a greater proportion of all very old people live in social rented accommodation, compared with the younger-old. For example, 22.7 per cent of those aged 75-84, and 25.5 per cent of those aged 85+ live in social housing. However, this national figure masks a big discrepancy between rural and urban areas. Only 16.6 per cent of those aged 75-84 in rural areas live in social rented housing, compared to 27.4 per cent of those of the same age in urban areas. For those aged 85+, only 18.6 per cent of those in rural areas live in social housing, compared to 30.8 per cent in urban areas. A greater proportion of very old people are owner-occupiers in rural areas than in urban areas. Given the preferences for people to

39

remain living in their own homes, and the costs of building new affordable housing, greater attention is required on supporting ways for people to continue living in their homes where they would prefer to do so.

The English House Condition Survey (2001) shows that the proportion of non-decent homes in country areas (31 per cent) is marginally lower than in towns and cities (34 per cent). However, there are considerable variations within these areas. Village and isolated rural areas (42 per cent), along with city (48 per cent) and other urban centres (41 per cent), have much higher proportions of non-decent dwellings than suburban (30 per cent) and rural residential areas (26 per cent). Indeed, taking isolated rural areas alone, 50 per cent of the dwellings in these areas are non-decent. The English House Condition Survey notes that this pattern reflects differences between the age, type and tenure profiles of the stock between these different types of area. Dwellings in village centres and isolated rural areas tend to be older, and those in privately rented or local authority tenures in particular have above average proportions of non-decent homes. In contrast, dwellings in suburban and rural residential areas tend to be newer. Older people comprise a higher proportion of the population in rural areas than in urban areas of England. Nearly 1 in 3 people in rural areas are aged 55 and over, compared to 1 in 4 people living in urban areas.

Greater investment on non-decent homes in rural areas could reap dividends in terms of bringing a proportion of these properties up to decent standard. Results from the English House Condition Survey, 2001 indicates that the mean costs of repairs to make dwellings decent in rural residential areas are relatively low, compared with other types of area (Table A4.10). Further, a low median figure for non-decent properties in village and isolated rural areas suggests that a proportion of these could be brought up to decent standard relatively cheaply.

Analysis of the 2001 SEH showed that compared with younger age groups, older people tended to demonstrate considerable satisfaction with both their homes and the area in which they lived (Tables A4.13 and A4.14). These levels of satisfaction pointed towards a commitment to home and neighbourhood, which supports a policy emphasis upon promoting independent living.

However, the results from the tables do suggest that overall averages were masking a considerable diversity of experience amongst older people. Research has noted that disadvantaged groups and individuals in rural areas are likely to be hidden within communities that, on the face of it, appear wealthy (Le Mesurier, 2003b; Oldman, 2002). The averages point towards difficulties experienced by a proportion of older people across a range of different aspects of daily living (see Tables A4.15 – A4.21).

Levels of satisfaction with home and neighbourhood were not necessarily translated into views on access to services and facilities. The proportion of people without access to a car gradually increases with age, but suddenly jumps among those aged 75 (Table A4.22). Clearly, access to a car has a different significance in a rural context as there are likely to be

40

few, if any, alternatives to private means of transport. Access to a car is an essential facet of living in rural areas rather than a measure of affluence. However, what is clear from these data is that although older people in rural areas appear to be more advantaged compared to their urban peers, there are still significant numbers of older people in rural areas who do not have private transport, more than 1 in 6 of people aged 65-74, 1 in 3 of people aged 75-84, and more than half of those aged 85+.

Households with people aged 75 and over were much more likely to report difficulties in getting to a range of local services (Tables A4.24 – A4.28). Access to health services was the most problematic. Whilst 9 per cent of all households in the smallest settlements stated that they found it fairly or very difficult to get to a doctor, this figure increased to 22 per cent for those households containing people aged 75 and over. This issue was more pronounced in relation to access to a local hospital for those living in the smallest settlements. Nearly a third of households of all ages stated that they found it fairly or very difficult to get to a local hospital compared with nearly half of households with people aged 75 and over. However, perhaps what was surprising was the level of similarity between urban and rural areas in the SEH, particularly in relation to households’ experience of accessibility to services and facilities.

Profiles of case study areas

Five rural districts

The five districts of Scarborough, Waveney, North Dorset, Bromsgrove and Pendle were initially selected for investigation because they were each located in counties that represented different aspects of rurality in different parts of England. Both Dorset and North Yorkshire are popular places for retirement and relocation and have extremely pressurised housing markets. North Yorkshire is the second largest English county and has two National Parks. Similarly over 50 per cent of Dorset is designated as an Area of Outstanding Natural Beauty (AONB). The county is characterised by a relatively sparse population compared with England as a whole. Worcestershire borders Birmingham to the north, and is within easy commuting distance of the main West Midlands conurbations. There is significant demand for housing from outside the county. The State of Suffolk Profile (2002) notes that Suffolk is a predominantly rural county. A substantial portion of the coastline is designated as heritage coast, whilst two areas are classed as AONBs: Dedham Vale and Suffolk Coast and Heaths. Lancashire presents more contrasts. Much of the northern and eastern parts of the county are very rural, bordering Cumbria and North Yorkshire, however, the southern part of the county, in close proximity to Manchester, forms part of the North West industrial belt, although the Lancashire mill towns are some of the most deprived areas in England. There is also a significant BME population.

Each district is briefly profiled below highlighting particular socio-economic and demographic factors.

41

Scarborough District

Scarborough district lies along the north east coast in the county of North Yorkshire, extending inland into the Esk Valley. Much of the district is within the North York Moors National Park. The district has three main population centres: the seaside resort of Filey in the south of the district; Scarborough, the largest of the towns, a traditional seaside resort with some pockets of deprivation; and Whitby at the northern edge of the district. Whitby was a fishing port; however, the fishing industry is in decline and is being replaced by a growing tourist trade. There are many second homes and holiday lets across the district. Scarborough Borough (and North Yorkshire generally) has traditionally been an area where people come to retire.

Outside the main towns, the population is dispersed in small villages and settlements, with economies mainly supported by the agricultural industry (which has suffered as a consequence of the Foot and Mouth outbreak) and tourism. The planning restrictions preclude much new development within the boundaries of the National Park. The local economy is a low wage economy. There are growing concerns about the supply of affordable housing and rising house prices (see below). A greater proportion of the housing stock is made up of houses and bungalows (61.8 per cent) than the national average (53 per cent).

In 2002, Scarborough Borough Council commissioned a housing needs study prior to undertaking a stock transfer. The needs study noted that the predicted increase in the numbers of older people, particularly the over 75s in the borough. Although it made no specific recommendations regarding older people’s housing requirements, it noted that existing stock was often not of the right type or in the right areas for older people, and did not meet people’s expectations. Most of the new Housing Association’s sheltered housing is located around main population centres and in some of the larger villages. There is an Extra Care Housing scheme run by Hanover Housing Association in Scarborough itself, reflecting North Yorkshire County Council’s strategy to move away from residential care to the provision of Extra Care Housing across the county. There are a significant number of private sector retirement schemes in Scarborough town itself. Scarborough Borough Council does not have an Older People’s Housing Strategy, although a strategy is planned on completion of the stock transfer.

There is a relatively new Home Improvement Agency, located in the Borough Council’s Environmental Health Department. People over 60 are its target group.

Traditionally North Yorkshire depended heavily on residential care as the main stay of support for older people, however, the main thrust of North Yorkshire County Council’s strategy for older people is to promote independence in the community via a number of different services, including more intensive home care, intermediate care, and the development of resource centres and Extra Care Housing schemes across in the county.

42

The county provides funding to voluntary sector agencies to develop and support low-level support and preventative services.

Waveney

Waveney is a coastal district in the North East of Suffolk. The main town is the port of Lowestoft, with four market towns of Beccles, Bungay, Halesworth and Southwold.

The district faces a considerable challenge to overcome significant economic decline as a result of a reliance on declining traditional industries, notably engineering, fishing, food processing, port and offshore energy sectors as well as traditional seaside tourism. Reviews of the County show that of the seven districts in Suffolk, Waveney is the only one to combine weak economic performance with high deprivation (Suffolk Development Agency, 2003). The district has significant pockets of deprivation, and has attracted funding to try and alleviate this situation via European Funding Objective Two, Rural Priority Status and Single Regeneration Budget. The Index of Multiple Deprivation (2000) shows that the 4 most deprived wards in Suffolk are located in the district, and that these wards rank in the 10 per cent most deprived wards in the country. As a consequence, unemployment in the district is above the national average, whilst local incomes tend to be relatively low. The Regional Housing Strategy notes that pressures on the local housing market are not as severe as other parts of the region. Nevertheless, the level of local incomes presents particular difficulties for many people in relation to trying to buy a home in the face of house price rises, with knock-on effects on levels of homelessness in the area.

Waveney District Council’s draft housing strategy statement 2004 highlights the diverse nature of the housing markets across the district. The rural areas in the northern part of the district, including the market towns of Beccles and Bungay have increasingly been affected by house prices rises due to the strong market around Norwich. The Regional Housing Strategy notes the strong demand for housing in the south of the district, partly arising from a buoyant local economy, but also from second and holiday homes. A third of households in Southwold itself are second homeowners (Suffolk Development Agency, 2003).

As a county, Suffolk has well-established structures in place for joint working between housing, health and community care. The Housing Programme Group came about through the Joint Care planning process, to promote joint working between Social Services, health and housing. The group is made up of the seven district councils, County Council, representatives of housing associations and health. Six of the districts head up a Housing Task Group, each focused on a Social Care and Health client group, one of which includes older people. Each Housing Task Group has the following aims: identify existing provision; identify housing needs; develop housing opportunities to meet those needs; develop best practice, and to retain a watching brief on Best Value and Housing Standards. Each task group reports to the Suffolk Housing Programme Group and Supporting People Commissioning Body, and recommends a three-year rolling housing programme in response to identified needs.

43

Part of the role played by these groups has been to have a programme of housing awareness training to promote what housing can achieve in the context of joint working, and to reduce a ‘silo’ mentality in the way that services may be delivered.

The development an Older People’s Housing Strategy is currently being undertaken, with links between local authority districts and the county-wide task group to ensure that strategies are produced in line with the DoH/ODPM Guidance: Preparing Older People’s Strategies. The Regional Housing Strategy seeks means to enable older people to remain in their own home for as long as possible, when they wish to. However, the Regional Housing Strategy notes that there are lower levels of preventative support in the region to help older people stay at home than in other parts of the country. Older people comprised the largest group served by services covered by Supporting People (66 per cent of places identified), provided mainly through a range of sheltered housing, very sheltered housing services, almshouses and community alarm services. The Supporting People Strategy noted that there were no specific services for older people in their own homes apart from Home Improvement Agency services. The importance of the services that Home Improvement Agencies can provide has been recognised, and a Home Improvement Agency sub-group within Suffolk Supporting People has been set up to carry forward the development of these services.

In terms of housing provision, a key response has been the development of Very Sheltered Housing over the county, reflected in strategies for the county such as Suffolk County Council’s Policy and Performance Plan, 2002/03. A number of Very Sheltered Schemes have been developed over the county, some with an Extra Care wing, to accommodate older people with particular needs within the buildings. Two of these schemes have Extra Care wings to accommodate older people who have dementia, whilst a third has accommodation for older people with functional mental health problems.

Pendle Borough

Pendle borough is located on the western edges of the Pennines, on the Lancashire Yorkshire borders. About three-quarters of the borough is designated as rural and about one-third of the population live in rural wards. A chain of 5 former mill towns running north to south – Brierfield, Nelson, Barrowfield, Colne, and Barnoldswick – are the main population centres. Nelson and Briersfield have significant Asian populations. The borough is the 15th most deprived in England. The former mill towns contain areas of high deprivation, with some of the worse housing deprivation in England, mainly former terraced houses built for 19th Century mill workers. The local housing market in these towns has virtually collapsed. Single Regeneration Budget and Housing Market Renewal Initiative funding has been directed to Nelson and Colne. In contrast, outside the Housing Market Renewal Initiative area, the housing market in the attractive rural villages, particularly those within easy access of motorways links to the North West urban conurbation, is buoyant. There is very limited new development in rural areas, high demand, and an under-supply of affordable housing.

44

Pendle Borough Council has recently produced a draft Pendle Rural Strategy 2004–2009. This provides a detailed profile of Pendle’s rural areas. Pendle Borough Council are also working on a Joint Older People’s Strategy, supported by the local PCT, social services and the voluntary sector (see case example later in this chapter). Pendle Borough Council has traditionally provided a whole raft of community services, over and above services on behalf of the County Council, acting as an agency for the county but also putting in its own resources.

In broad terms, Lancashire County Council’s strategy for older people aims to reduce long-term residential and nursing home admissions by the development of Extra Care Housing, intensive home care, and the provision of additional rehabilitation and intermediate care services.

Bromsgrove

The Bromsgrove district lies on the northern edge of Worcestershire. It was identified as a potential case study as it represents a relatively rural area with much green belt land on the edge of a large urban conurbation – Birmingham. It is not a physically large district. Its centre is the small town of Bromsgrove. It is relatively affluent, although there are small pockets of deprivation mainly in the more urban and suburban parts of the district. Property prices are among the highest in the county of Worcestershire. Local wages are low. Affordability is an issue, and council stock has been reduced by the Right to Buy. There is increasing pressure to develop new private sector housing as there is significant demand from outside the district. Bromsgrove is seen as an attractive place to live and is convenient for commuters from the West Midlands urban conurbation. Second homeownership and holiday lets are not an issue in Bromsgrove.

Bromsgrove District Council has very recently transferred its housing stock to a newly formed Housing Association. The transfer will allow the Council to focus on strategy development, including the development of an Older People’s Housing Strategy. A Housing Needs Survey has been conducted, but council officers recognised that there are limitations to these. Clearly there is a lot of demand for housing in rural areas, and this comes mainly from outside the district, but surveys could not identify needs in rural areas so the surveys make it difficult to prove that there are rural needs that cannot be met in other, more urban, parts of the district. There are a number of older people on the housing waiting list who want to move from rural areas to more urban areas around Bromsgrove so as to be able to access local services and facilities.

Approximately 30 per cent of the new Bromsgrove Housing Trust properties are sheltered housing units for older people (about 800 units), with an additional 100 bungalows designated as older people’s accommodation. The level of provision does vary across the district, although there are sheltered housing schemes located in some villages. Currently there is at least one warden based in each sheltered scheme. However, the service is moving towards mobile warden services. There is low demand for some sheltered housing

45

schemes, although schemes in rural areas are rarely difficult to let. Low demand is usually related to the size of the accommodation on offer (for example, bedsits and one-bedroom flats). First floor flats in particular are not popular. Flats are not as popular as bungalows. Two-bedroom bungalows, however, are always in demand. Location factors also come into play, for example, Withall on the western edge of the district, is closer to Birmingham and Solihull. People from other parts of Bromsgove do not want to move there, and people from Withall do not want to move to other parts of Bromsgrove. There are three Housing Trust sheltered schemes in Withall, and a voluntary sector scheme. Voids are usually managed by letting to people from outside the district from Birmingham or Solihull who are looking to move nearer family in Bromsgrove, and by letting to people in their 50s as opposed to those over 60. The Trust also has about 100 tenants who do not live in sheltered properties but have a life line service connecting them to a warden.

There are also growing numbers of private sector schemes for older people in the town of Bromsgrove. However, these are expensive with flats typically costing more than £160,000, and additional annual service charges.

Recently a bid was submitted to the Department of Health (DoH) for an Extra Care scheme in Bromsgrove itself, although the bid was unsuccessful. Council officers felt that there was sufficient sheltered housing to meet the needs of older people in the district, particularly if people were willing to move to more urban parts of the district (and some clearly are). However, as people are being supported in their own homes for longer with Community Alarms and other support services, when they do need to move they need a higher level of support than offered in existing sheltered housing schemes.

A recent needs survey identified that older homeowners do not want to move away from their house, or community, and want services to be delivered to them in their own homes, as opposed to council tenants who appear to be more likely to consider or request a transfer to a sheltered housing scheme.

There is currently no Home Improvement Agency serving the Bromsgrove area. However, the development of a Home Improvement Agency is seen as a priority, and a Home Improvement Agency is planned that will serve Bromsgrove and neighbouring districts. It is not clear where funding for the service will come from. There are concerns about older homeowners who cannot afford to maintain their properties, and are unwilling to release the equity in their properties. In a recent condition survey in the district, 16.3 per cent of properties measured as unfit were occupied by older owner-occupiers. Most commonly properties required significant repairs, such as a new roof, damp proofing, and heating. Although there is no Home Improvement Agency, Age Concern operates a minor repairs scheme in Bromsgrove with support from Worcestershire Social Services. One of the priorities of the new Home Improvement Agency will be assistance with discharge from hospital to allow people to return home more quickly from hospital.

46

Worcestershire Social Services have 3 commissioning priorities for older people’s services: intermediate care, home-based support and dementia care. Services were seen to be improving following a period of stagnation as a consequence of spending cuts made in the late 1990s. Older people services bore the brunt of these cuts. Home care is relatively underdeveloped compared to residential care. However, things are improving as evidenced by the Performance Indicator C32, which showed that in 2002/03 more that 7,000 people were assisted to live at home, compared to 4,400 in 2001/02. There has been increased investment in preventative services, and closer working with the voluntary sector. A high proportion of GPs have attached social workers across the county.

North Dorset District

North Dorset has two AONBs, Dorset Downs and Cranbourne Chase, in the South and East of the district. The Blackmore Vale is located in the west of the district. The district, and most of the county, has a very dispersed pattern of settlements and a relatively sparse population. Although there are five market towns in the district, comprising Blandford Forum, Gillingham, Shaftesbury, Stalbridge and Sturminster Newton, the last Countryside Agency indicator of urban and rural areas categorised the district as entirely rural. This factor perhaps reflects the high proportion of areas in Dorset which are classed as deprived in terms of access to services by the Index of Local Deprivation (DTLR, 2000). The accessibility measure in the Index of Local Deprivation takes into account access to the following services: post office, food shop, GP surgery and a primary school. In total, 15 wards in Dorset (including 3 in North Dorset) fall within the top 5 per cent most deprived wards in England in terms of access deprivation.

However, as a county, Dorset has experienced considerable population growth as a result of in-migration from other parts of the country. The growth rate of the county is the second highest of the English Shires. Dorset County Council (2002) pointed out that half the districts in Dorset are in the top 10 authorities with the greatest proportion of retired people (with North Dorset ranked 8th out of the 434 districts in the country). However, Dorset County Council also noted that people of retirement age have not been a significant feature of in-migration into the county. Instead, the greatest gains in population resulting from in-migration have been in the age groups 30-44 and 45-64. People tend to move prior to retirement age, and then remain in the county. It is this trend which has affected the age structure in Dorset.

House prices in North Dorset are significantly above the national average. Research by Wilcox (2003) showed that an adjacent district, Purbeck, had the worst affordability levels in the country outside of London. The impact of this housing market is having a knock-on effect on North Dorset, as people seek out relatively cheaper housing within the county. However, income levels are below the national average, and this presents particular difficulties for households as they try and compete for owner-occupied accommodation.

A key unmet need identified in the Dorset Supporting People Shadow Strategy (2002) was for floating support to older people in their own homes. Services are currently focused on

47

accommodation-based services, particularly traditional sheltered accommodation in the public sector, whereas there were no specialist floating support services for older people. In a part of the country where it is felt that there are high levels of owner-occupation, agencies have reported the need for housing-related support services geared to maintaining the independence of older people living in their own home (including low-key befriending, practical and emotional support short of personal care), no matter what their tenure.

A further emphasis is upon the provision of Extra Care, and addressing the dilemma of balancing the cost of providing these services across the district and meeting local needs in rural areas. A particular issue is that the small scale nature of schemes that are required in rural areas presents difficulties for agencies in terms of the costs of revenue-based services. The response to this issue in North Dorset has been to locate smaller Extra Care schemes in the four market towns in the district (two have been built already), and are then planning to offer a single contract for care services across all four to meet economies of scale required.

A key response in North Dorset district has been the development of an Older Persons Housing Strategy by a range of agencies. The objectives of the strategy are to:

• ensure necessary strategic partnerships and delivery mechanisms are in place; • reduce the number of people on low incomes who are living in unfit housing; • develop a range of housing options to meet informed choices.

The strategy notes that an important step towards effective delivery of the strategy is through improving the integration of services delivered at the local level by housing, social services and health authorities, and nationally through government departments. The Local Delivery Plan for North Dorset Primary Care Trust reiterates the necessity for effective multi-agency working to establish a joint housing strategy for older people in the district. As part of the development of a whole system approach, older people’s services have been set out in a strategy document The Primary Care Department of Elderly Care. This strategy covers most of the requirements of the National Service Framework for Older People and is being piloted in the Blandford locality, a market town in North Dorset, around the establishment of an intermediate care service.

Illustrating rural diversity

The profiles above demonstrate the differences and similarities between areas that might all be described in broad terms as rural. The age profiles of the population of each district clearly demonstrate that rural populations generally tend to have greater proportion of people aged 55 and over, and that the most significant differences between the proportions of older people living in rural and urban areas are to be found in the younger-old age group. Amongst our 5 case study areas, Bromsgrove – the most ‘suburban’ of the areas – provides the exception to this generalisation.

48

The data also indicated that rural older people are more likely to be homeowners than their urban peers, and this raises the question of whether this trend reflects broader changes in society towards greater homeownership, or simply that older people do not have the choice of tenure that might be available in urban settings. Again, there are differences between the districts in terms of the types of tenure of older people. For example, 81 per cent of the rural population aged 55+ in Scarborough district are owner-occupiers compared to 69 per cent of the urban population over 55+. In Bromsgrove, however, a slightly greater proportion of people aged 55+ are owner-occupiers in urban areas (87 per cent) than in rural areas (85.5 per cent). Similarly proportions of people who are living in the social rented sector are different between different areas. In North Dorset (where there are no urban wards), 12 per cent of the population aged 55+ live in the social rented sector. In Bromsgrove 10.3 per cent of people aged 55+ live in the social rented sector in rural areas compared to 8.6 per cent of older people in urban areas. In Waveney, Scarborough and Pendle, however, a greater proportion of older people in urban areas live in social rented housing compared to older people in rural areas. The biggest difference between urban and areas in terms of the social rented sector is in Scarborough where 9.3 per cent of rural older people live in social housing compared to 21.3 per cent of urban older people. This may be explained by a number of factors: the large geographical area covered by the district and the nature of its rural settlements (ie, small and dispersed over wide areas), making it difficult to site sheltered housing or other social housing where there is sufficient need to justify its development; the presence of a National Park which constrains any new development; and the traditional patterns of retirement to the seaside that has long characterised North Yorkshire’s coastal towns and created need in the more urban locations. Overall these data seem to indicate that social housing has developed in different ways in different rural areas in response to different local socio-economic and demographic factors. It is to be noted however, that although there are differences between the districts in terms of types of tenure, there are also significant differences within the districts in terms of tenure across different age bands, with a general tendency for the younger-old to be homeowners compared to those aged over 75. This could simply reflect increasing levels of homeownership in the younger generation, or the choice of moving to sheltered housing in later life.

Access to a car is also different across the districts. Of all the districts Scarborough had the largest proportion (21.5 per cent) of those aged 55+ living in rural wards with no access to a car, (rising to 40 per cent of those aged 75-84, and 67 per cent of those aged 85+). In comparison, in Bromsgrove 12.5 per cent of the population over 55 in rural wards had no access to a car (rising to 33.5 per cent of those aged 75-84, 53 per cent of those aged 85+). For all the districts, the proportion of those with no access to a car unsurprisingly increased sharply in the later age groups – but there was still a difference between districts.

House prices in the case study areas

Table 3.1 shows the difference in house prices between urban and rural parts of the case study areas. The list is indicative of the differences within the case study areas, rather than

49

definitive, because boundary changes to some wards since the Countryside Agency indicator of rural and urban wards was produced has meant that not all wards could be included in the analysis. Nevertheless, the table shows that house prices were much higher in the rural parts of all five case study areas.

Table 3.1

Mean dwelling price in urban and rural wards by local authority, 2001

Urban wards Rural wards

Bromsgrove £116,585 £147,211

North Dorset – £136,888

Pendle £45,507 £72,590

Scarborough £60,190 £89,106

Waveney £54,092 £90,103 Source: Land Registry

Differences in house prices could be quite stark within individual case study areas. In Pendle, East Lancashire, parts of the urban areas such as Nelson and Colne have suffered with an oversupply of terraced properties, many in private ownership and a local collapse of the localised housing market. These areas have attracted Single Regeneration Budget monies and Housing Market Renewal Pathfinder status to help boost their housing markets. In contrast, it was felt that the housing market in the adjacent rural areas had remained buoyant, causing difficulties for many households because the area has a low wage economy. The average price in the urban parts of this district was £45,507, compared with £72,590 in the rural areas of Pendle. Indeed, there could be very wide variations in prices within the district. For example, the average house price in one urban ward, Whitefield, was £17,221, compared with the rural area of Pendleside, where the average cost of a house was £129,497.

A similar situation was apparent in Waveney. As has been noted, this district is characterised by very wide variations in its social and economic profile and this is reflected in the way that house prices vary over the area. The average price of a home in Harbour ward, in Lowestoft, was £43,755 in 2001. Yet a few miles down the coast, the average price of a property in Southwold was £149,940.

Whilst house price information at ward level is drawn from Land Registry information for 2001, significant changes have taken place in house prices since that date. Table 3.2 illustrates these changes, looking at how house prices have changed between the last quarter of 2001 and the last quarter of 2003. This table allows us to look at the more recent changes that have taken place in the case study areas, but needs to be treated with some caution. The data are only drawn from a single quarter in each year and, therefore, may be subject to untypical fluctuations in sales. In particular, no account has been taken of the mix of dwelling types which have been sold, which could also affect the average price.

50

Nevertheless, the table shows quite large increases in house prices across the case study areas over this 2-year period, with Scarborough and Waveney witnessing the most significant increases, at 55 per cent and 53 per cent respectively. All 5 areas have seen price rises which were higher than the average for England as a whole, which was 36 per cent over the same period.

Table 3.2

Change in mean dwelling price by local authority, final quarter 2001 – final quarter 2003

Oct – Dec 2001 Oct – Dec 2003 % Rise

Bromsgrove 146,676 204,057 39

North Dorset 135,786 194,384 43

Pendle 50,639 70,585 39

Scarborough 79,567 123,125 55

Waveney 84,889 128,868 52

England & Wales 120,056 163,584 36 Source: Land Registry

Summary

Older people comprise a higher proportion of the population in rural areas than in urban areas of England. Nearly 1 in 3 people in rural areas are aged 55 and over, compared to 1 in 4 people living in urban areas.

A greater proportion of older people are owner-occupiers in the countryside than in urban areas. In total, 81 per cent of people aged over 55 own their own home compared with 73 per cent in urban areas. However, the proportion of people who own their own home drops with age. In total, 86 per cent of people aged between 55 and 59 are homeowners in rural areas compared with 69 per cent of people aged 85 and over. Conversely, the proportion of people renting from social landlords increases with age.

However, the proportion of older people in social rented accommodation in rural areas (11 per cent) is far lower than the proportion of older people who rent from social landlords in urban areas (21 per cent). Given the preferences for people to remain living in their own homes, and the costs of building new affordable housing, greater attention is required on supporting ways for people to continue living in their homes where they would prefer to do so.

At a more local level, housing options in relation to tenure varied quite considerably between the five case study areas. Overall the data indicated that social housing has developed in different ways in different rural areas, in response to different local socio-economic and demographic factors. It is to be noted, however, that although there are differences between

51

the case study districts in terms of types of tenure, there are also significant differences within the districts in terms of tenure between urban and rural areas. A further difference was apparent in relation to tenure across different age bands, with a general tendency for the younger-old to be homeowners compared to those aged over 75. However, it was not clear if this trend reflected broader shifts in society towards greater homeownership, or a preference in later life for housing options within the social rented sector.

Results from the English House Condition Survey, 2001 indicate that the mean costs of repairs to make dwellings decent in rural residential areas are relatively low, compared with other types of area. Further, a low median figure for non-decent properties in villages and isolated rural areas suggests that a proportion of these could be brought up to decent standard relatively cheaply.

Analysis of the 2001 SEH showed that compared with younger age groups, older people tended to demonstrate considerable satisfaction with both their homes and the area in which they lived. These levels of satisfaction pointed towards a commitment to home and neighbourhood, which supports a policy emphasis upon promoting independent living.

The averages point towards difficulties experienced by a proportion of older people across a range of different aspects of daily living. However, the results from the tables do suggest that overall averages were masking a considerable diversity of experience amongst older people.

Levels of satisfaction with home and neighbourhood were not necessarily translated into views on access to services and facilities. Households with people aged 75 and over were much more likely to report difficulties in getting to a range of local services. Perhaps what was surprising was the level of similarity between urban and rural areas in the SEH, particularly in relation to households’ experience of accessibility to services and facilities.

52

53

Chapter four Meeting the housing and support needs of older people: local responses

Introduction

This chapter details the outcomes of the interviews, supported by information from the various documents retrieved from the internet, or from the informants themselves. The first part of the chapter draws on interviews with provider agencies and supporting documentation; the findings regarding the housing and support needs of older people in rural areas are then considered. The particular challenges for service providers in rural areas identified by our informants and service providers’ responses are then outlined. Finally, there is a discussion of the outcomes and key points arising from this element of the project.

A total of 57 semi-structured telephone interviews were conducted with key informants in different agencies (both statutory and voluntary sector) who were engaged in commissioning and delivering a range of housing and support services to older people in each area. An example of an interview schedule is presented in Appendix 7. Those interviewed included: senior planners and service managers from within Supporting People teams, social services, housing departments and housing associations; members of parish councils; Rural Housing Enablers or Development Workers; managers of Home Improvements Agencies; Older People’s Lead Officers within Primary Care Trusts (PCTs); and voluntary sector service providers. As the work progressed it became clear that the views of private sector care providers and information regarding the private housing market would be useful. Two additional interviews were therefore conducted with one of the major independent care providers in one county and with one estate agent.

Additional data were also drawn from local housing and social service strategies, and commissioning plans, previously conducted surveys and consultations with key groups. These data were used to profile different patterns of need, and examine the factors that influence these patterns.

It is important to note that the project was not intended to evaluate or compare services in different areas. The intention was more to highlight common themes identified by a variety of agencies in different rural areas and to identify what were felt to be the major influences on, and challenges, to rural service providers and commissioners. A list of participating agencies is presented in Appendix 8.

54

Rural needs

This part of the chapter aims to highlight the characteristics of needs in rural areas with a particular focus upon how living in a rural area shapes the needs that older people experience. As part of this agencies and organisations were asked for their views on the characteristics of the needs of older people in rural areas. The following section considers:

• the nature of needs in rural areas;

• the way that needs are identified by agencies;

• providers’ views on the particular needs of different constituencies of older people;

• providers’ perceptions of the concerns of older people in rural areas.

Needs in rural areas

A significant characteristic of rural areas is the way that, unlike in many urban areas, households on low incomes are dispersed geographically so that total numbers in any one location are likely to be quite small. Furthermore, since rich and poor on the whole live in close proximity, measures of wealth and income based on averages tends to mask those households on low incomes. Whilst there is a huge diversity in the levels of wealth and income between older people, research has highlighted that a greater proportion of older people are likely to experience low incomes in rural areas (Shucksmith, 2000).

Linked to this issue is the proportion of older people who are asset rich but income poor. Central Government has not been slow to try and identify ways of encouraging people to unlock this capital through equity release schemes or loans. A number of respondents highlighted the unpopularity of these measures; there was a sense that the argument had yet to be won to convince people to take up these options, as they would result not only in giving up a legacy for their children, but also potentially compromising their most significant means of continuing independence. However, one way that a number of older people have used to release capital is by moving into schemes offering Shared Ownership, as the following case example illustrates.

55

The concept of leasehold Extra Care housing in rural areas is not well developed because there are no economies of scale to attract private developers, and because of the high level of care costs for small schemes. However, there are examples of a number of diverse approaches by nursing and residential home providers who have developed leasehold Extra Care or close care apartments and bungalows in rural areas. An example of Extra Care in a rural setting is provided below.

CASE EXAMPLE: THE WESTMINSTER, PRESTBURY, MACCLESFIELD, CHESHIRE

Tenure: Leasehold.

Size: 27 single story apartments and bungalows. 1 and 2-bedroom.

Development: The bungalows are built in small clusters around three courtyards. The apartments are attached to but quite separate from the nursing home.

Facilities: Lounge, guest facilities, garden, restaurant.

Services: On-site care staff and community alarm service.

Attached care 35 beds. Registered to provide personal care with nursing.

home:

Accessibility: 0.5 miles from Prestbury, 4 miles from Macclesfield. Shops, GP, post office, etc, in Prestbury. Very poor public transport but residents have access to in-house transport provided by and bookable through the scheme management.

CASE EXAMPLE: APPLEBY, CUMBRIA – HOME HOUSING ASSOCIATON

As part of a development in Appleby, Home Housing Association developed 14 bungalows on a Shared Ownership basis for people aged 55 and over. The initial need for housing for older people was identified by the local authority, whilst subsequent phases of the development have been down to high levels of demand for this accommodation. Whilst bungalows can be seen as a land hungry and an expensive solution to meeting housing needs, they have proved very popular with residents. So much so, that another phase to the development is planned with a mix of properties for Shared Ownership for people aged over 55, and also first time buyers.

One reason for the popularity of the scheme is the additional choice that it has been able to offer residents in this predominantly rural area in terms of meeting their various housing needs. Some residents have moved from smaller villages and hamlets in order to be nearer services and facilities. Other residents have viewed the development as an opportunity to either move back to the area to be near family, or to remain in the same locality as family and friends. A number of residents have also moved out of larger properties, releasing equity to provide additional resources for their retirement.

Another reason for the popularity is that the housing association has a management agreement to undertake external works to the properties and also maintenance of communal landscape areas, providing reassurance for residents in return for a service charge and management fee. Allied to this is the personal safety offered by the scheme, both in terms of security arrangements and a care line linked to a local call centre.

56

CASE EXAMPLE: BARN PARK GARDENS, BEAWORTHY DEVON

Tenure: Leasehold.

Size: 8 bungalows and houses, all 2 bedroom, including wheelchair and mobility standard properties.

Development: Close care accommodation is in the grounds of the care home.

Facilities: N/A.

Services: On-site care staff.

Attached 22 beds. Registered to provide personal care.

care home:

Accessibility: 8 miles from Holdsworthy, 11 miles from Okehampton. Public transport is very poor. Schememanagement provide a limited transport service and residents also have access to local ‘ring & ride’ transport, and transport provided by a local day centre.

CASE EXAMPLE: THE COURTYARD, SUTTON VENY HOUSE, WARMINSTER, WILTSHIRE

Tenure: Leasehold.

Size: 5 bungalows 1 and 2-bedroom. Includes mobility standard and wheelchair properties.

Development: A ‘village’ setting in the 25 acre grounds of a Grade 2 listed country house, with village green and duck pond.

Facilities: Lounge, laundry, garden.

Services: On-site care staff 24/7 and community alarm service.

Attached 28 beds. Registered to provide personal care with nursing.

care home:

Accessibility: 4 miles from Warminster. Shop, post office, social centre and GP are all 2 miles away. Bus stop at the entrance to the site.

57

Identifying need

Part of this chapter aims to set out providers’ views on the nature and extent of the needs of older people in rural areas. In particular, the intention was to explore with providers their views on the methods of uncovering and assessing needs in rural areas, and how far needs may remain hidden. The overall perception was that providers felt they have a fair understanding of the type of needs that people face, and where the gaps are in service provision, but that there continues to be a poor identification of the numbers involved in rural areas. One reason for the view that there continues to be difficulties surrounding pinning down numbers of people in need in rural areas was connected to methods of identifying need, collecting and interpreting data.

There is concern that indicators of need inadequately reflect the experience of need in rural areas compared with urban areas. Concerns have been raised about a range of measures including the Index of Multiple Deprivation (Noble and Wright, 2000), and housing need and affordability. North Dorset Primary Care Trust have drawn attention to the limited knowledge of the way that rurality impacts upon health. Furthermore, traditional indices of health-based on urban models may give a false impression of the health of the population in rural areas (North Dorset Primary Care Trust, 2003).

Large scale surveys are useful at the strategic level, but are quite blunt instruments for identifying rural needs. Respondents noted that district-wide housing needs surveys provided a helpful overall assessment of need, but usually could not be disaggregated to the level of individual rural settlements.

One feature of needs assessment was the extent to which it was demand led, recording numbers of people coming forward for services or from referrals. However, Oldman (2002) highlighted the extent to which needs in rural areas remain stubbornly hidden. A reason noted in the case study areas by agencies was a sense that people are less likely to come forward to ask for services. This seems to be tied up with the perception that older people in rural communities are more likely to make do, or struggle on, than younger people. In part, it was felt that such stoicism reflected an attitude that older people are from a generation that get on with life rather than expecting help from statutory services, and accept, or at least are used to, a way of life without services and facilities that others would feel are essential. Further, it was felt that people in some rural communities have lived in a culture of independence and of not asking for outside help, particularly amongst farming communities. Suffolk has established a Special Needs Housing Register to facilitate the continuous recording of individual needs across a range of sources as one means of identifying and measuring needs. However, it has become apparent that using this method has not thus far proved a useful way of uncovering the needs of older people, partly, it was suggested, because older people are less inclined to put themselves forward for help.

There was also a sense that there is a stigma associated with being seen to be taking up welfare, and a sense that people are very concerned to retain their dignity and privacy

58

amongst their peers and within the public eye. There is a danger that such needs remain hidden and unrecorded, or that service responses are not sensitive to the concern of people for privacy.

In particular, there was a feeling that there was a stigma surrounding social services departments, but it was felt that this was more linked with the perception that once social services are involved, a person’s independence will be compromised. In part, this view may stem from the feeling that once people have expressed a need, they may lose control over the decision-making process, and that since housing options are so limited in rural areas, then they may be steered towards accommodation that they do not really want, such as residential care some distance from their home. In some ways it was felt that Home Improvement Agencies and voluntary organisations (even if actually funded by social services), had an important role to play in this respect since they do not have the baggage (unfairly) associated with social services. Further, there is the issue of how far services need to raise awareness to help public perception to catch up with the broadening options available to older people around being able to continue living in their own home or Extra Care housing. This latter point also reflects lack of adequate sources of advice and information for older people, particularly for people who are very isolated.

Other reasons for not articulating need are because people lack knowledge about the services that are available. Also people see little point in asking for services that are available to such a limited extent in rural areas. One example is for social rented accommodation, where re-lets or new build is so rare in individual rural communities, that people do not bother applying (ACC, 1989). A concern here is if waiting list information is used as evidence of need, then this form of needs assessment reflects the pattern of existing supply, rather than unmet need. Commentators have noted the tendency for households to come forward in villages whenever they hear of a vacancy, revealing a formerly hidden need for accommodation in a rural community and its environs. Indeed, the Housing Corporation expect evidence to be drawn from small scale housing needs surveys in considering the development of affordable housing under the special rural programme in settlements below 3,000 population. There is an increasing emphasis upon methodologies based upon the analysis of local housing markets. It might be worth exploring the nature of housing needs in rural areas in districts which use choice-based lettings to see how far they reveal a different pattern of housing preferences compared with waiting lists that use points systems.

This issue also highlights the important work of local communities, parish councils and rural housing enablers in helping to put forward the housing needs of people in rural areas as an alternative measure of need. The following example illustrates one approach taken in North Yorkshire to needs assessment by communities themselves. The time and commitment required to develop this level of assessment should not be underestimated, but the example highlights the drive of this group to acquire the hard evidence to support attempts to meet the needs of older people in rural areas.

59

However, whilst the process of identifying needs and working with communities and agencies by rural housing enablers has become part of an institutionally accepted and agreed formula for tackling the development of affordable housing, the type of needs which will be met is still perhaps contested. The focus of the Housing Corporation’s rural programme on family-sized units in previous years has been recognised by that organisation (Housing Corporation, 2001). One of the Rural Housing Enablers noted some resistance to the idea of bungalows by a local social housing provider, who tend not to favour the development of single storey properties. This suggests that even if needs are quantified and set out in a very detailed way, there may still be resistance on the part of agencies at local or national level to meeting these needs. Competing claims on very limited resources is a fact of life, but it may be worth exploring the evidence base behind the decision-making of commissioners and providers.

There are many examples of mixed developments by housing associations, with, for example, a couple of bungalows as part of a development of half a dozen properties in villages. Discussions with older people as part of previous research highlight the way in which such small-scale developments can have an important role in enabling older people to continue living in rural communities. For instance, one couple noted that their new home provided the only option for them to remain living in a village where they had spent the last 40 years, since they had been compelled to move out of tied accommodation upon reaching the age of retirement. Furthermore, such developments can enable extended families to retain or re-establish social networks.

To a certain extent, detailed needs assessment was something that agencies were about to embark upon. There was a feeling of ‘watch this space’, in this respect, with Supporting People Teams gearing up to undertake needs assessment.

CASE EXAMPLE: ABBEYFIELD ESKMOORS SOCIETY

Based in the Upper Esk Valley, a sparsely populated area of approximately 60 square miles in the North York Moors National Park, the Abbeyfield Eskmoors Society (originally called the Esk Moors Action for the Elderly) was formed in 1999 by a group of local people who were concerned about the lack of local services for older people. Discovering there were no local data to indicate the level of needs in the area to support the development of local services, the group first carried out their own small scale needs survey with the assistance of Help the Aged, and were then successful in obtaining financial support from a number of local agencies including North Yorkshire Social Services, Help the Aged, and Yorkshire Forward (the Regional Development Agency) to commission a survey of the needs of older people in the Esk Valley.

The survey of the needs of older people was undertaken by Whitby Disablement Action Group. The project aimed to collect information about the circumstances and needs of everyone over 60 in the Upper Esk Valley. The preferred method of data collection was face-to-face interview. A wide variety of methods were adopted to make contact with all individuals over 60, estimated to be approximately 565. Over a 12-month period, the research team interviewed 436 people (77%). The report of the survey Sixty Years Plus in Moorland Yorkshire provides a detailed account of the needs of older people in the area.

The findings of the needs survey have enabled a care plan for the older people of the Esk Valley to be drawn up which includes an Abbeyfield Sheltered Housing Scheme, a day centre and additional home care services. The National Park have given planning permission for a new sheltered housing scheme to be built; it is the largest development the National Park has ever permitted. However, there have been difficulties in securing funding from the Housing Corporation and from the Supporting People Fund.

60

Housing opportunities in rural areas – affordable housing and suitable properties?

Affordability

Affordability problems are often presented in relation to the difficulties faced by groups in rural areas other than older people. For example, the recent press release by the ODPM (2005) detailing changes to the planning system makes reference to the role of affordable housing for key workers and young people.

As has been noted earlier in the chapter, affordability was a difficulty in all the rural areas across the case studies. In all the case studies, comments were made about increasingly pressurised rural housing markets as commuters seem prepared to travel greater distances to work. This impact was not only related to areas close to large urban centres such as Bromsgrove, but also more remote areas such as Waveney and North Yorkshire. Other research has also emphasised the significant role of people retiring into rural areas and the impact of this trend on affordability (Blenkinship, 2004; Tewdwr-Jones et al, 2002; Shucksmith et al, 1995). Shucksmith et al (1995) presented a classification of rural housing markets, identifying rural areas in 1991 that experienced particular pressure from retirement migration. Comparing the results of the classification by Shucksmith et al (1995) with the five case study areas revealed the significant role retirement migration in these areas. Certainly in North Yorkshire there was a view that of the strength of demand from older people in the private sector was helping to drive localised housing markets in rural areas. This point was also highlighted by research in Cumbria, which noted the important role played by older people in the housing markets in the case study areas of this project, particularly in relation to in-migration from other localities where properties were more expensive (Blenkinship and Gibbons, 2004). Furthermore, Blenkinship’s detailed research of a number of communities in Cumbria noted that there was some resentment felt by residents towards people who had retired into these communities, as the nature of these communities had been significantly altered (Blenkinship, 2004). However, the impact of retirement migration on affordability also illustrates the complexity of the issues affecting older people in the countryside, since older people on lower incomes and who do not own their own homes will also be adversely affected by these trends. One issue that was outside the scope of this research was to quantify the extent to which older people were being priced out of rural markets.

Condition

There were concerns about the extent to which services were tackling the needs of older homeowners in relation to the condition of their properties in the case study areas. A significant constraint was the extent to which a proportion of older properties may be virtually unadaptable, compelling people to move to meet their needs. However, the vital contribution of Home Improvement Agencies was recognised, as it was felt that where such organisations did not exist, then the needs of older people were not being picked up elsewhere. A further difficulty was the condition of a high proportion of privately rented

61

accommodation. A couple of respondents in North Dorset, in particular, highlighted the poor condition of tied accommodation.

A key issue here is how older people are able to provide for themselves in a safe way and much discussion has taken place about how to facilitate methods of equity release that can be relied upon by older people. An example of one way of helping people to afford repairs and maintenance is through low interest loans. Art Homes Ltd in the West Midlands works in partnership with local authorities and private lenders to offer affordable loans to low income homeowners for repairs and improvements. It offers a number of products, including a property appreciation loan (where a fixed share of property equity is taken) and an Islamic loan, as well as traditional repayment and ‘interest only’ loans.

Supply of properties

There was an issue about the volume of properties for sale noted in the case study areas, and not just in relation to the size of the demand from house buyers. To take the example of North York Moors National Park, this area has seen not only a rapid growth in house prices in the last couple of years, but also a dwindling supply of properties coming onto the market. In 1991, there were about 400 properties for sale. In 2003, there were 80.

Also of significance was the type of properties coming onto the market. A recurring theme from respondents was the popularity of bungalows in the case study areas, but the profile of the housing stock in many rural areas limits the ability of older households to exercise this choice in the market place.

In North Yorkshire there was the suggestion of forward planning by older householders in the market, with bungalows being snapped up, particularly in larger rural settlements with easier access to services and facilities. However, in terms of market response in this part of North Yorkshire it was noted that whilst bungalow development by private developers tended to feature in the 1970s, recent developments have moved away from this type of property. Planning Policy Guidance 3 (PPG3) has noted the importance of achieving a mix of property types on new developments, but one respondent felt that PPG3 tended to work against bungalow development, since it was difficult to attain a sufficient density of accommodation with this type of property.

A couple of respondents in housing departments also noted the popularity of bungalows in the public sector, not only in terms of the rate at which bungalows shifted when vacancies came available, but also in relation to responses to surveys of housing need and consultation exercises in parishes linked with, for example, the development of the Housing Strategy Statement. A housing needs study completed in Waveney in 2000 found that the main demand from households seeking to move in the next five years was for bungalows, followed by semi-detached and detached properties.

62

Difficulties with supply were also apparent in the public sector, with respondents highlighting the impact of Right To Buy in depleting the amount of property available to rent in rural areas. However, one case study area noted that by rejecting applications for tenants to exercise the Right To Buy for bungalows, this area had managed to preserve a reasonable supply of bungalows for future generations.

The case study areas also noted that building programmes in previous decades had secured a good supply of sheltered housing across many areas, both urban and rural. However, changing aspirations and lifestyles meant that a considerable proportion of this stock was becoming increasingly unpopular. There were mixed views on the conclusions to be drawn from hard to let sheltered properties in rural locations, in relation to the extent to which the property itself was unpopular due to its size and number of bedrooms available, or the location. An example of one way of developing a flexible response to housing needs in rural areas is provided by a project based in Horam, Sussex, which is a pilot study, funded by the Housing Corporation as an Innovation and Good Practice project, to develop a Village Resource Centre. The project aims to develop a co-ordinated service between housing, health and social care within a small rural community so that residents can continue to live in the community rather than having to move elsewhere.

It is not just the case, therefore, that older people have limited options in relation to housing in the public sector. Even if households have the means to readily afford market property, the stock available in smaller rural communities can preclude being able to exercise choice in relation to housing options for later life.

Therefore, in the context of an ageing society the most worrying aspect of this trend is that we are storing up difficulties for the future, by continuing to develop a stock profile that is not responsive to the growing needs of older people. Whilst it is the case that the needs of older people are the focus of considerable attention in terms of schemes such as Extra Care, and the preventative agenda, which aims to foster greater independence across all tenures, perhaps there is still a need to take a wider look at the current trajectory of all new build in both private and public sectors in terms of the type of property being developed.

A difficulty here is the low amount of new development in rural areas, with the consequent limited ability for policy to significantly influence the balance of property types into the future. Local Plans tend to emphasise that most new build in villages is focused on infill only, with virtually no development at all in the smallest communities. Thus future needs run up against current competition in the private market to satisfy demand for large family-sized properties. They also run contrary to environmental considerations and sustainability measures applied in the public sector to steer development away from the smaller communities. One respondent noted the difficulty of presenting a convincing case for the development of housing for older people in a rural community:

“The numbers are stacked against us. People pay lip service to the idea that we ought to provide better services for rural populations but when the

63

numbers start being put down on paper they shrink away. The scale of what we’re doing is going to be smaller – to be in keeping with our surroundings it’s got to be smaller – the national park think the building we want to put up in _____ is the biggest thing they’ve ever given planning permission for in their whole existence, and they’re probably right. The Housing Corporation think it’s the smallest thing they’ve ever grant aided and they’re right too. We respect both of them. Both have got to make a little bit of compromise if we are to make any progress.”

Greater emphasis needs to be placed on ensuring that new build can meet the needs and aspirations of older people in the future. Since October 25, 1999, Part M of the Building Regulations has required that house builders construct new housing to standards that permit disabled people, particularly wheelchair users and those with mobility or ambulant impairments, to visit a house and have access to a ground floor living space and toilet. It also seeks to enable occupiers to cope better with any reduction in their mobility. Whilst the changes to Part M of the building regulations have gone some way to improving access to new build, careful consideration is needed to make new housing as accessible and adaptable as possible to meet changing needs. Given the small likelihood of further new build in the immediate future, if new housing built in rural communities fails to incorporate these factors, then an opportunity has been lost for these communities.

One issue about the development of affordable housing on exceptions sites is that since they have to be outside of the Local Plan, they are more likely to be in less accessible locations on the edges of settlements. Ironically, this perpetuates the historic tendency seen in some villages for council properties in the 20th Century to be built away from village cores, for whatever reason. This issue is not just confined to exceptions sites. One parish councillor noted with regret that developers of executive style houses had snapped up development land in the centre of their village, whilst land potentially available for affordable housing was some distance from the centre of the village. Anybody with limited personal mobility would have to negotiate a journey along a road without a pavement.

Social capital and volunteering in the countryside

Le Mesurier (2003b) has emphasised the crucial role that older people play in rural areas, in relation to taking an active role in community groups or voluntary organisations. Voluntary organisations in the case study areas also highlighted this view, noting the vital importance of older people who volunteer their time.

Agencies also indicated the significance of voluntary organisations in providing schemes for older people specifically, who tend to be the beneficiaries of such activity. This relates not only to projects focused upon older people, obviously, but also more generic schemes such as community transport. Funding from agencies such as Social Services, PCTs, the Countryside Agency, Lottery funds, charitable trusts and others helped to facilitate voluntary

64

activity across the case study areas in order to provide the crucial low-level support services which are a key component of the preventative agenda.

Nevertheless, the view that rural communities look after ‘their own’ has been challenged as being largely a myth (Oldman, 2002). There is an issue here about not confusing communities of geography with communities of identity. Any settlement will have a range of networks and communities, with some groups of people highly connected socially, whilst others in the same community can be isolated, either through choice or adverse circumstance. Thus, whilst rural communities are traditionally associated with strong supportive networks, this perception can hinder the development of new self-help schemes, as there may be a view that needs are already catered for. A Rural Community Council in one case study area is concerned with breaking down this assumption, using evidence from village appraisals to encourage the development of good neighbour schemes.

How well do services meet the needs of older people in rural areas?

All respondents were asked whether there were any particular groups of older people who were cause for concern, or particular types of services that were lacking. A number of groups of older people were consistently reported to be poorly served.

Older people with mental health problems

Very few respondents felt that the needs of older people with mental health problems were being met, and particularly older people with dementia-type illnesses. In spite of Standard Seven of the National Service Framework for Older People, devoted to the mental health of older people, it was felt that this National Service Framework had still not given sufficient coverage to older people’s mental health services, neither was there a National Service Framework for Older People’s Mental Health (unlike for younger adults). Consequently there were not the targets and consequent funding to fully address the mental health needs of older people. Staffing difficulties were a concern (see below) and it was noted there were inadequate numbers of staff trained and experienced to work with people with mental health problems. Further difficulties in delivering services to address mental health problems in rural areas have been identified in recent work by MIND (2003) who produced a rural policy toolkit to support the development of mental health services in rural areas. This toolkit also highlights the needs of older people. Further, the Housing and Older People Development Group are producing a fact sheet on Housing Options for Older People with Mental Health Problems. An example of ensuring that rural issues are given necessary attention within policy can also be seen in the report that MIND has produced, rural proofing the National Service Framework for Mental Health (see Elder, 2004). As an organisation, MIND has also ensured that its rural work is being integrated with its core activities.

Most respondents recognised that there were serious shortcomings in services for people with dementia across all the case study areas. Many respondents questioned whether Extra Care Housing schemes would be able to accommodate many people with dementia. Neither

65

was it felt that intensive domiciliary care services could adequately support people with dementia in their own homes. New technologies offered some solutions but more in terms of surveillance, for example, sensors to detect whether someone had opened their front door and left the house. There were mixed views as to how best to help people with dementia, whether it was best to support people in their own familiar environment or to introduce them more gradually to other settings so any future transition to a care setting would be more easily managed.

However, there were a number of examples where services in the case studies, and also elsewhere, were addressing this problem and increasingly, authorities are looking to develop a range of services to increase the options available for people with dementia and their carers – a scheme in Morecambe Bay, Lancashire has been promoted by DoH as being a model scheme. One issue is that whilst Extra Care Housing is seen as a viable alternative to residential care for older people with physical disabilities or medical conditions, the position is less clear cut for older people with dementia. Three main service models are evolving:

• Extra Care/very sheltered housing; • independent living models; • multi-purpose resource centre models.

One example of an Extra Care Housing scheme is located in Brandon, Suffolk, which has an ‘extra-care’ wing – eight flats grouped on one wing – for people with dementia. Tenants who have come to live in the scheme have had mild to moderate dementia at the time of allocation. A longer period of residence is necessary before firm conclusions can be reached over how long people will be able to age in place if/when their dementia becomes more serious. The manager reports that tenants in the ‘extra-care’ flats and other tenants mix well, with all tenants using the communal lounges for activities and events. Policies on risk-taking and protocols on wandering have been worked on with older people, carers, families and members of the local community. The manager describes a range of positive relationships with colleagues in social care, GPs, district nurses, psychiatric nurses and local psychogeriatricians.

Smaller more domestic scale models are also emerging, as illustrated in the case example below on the Dementia Care Partnership. Although this example is based in an urban area, the model may well offer potential for rural areas. However, there are likely to be higher costs because of the smaller scale of the scheme.

66

CASE EXAMPLE: INDEPENDENT LIVING HOUSES FOR PEOPLE WITH DEMENTIA: DEMENTIA CARE

PARTNERSHIP (DCP)

DCP is a carer-led voluntary organisation based in Newcastle upon Tyne in England. It was set up when family carers of people with dementia were not happy with the existing service models. They wished to develop other approaches which they felt were more responsive to people with dementia and their carers. DCP started to provide support and care services into the home, using locally-based small teams of carers who offered a very individualised service, based around the expressed needs and wishes of the family carer and person with dementia. However, in some cases it was no longer possible to support the person at home, though family members were reluctant to see their relatives with dementia go into what they saw as large impersonal residential care or nursing homes

DCP therefore started small independent living houses, using ordinary houses and bungalows in the community, for people with dementia who would otherwise be in institutional care. People with dementia were matched with each other in small groups of between three and five, depending on the size of the building. Buildings were adapted if necessary. For example, by putting a walk-in shower in the bathroom, or putting a stair lift in.

The service model is one of normalisation. This is achieved through living in ordinary forms of housing, and through recreating as many aspects of normal living as possible. For example, going out to a bar or the cinema, helping with food preparation and cooking. This is seen as easier to achieve within a domestic setting than in larger group living models. DCP has developed the PEACH philosophy which is at the heart of its approach: P = PERSON AND PARTNERSHIP E = EMPOWERMENT AND EMPLOYMENT A = ATTACHMENT, ATTITUDE AND APPROACH C = CONTROL, CHOICE AND CONTINUITY H = HOME FOR LIFE The model is very popular amongst tenants for whom it offers:

• an alternative to residential care for people who want to share a house which offers friendship andcompanionship, private space and communal facilities;

• security of tenure and a commitment, unless there is challenging behaviour which affects the group, to a home for life;

• involvement in decision-making about day-to-day living and the retention of community links;

• very personalised care, support and supervision by staff on a 24-hour basis, with a staff ratio of 1:2 or 1:3, which, within the domestic scale environment provided, results in improved mental and physical well being, quality of life and family relationships.

The model is also very popular among family carers, who can maintain relationships and remain involved with the care, whilst being relieved of the main burden of care. It is also popular amongst staff, reflected in the fact that staff turnover is very low. DCP now runs 6 houses providing some 30 places, one of which is for younger people with dementia. Further houses are planned, grouping a number of bungalows on the same site in order to achieve economies of scale without losing the independent living philosophy.

A further way of helping older people with dementia to continue living in rural communities is provided by day centres which are focused on meeting the needs of dementia sufferers in rural areas, such as the Community Dementia Service provided by Age Concern in Northumberland.

67

This servisupport foAmble anstrong link

The centrhome, moaim to protheir placesupport todistancesbased in o

Older hom

The 2001homeownfew servithem withrich but inwindows.people. Efinding a cheated. their servthere was

Althoughany tenurcould be

This poincommentno longerstuck within public (2002) noprojects bpoint wasTransitiongroups otresponsewas a gaaccommo

CASE EXAMPLE: COMMUNITY DEMENTIA SERVICE, DAY CARE. AGE CONCERN, NORTHUMBERLAND

ce is specifically designed for dementia sufferers living in the community and also equally as a r their carers. One centre is based in Norham, just outside Berwick, and two others are based in d Warkworth. The project is supported in partnership with Northumberland Social Services, with s with health and the Alzheimers Society.

e offers 10 places specifically for people diagnosed as having dementia. Transport to and from rning tea, lunch and afternoon refreshments are provided at a minimal daily charge. The centres vide a person-centred service and to enable people to be part of the social setting, helping to retain in the community, yet in turn promote independence and self worth by providing the necessary build on strengths and minimise weakness. One difficulty faced by the project is the large that people have to travel in rural Northumberland and an ideal would be to establish satellites ther rural communities.

eowners

Census data indicate a larger proportion of the older population in rural areas are ers compared to urban areas. Older homeowners were also noted to have very

ces apart from Home Improvement Agencies (where these were in place) to assist maintaining their homes. Respondents referred to older people who were asset come poor, and unable to afford essential maintenance or to install heating or new It seemed that equity release schemes were not widely favoured by many older ven when people could afford repairs it was felt that many needed assistance with reliable builder or other tradesman to undertake the work and were fearful of being All the Home Improvement Agencies interviewed were cautious about publicising ices too widely as they could only cope with certain levels of demand. They felt considerable unmet need for these services.

many areas offered an emergency call/community alarm service to older people in e, it was felt that many of the warden services provided by Housing Associations extended to include older homeowners, rather than just tenants.

t highlighted the recognition of the need for floating support. One respondent ed that the models of housing provision which had been developed in the past were appropriate for meeting needs in rural areas. To a certain extent, providers were a legacy of accommodation-based services that served a minority of older people

housing, but were failing the large majority in other tenures. However, Oldman ted in a review of the Rural Supported Housing Programme that most of the ased on floating support were focused upon the needs of younger people. This highlighted in Suffolk, where it was noted that much floating support to access al Housing Benefit in the run up to Supporting People going live, was geared up for her than older people. However, this issue also touches upon public and private s to the changing aspirations and lifestyles of older people. It was felt that there p in the market for private developments – including leasehold Extra Care dation – to enable people who do not want to rent to retain equity within property.

68

Older people from Black and Minority Ethnic communities

Both Worcestershire and Lancashire have significant BME communities, although very few people from these communities live in rural settlements, tending to live in the larger towns. Another minority ethnic group is the traveller community, of which Worcestershire also has a large number of examples. Respondents felt that very little was known about the housing and support needs of older people in these communities, and there were few culturally appropriate services. In both counties, however, work was on-going within the BME communities to increase awareness of needs, and also to inform people of the types of service that were available. Whilst the number older people from BME groups is likely to be small in any one rural authority, the resources and staff time that authorities can commit may also be an issue. Certainly future planning of services is required to accommodate needs in years to come. In particular services need to be aware of the potential for overlapping forms of discrimination to arise in the way that polices and services are formulated and delivered in relation to geography, age and ethnicity. A respondent in another case study area noted that although the number of older residents from BME communities in their rural areas was small at present, services needed to ask questions of themselves in relation to awareness and how they engaged with people to find out what was wanted or required to accommodate future growth. This point echoes research by Manthorpe (2004), which covered urban and rural areas, who found that many local authorities were conscious of the need to improve access to services by older people from Minority Ethnic groups, or the need to build up channels of communication and consultation. Research has also highlighted the value of joint working between authorities and other agencies, especially for rural authorities and authorities with small numbers of older people from Minority Ethnic groups (Manthorpe, 2004, Birmingham Voluntary Service Council, 2004). In this regard the use of regional or national networks to share best practice in the development of strategies or services has been highlighted as a useful development, as is the use of DoH’s Audit Tool (2002) to assist local authorities in England in reviewing their services to Minority Ethnic older people – <http://www.dh.gov.uk>. As Manthorpe (2004) notes, the principles which lay behind this tool have wider applications beyond health settings.

Preventative services

What could broadly be described as ‘preventative’ services were also seen to be lacking. Services that assist people with such things as shopping, gardening, low-level home maintenance and engaging in social activities were all felt to greatly needed and invaluable in promoting independence and enabling people to stay in their own homes. However, a key issue identified was that, although preventative services were essential, they were not a statutory requirement. Most areas were working hard to get services in place, usually provided by the voluntary sector with funding from social services and other sources. However, voluntary agencies noted the uncertainty of the funding regimes in which they had to operate and that relationship with statutory agencies connected with funding sometimes tested the credibility of Local Compacts.

69

Meeting the needs and aspirations of older people requires greater emphasis on maximising use of the existing housing stock where practicable. A number of respondents commented that another way in which the preventative agenda could be boosted was that a higher priority could be given to the funding of adaptations and equipment through a Disabled Facilities Grant (DFG). This grant is currently undergoing a review at national level. Certainly demand for this type of grant will grow, not least as a consequence of an ageing population, yet the funding for DFGs remains quite restrictive. Some respondents questioned the low priority given to this type of assistance by a couple of the local authorities in the case study areas and the negative impact this had on private tenants and homeowners. In contrast, Waveney District, in Suffolk has focused considerable attention on this issue. Indeed, in 2001, the number of DFGs given by this authority was more than the total of all the other local authorities in Suffolk put together. However, even in cases where respondents in local authorities had considered that resources devoted to DFGs had been relatively generous in the past, recent financial constraints on local authorities had led to a recent squeeze on budgets.

Similarly, commentators have highlighted the fall in spending on renovation grants (Care and Repair England, 2001). One respondent noted that their local authority had relied upon the income generated through capital receipts from council house sales to fund renovation grants. However, since the recent stock transfer of this authority’s housing stock, this source of finance had been shut off, meaning that resources for grants would have to bid for funding from the general pot.

Issues of concern for older people

Respondents were also asked to identify what they considered to be the main issues that concerned older people in rural areas.

Transport

The inadequacy of transport was viewed as one of the primary issues for older people in the countryside. Similarly for service users, journeys to services located in larger settlements could also be costly, time consuming and difficult. Many older people do not have their own cars. Public transport is poor in rural areas. Trips by ambulance or community transport can take a long time as different people are collected from different villages. Taxis are expensive, and unless there is a local services, often unwilling to travel long distances to pick up a fare.

Isolation

Respondents often referred to isolation as a key feature of need in rural areas, be that physical or social isolation. Physical isolation could be due to living in geographically very remote locations, or due to limited personal mobility. Social isolation could be a consequence of being physically isolated, but not necessarily so. Some people prefer to have little contact with others. However, where it is not a lifestyle choice then social isolation

70

was viewed by respondents as a significant factor in shaping the overall well-being of residents in rural areas, contributing to loneliness and depression (although it is also important not to overlook the potential for physical and social isolation in urban areas as well).

In a couple of case study areas (North Yorkshire, Dorset and parts of Suffolk), second homes were seen as contributing to the isolation of permanent residents, with some communities with very high levels of second homeownership being virtually ‘dead’ in the winter months.

Physical and social isolation was viewed as a barrier to uncovering hidden needs in rural areas in the case studies, particularly because so many agencies perceive that word of mouth is such a powerful way of informing people of services available.

There was a sense of the potential for increasing isolation within current trends both in the way that services are delivered and more broadly within society itself. For example, people retiring into areas and having to establish new networks some distance from families. It was felt that there was an overall reduction in the opportunity for social contact witnessed in the decline of services and facilities such as shops and public transport, a growing emphasis on telephone or internet-based services, community alarms and the withdrawal of on-site wardens. It was felt that emotional support was a crucial element in enabling older people to sustain their quality of life, but was a factor which all too readily could drop off the end of service delivery, given the constraints which services operate under. One respondent noted that:

“What is so rare is to commission someone to get you integrated into the community, go to the local community centre, the local church, to maintain your contacts with other human being outside your house, and I think that's terribly important and terribly missed.”

In contrast, a number of respondents commented on the positive social benefits ascribed to projects that were focused on delivering transport services in rural areas. These services may not necessarily have been set up with this kind of outcome in mind, and were primarily established with the objectives of facilitating access to services. Nevertheless, their value as a social resource should not be overlooked in any assessment of the impact of these kinds of service, particularly when it comes to continuity of funding. The value of facilities such as post offices and shops was also highlighted as a hub for the maintenance of community support and social capital in rural communities, although a couple of respondents felt that their role in this respect was very much under valued.

Decline of facilities and services

The State of the Countryside Report (Countryside Agency, 2004) noted that since 1999 the availability of rural services has been fairly stable, although the exception here is post

71

offices, whose numbers have continued to decline. This trend was reflected in the comments made by respondents since the key service that was discussed was the closure of post offices. It was felt that this facility was important for accessing benefits and financial services, not only for older people without access to a car, but also for people who prefer this type of service and do not like to have to go to a bank.

Further, recent research has highlighted the complexity of the relationships between market towns and surrounding rural areas in terms of the way that residents in rural areas use facilities and services (Land Use Consultants, SERRL, Delow, 2004). Residents in villages seem to be less functionally attached to their locality than market town residents, and the role of market towns as service centres for residents in villages may be quite weak. This point supported work by the Countryside Agency (2004), which showed that market towns may play a more limited service function than previously thought. The research by Land Use Consultants et al (2004) suggested that people primarily choose their residence for lifestyle reasons and then connect up the other aspects of their lives to suit, using the car. This reiterates the point made by older residents in Chapter two about the extent to which living in the countryside for many respondents revolved around their access to a car. A key conclusion from the study by Land Use Consultants et al (2004) was that rural settlement planning for any particular locality should be evidence-based, and required a detailed understanding of how individual rural settlements actually function in relation to one another and in relation to neighbouring settlements and urban centres for use of a variety of services and employment. A necessary component of any such examination must include a consideration of the service and employment function of settlements in relation to older people.

Security and crime

Although most of the case study areas noted relatively low levels of actual crime in rural areas, there were mixed views on the extent to which this translated into fear of crime, which some respondents highlighted as a real worry for many older people, whereas others felt that it was not so much of a problem. Nonetheless, there were some concerns around criminal activity that could affect people wherever they live, such as the ‘cold calling’ of households by confidence tricksters. Further, whilst there may not be the concentration of difficulties witnessed in some urban locations, nuisance neighbours and anti-social behaviour can cause misery in any community. A particular issue for rural residents was the nature of service or facilities available in comparison with urban areas. One issue was the distance that police are based from rural communities and consequent long response times to any emergencies. Another issue was the desire for specific security measures such as neighbourhood wardens and CCTV, as well as more general factors such as lack of street lighting.

72

Moving home

A couple of respondents highlighted that they felt there was a need for a service to take the stress out of the process of moving home. Nationally help is available from agencies such as the Elderly Accommodation Counsel (www.housingcare.org), or as part of the services provided by the Local ‘Housing Options’ service by Care and Repair England (www.careandrepair-england.org.uk). Anchor Home Improvement Agency in Burnley has a Moving On Scheme, which aims to guide people through the process of moving, including enabling people to visit different schemes.

Attachment to place

A defining characteristic of many rural residents was felt to be a strong attachment to the individual communities or area where people lived. In many ways this is only an issue in policy terms because the options for people with any vulnerability are so limited within rural areas that they are compelled to move some distance to meet their needs. Such a move causes immense upheaval not only in terms of people’s sense of place or belonging, but also in relation to social and family networks, place of worship, and services such as doctors. One respondent described this view of attachment as…

“...Comfort of the people you know, who you can rely on, who you feel comfortable with, it's that really – yes you may feel wedded to the landscape, you know the area well, you feel at home there, but it's also the human connections. If you're going to need the nurse to come to you, you're glad it's the same one that always comes, and I think they have a tremendous fear that they will become anonymous in a town. And if you move away your friends don't move with you.”

However, as noted by Fletcher et al, (2001), a proportion of older people want to make a positive move to accommodation which they feel will suit their future requirements, including access to local services.

A voice for older people

There were mixed views over the extent to which older people had a say in the way that services are run, or engaged in consultation exercises to explore what older people want from services. Older people in public sector housing tended to have the greater opportunity to be involved, although a couple of respondents noted the particular difficulties of getting participation in the more remote rural areas, not necessarily, it was felt, because of problems around the dispersed nature of the population and getting people together, but because of a concern to retain their privacy.

A number of agencies noted specific events in which they had engaged with older people, particularly around service reviews, or stakeholder events in connection with Supporting

73

People, or the National Service Framework for Older People. There was a sense that the development of Older People’s Forums was a very positive development, although still very new. Even so, in one case study where an Older People’s Involvement Officer had been established, it was noted that there was still an issue about how the interests of older people in rural areas could be represented within groups essentially based in the market towns. In this instance, a couple of the forums had received some funding to facilitate greater involvement of older people in rural areas by visiting village halls and attending social events. In a couple of the case study areas, promoting a voice for older people was felt to be quite well advanced – North Yorkshire had been a pilot for Better Government for Older People.

Care and Repair England have published a toolkit for older people called ‘Having Our Say, A Housing Action Toolkit’ (Care and Repair England, 2003). This toolkit provides useful advice, tips and examples of how older people can get involved and participate more fully in the housing decisions affecting their communities. Another source of guidance on involving residents in rural areas can be found in the publication ‘People Make the Difference: A good practice guide for involving residents in rural regeneration’ (Hood and Chater, 2000).

The challenge of providing services for rural communities

In all the interviews with service providers and commissioners, respondents were asked what the greatest challenges were for delivering services in rural areas. A number of themes consistently emerged from all the case studies relating to the practical and organisational difficulties of working in a rural area. This part of the chapter addresses these themes, and highlights the particular constraints placed on rural services by:

• physical geography of their areas; • local socio-economic and demographic factors; • nature and size of organisations in rural areas and the costs of service provision or

development.

A further difficulty consistently reported is related to levels of funding. Although this is not a problem unique to rural areas, as noted earlier in the chapter, many rural local authorities are determined to be low spending authorities, thus investment in public sector services is inevitably constrained. For example, Craig and Manthorpe (2000) found that rural authorities traditionally spent less on social care services and direct provision.

Geography

Dispersed populations and equity of access

Research has emphasised how the characteristic features of many rural areas affects the provision of services, not least that the cost of supplying services is higher per capita in rural than in urban areas. However, as has been pointed out by several commentators, resource

74

allocation systems in England, with a few exceptions, do not incorporate rural dimensions of need or take account of the impact of rurality in relation to the provision of health services (Asthana et al, 2002). In this respect, England stand apart from both Wales and Scotland, who both significantly adjust healthcare resource allocation funding to compensate for the costs that result from rurality (Asthana et al, 2003). Wood (2004) has highlighted that rurality features in local government non-health allocations. Even so, other research has noted that social care services tend to be focused towards provision in urban areas. Asthana et al (2002) have drawn attention to a study by Cumbria County Council which showed that 1 in 16 people over the age of 65 received home care services in urban areas of that county compared with 1 in 30 in remoter areas. Gordon et al (2004) highlight the potential for a double discrimination where the difficulties of delivering services in rural areas combines with the specific needs of an older population, and the necessity for resources to reflect these needs. Facilitating housing choice in the countryside is about promoting solutions for people to stay in their homes just as much as it is about providing a variety of alternative types of accommodation to meet the diverse range of needs that people experience. The notion of delivering services to people in their own homes, rather than the other way around is already well understood by service providers. However, successfully translating this strategic aim into a shift in direction away from predominantly accommodation-based services needs to be backed by sufficient resources, particularly to cope with growing demand for these services in rural areas in the future. The Barker Review highlights the effect that additional housing growth can have on local authority finances (Barker, 2004). The Review notes that in distributing central funds to local authorities, the Government determines their relative spending needs called Formula Spending Shares (FSS). However, the sources used by central Government to calculate FSS are typically backward looking, in that they indicate the situation in a local authority at the time the data were collected. Thus, the FSS can fail to allocate sufficient funds to areas where there is a rapid growth in population, and Barker (2004) makes particular reference to the resources required in areas where, for example, sheltered housing schemes are developed.

The rural populations of all the case study areas, even the smaller more rural/urban area of Bromsgrove were dispersed, and generally public transport services were perceived to be poor. Service commissioners and providers struggled with the question of how and where to cluster services to provide equity of access to all their catchment area population, particularly to those people living in smaller settlements. There was recognition that although needs might be the same in many respects in rural and urban areas, services responses would have to be different.

The dispersed nature of rural populations reduces the opportunities for economies of scale. This applies to all types of services, from sheltered housing developments, to day care services, to advice and information, to voluntary befriending and visiting schemes, and to out-of-hours emergency General Practitioner services.

When services are delivered in the home, or on an outreach basis, travel distances increased the costs of service provision both in terms of travel costs (for fuel, travel

75

allowances and so forth) and staff time required to make the journey. Many agencies reported these additional costs reduced their capacity to meet the demands for their services, and some were reluctantly forced to restrict home visits to clients in remoter locations. Bainbridge and Ricketts (2003) highlight the approach taken in East Sussex, who have set up a rural issues group to examine the impact of unit costs of providing services in rural areas. A rural premium has been provided, which recognises the costs of operating in rural areas. It is reported that this development has helped to develop a sustainable market for domiciliary care in this part of the countryside.

For service users, it was felt that many older people simply could not be bothered with the inconvenience and discomfort of travelling long distances, and thus did not take up services which could have been beneficial to them such as physiotherapy, chiropody, day care, and respite care. Nevertheless, there are numerous examples of transport services across the country that help to meet the needs of older people in rural areas such as North Dorset Community Accessible Transport (NORDCAT), or the Whitby Transport Group (see case example on next page).

Respondents frequently noted the difficulties in ensuring people in rural settlements could access information about services. Various methods had been adopted to promote services, and provide information about what was on offer. Some councils produce regular council newsletters delivered to all homes in their areas, giving broad information about services and highlighting new service developments. Information about services was sometimes included with Council Tax bills. One local authority promoted any vacancies in sheltered housing schemes in this way. Most agencies produce publicity leaflets about their services and attempt to have these displayed in council offices and information points, GP surgeries, post offices, local libraries and other public venues. Nevertheless, it was felt that older people in rural areas were disadvantaged to some extent, as their opportunities to use such facilities were limited (Brown, 1999).

Many agencies commented on various advice and information mobile services that had been withdrawn because of lack of clients. It seems that people in small communities do not want to be seen by their neighbours using certain services, an example being a Benefits Advice Bus parked in the local market place. Similarly ‘special days’ often organised as joint ventures by housing, health and social care agencies had sometimes generated very little interest in smaller communities despite publicity, and again it was thought people did not want to be seen seeking advice so publicly. It appeared that piggybacking advice or information sessions onto an existing social gathering such as a regular lunch or social club worked well as no-one had to identify themselves as being in need of a particular service. Many respondents felt that word of mouth was the most effective way of promoting services. It was felt that people who are either physically or socially isolated are unlikely to know about what might available to them.

It was also felt that people need information about services before they reach a crisis and then struggle to access services. There was a sense of frustration that Social Care and

76

CASE EXAMPLE: WHITBY TRANSPORT GROUP

The Whitby Transport Group was started in 1996, as part of the then Whitby District Volunteer Centre, and became an independent charity in 1998. There are three elements to the scheme: a volunteer car scheme, a mini-bus brokerage service, and more recently a car share club. There are 3 part -ime organisers. Funding comes from a variety of sources but mainly from North Yorkshire Social Services. The scheme has a small contract with a local PCT to take people of all ages from a village to a GP surgery following the closure of a sub-surgery.

The volunteer car scheme has approximately 700 ‘registered’ passengers, and approximately 40 volunteer drivers. It is intended for people over 60, for people with disabilities and for others in need. Almost all the passengers are over 60, and most of the volunteer drivers are over 55. The scheme covers the town of Whitby on the North Yorkshire coast, and the surrounding villages and settlements. It provides a weekday service but will also try to provide cover for weekend journeys for essential hospital visits. It is not a free service. Passengers are charged 50 pence per mile for the first 10 miles, and then 20 pence for any additional miles, making the shorter journeys slightly more expensive. The fares go to pay the drivers’ expenses, although they give their time free. There are no restrictions on the reasons why people want to travel, although obviously priority would be given to those needing transport to hospital or health appointments. Passengers are asked to book their journey 48 hours in advance. The service does not provide escorts, only a driver, and most of the volunteers are older people themselves so the service is not meant for people who require lifting or skilled handling.

On average the scheme provides about 5,000 journeys per year. In the quarter July/September 2003, the scheme provided more than 1,449 single journeys, for 328 passengers and covered 16,000 miles. About 14,000 miles of the miles covered were to health destinations such as hospital, day centres and hospices. Most of the demands for the service can be met, the few ‘fails’ are usually because the scheme has not been given sufficient notice.

The mini-bus brokerage organises the sharing on mini-buses between different community groups, and arranges the insurance cover. The car share club is very recent, starting in 2004 with three cars. Members pay an annual fee and can hire the car by the hour. It is intended for low mileage drivers, many of whom will be elderly.

Health were so resource-constrained that they could increasingly only cater for people with critical needs. A number of respondents from within Social Care and Health commented that in recent years they had witnessed a growing trend towards providing services for increasingly vulnerable people. Even day centres which used to provide services primarily to help overcome isolation were now coping with individuals with much more intensive care needs.

It was felt that there was a growing need to help the proportion of older people who do not meet the eligibility criteria for help from Social Care and Health, but who nevertheless would like help to enable them meet their needs. An example of service promotion was the Well Check service provided by Age Concern in Worcestershire. People with age-related needs can have a home-based assessment and be directed to a range of low-level and preventative services on offer from a range of agencies, as well as receive advice about more generic services such as benefits advice. This was a relatively new scheme, which was planned to be rolled out across the county. It is to be noted that there is a national pilot project – The Oaks Project – currently being conducted jointly by Age Concern and the Zurich Financial Services Community Trust that is testing and evaluating different ways of providing information services to rural areas.

77

However, some agencies, particularly Home Improvement Agencies and voluntary sector groups, were cautious about advertising their services too extensively, as they could not cope with the additional demands that promotional campaigns generated.

Service providers were responding in a number of different ways to the challenge of providing equity of access. One approach was to locate their service in one of the larger population centres and bring clients to the service, although it was recognised that many older people did not relish a long journey to and from a service. However, it was felt by some respondents that specialist provision (such as day care for dementia sufferers) was difficult to provide on an outreach or mobile basis. Several Extra Care Housing schemes were used as a base from which outreach services could be delivered to local people who were not resident in the schemes. There were examples of mobile services that visited different locations on different days, using local village halls or pubs as a venue. Some respondents felt that adopting new technologies and increasing the access to the internet in the home would be one way forward for rural areas.

Examples of such services included a mobile day centre in Worcestershire. A mini bus and caravan would go to a different village each day. The mini bus would then go and collect the day centre attenders. Local volunteers from the village would help with the scheme, who might not be able to volunteer in local towns due to lack of transport. This scheme had been started in Herefordshire and proved very popular and successful. Another example was a very new advice and information scheme in Lancashire set up in partnership between Age Concern and CAB. Located in a smaller settlement, it planned to provide outreach surgeries to surrounding villages, and also home visits to people in remote settlements.

In Suffolk an Extra Care scheme had been developed in response to a needs survey in the village of Orford. Orford Parish Council has been instrumental in driving the development, and oversees the management of facilities which are run from the scheme for the benefit of the wider community, including a number of surrounding smaller parishes.

CASE EXAMPLE: BARONS MEADOW/ESMOND HOUSE, ORFORD, SUFFOLK

New build scheme developed by Orwell Housing Association, in partnership with Suffolk County Council Social Services Department, Suffolk Coastal District Council and the local community.

6 bungalows for frail, older people.

Day-centre for up to 15 people daily.

Day care provided for people in Orford and the surrounding parishes.

Mini-bus, provided and funded by local charity.

Close working relationships with local GP practice.

Staff work flexibly, providing domiciliary care and support and day care services.

Local people consulted at every stage of development – instrumental in changing original concept from a residential home to a very sheltered housing scheme.

Local resource for local people, part-funded by the local community, with local staff and volunteers.

78

Other features of the scheme include:

• Working with the local community attracts local volunteers and staff and assists in making assessment and allocation procedures person-centred and informal.

• The importance of providing transport – to bring in people from the parishes for day care, counselling, clinics, and to take tenants and people in the community on visits and outings.

• Where staff are flexible in the range of tasks they perform and activities in which they are involved, this can help to reduce costs in such small scale schemes.

• Partnerships with the local community can expand and enhance buildings and resources, for the benefit of older tenants and the community.

• The Extra Care scheme can be at the heart of the community providing a range of services for older people.

However, whilst the scheme was felt to be a very good example of how Extra Care and community facilities can be delivered in a rural environment, it was felt that the revenue costs of the scheme around care are very expensive, which comes back to the question of economies of scale. In Dorset, providers were trying to overcome this problem by developing smaller Extra Care schemes in four market towns in North Dorset, with care being provided by one agency across all four schemes.

Other approaches that have been developed include The Old Maltings, which is situated in the traditional market town of Swaffham in rural Norfolk and provides a resource centre for older people in the town and surrounding villages. In addition to bringing up to 20 people daily into the complex for day care, the scheme acts as a base for isolated staff working in rural areas. Meals on wheels and domiciliary care services are provided to older people in the small villages near Swaffham from staff based in The Old Maltings.

CASE EXAMPLE: THE OLD MALTINGS, SWAFFAM, NORFOLK

Converted old maltings in the centre of town.

Developed by Peddars Way Housing Association, in partnership with Norfolk County Council Social Services Department, Breckland Council and Flagship Care & Support, supported by the John Chapman Day Centre Charity.

30 flats for frail older people.

Purpose built day-care centre for up to 20 people daily.

On-site catering services provide meals for tenants, day-care clients and the community.

Domiciliary care and meals-on-wheels provided from the scheme.

Provides housing, care and/or support to 150+ people.

79

A further issue was considerable diversity across different counties, districts and within districts. The needs of rural communities are not homogeneous, and can vary from village to village depending on location, local facilities, access, transport routes, existing community groups, and so forth. The need to avoid a ‘one size fits all’ approach was consistently highlighted.

Land use and planning requirements

Developing sheltered housing schemes, larger retirement communities, or providing small numbers of units of accommodation designated for older people was considered by respondents to be particularly problematic, not only because identifying a crucial mass of people in a small community requiring such accommodation could be difficult, but because the process of planning and developing schemes was often lengthy, and those who had originally been identified as being in need of such accommodation had frequently moved on by the time schemes were completed.

Apart from the difficulties of identifying a critical number of people, the cost of land for building is usually very high because so few sites within the development limits of villages come onto the market, and these are highly sought after by private developers to build high cost executive homes. Suitable sites for development of social housing of any sort are difficult to find. There are stringent planning restrictions in national parks, green belt areas, conservation areas, and AONBs or scientific interest. Building costs were also considered to be higher in rural areas, particularly in more remote settlements and places inaccessible to vehicles where it required tools, equipment and materials to be carried on site by hand. In addition there are planning requirements, particularly in the National Parks which require any new building to be designed to be in keeping with its surroundings, using traditional methods and materials which in turn add to unit costs, as well as requirements that may be attached to Section 106 Agreements. Many agencies felt that Housing Associations were reluctant to take on smaller developments because the unit costs were so high, and thus reflected badly on their performance indicators.

“It just isn’t easy building in rural areas, anyone who says it is isn’t being honest, it just isn’t easy. Even if you’re building on a brown field site, the land is expensive, the lead-in time is a problem, people are nervous about signing 106 Agreements about only letting to people born and bred in the parish…”.

In North Yorkshire it was noted that private developers of older people’s housing schemes, (such as McCarthy and Stone) are actively seeking sites suitable for their developments. However, it was proving difficult to find appropriate sites. The developers require sites to be located usually near to the centre of market towns, flat, and within easy access of a range of facilities.

80

Socio-economic factors

It was felt that the indigenous population were more likely to be on low incomes, and if they were homeowners more likely to have difficulties maintaining the properties they had occupied for many years. The lack of affordable housing for younger people had also affected family support networks and there was a feeling that rural communities still ‘looked after their own’, although this was and will continue to change as younger people move away seeking affordable housing and work opportunities. In Worcestershire, some consultation had been carried out with older council tenants regarding their future housing choices. It seemed that if people had good neighbours, they were very unwilling to move.

Recruiting and retaining staff

All service providers remarked on the considerable difficulties they experienced recruiting and retaining social care staff. It was consistently reported that low rates of pay for care staff, lack of career development, a common perception that caring was a low status occupation, low levels of unemployment and more attractive low-paid employment opportunities (for example, hotel and catering, and supermarkets) were driving a growing staffing shortage, and high levels of staff turnover. Many staff are caught in the benefits trap. It was felt that improved care standards could not be delivered within the framework of a workforce paid the minimum wage.

In Suffolk, one approach to tackle the issue of the lack of care staff in rural areas was to offer an alternative to both the private sector and statutory public provision by establishing a new social enterprise. This pilot project, called Helping Hands, aims to provide care and support services specifically for older people in rural areas. As a co-operative it also aims to enable the full participation of customers in the way services are delivered and in the running of the organisation.

The requirement for staff to be better trained and qualified to meet national care standards although welcomed, was also seen to be increasing costs, partly due to the costs of training itself, but also because, once trained, staff had greater expectations of better wages and promotion. It was felt that the resources available through the Training Organisation for Personal Social Services (TOPSS) to support training initiatives were woefully inadequate, ‘a drop in the ocean’.

In addition, a severe shortage of affordable housing (both for sale and for rent) in most rural areas is forcing the younger, and less well paid, workers to move to areas where housing is cheaper. Even in those case study areas, notably Suffolk and Lancashire, with pockets of considerable deprivation, (the housing market has effectively collapsed in some of the former Lancashire mill towns) house prices in rural areas and villages were high, and well beyond the reach of those working in the local economy. In locations such as Bromsgrove, or the so-called Golden Triangle of Harrogate, York and Leeds, which are within relatively

81

easy reach of large urban conurbations, any new developments tend to be of costly executive homes. Social housing stock had been greatly reduced by the Right to Buy.

It was not within the scope of this project to examine rural housing markets in any great depth, however there was recognition among all those interviewed that the severe shortage of affordable housing in rural areas was helping to exacerbate staffing shortages.

In one case study area (Dorset) it was reported that sometimes no provider agency could be found who would deliver domiciliary care to people in more remote rural areas. In another case study area (North Yorkshire), independent sector care providers were transporting care staff in from neighbouring counties on a daily basis. There seems to be dichotomy here between the strategic intention to support and maintain more older people, and increasingly very frail older people, in their own homes, and the ability of agencies to recruit and retain sufficient number of suitably trained and qualified staff to realise the strategy.

Many service commissioners and providers were already responding to these difficulties. Social services commissioners were increasing by using block contracting (purchasing a total number of hours of care from a care provider) instead of spot purchasing, allowing care agencies to offer more secure work opportunities to their care staff, and undertake better recruitment and service planning. Block contracts also allowed cover for rural and urban areas to be included in one contract to ensure coverage across both areas. Employers were increasingly offering incentives such as cheap mobile phones, interest-free loans for car repairs and maintenance, and other small perks to make their employment packages more attractive.

It was also felt that making training opportunities more available locally might encourage people to take up caring who would have otherwise not considered taking on this type of work.

It was felt that the Disabled Living Allowance might make it easier, particularly for people in rural areas, to employ their own carers, perhaps recruiting a neighbour who was well-placed to help a particular individual. There were some concerns, however, about the lack of regulation of personal carers. There is no requirement to be registered (unlike, for example, childminders), and there was some anecdotal evidence that carers who had been dismissed by care agencies, were becoming personal carers and working independently for a number of clients. There were also concerns that the problem of staff recruitment and retention were being passed on to clients and their families.

Some service providers also felt that new technologies might also help reduce the need for visits from care staff in some circumstances. Although there were some pilot projects and areas where new technologies had been adopted in our case study areas, the use of these technologies beyond the more standard type of equipment, such as community alarms, did not appear to be widespread. There were some suggestions that they were not very popular

82

with older people themselves, and might only increase social isolation for those who were dependent on care staff for human contact.

Some respondents were investigating the possibility of having more generic care staff who would be able to cover a range of tasks and make referrals to more specialist staff if required, and many were supportive of the idea of generic care workers. This would reduce the number of different staff from different agencies visiting the same clients to do either ‘health’ or ‘rehabilitation’ or ‘social care’ tasks, and reduce the time spent on travelling. The independent care sector provider raised a note of caution, suggesting that insurance premiums for care providers would increase dramatically if their staff were carrying out additional duties that were perceived to carry greater risk. It was also noted that young people under 18 can work in residential care, but not as personal carers and this was felt to be restrictive.

Although the shortage of social care staff was most frequently mentioned, recruitment difficulties in occupational therapy, speech and language therapists, social workers and nursing staff were also highlighted.

In terms of recruiting volunteers, all voluntary sector agencies interviewed remarked that recruitment was a constant concern, and a time-consuming activity. The majority of volunteers were people aged 55 and over, and mainly women. Men were more likely to volunteer for services that involved driving, or offered small scale repairs and maintenance in the home.

Organisational challenges

Respondents agreed that the partnership working was crucial if the various needs of older people were to be met. However, in rural areas partnership working can be a complex activity. Unlike urban areas, where there is likely to be one unitary authority, in a rural county served by a County Council there are a number of district councils, possibly several PCTs usually with boundaries that are not coterminous with district council boundaries, a patchwork of different voluntary sector agencies serving different areas, some Home Improvement Agencies, various Housing Associations, maybe a National Park, various acute hospital trusts serving populations within and across district and county boundaries, as well as Strategic Health Authorities and Regional Housing Boards. Linking all these agencies together to produce district or county-wide strategic plans and partnership is a complex and resource-hungry task.

Different agencies also have different priorities and statutory duties, with varying levels of funding available. For example, some of the PCTs who participated were subject to Financial Recovery Plans, seriously limiting the amount of funds they could make available for new service developments. In Worcestershire Older People’s services delivered by social services were undergoing a transformation, and new services were being developed. Furthermore, unlike researchers, providers have to juggle all competing claims against

83

limited resources. For Waveney district, Suffolk, the emphasis was on family housing as this group present greatest need for housing in the area. In Dorset, claims for resources for different groups had to be balanced against the needs of homeless households.

Different organisations collect different types of information for different purposes. A variety of groups are in place to progress different strategies and services. District councils and other agencies in rural areas are usually small organisations. It was not uncommon in the interviews to find one officer responsible for a number of different tasks of which one was strategy development or older people’s services, and it was simply not possible to attend all the possible meetings, and contribute to all the different strategies. Similarly, information and intelligence gathering particularly around needs could be constrained by agency resources. Again distances to be travelled to attend meetings, particularly in the larger shire counties add to the difficulties.

It became apparent during the course of the research that various pieces of research or information gathering, such as consultations with local community groups were being undertaken by different agencies. Various respondents felt there could be better information sharing to avoid unnecessary duplication, and also to create a shared pool of evidence around needs, services and resources.

Despite these difficulties, most respondents felt there were good links into partner agencies, although some felt there was still some way to go before seamless services became a reality.

Older people’s strategies in rural areas

The Government is encouraging the development of cross-cutting strategies for older people. This is equally important in rural areas, as in urban areas and a key message from this report is for rural authorities to develop strategies for an ageing population which engage a wide range of agencies and older people themselves as partners. Some areas have developed broad based Quality of Life Strategies, which aim to promote independence and well-being across the older population as a whole.

Other authorities are developing housing, care and support strategies, building on the ODPM/DoH guidance referred to in Chapter three (ODPM, DoH and the Housing Corporation, 2003).

These strategies aim to link housing with health, social care and other aspects of older people’s lives rather than having a narrow housing only focus. Experience from shire counties which have developed such strategies – for example, county Durham – highlights the complexities and opportunities of working in a two-tier county and district local authority structure, with often different health (PCT and Hospital Trust) structures to contend with as well.

84

The County Durham experience is that it is possible to develop a county level vision and overall direction and plan, together with bottom up district level action plans, which reflect the distinct circumstances of each particular district within a county. This can apply to small districts – in terms of population and resources, such as Teesdale in County Durham, as well as larger district councils. Where a PCT covers more than one district council area then there are advantages for districts to work and plan together with the same PCT. This happens in County Durham where the Durham Dales Primary Care Trust covers Wear Valley and Teesdale Council areas.

CASE EXAMPLE: PENDLE OLDER PERSONS STRATEGY Pendle Borough Council has come together with Lancashire County Council, Burnley, Pendle and Rossendale Primary Care Trust, and Age Concern Lancashire to develop an Older People’s Strategy. The partners cover different geographical areas, have differing strategic styles and differing Performance Indicators. However, they have seen the mutual benefits of developing a joined-up strategy for the local older population and have all committed to play a leadership role in addressing and taking forward a set of key success factors, built around:

Shared Vision – ‘Pendle will provide a high quality of life for its older people – known locally, regionally and nationally as a place where they are fully informed and involved in the planning, delivery and enjoyment of a wide range of integrated services’.

Consultation – At various levels with older people, councillors and non-executive members, and other stakeholders.

Agreed Mission Statement:

• To promote the well-being of older people in Pendle by the provision of an accessible range of quality integrated services tailored to individual need that encourage informed choices and opportunities.

• To ensure that through partnership, personal independence, dignity, respect and autonomy are maintained and that social exclusion and health inequalities are combated by the use of quality housing, health and social care services within the community.

Agreed Key Strategic Aims and Objectives

Definition of Older People in Pendle – ‘Older people in Pendle are people living within the borough of Pendle who consider themselves to be older’.

A draft Action Plan has been developed to deliver the aims and objectives, with an agreed format. A structure has also been developed which engages all relevant stakeholders, as shown in the chart in Appendix 6.

The partners are now going through a process of turning the plan into action by:

• consulting on and prioritising the draft action plan;

• developing Service Development Groups;

• capacity building within the community; and

• engagement with ethnic minority community.

A key part of this work is commissioning Age Concern Lancashire to build an engagement and partnership approach with older people through the development of an Older People’s Forum. This will ensure that older people can directly contribute to the development and implementation of the strategy.

The strategic aims and objectives, together with examples of the housing actions in the plan are set out in Appendix 6.

HatLPbdsho

TosHeiac

F

Aabilcpov

RItTdovs

85

owever, the experience so far is that the development of strategies for older people in rural reas has been slow to happen. Nevertheless, both North Dorset and Suffolk were both in he process of developing housing strategies for older people. For a county such as ancashire, with 12 district councils, the situation is particularly complicated. However, endle – the Lancashire case study area – has made considerable progress in developing a road based Older Persons Strategy, which builds in the housing, care and support imensions alongside other issues such as community safety. There is also a specific ection on diversity, in recognition of the significant Asian population in the borough. Pendle ave adopted a multi-agency approach and are looking to build an engagement model with lder people. More information on the Pendle strategy is provided in the case study above.

he role of the independent care providers was not fully investigated in this project, and only ne independent provider was interviewed. Given the increasing role of the independent ector in providing a range of care services, both domiciliary care and care within Extra Care ousing, and residential provision, it would seem that this key group could be more fully ngaged with strategic discussion and networking. Similarly the role and levels of activity of

ndependent sheltered housing providers such as McCarthy and Stone, and Bovis do not ppear to be taken account of at strategic level within statutory services, and yet there is learly a growing market for these types of schemes.

unding

ll public sector services in rural and urban areas face funding shortfalls, or would develop nd expand services if additional funding were provided. Perhaps the main difference etween rural and urban areas is that rural areas rarely score highly enough on deprivation

ndices to attract certain types of regeneration funding. Many rural councils are traditionally ow spending authorities, and are reluctant to increase local taxes. A number of respondents riticised the withdrawal of Local Authority Social Housing Grant (LASHG) as having a articularly detrimental impact on rural authorities. It was felt that this removed a key source f flexible local funding for rural areas, which do not attract significant mainstream funding ia the Approved Development Programme.

espondents from voluntary sector agencies reported funding to be their biggest challenge. t appeared to be much easier to get funding for new and apparently innovative services than o obtain funding to sustain existing services that were already working and working well. his was a cause of much frustration. Various respondents reported on schemes that had isappeared due to funding restraints, despite being used and valued, and serving a number f agendas. An example of this was a Hospital Discharge scheme where volunteers would isit people as soon as they were discharged from hospital offering practical assistance and upport to ensure they were managing their return home.

86

Summary

All the agencies interviewed were addressing the question of how best can equity of access to services be achieved for older people in rural areas, recognising that there are no easy ‘off-the-peg’ answers, and that older people in rural areas are not easily able to access information about services. Transport in rural areas was a major concern. There is some evidence that some older people will make trade-offs between the advantages and disadvantages of remaining in a village or remote settlement, and moving to larger settlements with easier access to facilities.

Agencies have clear views about what needs are, but are either less able to quantify needs or accept that the numbers of people with needs will always be less than in urban areas and the costs will inevitably be significantly higher. As a result, agencies find it hard to make a case to justify the provision of resources for particular services or groups. Needs assessment methods are lacking, although there is a shared recognition that there are considerable unmet needs for a range of services. However, agencies already struggle to meet known needs. Areas of concern for service providers are: older people’s mental health services, particularly services for dementia; older people from BME communities; older homeowners.

Preventative services are crucial to maintaining independence, preventing social isolation, providing a route into other services, and providing opportunities for regular checks on health status and general well-being. Low-level preventative services are most usually provided by voluntary sector agencies supported by funding from the statutory sector. These services require more long-term funding.

The lack of both affordable and suitable homes limits the choices of older people themselves, and is also impacting on other sections of the community. There is a need to give much more explicit attention to housing markets in rural areas in relation to older people. There are also other consequences for older people if the rural housing market is unbalanced, and there is a shortage of rented and shared ownership housing as well as affordable homes for sale, notably difficulties in recruitment and retention of care staff, and the loss of informal family support networks. Care staff shortages were cause for great concern. Can high quality care services be delivered to all those who need them within a minimum wage framework?

Planning requirements tend to reflect concerns that affect urban rather than rural areas. For example, requirements for high density developments do not allow for the construction of single storey properties, the preferred option of most older people in both public and private sector, or for one or two properties, which is all that may be required in some rural areas.

Some existing sheltered housing schemes, particularly those that are older, providing small bedsit type units, are already difficult to let; there appears to be a reasonable supply of

87

sheltered housing, however, some of it does not meet the expectations of many older people.

Large numbers of older people in rural areas are homeowners. Some are asset rich but income poor. Further investigation of how best to assist this group with the up-keep and maintenance of their properties is required, particularly around the role of the Home Improvement Agencies, and mechanisms for equity release.

Statutory agencies in both health and social care are driven by performance indicators, which although they are pushing services towards better performance in some areas, do not necessarily reflect the preferences of some older people, and do not always allow for the provision of a spectrum of services including residential care. The assumptions that residential and nursing home provision can effectively be replaced by intensive domiciliary care and Extra Care Housing were questioned, particularly for certain client groups such as people with dementia. However, Extra Care Housing does extend the housing and care choices of older people. There is a need for further development of more flexible housing and service models which are tailored to the specific needs and situation of different rural communities.

The costs and complexity of developing and delivering services in rural areas highlights the importance of the development of older people's strategies, such as illustrated by the Pendle case study. These need to cover the whole spectrum of older people's lives so that services can be planned in a flexible way to achieve economies through integration – for example, more than one service using a mobile van – rather than the economies of scale that can be achieved in urban areas.

88

89

Chapter five Conclusions and recommendations

Introduction

In previous chapters of the report we have considered key policy trends and national strategy, the housing circumstances of older people in rural areas nationally and in the case study districts, and the views of older people themselves. In this final chapter we draw together the different strands of evidence from this study to make a series of observations and recommendations regarding the housing and support needs of older people in rural areas.

Meeting needs in the variety of circumstances found in different rural areas requires specific and tailored approaches, which are often more difficult and costly than in urban areas. Older people as a group in society reflect very diverse needs and aspirations. However, the starting point for addressing these needs is one of recognising the aspiration of equity and diversity in the way that policy responds to older people in rural areas. This aspiration prompts the following questions of politicians, councillors, service providers at national, regional and local levels and of older people themselves:

• Have the needs and aspirations of older people in rural areas been acknowledged? • Have the needs and aspirations of older people in rural areas been analysed? • How are these needs being addressed? Do they reflect the circumstances in my rural

area?

Diversity and disadvantage in the rural context

The diversity of views amongst the older people interviewed for this project demonstrated the heterogeneity of older people in rural areas, and reinforced the point that it is not possible (or desirable) to be prescriptive about what older people as a single group may or may not want or need. Instead, the key to these discussions was to examine how services could respond to the diverse needs and aspirations of older people in the distinctive context of the countryside, and allow older people choices and options in regard to housing and support. Fundamentally, older people aspire to the same needs and wants in housing as anybody else. Ageism, in the way that housing policy has been conceived and implemented, has helped to shape the housing stock – attitudes which led to the implementation of housing policy in the past have literally been set in bricks and mortar. Nevertheless, ageism

90

in housing is currently being tackled via developments such as the Housing and Older People Development Group. There is clearly awareness on the part of agencies that rural areas require specific approaches, and that the development and implementation of policy requires greater attention to the diverse needs of older people.

Analysis of the 2001 SEH showed that, compared with younger age groups, older people tended to demonstrate considerable satisfaction with both their homes and the area in which they lived. These levels of satisfaction indicate a commitment to home and neighbourhood that supports a policy emphasis upon promoting independent living, However, this study highlights the ways in which older people’s independence can be undermined in the rural context. Older people in rural areas, particularly those aged 75 and above, potentially appear to suffer disadvantage both on the grounds of their age, and also because of where they live.

Many older people are no longer able to drive or cannot afford a car. The frequent lack of transport alternatives to the private car in rural areas reduces opportunities for accessing a variety of services and social activities. Concessionary fares for older people are less of a benefit where there is very little public transport. It would seem that the oldest people in rural areas are the most disadvantaged in terms of transport. Census data show (see Table A4.22) that 34 per cent of people aged 75-84, and 57 per cent of those aged 85+ do not have access to a car.

The lack of choice regarding both private and public sector housing in smaller settlements means people have to either stay put in properties that are difficult to manage or constrain their activities (for example, not having a bathroom/toilet downstairs), or move some distance to a suitable property and risk losing their social and family networks. The overwhelming majority of the older people in the countryside are owner-occupiers. In total, 81 per cent of people aged over 55 own their own home, although this proportion does fall with age. The proportion of older people in social rented accommodation in rural areas (11 per cent) is lower than the proportion of older people who rent from social landlords in urban areas (21 per cent). Among those aged 75 and above in rural areas approximately 17 per cent live in social rented accommodation, compared to 29 per cent of people aged 75 and above in urban areas.

Another area where rural disadvantage is thrown into sharp relief is around affordable warmth. This is a particular issue in rural areas where householders may have more limited options in relation to the fuel they can use, such as oil or solid fuel. Adequate warmth in the home is crucial for the health and well-being of older people, particularly given the number of avoidable winter deaths among older people (Wilkinson et al, 2001). Whilst slightly more older people in rural areas (93.3 per cent) have central heating than in urban areas (91.3 per cent), the most significant difference is between the younger-old and the very old; 89.2 per cent of people aged 85+ in rural areas have central heating, compared to 94.4 per cent of people aged 50-54.

91

As well as the particular difficulties for rural older people around housing choices and transport, there is the issue of poverty in rural areas and what are often referred to as ‘hidden needs’. Research has highlighted that many people in rural areas on low incomes are no longer working and reliant solely on the state pension (Shucksmith, 2000). The SEH showed that just over a quarter of people over 75 had a gross household income of £100 or less per week in rural settlements with a population of under 3,000 people in 2001. A significant characteristic of rural areas is the way that, unlike in many urban areas, households on low incomes are dispersed geographically so that total numbers in any one location are likely to be quite small. Furthermore, since rich and poor on the whole live in close proximity, measures of wealth and income based on averages tends to mask those households on low incomes. Indicators of deprivation at national level have been criticised for failing to utilise data in a way that are sensitive to the rural context (Noble and Wright, 2000).

A key issue to arise from discussions with agencies in this research was the view that whilst the nature and type of needs amongst older people in rural areas was well understood, providers did not always have a grasp on the numbers or location of people in need, thus making it difficult to make the case for resources to be directed at particular services. There is considerable good practice highlighting ways in which needs in rural areas can be measured at local level (see Scott, 2003). One example from North Yorkshire, in Eskdale, has highlighted the way that older people in rural areas can initiate and control the process of needs assessment. Nevertheless, the drive and commitment necessary to undertake needs assessment of this nature should not be underestimated. Alternative methods include needs assessments undertaken as part of surveys by Rural Housing Enablers, parish plans, or via initiatives such as the Community Investment Prospectus across North Yorkshire. Such rural-specific needs assessment methods should be widely promoted. In addition needs data could be shared between agencies that commission and provide services for older people (for example, Housing Associations, Home Improvement Agencies, PCTs, Supporting People Teams). Small area data should be collated at regional level to inform Regional Housing Strategies and ensure they have a rural dimension.

The housing market – maximising the potential of existing housing stock

Given the preferences for people to remain living in their own homes, the greater proportion of older people in rural areas who are owner-occupiers, and the costs of building new affordable housing, then meeting the needs and aspirations of older people, requires greater attention on maximising the use of the existing housing stock where practicable. The crucial issues here are home maintenance and improvement, energy efficiency and ensuring that there are meaningful choices for older homeowners who may wish to move. There are a number of ways in which the potential utility of the existing housing stock could be maximised.

Greater investment in non-decent homes in rural areas could reap dividends in terms of bringing a proportion of these properties up to decent standard. The English House

92

Condition Survey, 2001, indicates that the mean costs of repairs to make dwellings decent in rural residential areas are relatively low, compared with other types of area. Further, figures for non-decent properties in villages and isolated rural areas suggest that a proportion of these could be brought up to decent standard relatively cheaply. Improving non-decent homes also offers opportunities to bring these properties up to Lifetime Homes standards, thus enlarging the possible pool of properties that are suitable for older people.

Given the lack of housing options in rural areas, and the preponderance of owner-occupiers, the development of Home Improvement Agencies to achieve national coverage across rural areas needs to be addressed with some urgency. Although services should reflect local needs, there should be a national standard which indicates the minimum Home Improvement Agency service that people might reasonably expect1. Assisting householders to help themselves has broader benefits in relation to maintaining the quality of the housing stock in rural areas. Moreover, Home Improvement Agencies are one of the few services that can assist homeowners, and the majority of their clients are older people. A further question concerns whether Home Improvement Agencies should be local, district-based agencies or be organised on a county or regional basis.

Attention also needs to be focused on the extent to which the needs of older households for adaptations and equipment in rural areas are being met adequately through DFGs. We welcome the review of the DFGs currently being conducted by the ODPM, and recommend that, within the review; particular consideration should be given to the operation of DFGs within rural areas.

The housing market – future housing provision

Although housing markets are high on the Government agenda at national, regional and local levels, little notice has been paid up till now to older people in this debate, despite the fact that we have an ageing population and the proportion of older people who are homeowners is increasing. The rural dimension is particularly important since the level of homeownership by older people is higher in rural areas than urban areas. Whilst the Barker Review (Barker, 2004) has focused attention on rates of new build in rural areas, the proportion of the population who can take advantage of new properties in the countryside is very limited. A difficulty here is the low amount of new development in rural areas, with the consequent limited ability for policy to significantly influence the balance of property types into the future. Local Plans tend to emphasise that most new build in villages is focused on infill only, with virtually no development at all in the smallest communities. Thus, future needs run up against current competition in the private market to satisfy demand for large family-sized properties.

1 The development of Home Improvement Agencies was clearly a priority in the case study areas where these services did not already exist. Even where Home Improvement Agencies had been established, evidence from the case study areas suggested that they were under-resourced and there were high levels of unmet needs.

93

Since the amount of new build in rural areas is so limited, the dwellings that are developed have a proportionately more significant role to play in helping to broaden choice in rural communities. In the context of an ageing society it is essential to develop a stock profile that is, and will be, responsive to the needs of older people. The current trajectory of all new build in both private and public sectors in terms of the type of property being developed should be examined. Great emphasis needs to be placed on ensuring that new build – both in the private and public sector – can meet the needs and aspirations of older people in the future. Whilst the changes to Part M of the building regulations have gone some way to improving access to new build, careful consideration is needed to make new housing as accessible and adaptable as possible to meet changing needs. A further issue is space standards in new properties, with smaller room sizes limiting the opportunity to adapt properties in the future, or to accommodate equipment if needed. In addition, older people consistently say that they want two-bedroom accommodation so that relatives, friends and carers can come to stay. For bungalows, and other new accommodation a minimum of two-bedrooms should therefore, become standard as a planning requirement. Given the small likelihood of significant further new build in rural areas in the immediate future, if new housing being built in rural communities fails to incorporate these factors, then an opportunity has been lost for these communities.

The Planning System, via PPG3, has a key role in enabling the development of a diverse range of property types to accommodate mixed and balanced communities. This diversity relates not only to levels of affordable housing, but also to the types of properties developed. Research has highlighted that authorities in rural areas have not necessarily made use of the full potential of the provision of planning guidance in Circular 6/98 (although this circular is about to be replaced by a practice guidance) to set thresholds for affordable housing on developments. Information collected as part of Housing Market Assessments can help to provide the evidence required to support robust policies for the development of affordable housing in rural areas. Such assessments need to take into account the current and future needs of older people (particularly combined with village appraisals, parish plans and so forth).

Exception policies provide one mechanism to enable local authorities to grant planning permission for the development of affordable housing on small sites that may be subject to policies of restraint, and would not otherwise be released for housing. However, by their very nature, exception sites are perhaps more likely to be in less accessible locations, since the most obvious parcels of land for development are likely to have been already identified in Local Plans. The changes to PPG3 to allow planning authorities to identify land solely for affordable housing are to be welcomed.

The availability of affordable housing is important not only for older people, but for people of all ages in helping to sustain mixed communities. The development of affordable housing goes beyond meeting housing needs but can enable family support networks to be maintained. Some respondents were keen to stress that discussions about family networks

94

did not necessarily imply any form of dependency, with older people as passive recipients of support. These emphasised the positive contribution that older family members played in terms of support such as childcare, or providing accommodation for other members of their family during crises such as relationship breakdown. The interaction between local labour markets and affordability of housing, and particularly care staff shortages in rural areas, was a cause for great concern.

Offering choice for people who want to move

Whilst many of the older people in the research wanted to remain in their current home, this intention reflected not only a commitment to their actual home, but also an attachment to the area in which they lived. This latter point highlights the value of locally-based housing alternatives to minimise the necessity to move some distance to meet needs. It must also be noted, however, that some of our respondents had moved or said they would be prepared to move at some point – usually when the time came when they could no longer drive – to larger settlements in recognition of the need for easier access to services and facilities.

A number of innovative schemes have illustrated the kind of developments that can be developed in rural areas, including, for example, floating support delivered to rural localities from schemes. However, one factor arising from the case studies was not just the capital costs of new developments but also the sustainability of developments in rural areas in relation to revenue costs. Whilst ‘flagship’ schemes can point the way in terms of future development, they can also throw into sharp relief the paucity of opportunities for people in rural areas where these schemes are not only absent, but realistically are unlikely to be developed anytime soon due to their cost. There is a real issue of replicability across other rural areas, particularly when faced with the ending of funding streams that have been utilised by rural authorities such as Local Authority Social Housing Grant. Currently it would be unrealistic to recommend that development such as Extra Care Housing should be developed in the smallest settlements. Such schemes would be better located in larger centres with a wider catchment area, thus ensuring their future viability. In smaller settlements, attention should be more focused on ensuring that the potential of existing properties and any future new build is maximised (see above). However, even if smaller communities could not sustain developments of a diverse range of affordable housing, including sheltered accommodation at the present time, changing demographics in future years might well mean that developments may become viable in the future. Both planners and providers need to take on board the new Housing Corporation definitions of housing for older people (see Appendix 3) in planning new housing for older people in rural areas.

Much has been written about Extra Care Housing and its potential to meet a much wider range of needs in more flexible ways than the traditional models of sheltered housing. A number of examples have illustrated how Extra Care housing might work in the rural context and how far additional services such as outreach services, links with community transport, and other services that are difficult for many older people to access in rural areas could be built into Extra Care schemes. The Housing and Older People Development Group could be

95

a useful forum for promoting models of Extra Care that respond to the needs of older people in rural areas.1

Resources for housing and care in rural areas

Inevitably, the extent to which needs may be met in rural areas comes down to pressure on resources. On one hand there is a principle of equity, that people who live in rural areas should be able to expect a similar level of service to people who live in urban areas – although the way that the service is delivered may be very different. On the other hand there is a question over how far there should be sense of individual responsibility in the extent to which people who choose to live in the countryside trade off the various advantages and disadvantages of rural living. However, this latter view presupposes that all older people in rural areas are in a position to exercise choice, whereas other research has noted the number of older people who lack both income or wealth (Shucksmith, 2004).

A feature of each of the five case study areas was the pressure on rural housing markets, driving house prices beyond the reach of many households within these areas, with limited alternatives in the form of accommodation from private landlords, local authorities, or housing associations. Whilst this research was focused upon the needs of older people, a number of agencies in this research drew attention to the competing claims on their resources to meet needs in rural areas arising from other groups in the countryside such as young people, families and homeless households. There was a view that all these groups have valid claims, but prioritising the needs of one group meant that others would have to go without or find alternatives. Other research has highlighted the additional costs involved in providing services in rural areas, and the implications for the equitable treatment of rural dwellers that this poses (Milne et al, 2002). However, it also raises questions about funding priorities at national level to meet housing and support needs in the countryside. There were concerns that with the advent of regional governance, regional strategies for housing would focus on urban housing and fail to give full consideration to rural housing.

At the same time, the question of where funding should come from also raises the thorny issue of how far individuals should be expected to help themselves, out of their own resources. A number of older people expressed anger and frustration at means testing for services such as care. There was a feeling that individuals who had acted responsibly throughout their working lives by saving were being penalised by statutory services. Nevertheless, there is also a separate issue over the extent to which people can reasonably be expected to draw on the housing capital through equity release schemes, particularly in

1 HOPDEV was formed following the publication of Quality and Choice for Older People (DoH/ODPM). With representation from older people, housing associations, private sector providers, voluntary sector organisations and local authorities, it acts as a sounding board to Government, and has taken forward initiatives on information and advice and the development of joint strategies for older people’s services (see www.odpm.gov.uk).

96

the light of recent rapid house price rises, which arguably leads to increases in unearned wealth. In the rural context where the majority of older people are homeowners, further attention should be given to the potential for safe equity release schemes, and also to developing schemes with shared ownership (for example, the scheme by Home Housing Association in Appleby, Westmoreland. Other research has considered the success or failure of different types of equity release (see, for example, <http://www.jrf.org.uk>).

Low-level support and preventative services

As noted in Chapter two, preventative, low-level support services were seen to be invaluable in promoting independence, reducing social isolation and enabling people to stay in their own homes. As one respondent remarked:

“If we look at younger people with physical disabilities, we concentrate far more on their quality of life and emotional well-being; for older people quality of life tends to be ignored, emotional well-being tends to be ignored…”.

In all our case study districts there was a range of ‘preventative’ services usually provided by voluntary sector agencies and funded by the statutory sector. It is important to be clear that ‘preventative’ services in this context go beyond health promotion, and include services that aim to help people maintain their homes, go about their daily lives, and engage in social activity. The great value placed on preventative services by older people has been well documented by a body of research, and is endorsed by the findings of this study. Given the lack of housing options, and limited transport services making access to services problematic, preventative, low-level support services that help maintain people’s independence are of particular importance in the rural context. Our respondents also noted that preventative services are all too frequently dependent on insecure sources of funding, and are often tailored to meet the requirements of a particular funding source rather than the needs or preferences of older people themselves.

The National Service Framework for Older People, Best Value reviews and performance indicators have driven the development of health and social care services. However there are no similar incentives to drive the development of preventative services, and there is no national programme or standard that indicates what older people should expect as a minimum. This is perhaps not surprising. Defining what ‘preventative’ services are or should be is problematic. Clearly falls prevention programmes, support following hospital discharge, intermediate care and other services with a health focus can be seen as preventative services; however, the net could be cast much wider to encompass services that broadly speaking promote independence and well-being. Community transport services, handy person schemes, lunch clubs, carers’ support and so forth could also be described as preventative. Beyond definitional difficulties around preventative services, there are issues about how these services should be funded and commissioned across different agencies, each within its own set of priorities and constraints.

97

Preventative services play a particularly crucial role in rural areas, and the development of a national strategy for preventative services or national preventative service framework would appear to be one way in which services might achieve a greater consistency across England and a more stable funding base. We recognise the challenges this presents. In the short term, as the National Service Framework for Older People is currently being reviewed, an additional standard regarding preventative services could be added to the Framework, ensuring that preventative services are seen as part of the mainstream. Supporting People also, in principle, provides a mechanism to extend support to people in their own homes, rather than requiring the disruption of a move to alternative accommodation. As noted above, this factor is of particular significance in rural areas, given the dearth of housing choices in any particular locality. Evidence from this study indicates that there is a shift towards more tenure-neutral services in Supporting People programmes, although Supporting People was seen by some as a lost opportunity to develop the type of low-level preventative services that older people so frequently say they want. Further, there is no getting away from the fact that delivering preventative services in rural areas comes at a price because of the distances that services need to cover to reach older people. However, the costs of delivering preventative services in rural areas need to be considered against the social and economic costs of individuals having to give up their own home, or spend more time in other settings such as hospitals.

Older people's strategies for rural areas

At a national level, the Government, through work led by the Department for Work and Pensions, is developing an integrated vision and strategy for an ageing population. The scope of the strategy is not yet known, nor whether it will provide only the overall vision, direction and outcome aims or go further in terms of defining how strategies are to be developed at a local level. However, it is likely that the vision will be a broad one which focuses on quality of life and well-being for all older people across all tenures. It is also likely to include an expectation of developing partnership and engagement approaches with older people as part of the expectation for developing local strategies.

The development of strategies for older people in rural areas appears at the moment to be more developed in most areas at a county rather than a district level. Older people want to see an integrated approach to both mainstream and specialist services which addresses the range of issues which help or hinder quality of life, independence and well-being in older age. This cannot be achieved without a joined-up strategic approach.

For example, over time Supporting People strategies could include a wider range of flexible preventative support services which could be designed to meet the needs of older people in rural areas. However, they would need to work alongside other local services such as transport, primary care and home care to be effective. At a local level, joint strategies for older people’s services (such as that being developed in Pendle) could provide a focus and impetus for the development of a core of preventative services, as well as services for more dependent older people.

98

At a regional level the policy framework is evolving so that regional housing strategies are likely to sit within a broader regional planning framework. There is a growing recognition that social needs and housing needs must be addressed alongside each other (see ODPM, 2004 Planning Policy Statement 7: Sustainable Development in Rural Areas). However, the rural dimension of regional planning appears to be underdeveloped both in terms of housing and other related strategies.

The relationship between regional and local government planning is also likely to change. Since we first began writing and researching this report the planning system and regional arrangements have been in a state of change. Very recent changes indicate that the Government intends to abolish County Structure Plans and strengthen the role of districts to have an input into planning policy by feeding in a range of strategies and plans through Local Development Frameworks to regions (see ODPM, 2004 Regional Planning Guidance). Unitary authorities will also contribute through these new arrangements. If the aim of developing unitary local authority structures below the regional level is achieved, then the role of county level planning is likely to be replaced by the new district level unitary authorities. These should be able to be more sensitive to the particular needs of rural communities, and reinforce the importance of developing integrated strategies for older people at a district level, which include housing as a key component.

Care staff recruitment

There were serious concerns about the difficulties agencies faced in recruiting and retaining social care staff. The strategic intention to provide intensive home care, and increase the numbers of older people supported in their own homes, may be undermined by the lack of sufficient care staff to deliver services.

Difficulties with care staff recruitment and retention are not limited to rural areas. However, the lack of affordable housing in rural areas, a smaller labour pool on which to draw, and the generally older age profile of rural populations make problems with staff retention and recruitment particularly acute. There is also the question of the most efficient use of scarce resources (ie, skilled care staff). The travel distances and time spent travelling to clients in rural communities can be considerable – indeed some care staff may spend more time in their cars than they do with their clients.

Some of the older people we spoke to were also concerned about the number of different individuals who might be visiting one person – both in terms of different staff from the same agency or staff from different agencies, and the limitations placed on formal carers by care plans. There certainly was some interest in ‘generic workers’ who could carry out both health and social care tasks. Generic care workers who are able to undertake a wide range of tasks might be one way of easing staffing difficulties, and making the best use of available resources. We do not underestimate the difficulties there might be in developing the role of generic care workers, in terms of training, insurance, health and safety legislation, and

99

supervision, nevertheless there needs to be some radical thinking regarding future care staff recruitment and retention.

We also discussed with our reference group their views on the employment of older people themselves as carers. There was some support for the notion of a ‘staged retirement’ where engagement with the world of work did not simply stop at retirement age; however our group was also quite aware of the poor levels of pay and demanding nature of care work. The level of voluntary ‘caring’ activity among older people indicates an interest and willingness to participate in care giving, although not necessarily a willingness to be employed as carers.

Difficulties in recruiting and retaining care staff highlight the need to support informal carers. Schemes that provide a break for carers by providing respite in the home are of particular importance in rural areas, as choices for carers in rural areas in terms of the availability and location of respite care facilities are likely to be limited.

Linking housing, transport and access to services in the countryside

Respondents made clear that enabling choices around meeting housing needs in rural areas was not just about housing itself, but about making critical linkages with other key features of rural living, such as transport and access to services. Transport was viewed as the single most significant issue facing older people in the countryside. An implication for policy is that spending on features such as transport and low-level support will indirectly help to facilitate and support the housing choices and preferences of older people in the countryside. A number of respondents in the research noted that the point at which they had to give up driving had knock-on effects upon housing decisions. An imperative for the development of ‘whole system’ approaches to the development of strategies in rural areas is the links between agencies and services which help people to draw together these diverse aspects of daily living. The support given by the Countryside Agency to community transport schemes is invaluable.

Black and Minority Ethnic groups

Although the BME communities in our case study areas tended to live in the urban wards of our case study areas, over time the numbers of older people from BME groups living in rural areas will increase, and agencies should be considering how their future needs will be met in the rural context. In particular, services need to be aware of the potential for overlapping forms of discrimination to arise in the way that policies and services are formulated and delivered in relation to geography, age and ethnicity. Other research has also highlighted the value of joint working between authorities and other agencies, especially for rural authorities and authorities with small numbers of older people from minority ethnic groups (Manthorpe, 2004; Birmingham Voluntary Service Council, 2004). In this regard the use of regional or national networks to share best practice in the development of strategies or services has been highlighted as a useful development, as is the use of DoH’s Audit Tool (2002) to assist local authorities in England in reviewing their services to minority ethnic older people –

100

<http://www.dh.gov.uk> As Manthorpe (2004) notes, the principles which lay behind this tool have wider applications beyond health settings.

Mental health services

A consistent view from the service commissioners and providers interviewed was that older people with mental health problems (including dementia, but not just dementia type illnesses) in rural areas were particularly poorly served. Other agencies have highlighted developments in ensuring that rural areas are considered as part of overall strategies (see rural proofing of the National Strategic Framework for Mental Health by Elder, 2004), and also the work by HOPDEV on a fact sheet on Housing Options for Older People with Mental Health Problems. In reviewing the National Service Framework for Older People it may be that greater emphasis is required on the mental health needs of older people, but especially ensuring that the needs of this group living in rural areas are considered alongside the constraints in terms of delivering services in rural areas.

Future research

This report adds to a large knowledge base regarding the housing and support needs of older people generally. It was not within the remit of the project to review the existing evidence; however as the project progressed we were directed towards key pieces of national research, as well as many local studies and evaluations, commissioned and conducted by a range of organisations. We consider there is an urgent need to review and synthesise these various types of evidence in a systematic way, and draw together the main messages, areas where there is conflicting evidence, and identify the gaps in the knowledge base. In addition, much of the literature refers to ‘hidden needs’ in rural areas. The notion of hidden needs hangs over much of the debate about equity of access to services in rural areas, and yet without quantification does not move the debate forward. A systematic review of the evidence would allow what is known about hidden needs in rural areas to be drawn together.

Other research has highlighted the role of older people in shaping rural housing markets (Shucksmith et al, 1995, Blenkinship and Gibbons, 2004). Evidence also suggests that despite the attention given to second homes as a cause of housing shortages and house price increases in rural areas, it is the trend towards rural retirement that has the greater impact on rural housing markets (Tewdwr-Jones et al, 2002). The limited evidence from this study supported by other on-going work in the Centre for Housing Policy also highlighted that older people are important drivers of rural housing markets. However, evidence from Dorset, for example, also noted the important role of younger age groups in local housing markets who are moving into the area, and intending to remain there into retirement. Further research could provide more detailed analysis of the diverse experiences of older people within housing markets both in terms of shaping rural housing markets and also the options available to older people as a consequence.

101

Summary of recommendations

Needs assessment

• Needs assessments undertaken as part of surveys by Rural Housing Enablers, parish plans, village appraisals, or local initiatives (such as the Community Investment Prospectus across North Yorkshire) should be widely promoted. Small area housing needs data should be collated at regional level to inform Regional Housing Strategies, and ensure they have a rural dimension.

• Needs data could be more widely shared between agencies that commission and provide services for older people (for example, Housing Associations, Home Improvement Agencies, PCTs, Supporting People Teams).

Maximising the potential of the existing housing stock

• The potential of the existing housing stock in rural areas should be maximised by: - greater investment in non-decent housing stock in rural areas; - the development of Home Improvement Agencies, including a minimum

standard of service, to achieve a minimum standard of service across all rural areas;

- giving particular consideration to the operation of the DFG as part of the review currently being undertaken by the ODPM.

The housing market – future housing provision

• Much more attention is needed on the place of older people as a key group in housing market planning, at both regional and local authority levels. Older people are important to ensuring the sustainability of rural communities, given the high proportion of older people who live in the countryside, and migration trends.

• It is essential to develop a (rural) stock profile that is, and must be, responsive to the needs of older people. Greater emphasis needs to be placed on ensuring that new build in the private and public sector can meet the needs and aspirations of older people in the future. Beyond accessibility, consideration needs to be given to space standards to allow opportunities in the future for adaptation and installation of equipment.

• New development in rural areas should take account of the requirement for affordable housing, but also for diversity in the types of properties developed.

Offering choice for people who want to move

• There is no doubting the difficult trade off between individual responsibility and the cost in public funding that will be required to offer a wide range of housing choices to older people in rural areas, particularly in the smallest settlements. In smaller settlements attention should be more focused on ensuring that all new build in the

102

future, including small developments of affordable housing, maximises the potential to meet the needs and aspirations of older people.

• Models of Extra Care Housing that specifically address rural needs through services such as outreach, links with community transport, etc, should be evaluated and promoted. In addition, new thinking is needed about flexible service models that cross housing support, primary care, social care and other community support services which can support older people in living in ordinary housing in rural communities. The Housing and Older People’s Development Group could provide a forum for promoting housing models that respond to the needs of older people in rural areas.

Resources for housing and care in rural areas

• In the rural context the majority of older people are homeowners. Further attention should be given to the potential of equity release schemes and developing schemes with shared-ownership.

• Competing claims on very limited resources are a fact of life, but it may be worth exploring the evidence base behind the decision-making of commissioners and providers. How far is there an awareness of the needs of older people in rural areas amongst key groups such as councillors?

Low-level and preventative services

• Low-level support and preventatives services are of particular importance in the rural context. To ensure that low-level support and preventative services are seen to be part of the mainstream, the National Service Framework for Older People, Supporting People Strategies and local Joint Strategies for Older People should place greater emphasis on preventative services. Although it may be challenging, the development of a national strategy for preventative services would appear to be one way in which services might achieve a greater consistency across England and a more stable funding base.

Strategies for older people in rural areas

• The rural dimension of regional and sub-regional housing strategies need to be further developed: there is evidence of rural proofing, but clearly greater consideration of the needs and aspirations of older people at regional level is required. The opportunities presented at regional level by the merger of regional housing and planning boards, as well as the developing role with regard to transport policy at this level are just too good to miss. This should be paralleled by a requirement for integrated strategies for older people – including housing – at a district level, linked to the Local Strategic Partnership and the Community Plan, where these exist. These strategies will need to relate to the Government vision and strategy framework for older people, which is now being developed.

103

Care staff recruitment

• Care staff retention and recruitment difficulties are particularly acute in rural areas. Generic care workers who are able to take on a wide range of tasks may be one way forward, although we do not underestimate the difficulties there may be in terms of training, insurance, health and safety legislation and so forth.

• Staff shortages also highlight the need to support informal carers.

Linking housing, transport and access to services in the countryside

• Most respondents viewed transport as the most significant issue facing older people in the countryside. Indeed, policies and investment aimed at promoting accessibility for older people is likely to have knock-on effects in terms of helping to sustain housing options in rural areas. Strategies in rural areas must make the links between the diverse aspects of daily living as part of a whole system approach. Developments at regional level with regard to transport planning must embrace examples of what works in rural areas up and down the country.

Black and Minority Ethnic groups

• Agencies should consider how the needs of BME households can be met, including elders, both now and in the future in the rural context as a matter of principle. Rural local authorities often lack the staff time and resources that larger authorities can afford to devote to needs assessment and the development of inter-linked strategies. However, joint working, for example, through rural forums, particularly at regional level, can help to coordinate and facilitate these developments.

Mental health services

• A consistent view from service providers and commissioners was that older people with mental health problems were particularly poorly served in rural areas. Again, in reviewing the National Service Framework for Older People, greater emphasis could be placed on services that respond to the mental health needs of older people.

Cost, value for money and sustainability

• It is undeniable that providing housing and services in rural areas costs more. This is a well-known fact which is always mentioned in any study on the countryside, but somehow the fact that things cost more seems to be held against rural areas or is used as an excuse for inaction. It is time that higher costs were accepted as a fact. Volume savings cannot always be made and it would be inappropriate in many instances to try. However, higher costs can be mediated through achieving good value for money and they can be justified when the benefits of providing a building or service add to the sustainability of a local community.

104

Listening and responding to older people

• Finally, the way that providers and policy-makers engage, and work in partnership with older people is a necessary component of any policy or service development which touches on the concerns of older people themselves. It is essential that the views of older people living in the countryside are part of this process and that the development of engagement models include the potential for incorporating a rural dimension.

105

References Appleton, N. (2002). Planning For The Majority: The needs and aspirations of older people in general housing. York: York Publishing Services.

ACC (1989). Homes We Can Afford. London: Association of County Councils.

Asthana, S., Gibson, A., Moon, G., and Brigham, P. (2003) Allocating resources for health and social care: the significance of rurality. Health and Social Care in the Community, 11, (6) pp 486-493.

Asthana, S., Halliday, J., Brigham, P. and Gibson, A. (2002). Rural Deprivation And Service Need: A review of the literature and an assessment of indicators of service planning. South West Public Health Observatory, <http://www.swpho.org.uk>

Bainbridge, I. and Ricketts, A. (2003). Improving Older People’s Services: An overview of performance. London: Department of Health.

Barker, K. (2004). Delivering Stability: Securing our future housing needs, London: HM Treasury.

Better Government for Older People Steering Committee (2000). All Our Futures. Report from the Better Government for Older People Programme, Wolverhampton: BGOP.

Birmingham Voluntary Service Council (2004). Connecting Black Minority Ethnic People In Rural Areas – Are We Doing Enough? Conference proceedings: October 21, 2003.

Blenkinship, J. (2004). Housing: An effective way to sustain our rural communities. Part 1: The effects of affordable housing on rural communities. Cumbria Rural Housing Trust.

Blenkinship, J. and Gibbons, J. (2004). Housing markets: preparing for change. London: The Housing Corporation.

Brown, D. (1999). Care in the Country – Inspection of community care in rural communities. London: Department of Health.

Care and Repair England (2001). Trends in Private Sector Renewal Grant Activity 1991-2001. Nottingham: Care and Repair England.

106

Care and Repair England (2003). Having Our Say: A housing action toolkit for older people, Nottingham: Care and Repair England.

Chandola, T., Lloyd, M., Wright, G., Wigglesworth, R. (2000). Rural Deprivation: An analysis of the indices of deprivation 2000 for rural areas. Oxford: Social Disadvantage Research Centre, Oxford University.

Clark, H., Dyer, S., Horwood, J., (1998). ‘That Bit Of Help’: The high value of low-level preventative services for older people. Bristol/York: The Policy Press/Joseph Rowntree Foundation.

Clough, R., Leamy, M., Bright, L., et al (2003). Homing in on Housing: A study of housing decisions of people aged over 60. Lancaster: Eskrigg Social Research.

Countryside Agency (2000). People Make the Difference. A good practice guide for involving residents in rural regeneration, Cheltenham: Countryside Agency.

Countryside Agency (2002). Support and Housing in the Countryside. Innovation and choice. Gloucester: Countryside Agency and the Housing Corporation.

Countryside Agency (2003). The State of the Countryside 2003. Cheltenham: Countryside Agency.

Countryside Agency (2004). The State of the Countryside 2004. Cheltenham: Countryside Agency.

Craig, G. and Manthorpe, J. (2000). Fresh Fields. Rural social care: research, policy and practice agendas, York: York Publishing Services.

Croucher, K., Pleace, N., and Bevan, M. (2003). Living at Hartrigg Oaks: Residents’ views of the UK’s first continuing care retirement community. York: Joseph Rowntree Foundation.

Department of the Environment, Transport and the Regions (1998). Supporting People. A new funding framework for support services. London: DETR.

Department of the Environment, Transport and the Regions (2001). Supporting People: Policy into practice. London: DETR.

Department of the Environment, Transport and the Regions /Department of Health (2001) Quality and Choice for Older People's Housing: A strategic framework, London: DETR/DoH.

Department of Transport, Local Government and the Regions (2000). Urban White Paper Working with Towns and Cities. London: DTLR/ODPM.

107

Department of Transport, Local Government and the Regions (2000). Rural White Paper Our countryside, the future, a fair deal for rural England. London: DTLR/ODPM.

Department of Transport, Local Government and the Regions (2001). Supporting People. The administrative guidance. London: DTLR.

Dickinson, P. and Whitting, G. (2002). The Big Picture: Older people, London: The Housing Corporation.

Department of Health (2001). National Service Frameworks for Older People, London: DoH.

Dorset County Council (2002). Dorset Rural Profile. <http://www.dorsetforyou.com>

Elder, K. (2004). Rural Proofing the National Service Framework for Mental Health. MIND: <http://www.mind.org.uk/About+Mind/Networks/ruralMinds/RPR.htm>

Esk Moors Action for the Elderly (2000). Sixty Years Plus in Moorland Yorkshire: Report of a survey of older people in the Upper Esk Valley, North Yorkshire, Esk Moors Action for the Elderly Committee.

Fletcher, P. and Riseborough, M. (2005) Strategic Moves. Thinking, Planning and Delivering Differently. Strategic Commissioning for Older People’s Services Workbook. London, Department of Health.

Fletcher, P., Riseborough, M., Humphries, J., Jenkins, C. and Whittingham, P. (1999). Citizenship and Services in Old Age: The strategic role of very sheltered housing. Beaconsfield: Housing 21.

Fletcher, P., Riseborough, M. and Mullins, D. (2001). What Future for Category 1 Sheltered Housing? Updating ideas, policy and practice. Birmingham: University of Birmingham.

Fletcher, P. and Riseborough, M. et al. (2002). Caring for Our Own – and Others Who Live in Our Communities. A supported housing strategy for Liverpool, Liverpool: Liverpool City Council.

Fletcher, P., Riseborough, M. et al. (2003) Report on an Accommodation Strategy for Older People in Liverpool. Liverpool: Liverpool City Council.

Gant, R. (1997). Elderly people, personal mobility and local environment, Geography, vol 82.3, pp 207-217.

Gordon, D., Kay, A., Kelly, M., Nandy, S., Senior, M. and Shaw, M. (2004). Targeting Poor Health: Review of rural and urban factors affecting the costs of health services and other implementation issues. Cardiff: National Assembly for Wales.

108

Hampshire County Council (2002). The Hampshire Supporting People Strategy 2003-2004 <http://www.hants.gov.uk/housingsupport/strategy-for-sign-off.html>

Hanson, J. (2001). From Special Needs to Lifestyle Choices, in Peace, S. and Holland, C. (Eds) Inclusive Housing in an Ageing Society: Innovative Approaches. Bristol: The Policy Press.

Heywood, F., Oldman, C., Means, R. (2002). Housing & Home in Later Life. Buckingham: Open University Press.

Hood, M. and Chater, C. (2000). People Make The Difference: A good practice guide for involving residents in rural regeneration. Cheltenham: The Countryside Agency.

HOPDEV – for information on HOPDEV and Government policy on older people go to www.odpm.gov.uk/index.asp?id=1162198 and www.dh.gov.uk

Horwood, J. (1998). That Bit of Help: The high value of low-level preventative services for older people York: Joseph Rowntree Foundation.

Housing Corporation (2001). Rural Strategy. London: Housing Corporation.

Housing Corporation (2002). Housing for Older People. London: Housing Corporation.

Land Use Consultants/SERRL/Emma Delow (2004). The Role Of Rural Settlements As Service Centres. <http://www.countryside.gov.uk/LAR/Landscape/PP/planning/ruralsettlements.asp>

Le Mesurier, N. (2003a). The Hidden Store – Older People’s Contributions to Rural Communities. London: Age Concern.

Le Mesurier, N. (2003b). Best Practice In Building Capacity Amongst Older People In Rural Areas. Conference paper: Regions for All Ages, March 2003. London: Age Concern And English Regions Network.

Lowe, P. (2003). Demographic Ageing and Rural Areas. Conference paper: Regions for All Ages, March 2003. Age Concern and English Regions Network.

Manthorpe, J. (2004). Older People from Black and Ethnic Minority Groups: Local government strategies. London: University of London. Better Government for Older People: BGOP Research Series No 2.

Milne, A., Hatzidimitriadou, E., Wiseman, J. (2002). Ageing in the Countryside: Policy making and older people in rural areas. Canterbury: The Tizard Centre, University of Kent at Canterbury.

109

MIND (2003) Rural Minds Toolkit. MIND: <http://www.mind.org.uk/About+Mind/Networks/ruralMinds/RMT.htm>

Moor, C. and Whitworth, J. (2001). All Together Now? Social inclusion in rural communities. London: Local Government Association.

Moseley, M. (1980). Is rural deprivation really rural? The Planner: p97, July 1980.

Moseley, M. and Chater, C. (2002). Trends in Rural Services and Social Housing. Cheltenham: The Countryside Agency.

National Statistics (2002). Census 2001. <http://www.statistics.gov.uk/census2001/demographic_uk.asp>

Nayak, U. and Hodsoll, K. (2002). A Survey of the Needs of Older People in a Very Rural Area in Shropshire. Birmingham: Centre for Applied Gerontology, University of Birmingham and Shropshire County Council Social Care and Health Directorate.

Noble, M. and Wright, G. (2000). Identifying poverty in rural England. Policy & Politics, 28.3 pp 293-308.

North Dorset Primary Care Trust (2003). Public Health Report. Dorchester: North Dorset Primary Care Trust.

North Yorkshire County Council (2002). Shadow Supporting People Strategy. North Yorkshire County Council.

Office for National Statistics (2002). Census 2001. National Statistics Online – See <http://www.statistics.gov.uk>

ODPM (2002). Green Paper Sustainable Communities – Delivering through planning. London: ODPM.

ODPM (2002). White Paper. Your Region, Your Choice: Revitalising the English regions. London: ODPM.

ODPM (2003). Supporting People: Information guide on services for older people. London: ODPM.

ODPM (2003). Sustainable Communities: Building for the future. London: ODPM.

ODPM (2004). Regional Housing Strategies and Recommendations for Housing Capital Allocations. Guidance Note to Regional Housing Boards, June 2, 2004.

110

ODPM, Department of Health and the Housing Corporation (2003). Preparing Older People’s Strategies. Linking housing to health, social care and other local strategies. London: ODPM.

Oldman, C. (1990). Moving in Old Age: New directions in housing policies. London: HMSO.

Oldman, C. (2002). Support And Housing In The Countryside: Innovation And Choice, Cheltenham: The Countryside Agency.

Peter Fletcher Associates and Moyra Riseborough (2003). A Housing, Care and Support Strategy for Older People, Birmingham: CURS, University of Birmingham.

Raynes, N., Temple, B., Glenister, C., Coulthard, L. (2001). Quality at Home for Older People: Involving service users in defining home care specifications. Bristol/York: The Policy Press/Joseph Rowntree Foundation.

Riseborough, M. and Jenkins C. (2004). Now You See Me, Now You Don’t. How are older citizens being included in regeneration? Care and Repair England, Age Concern England, Better Government for Older People and the Beth Johnson Foundation. <http://www.careandrepair- england.org.uk/reports.htm>

Riseborough, M. and Srbjlanin, A. (2000). Overlooked and Excluded: Older people and regeneration. London: Age Concern England.

Riseborough, M., Fletcher, P. and Mullins D. (2001). What Future for Category 1 Sheltered Housing? Updating Ideas, Policy and Practice. Birmingham: School of Public Policy, University of Birmingham, occasional paper no. 13.

Royal Commission (2000). Report on Long Term Care. With respect to old age. London: HMSO.

Scharf, T., Phillipson, C., Smith, A.E. and Kingston, P. (2003). Growing Older in Socially Deprived Areas. Social exclusion in later life. London: Help the Aged.

Scott, R. (2003). Undertaking effective housing needs assessments: A guide to local authorities serving rural communities. Cheltenham: Countryside Agency.

Shaw, J. M. (1979). Rural Deprivation and Planning. Norwich: Geo Abstracts, University of East Anglia.

Shucksmith, M. (2000). Exclusive Countryside? Social inclusion and regeneration in rural areas. York: Joseph Rowntree Foundation.

Shucksmith, M. (2004). Social Exclusion in Rural Areas: A review of recent research London: DEFRA.

111

Shucksmith, M., Henderson, M., Raybould, S., Coombes, M. and Wong, C. (1995). A Classification of Rural Housing Markets in England. London: HMSO.

Simmons, M. (1997). Landscapes of Poverty. Aspects of rural England in the late 1990s. London: Lemos & Crane.

Social Exclusion Unit (2000). National Strategy for Neighbourhood Renewal: A Framework for Consultation, London: The Cabinet Office.

Speak, S. and Graham, S. (2000). Service Not Included: Social implications of private sector service restructuring in marginalised neighbourhoods. Bristol: The Policy Press.

Tewdwr-Jones, M., Gallent, N. and Mace, A. (2002). Second and Holiday Homes and the Land Use Planning System, Research Report – prepared for the Welsh Assembly Government, London: Bartlett School of Planning, UCL.

Warnes, A.M. and Ford, A. (1993). Residential Strategies in Later Life: Focus group and interview results. London: Kings College, Department of Geography and Age Concern Institute of Gerontology, occasional paper no. 8. Wilcox, S. (2003). Can Work–Can’t Buy. Local measures of the ability of working households to become homeowners. York: York Publishing Services.

Wilkinson, P., Landon, M., Armstrong B. et al (2001). Cold Comfort: The social and environmental determinants of excess winter deaths in England, 1986-96. Bristol: The Policy Press.

Wilson, D., Aspinall, P., and Murie, A., (1995). Factors Influencing the Housing Satisfaction of Older People. Birmingham: Centre for Urban and Rural Studies, University of Birmingham.

Wood, J. (2004). Rural Health and Healthcare: A North West perspective. North West Public Health Observatory: <http://www.nwpho.org.uk/reports/ruralhealth.pdf>

Worcestershire County Council (2002). Supporting People Shadow Strategy 2003/04.

112

113

Appendix 1 Policy overview – The need for housing, care and housing-related support for older people in rural areas

Introduction

This appendix briefly presents the current policy background and highlights key trends, including signs that a more coherent national policy for older people is emerging. The appendix also refers to Supporting People and broader policy changes such as those set out in the White Paper on Rural Areas (ODPM, 2001) and moves towards regional governance.

Housing policy in the UK is closely linked to a range of other policy areas. For example, policies governing ‘social’ housing are linked to regeneration and improving local communities while regeneration policies are linked in turn to policies to reduce crime, improve health and educational attainment levels, reduce the number of homes in disrepair including the number of non ‘decent’ privately owner-occupied and rented homes. In addition, policies to improve social and personal services for older people (and the rest of the population) emphasise the importance of community rather than residential care and enabling people to continue to live in ‘ordinary’ housing.

New policies introduced in the spirit of community care include Supporting People, which was implemented in 2003. In addition there have been a number of Government initiatives to increase spending and capacity on grants for repairs, adaptations and other services as well as expand the range of housing options for older people, including Extra Care Housing. The content and direction of current policy has been affected by older people’s expectations and aspirations and by the realisation that what we mean by older age has changed compared with say 30 years ago.

At the delivery end of policies there is ample evidence that ageist attitudes and practice adversely affect all older people regardless of where they live (see, for example, evidence presented to the Royal Commission (2000) and, All Our Futures, a report by the Better Government for Older People Project (2000). Lack of housing, care and support options and information about them are problems cited by many older people. Poor communication between agencies and a failure to genuinely work in partnership are also regularly referred to despite attempts by Government to force health and social care commissioners to work

114

together, pool budgets, make joint decisions and include housing and other partners in discussions. In relation to the countryside, agencies are obliged to rural proof polices and services, and the Countryside Agency has produced advice notes to assist with this.

Then there are the problems caused by changes in responsibilities and reorganisation. Looking back over the last decade, both local government and the National Health Service, for example, have experienced constant change and reorganisation. At the present time, the institutions that deliver important areas of policy are being radically changed. Various duties and powers are being transferred from central and local government to regional bodies, such as, Regional Housing Boards (see Sustainable Communities’ Action Programme (ODPM 2003). Some regions are likely to move towards regional government. This will also bring change and possibly further devolution of powers and/or funds.

Regional change raises a number of challenges, such as how links are going to be made between regions and local areas and how these links will help or hinder complex and overlapping local plans and strategies. One example is how changes at regional level may impact on partnership strategies to improve services for older people that cut across investment plans for housing and care and support services. To overcome likely problems efforts have been made by Regional Development Agencies and Regional Housing Boards to amass and make sense of local plans and strategies and understand how they contribute to an understanding of a region. There has also been a commitment amongst some Regional Housing Boards to ensure that both the needs of people in urban and rural areas are met, for example, Yorkshire and Humberside. Yet some rural local authorities have expressed fears that regional investment decisions will favour the large towns and cities and urban areas (see Riseborough and Jenkins, 2004). The fact that the Government currently relies on a distribution formula for funding local authorities that tends to result in urban areas receiving more money for services compared to rural areas (see Scharf et al (2003) for a discussion) may be part of the reason for the concern.

It is against this backdrop that changes affecting older people and housing should be seen. The appendix next describes some key policy trends and considers their implications.

Key policy trends

Moves towards a coherent policy for older people

Areas of policy that affect older people include: ‘social’ housing; planning; regeneration and housing renewal; social or personal care; health; a range of welfare assistance; grants for repairs and help to pay for disabled facilities; pensions and state subsidies for incomes together with fiscal policies that affect private and occupational pensions; savings; earnings; property ownership; mortgages and other personal financial arrangements. Policy discourse about older people in the past tended to focus on ‘welfare’ and wider linkages were often overlooked while older people’s contributions to social and economic life were disregarded. Today there are signs that things are different: England has never had an explicit older

115

people’s policy but there are signs that a more coherent policy approach is emerging. From 1999, Government policy has aimed to consistently link in and join up areas of policy that affect older people. Government policy also reflects an awareness of social and economic change and diversity amongst the older population. Older people’s contributions to society are also increasingly acknowledged.

Two White Papers signalled the change. ‘Modernising Social Services’ confirmed the Government’s commitment to promoting independence, improving protection and raising standards in social services. Next, the NHS Plan stated that health policy should help older people enjoy, rather than endure, the prospect of living longer. It also mentioned flexible services that enable older people to receive care ‘close to home’ and recognised that most older people want to stay in their own homes, living independently for as long as they can.

Further signs of change showed up in policies designed to integrate health, care, housing, and support service planning, and their delivery to benefit older people. Health audiences recognise the central importance to health of having a warm and ‘decent’ home. A number of changes were made to align Health Action Zones with regeneration areas because populations in those areas have high incidences of poor health and deprivation. During the 1990s, Regional Health Authorities were obliged to produce Health Improvement Plans, which identify health problems (eg, strokes) and set out proposals to reduce such problems (Health Improvement Plans have now been subsumed under Local Delivery Plans and responsibility for producing plans has now passed to PCTs while Regional Health Authorities were abolished). There are performance implications for health that relate to housing for older people. For example, the National Service Framework for Older People requires actions to reduce the number of falls older people have in the home while social services departments are required to supply performance figures (using a standard set of measures called the Performance Assessment Framework or PAF) showing amongst other things how many older people are able to continue in the community rather than moving into long-term residential care.

The need to make further links between housing, care, support, health, transport and regeneration is recognised in Quality and Choice for Older People’s Housing: A Strategic Framework (DETR/DoH, 2001) and in Government guidance to encourage local authorities to take the lead in drawing up linked strategies to benefit all older people and enable them to contribute to local life if they wish (see Preparing Older People’s Strategies: Linking Housing to Health, Social Care and Other Local Strategies (ODPM/DoH/Housing Corporation, 2003)).

Within established areas of policy, change has continued. The community care reforms of the late 1980s and early 1990s produced substantial closures of long stay mental hospitals and institutions. There were huge shifts in planning and budgeting. For example, from being the major provider of services, Social Services departments were required to encourage the private and non-statutory sectors to provide at least half of the required residential care and domiciliary care services. There was an unprecedented growth of housing models and types of community-based support for different groups of people whose needs had previously

116

been served in institutional care. Genuine progress was made in shaping services around people rather than departments or agencies particularly in the field of learning disabilities. However, only a few years into the reforms, community care budgets were capped and Social Services departments were forced to concentrate funds on people with the highest need for personal care. For older people the outcomes were severe since low-level, preventive services for domestic help, shopping and bathing were cut. More recently, some of these options were restored and new options have opened up through, for example, Prevention Grants (made available to PCTs), funds for Intermediate Care, more flexible arrangements allowing Care Trusts and PCTs to spend health monies on preventative interventions and opportunities for new support services from Supporting People.

The desire to improve residential care services and regulate domiciliary care services led to the Care Standards Act, 2000, implemented in 2002. The general consensus is that standards are improving although there have been some problems including stories in the national press concerning private residential homes allegedly forced to close because local Social Services authorities refused to pay a realistic fee for residents placed there. Further, the demands of the Care Standards Act to improve and modernise care homes and upgrade staff training and their qualifications have been blamed for a number of residential home closures.

Supporting People

Supporting People – announced in 1998 and finally implemented in 2003 – was a key change in policy. The Supporting People Administrative Guidance (DTLR, 2001) specifically comments on and makes suggestions for future housing-related support services for older people.

The Supporting People programme is designed to complement existing services that enable older people to continue living in ‘ordinary’ housing rather than institutional care. Supporting People does not fund day centres or personal care, which is funded by social services departments, or health care, which is provided by the NHS. However, it is intended to be one element within a wider package if this is required. For example, a support service may be one element in a rural outreach project for older people. Other elements may include inputs from health to promote healthy living or leisure to promote active longer life. Increasingly, ingredients for such projects are assembled by a mix of partners drawing on a mix of funds and services. Good examples are a rural outreach project led by Warwickshire Age Concern and a healthy living project, which also provides advice on keeping warm and handyperson services as part of a Health Action Zone in Cumbria.

Supporting Older people

Older people are the largest single group of people using Supporting People services. Supporting People funds can currently cover:

117

• paying the cost of a community alarm service; • the costs to install and maintain burglar and smoke alarms; • advice and support on repairs and home improvement work including help to manage

the work; • handyperson services.

Handyperson services are often linked to Home Improvement Agencies and ‘handy van’ services. Agencies can arrange for minor repairs to be done in older people’s homes and are particularly useful for older owner-occupiers. They can arrange minor adaptations, such as handrails, give energy advice and grants (often as contractors for the local authority), give home security advice and may do accident reduction checks in people’s homes under contract to the PCT or Health Action Zone (Help the Aged and Age Concern organisations have a number of these contracts with different authorities and agencies).

Other housing-related support currently eligible for Supporting People funds include practical help such as help with shopping, advice on keeping the home secure, help to budget and obtain benefits, help to obtain and retain a tenancy and finding out about other services. Supporting People funds can also pay for befriending services, help to make social contact with other people, and provide services that give emotional support, advice and counselling.

Funding Supporting People

Local Supporting People Funds do not compare in size to community care budgets. They can nonetheless be significant in terms of local ‘pots’ of funding for older people’s services. The National Supporting People Fund and amounts allocated to local areas have been the subject of a bitter wrangle. Formulas used to allocate local funds were initially based on estimates submitted by local areas prior to implementation in 2003. Estimates were considerably higher than anticipated and there is a division of opinion on the reasons behind this. There is evidence on the one hand that a proportion of local areas tried to shunt the cost of services from Social Services budgets to Supporting People. On the other hand local areas were also encouraged to identify and plan for the costs of providing new services. The consequences so far are that local areas received less funds than they budgeted for and cuts of around 5 per cent were planned for 2004-05.

Administering Supporting People in rural areas

Responsibility for planning and administering Supporting People in local areas is quite complex. In rural areas of England, with more two-tier authorities, there is a tendency for Supporting People programmes to be planned for the whole administrative area. In two-tier authorities responsibilities for co-ordinating and planning the programme are usually discharged by County teams (the Supporting People Administering Authority) although there has to be input from District Councils in the area1. Each Supporting People Administering

1 The exact arrangements vary between different locations.

118

Authority is required to produce a Supporting People Strategy for the whole area, which should reflect needs and gaps in services across all the districts. Some rural and semi-rural areas, for example, Rutland and the former county of Berkshire, are unitary authorities. In these cases they produce separate Supporting People strategies and programmes.

All Supporting People Administering Authorities were required to produce a Shadow Supporting People Strategy followed by a one-year strategy, which sets out their priorities, and spending plans up to 2004. Only a few authorities produced one-year strategies and Shadow Strategies are the main documents available. Currently authorities are developing five-year Supporting People Strategies and ODPM required these to be submitted by 2004. Some Regional Housing Boards are also developing regional Supporting People Strategies to inform Regional Housing Strategies. For example, the West Midlands Regional Housing Board.

In line with Best Value, Supporting People funded services have to be reviewed for their quality, efficiency and effectiveness, and reviews are currently being carried out for various services. Poor reviews and poor performance could lead to funding for support contracts being withdrawn if services are viewed as failing. Until very recently it was expected that older people’s services would be reviewed with a light touch. This was because the main changes were expected to come from cross-cutting and more comprehensive Best Value reviews of older people’s services which have tended to result in big changes in direction and better use of funds overall. Community Care reforms allowed older people to stay at home for longer, but where housing has become unsuitable, or where a lack of low intensity and social support is undermining independence, personal care services on their own are not enough. For older people in rural areas, Supporting People brings more opportunities to continue to live independently where they wish. Services such as Home Improvement Agencies and handyperson teams and practical and social support may help prevent the onset of dependency, and complement personal care. Supporting People is being used in this way in planned programmes of change to implement older people’s strategies. Strategic plans often include funding more Home Improvement Agency services, de-commissioning residential care, remodelling existing sheltered housing, and commissioning new Extra Care Housing with provision for more intermediate and respite care (see Fletcher et al (1999) for a discussion and Durham Older People’s Strategy 2003 for examples of planned changes in a rural setting).

Supporting People offers more opportunities to develop services that people require regardless of the kind of housing or tenure they live in. Supporting People is also designed to work for the individual and each person is expected to have a personal support plan, which should explain what they can expect depending on the amount and nature of support needed. Some people may require support for a fixed period. For example, while recovering from an accident while other people may need constant, low-level support or support that can go up and down in intensity depending on their health or circumstances. However, these kinds of flexible support service are relatively undeveloped, and while there are some excellent examples that seem to work, it is still new territory.

119

The cost of services is a thorny issue. Attempts to identify costs of support services and disentangle them from housing management and or social care have been going on at a national level since 1999, and locally since 2001. Local Supporting People teams are beginning to get to grips with the resulting financial data although there is a long way to go before robust data on the unit costs for services will be available. However, it is clear that costs are likely to be higher in rural as opposed to urban areas, for the same reasons that domiciliary care costs and community health services costs are higher. This is a factor that can easily be overlooked in Best Value reviews and should concern all rural areas.

Rethinking the role of sheltered housing in rural areas to support ageing in place

Chapter one outlined a number of changes in relation to the role of sheltered housing in rural areas, including new definitions of housing for older people and supported housing by the Housing Corporation. Supporting people reviews and the Quality Assessment Framework (PAF) exercises will also be helpful in getting both providers and commissioners to have a clearer idea about where their sheltered housing fits in the spectrum of supportive housing and housing-related support. In developing service models for the future three trends are emerging which are important for rural areas. Firstly, an increasing number of local authorities and their partners are treating the specialist accommodation system for older people as one system rather than distinct health, social care and housing systems. Counties such as Cambridgeshire, North Yorkshire, Cheshire and Lancashire are looking to use the specialist housing system to shift the balance away from residential and nursing home care and towards sheltered and very sheltered housing. They are also looking to develop housing models for meeting specialist needs, such as for people with dementia and learning disabilities, and housing models for intermediate care. Key to all these housing options is the shift of emphasis from ‘quality of care’ to ‘quality of life’ (see case examples from Housing 21, Appendix 2). Older people increasingly see moves into specialist housing as making a lifestyle choice as well as care choice. This is illustrated by Figure A1.1, which looks at the ingredients of Extra Care Housing in terms of their contribution to an older person’s quality of life.

120

I I n n g g r r e e ddP P r r i i n n c c i i p p l l e e s s

• Focus on individua• Rehabilitation • Independence • Residents have co

separate from care • Neighbourliness • Access to commu• Community resour

C C a a r r e e a a n n d d L L e e i i s s u u r r e e

• Flexible care • Working with, not • 24 hour support • Care team based in• Restaurant/commu • Domestic support • Suppor ting social

Secondly, moving to a tegeneral needs housing, being building based. Thenable older people to ror sheltered housing. Thexample, Broadacres Hogoing further by linking ttogether. They are devewarden service and comhome, and some are alsBorough Council in Surr

Thirdly, developing the rhousing. The case examfor a rural area. The casremodelling a sheltered

Joint policies – listenin

There are regular oppordirectly with governmenOlder People’s programsignificant impact and br

Figure A1. 1: Ingredients of Extra Care Housing

i i e e n n t t s s o o f f E E x x t t r r a a C C a a r r e e H H o o u u s s i i n n g g

ls

ntrol – tenancy rights

nity activities ce

DDeessiiggnn • Individual flats are seen as “home” • Design allows for a range of social activities • Progressive privacy is built in for residents

doing for residents

scheme nity cafe and leisure opportunities

AAsssseessssmmeenntt aanndd AAllllooccaattiioon n

• Joint assessment and allocation • Balance of dependency levels • Positive approach to mental health • Step up and step down places • Home for life

Q Q U U A A L L I I T T Y Y O O F F L L I I F F E E

am based floating support approach across both sheltered and so that the service is shaped to meet individual needs rather than e goal is explicitly to provide the first line of contact and support to

emain in their home, whether that is general housing for rent or sale is approach can be applied just as well in rural as in urban areas (for using Association in North Yorkshire). Some authorities are now

he sheltered warden, mobile warden, and community alarm services loping an area-based approach of tenancy support where the munity alarm operate in an integrated way to support people at o looking to develop this across tenure (for example, Waverley ey).

ole of sheltered housing to move it towards that of very sheltered ple from Richmondshire in Appendix 2 provides an example of this e example from Housing 21 in Penrith also provides an illustration of housing scheme to very sheltered housing (Appendix 2).

g and responding to older people?

tunities for a wide range of older people’s groups to talk and work t and key departments and agencies. The Better Government for me (now a partnership rather than a programme) has made a ought about many changes. Government has a Cabinet Committee

121

to oversee and consider older people’s issues and concerns, which extend far beyond ‘traditional’ concerns with welfare and pensions but which do not exclude these topics either. Inter-departmental groups such as the Housing and Older People Development Group have also been established. This Group is helping shape better policy on housing, support, transport and neighbourhoods from the perspectives of older people. Older People Development Group members include older people, senior civil servants, older people’s groups and experts.

Most striking is the fact that policy decisions are increasingly being made and announced jointly by key government departments (eg, DETR and DoH 2001: Quality and Choice for Older People’s Housing). The joint approach reflects an awareness that housing, health and general ‘well-being’ cannot be confined to one area of policy, and no single department should aim to develop policies on its own. Since the mid-1990s the DoH, for example, has employed and seconded housing specialists into its policy team. It also has a Change Agent programme which aims to stimulate knowledge about housing amongst health professionals and commissioners. The Change Agent Housing, Learning and Improvement Network (LIN), is part of this programme of work. The Housing LIN regularly commissions guidance, research and training.

A wide range of practical changes are also taking shape. They include integrated Community Equipment arrangements that aim to get rid of duplicate services for aids and equipment, which used to be provided by either health or social services. There are now single systems in place, which make it easier for health and care professionals to track down the equipment people need, although in rural areas travelling and delivery costs still have to be added. Some progress is also being made towards joined-up assessment processes between health and social care. However, older people who receive a variety of services are still likely to be multiply assessed at regular intervals.

Broader policies affecting older people – and others

Important changes were announced in a White Paper on Urban Areas (ODPM, 2000), the first for many years, and a White Paper on Rural Areas (ODPM, 2001). These changes set out the Governments plans for the future and demonstrate the extent to which the Government would like to encourage local areas to link policy streams together and use the resources available jointly in a planned way. The White Paper identified main priorities for rural communities including the need to raise the capacity of local communities to take an active role in the regeneration of their area. The need to tackle rural decline and deprivation and the devastating impact of Foot and Mouth Disease also led to the creation of two Rural Action Zones in 2002.

In 2001, the Government published New Commitment to Neighbourhood Renewal: A National Strategy Action Plan. Regeneration and renewing local communities are central themes in the Strategy. The Neighbourhood Renewal Unit was established within DTLR (now the ODPM) to implement the National Strategy Action Plan. Under the Plan local

122

authorities were required to set up Local Strategic Partnerships. Local Strategic Partnerships were given responsibilities for producing a local plan to implement a neighbourhood renewal strategy, and framework for co-ordinating renewal priorities to be followed by everyone.

Local authorities were also charged with producing cross-cutting Community Strategies or Plans aimed at bringing an increasing number of local plans and strategies together in one vision, and an action plan for a locality (or combine the sum of community strategies in the case of two-tier authorities). These are not to be confused with Communities Plans, which largely focus on housing and planning. Community Plans are intended to produce the over arching blueprint for a local area and all other strategies are supposed to link in, so one should be able to see the broad intentions of, for example, an older people’s strategy in a Community Plan and see it reflected further down the hierarchy in a housing strategy or Supporting People strategy. The strategies should also link together.

In 2002 the Government published a White Paper setting out its intentions to provide Regional Elected Assemblies where these are wanted (May 2002). In addition to structural and decision-making announced in Sustainable Communities: Building for the Future, described earlier, the document sums up Government policy and its views on actions needed to sustain different communities across England which face different pressures. The differences between regions are highlighted in the document and solutions include demolishing properties in some areas and building on a large scale in others. ‘Daughter’ reports for each region were also produced which go into further detail at a sub regional level.

Re-organisation, change and regional shifts

The movement towards a more coherent policy for older people and integrated mechanisms to enable these to be implemented in practice come at a time when the institutions and agencies that make and deliver policy are changing. Health policy changes reflect a number of things including the drive to manage public resources better, a determination to tackle medical inequalities and avoidable diseases, and medical advances and improved knowledge. The changes include an almost constant re-organisation of our health services and a gradual re-engineering which has resulted in more services and medical interventions being delivered at a community level or through out patient and day surgery. At the same time, more of the acute and specialist forms of medical intervention are being concentrated in larger hospitals, which serve larger populations, often across a regional area.

Re-organisation in health is only one example of far reaching changes. Significant changes at a regional level have occurred that affect local arrangements for housing and support in the broadest sense. New regional decision-making structures in England have been introduced that oversee pots of funding and decide on regional priorities. Spending and planning for social housing, land use and regeneration are switching from the present central-local arrangements to regions.

123

A highly important funding stream for housing regeneration and neighbourhoods is the Single Regeneration Budget. It is now part of a larger Single Pot fund administered by the Regional Development Agencies. Regional Housing Boards were established in 2003 composed of local authority representatives, the Housing Corporation, housing associations, English Partnerships and Government Offices for the Regions. Regional Housing Boards allocated funds from a regional pot for housing investment from April 2004. This contained the two main funds allocated by the Government for developing new social housing (local authority Social Housing Grant and Housing Corporation grants). As mentioned earlier, strategies are being developed by the new regional housing boards that help to determine how funds are distributed to local authorities and housing associations. However, further changes have overtaken governance at regional level and the ODPM have announced that Regional Housing Boards and Regional Planning Bodies are to merge. Potentially this merger can be seen as a positive development as it provides an opportunity to take an overview of housing and planning issues for older people. Regional Spatial Strategies, as the principal means of delivering sustainable community development, also offer opportunities to engage with overarching issues such as ageing in society, as well as embracing the essential role that older people play in the sustainable development of communities. At more local level, Local Development Frameworks also cover issues of particular relevance for older people and rural areas, and it is worth considering how far Supplementary Planning Guidance would ensure that both are fixed firmly on local authority agendas.

Regional Development Agencies and the Regional Housing and Planning Boards are part of an expanding set of regional governance arrangements. Other constituent parts are Government Offices for the Regions whose roles have expanded and who manage and administer an evolving set of regional plans. In addition, health structure changes in 2002 Regional Health Directors, responsible for public health issues. They are now in post and are located in Government Offices for the Regions. Added to all of this are Regional (shadow) Assemblies who oversee and comment on key regional plans and strategies.

Implications and impact of policy change

The pace of policy change is difficult to deal with. No single department takes responsibility on its own for many of the services older people require or want. Policy tends to be both less and more directive. It is arguably less directive because policy increasingly takes the form of a framework with a set of ‘sticks and carrots’ rather than a detailed list of how to do things. Government tends to leave it up to local authorities or others at a local level to make their own arrangements on how they actually carry out policy. Yet policy is also more directive because regulation and inspection along with performance measurement, targets, competitive bidding for government funds to do something new, and pilots and inducements to develop better practice keep growing. The over regulation of some service areas produces immense bureaucracy and can stifle innovation and flexibility. For example, the Commission for Social Care Inspection (CSCI), formerly the Care Standards Commission,

124

has a risk avoidance approach for regulating care homes and domiciliary services which is somewhat at odds with principles to enable people to live in the community, take risks and have flexible living and support/care arrangements. There have been difficulties as a result between different regulators on many aspects of supported housing. Moreover, while Supporting People started out with a flexible approach and was intended to stimulate the support service market, it is debatable whether the level of bureaucracy associated with it is stifling these objectives.

However, the direction policy has taken is probably more inclusive than ever before. Government, as the chapter indicates, makes serious efforts to listen to older people. More older people have the opportunity to benefit and be considered as full citizens as compared to the past. Wide areas of policy are theoretically being brought into play – from how market towns are regenerated, and for whom, to planning permissions for owner-occupied retirement housing in small villages. This kind of broad approach is vital if policy is to reflect older people’s needs and aspirations today and tomorrow regardless of income or tenure, race or ethnicity or where they live.

Nevertheless, progress at inclusion is mixed. For example, there is a distinct lack of strategic and service development for older people from BME communities. Very few housing or support strategies for rural areas have developed any understanding of the needs of minority communities despite the evidence that the number of older people from BME communities is increasing.

Progress towards developing integrated older people’s strategies is also mixed. The ODPM and DoH are keen to see such strategies developing. However, some of the structures and processes needed are still emerging. Currently only Liverpool has a Strategic Commissioning Board that has the authority to take cross-cutting and highly strategic decisions although other areas, including some rural areas, have elements in place – see the Pendle case study in Chapter four – and more are beginning the process. (See notes from a Master Class on Strategic Commissioning on the Housing LIN website www.changeagentteam.org.uk/index.cfm?pid=10doh.gov.uk/changeagentteam/housing-lin.htm.

The development of overarching Community Strategies – the strategy that should link everything that affects local populations together – has been disappointingly slow. For rural areas there have been opportunities through the Countryside Agency Vital Villages programme of funding for parish or village appraisals to conduct small local level studies that examine needs for leisure, education, housing, support, care and transport in the population, and then feed them into district and county or unitary community strategies and older people’s strategies. The same is true of the Countryside Agency’s programme to assist market towns (Market town health check action plans). However, it is unclear how the process of feeding in should be managed and by whom. Similarly, arrangements that give parish councils a role in developing local structure plans and housing strategies appear to be undeveloped in some areas (for example, Northumberland) and it is not clear how decisions

125

are made on what is included. There are arrangements available for parish councils to approach Rural Housing Enablers to assist with carrying out housing need studies and to identify sites for new development – the arrangements seem to work well provided people know about them. However, there is a limit to how much parish or village and community councils can realistically take on. Few are in a position to become fully acquainted with the complexities of strategies, agencies, partners and funds that have to be identified. This is not to say that parishes and communities in rural areas do not take on such tasks because they do – rather that the level of knowledge required (and project planning) is daunting. At the same time lack of clear connections to district and county or unitary authorities to the wider planning arrangements presents barriers for parish and community level groups in rural areas. Once they have evidence on local needs who should it be presented to and will anyone listen? These questions were asked recently in three separate Parish Plan groups in Northumberland (Bywell, Riding Mill and Slaley villages, available from the Countryside Agency).

There are some real problems that result from lack of connections, lack of knowledge and lack of expertise. Many local housing authorities have little or no knowledge of the wider population of older people and their visions tend to be narrow. There are hardly any local authorities with experience of building or commissioning new housing. The expertise lies with housing associations and charitable organisations on the one hand and the private sector on the other, including specialist Extra Care and retirement providers in the social or commercial sectors. There are few links between housing and planning – yet the people who may need accommodation and or services are increasingly able and would often prefer to purchase these. Then there are regional changes. The full implications are not known yet, but there are obvious impacts on local housing strategies and spending plans, and Supporting People Strategies particularly where plans for new schemes and services depend on assembling a range of funds such as, Social Housing Grant or regional funds. In addition plans will be affected by shifts in priorities for regeneration. This is because a substantial proportion of funds to improve local areas, for new housing and for refurbishment comes from regeneration funds or funds that are not strictly earmarked as housing. These funds are often used for a mix of community purposes including prevention schemes that are linked to projects supported by health, social care, housing and voluntary agency partners. Further, ODPM guidance has highlighted that whilst Regional Housing Strategies must continue to address the range of particular demands of all rural communities from small villages to market towns, they are invited to propose alternatives to the current rural housing targets for agreement with ODPM and Defra (ODPM, 2004).

The shifts leading to regional strategies and spending arrangements occurred suddenly and there are indications that many local authorities, other agencies and partnerships are poorly positioned to take advantage of them. Few draft Regional Housing Strategies, for example, referred to older people’s needs or made links to the need for support services and

126

supported housing. Nevertheless, the position is changing and a framework for arrangements is beginning to emerge. However, Supporting People currently has limited regional arrangements in place.

Certainly in recent year’s economic development, regeneration and transport and infrastructure changes rather than housing have tended to dominate regional agendas. It is possible that housing could be sidelined in some regions. The exceptions are ‘growth areas’, such as the Thames Gateway identified by ODPM as an area with acute housing shortages and high demand. Growth areas will receive huge investment for housing. How will older people fare in regional agendas of the future? There are some well-founded fears. For example, there is a pervasive tendency for older people’s housing and other issues that affect them to be seen as marginal. This is something that Better Government for Older People and the Housing and Older People Development Group have continued to lobby Government on. The Housing and Older People Development Group will also be gathering more information on regional bodies’ efforts to reflect older people’s interests and concerns. At the moment the evidence is that Regional Housing Strategies in general have not reflected older people in all their diversity although there are encouraging signs in some areas. In Kent, for example, which contains Ashford – a key ‘growth area’ – there are plans to ensure that a developing county-wide older people’s strategy has clear messages that can be used to affect regional agendas and plans. At the very least this might ensure that older people are considered as one of the groups who might occupy the new housing planned for the area. It is also one method of ensuring that some of the pots of money available are spread across the whole older population including people in rural and semi-rural areas away from Ashford.

An interview with a spokesperson from the Yorkshire and Humberside Government Office for the Regions indicated that while the Regional Housing Board had taken rural concerns seriously their understanding of older people’s needs and concerns had still to be developed. In the north-east older people’s interests are well represented on the Regional Development Agency and efforts are being made to ensure that the Regional Housing Board reflected both rural concerns and older people’s interests.

Regional arrangements and strategic approaches have other implications for what might broadly be called partnering, joint commissioning and planning arrangements. Currently departments in unitary authorities and county councils in the case of two-tier authorities are required to join together with various agencies to develop Local Strategic Plans and Local Delivery Plans. Key departments include social services and to a lesser extent housing. However, only Supporting People requires a formal Commissioning Body to be in place, which must be composed of all the key stakeholders. This is to ensure that all the key stakeholders take decisions jointly and to ensure that no single department is able to dominate the decisions on budgets and priorities. A greater focus for the regions has its advocates and opponents.

127

Current research on the subject of older people and regeneration (Riseborough and Jenkins, 2004) indicates a high level of concern that new structures are being put in place at a regional level too quickly. Local housing authorities have expressed their dismay at the loss of the social housing grant and most have no idea how much funding they will receive for future investment. It is unclear how Local Strategic Partnerships that work across health and care and link with housing and support services will work with, or have a voice in, regional planning for regeneration and housing. There are implications for local community organisations and parish and community councils. Nationally, some older people’s organisations, such as Age Concern England and large voluntary groups, have carefully tracked shifts and changes in policy and they have worked hard to develop strategic alliances on ageing at a regional level. A key contribution they are making is providing evidence on issues affecting older people while also promoting older people’s capacity to contribute to a better society.

Overall then, regional changes are still being bedded in. Awareness is still developing amongst regional bodies of the need to take account of the diverse pressures on different parts of the region including rural areas and to make sure these are reflected in, for example, regional housing strategies. The Countryside Agency has produced helpful advice notes on the subject while the Housing and Older People Development Group is in the process of producing regional briefings on older people’s needs and wishes and the relevance of strategic working in regional settings.

Summary

The chapter underlines the existence of a complex web of public policy, which affects older people and access to the right kind of housing for them. Policy areas include: ‘social’ housing; planning; regeneration and housing renewal; social or personal care; health; a range of welfare assistance; grants for repairs and help to pay for disabled facilities; pensions and state subsidies for incomes together with fiscal policies that affect private and occupational pensions; savings; earnings; property ownership; mortgages and other personal financial arrangements. A change in one part of the web necessarily impacts elsewhere. Policy trends are moving towards ensuring that older people are thought about and included in every part of the web. However, the devil is often in the detail and older people can get missed out by default or through lack of imagination, for example, in regeneration.

In particular, the chapter highlights the following points:

• policy complexity. There are more policies and more are interdependent, with an increase in both the number of policies and also the extent to which there is an inter-dependence between policies;

• an expectation of more joined-up working between agencies; • the impact of the emergence and growing significance of regional governance;

128

• growing regulation and inspection; • the need to take account of new thinking about, and new definitions of, housing and

services such as sheltered housing; • continuing age discrimination, although there is a recognition of the importance of

involving older people in policy development and implementation; • an opportunity for a local and rural input is not always possible because the

structures of government, and systems and processes do not always take account of local plans and hopes.

129

Appendix 2 Rethinking the role of sheltered housing in rural areas – case examples

CASE EXAMPLE: HOUSING 21 – DEVELOPING A QUALITY OF LIFE APPROACH IN SHELTERED HOUSING

Tenants and residents of Housing 21 have made it clear that they are looking for more than a good housing management and maintenance service. They have identified a number of other aspects of living that are central to their well-being. Housing 21 has, therefore, developed a service promise to either link older people up with, or directly provide, a range of services and opportunities. The service promise covers:

• Getting out and about.

• Shopping and cleaning services.

• Welfare benefits advice (Housing 21 welfare benefits advisers enable tenants to access over £1m additional unclaimed benefits a year).

• Access to personal care.

• Physical and mental activities.

CASE EXAMPLE: RICHMONDSHIRE – EVOLVING SHELTERED HOUSING INTO VERY SHELTERED HOUSING IN RURAL AREAS

Richmondshire District Council, North Yorkshire County Council and the PCT have piloted two different ways of providing Extra Care in ordinary sheltered housing. These services have been evaluated and the summary findings are set out below.

There are two main service models, both of which are seen to be successful:

1) Providing Extra Care by adding to the warden’s job, if the warden has the capacity, experience and training to take on extra duties. Increased demand on top is handled by home care and nursing services

2) Providing Extra Care with an additional member of staff. This is suitable where the warden does not have spare capacity or where there a number of tenants with high care needs. The model can be either flexible hours home care support, with hours determined by the level of need at any one time, or fixed hours model, with spare capacity used either for developing health promotion activities or supporting other people off-site.

The underlying principles of the scheme are to:

– provide continuity; – allow flexibility whilst maintaining standards; – trust local workers to show common sense and initiative in meeting care needs; – value the friendly and caring qualities shown by wardens and Extra Care workers; – develop good liaison and partnership;

130

– balance providing support with encouraging independence; – develop and promote community activities yet allowing personal space and privacy; – consider how design of buildings and day-to-day maintenance can affect quality of life; – build on local resources and resourcefulness; – enable effective support to be provided by health, social care and housing provision, by creating pooled budgets and ease of accounting. The key services offered are: – bathing assistance; – collecting prescriptions and putting out medicines; – minor nursing procedures such as drops, dressings, and changing catheter bags; – shopping; – extra practical and personal support when someone is poorly; – development of activities – increasing the range of what’s on offer eg, encouraging physical and mental agility through quizzes and baking days, social interaction through shared meals and social afternoons. Extra Care workers are trained to take on these duties. Funding is provided jointly through health and social services. Residents, wardens, local workers and managers appear very satisfied with how Extra Care operates and the quality of life at the sheltered schemes. The benefits are described as: – Reducing or delaying the need for some residents to move to residential or nursing home care, which prevents upheaval, saves local authority costs, reduces demand on institutional care. – Further cost savings through reducing the number of visits and travelling time for district nurses and home care; and freeing up these staff resources to be used elsewhere. – In the examples studied in the evaluation it was estimated that the cost of care would have been at least six times greater without Extra Care taking into account those people who would have needed to move to residential or nursing care or have extra home care and nursing services. – Extra Care provides a continuity of care, able to respond as needs arise and act in as preventative way to safeguard physical and mental health. It can cover the grey areas between health and social care ie, tasks otherwise not specifically anyone’s remit but nonetheless crucial to resident’s well-being. – It assists in meeting the Health of the Nation target, for example, Extra Care exemplifies the advocated model of health promotion where health messages are put across at the most appropriate time and backed up by different workers. For example: encouraging good diet and exercise; enabling access to regular meals; promoting activity and mobility and ensuring medicines are taken regularly as prescribed. – Extra Care is on the spot to respond if people are poorly and provide support when people come out of hospital. In some cases it may have enabled individuals to be discharged from hospital sooner, although it depends on each situation and should not be taken for granted. – It reduces turnover and increases the letability of housing, particularly in hard to let rural schemes. – It increases staff satisfaction and career development; recognises and remunerates tasks previously done beyond the call of duty; gives confidence and training for an extended role and brings the rewards of being more directly involved in residents’ care and support. – For residents it improves quality of life; provided support in access to services particularly in rural areas; where these can be inaccessible; creating activities end events and ensuring increased availability of a listening ear and practical support. – Extra Care can work flexibly in conjunction with nearby services to enable effective use of resources – for example, utilising the meals cooked at the nearby residential home and building up good liaison with the local GP surgery.

131

CASE EXAMPLE: HOUSING 21, LONSDALE COURT, PENRITH – REMODELLING SHELTERED HOUSING TO VERY SHELTERED HOUSING

An existing Housing 21 sheltered housing scheme is being refurbished by a mix of joint finance and Social Housing Grant with Housing 21 top up. The scheme will have 30 units, 20 funded for Extra Care and 10 ordinary sheltered.

The personal care service is purchased by social services from Housing 21 according to needs assessment of individual residents, each of whom has a care contract with social services

Night-time cover presently available via mobile warden call system, but social services anticipate purchasing on-site cover when all Very Sheltered Housing places are occupied.

Joint Finance is funding excess care costs during the pilot programme. Social services is committed to pick-up the whole care costs on completion according to their charging policy.

The aim is to demonstrate that Very Sheltered Housing is a realistic alternative to residential care, so eligibility criteria are the same. Social services have a list of people assessed for residential care who have chosen to wait for a place in Lonsdale Court.

Rolling programme of refurbishment as and when existing sheltered units become vacant. Target is up to 10 Very Sheltered Housing in year 1, 15 in year 2 and 20 in year 3. All communal areas have been refurbished.

A full meals service is contracted to Cumbria Catering.

Remaining sheltered housing tenants may purchase care services from Housing 21 and some may have some home care spot purchased for them by social services.

132

133

Appendix 3 The Housing Corporation’s definitions of housing association supported housing and housing for older people

This appendix reproduces Housing Corporation regulatory Circular No: 03/04, dated April 2004, which sets out the new definitions of housing association supported housing and housing for older people. HOUSING CORPORATION REGULATORY CIRCULAR NUMBER: 03/04 DATE FIRST ISSUED: April 2004 Note: ‘housing association’ is used as a generic term for Registered Social Landlords(RSLs). ‘Corporation’ means Housing Corporation. TITLE: The Housing Corporation’s definitions of housing association supported housing and housing for older people SUMMARY: The purpose of the definitions is to enable housing associations to categorise their housing for rent as either general needs housing or supported housing or housing for older people within the Housing Corporation’s regulatory, data collection and investment systems. THIS CIRCULAR IS FOR THE ATTENTION OF:

• All Registered Social Landlords; excluding co-ownership societies; • Local Authorities; • Registered Social Landlords’ Auditors; • Registered Social Landlords’ Solicitors.

1.0 Legislation, regulation and policy requirements This circular applies to all housing associations excluding co-ownership societies. It should be read by all housing associations which own or manage supported housing, housing for older people or general needs housing for rent. This circular replaces Circular R1-11/99 and provides new Housing Corporation definitions of supported housing and housing for older people. The definitions are necessary for us to ensure appropriate regulation and funding of housing association stock. The definitions enable housing associations to categorise within the Housing Corporation’s regulatory, data collection and investment systems their housing for rent as supported housing, housing for older people, or general needs housing.

134

This categorisation must be in full accordance with the guidance set out below. The Corporation may, by exception, require an association which has inappropriately classified its stock to re-designate it. However, please note 3.1 below regarding CORE in 2004/05. 2.0 Definitions 2.1 Definition of supported housing There are two types of supported housing: Purpose designed supported housing; and designated supported housing. The term 'supported housing' applies to purpose designed or designated supported housing. The delivery of support under the Supporting People framework does not necessarily result in the categorisation of housing as supported if the property is not purpose designed or designated for a particular client group. In the absence of either of these two conditions, housing is general needs. The design features which distinguish the two types of supported housing that interest the Housing Corporation are listed below. 2.1.1 Purpose designed supported housing: Buildings that are purpose designed or remodelled to enable residents to adjust to independent living or to enable them to live independently and which require specific design features. There must be support services provided by the landlord or another organisation. At a minimum, a building or scheme must have the following: Facilities: The scheme or main building must have basic facilities of a laundry for residents or washing machines in living units provided by the landlord. The scheme must also have a communal lounge. Design features: The entrance area into the building, communal areas and some living units must be designed to wheelchair user standards. 2.1.2 Designated supported housing: Buildings with some or no special design facilities and features but that are designated for a specific client group with support services in place to enable them to adjust to independent living or to enable them to live independently. 2.2 Definition of housing for older people There are three types of housing for older people:

• Housing for older people (all special design features); • Housing for older people (some special design features); • Designated supported housing for older people.

Properties should be described as housing for older people if they are intended for older people (regardless of the actual characteristics of each tenant) and they either incorporate the range of basic facilities and special design features set out below or are specially designated supported housing for older people. The distinctive design features should be over and above lifetime homes adaptations to general needs properties. The age of tenants actually resident is not a defining feature. Tenants in housing for older people (all special design features) or housing for older people (some special design features) should have access to support services as need arises to

135

enable them to live in the property for the rest of their lifetimes. Access to support means that at a minimum, a process is in place to assist in accessing and/or signposting tenants to support services that they need. Except in the case of ‘designated supported housing for older people’, the delivery of or level of support is not a defining feature. The three types of housing for older people are described below. 2.2.1 Housing for older people (all special design features) Remodelled or purpose-built grouped housing that has all the basic facilities and all special design features intended to enable people to live there for their lifetimes. All the following requirements have to be met: Basic facilities: The scheme or main building must have basic facilities of a laundry for residents and/or washing machines in living units or provision for washing machines to be installed. The scheme must also have a communal lounge. Special design features: The whole scheme including entrances and the buildings that comprise it must be designed to wheelchair user standards. Living units must have walk in showers or bathrooms adapted for people with mobility problems or wheelchair users. Bathrooms in living units that are wheelchair standard must meet the criteria for adapted bathrooms. Living units must have kitchens that are designed to wheelchair standards. The scheme must have a bathroom with provision for assisted bathing. If there is more than one storey there must be a lift. 2.2.2 Housing for older people (some special design features) Remodelled or purpose built grouped housing that has all the basic facilities and at least one or more of the special design features listed below. Residents must have access to support services to enable them to live there for their lifetimes. In addition, if there is more than one storey there must be a lift. Basic facilities: The scheme or main building must have basic facilities of a laundry for residents and/or washing machines in living units or provision for washing machines to be installed. The scheme must have a communal lounge. Special design features: Living units have walk in showers or bathrooms adapted for people with mobility problems or wheelchair users. Bathrooms in wheelchair standard living units meet the criteria for adapted bathrooms. The living units, the entrance area into the building and communal areas are designed to wheelchair user standards. 2.2.3 Designated supported housing for older people: Buildings with none of the special design facilities and features listed above but which provide accommodation designated for older people requiring support, with support services provided by the landlord or another organisation. 2.3 Further interpretation and clarification of the definitions 2.3.1 Care homes

136

Under the Care Standards Act 2000, the National Care Standards Commission defines care homes under service categories. In line with this the Corporation makes the following distinctions: a) ‘Care homes providing personal care’ fall within the definition of social housing and are either purpose designed supported housing or housing for older people (all special design features). b) ‘Care homes providing nursing care’ are excluded from the definition of social housing and are therefore outside the definitions of supported housing and housing for older people. 2.3.2 Care or support services provided by other agencies The provision of care or support services to a resident such as domiciliary care is not in itself grounds for classifying the stock as supported housing or housing for older people. One of the above definitions must be met. 2.3.3 Night shelters Night shelters which only provide accommodation overnight or a very short-term resting place and give no written occupancy agreement are considered not to be social housing and therefore not supported housing. Those night shelters which constitute a home and provide a written occupancy agreement will be considered as social housing and, provided one of the above definitions is met, should be categorised as supported housing. 2.3.4 Floating support and move-on accommodation The term ‘supported housing’ excludes floating or move-on support within general needs stock. 3.0 Corporation Expectations 3.1 Regulatory and other returns and regulatory implications Housing associations are required to report to the Corporation consistently on supported housing stock and housing for older people throughout their accounts, financial reports and plans (FV5 and FV3), Regulatory and Statistical Return and the CORE system. Regulatory and Statistical Return and RSL accounts Stock defined as supported housing or housing for older people will be treated together for the purpose of performance indicators. CORE Stock defined as housing for older people is considered a subset of supported housing within the CORE system. IMPORTANT NOTE: The definitions set out in the 2004/05 CORE guidance are not consistent either with this Circular or with the RSR 2005 return. ‘Designated supported housing for older people’, will be classified as ‘general needs’ not ‘supported’ in CORE for 2004/05. This is a transition period until 1 April 2005 when CORE guidance will be amended. 3.2 Investment implications The Housing Corporation will pay Social Housing Grant to capital fund supported housing and housing for older people. As with all capital funding, projects must meet the Regional

137

Housing Strategies and follow the bids and allocations process for the whole capital funding programme. 4.0 Assessing Compliance Associations are expected to make their own assessment of compliance with our regulatory requirements and to report this to the Corporation. We expect that this assessment will take account of: a) Any relevant issues identified in reviews or other work on which governing boards base their annual Statement on Internal Controls Assurance. b) Any relevant issues identified by an associations’ external auditor during the preparation and audit of annual accounts. 5.0 Enquiries about this circular Please direct any enquiries about this circular to the regulation team at the appropriate regional office of the Housing Corporation.

138

139

Appendix 4

Older people in rural areas: national data

Introduction

To understand the housing circumstances of older people in rural areas, two national data bases were interrogated – the 2001 Census data, and the SEH. The 2001 Census is able to provide key statistics about housing circumstances, analysis of differences between age groups, and allows general comparisons to be made between older people in rural areas and their urban peers. The SEH provides some supporting information to the Census, and also enables additional analysis of attitudes and views of older people about living in rural areas. The appendix also draws upon the results of the 2001 English House Condition Survey to examine the condition of property in rural areas.

The appendix first considers the socio-economic circumstances of older people looking at key variable of age, gender, health status, income, and household composition. It then looks at housing and neighbourhood variables: tenure, house condition, and satisfaction with accommodation. Finally, the appendix considers access to key facilities.

Analysis of 2001 Census

Data from the 2001 Census for England and Wales is made available by the Office for National Statistics (ONS). The national tables in this report are based upon the data for England alone. To preserve anonymity it is not possible to gain access to the ‘raw’ Census data. Rather the data are made available as a series of cross-tabulations that contain counts of the numbers of people or households (usually) for a range of key variables, and which the analysis converted into percentages using the relevant base. An example of a cross-tabulation from the 2001 Census is the number of people, split into age bands, and cross-tabulated by their answer to the question: ‘Over the last 12 months would you say your health has on the whole been: good/fairly good/not good?’ The content of the tables made available by the ONS varies in terms of some of the key variables, and which had implications for the analysis: a range of different age bands is used, for example.

The Census tables are available for a range of geographical areas, such as local authority areas or health areas. In this report the principal geographical unit of analysis is the electoral ward as they existed at the time of the Census (April 29, 2001). There are 7,987 English wards included in the available Census data, and on which the average figures for England have been based. To protect anonymity, a small number of areas with low counts of people or households were merged with contiguous areas by the ONS (details are available at: <http://www.statistics.gov.uk/>).

140

The wards have been identified as rural or urban by using an indicator provided by the Countryside Agency. The Countryside Agency is currently producing a new rural/urban definition, but as this is not yet available, a revised version of the definition that applied to the 1998 wards was made available to the research (a revised version of the Oxford-CA Classification). This definition will therefore be subject to revision, but represented the only reliable identifier at the time of the analysis.

Survey of English Housing

The SEH is a continuous survey started in 1993. It is designed to provide a nationally representative sample of about 20,000 households in England. While the 2001 Census is able to provide key statistics about the circumstances of older people in rural areas, the SEH explores a number of issues in more depth, asking respondents about issues such as public transport, reasons why they may not have undertaken maintenance and improvements to their homes, reasons for not moving, and so forth. The SEH also allows the comparison of rural areas below 3,000 populations with settlements of between 3,000 and 10,000 population, and above 10,000, although it is to be noted that the number of households in a particular category may be very small. Nevertheless, the SEH data provide a useful counterpoint to the Census data.

Older people in rural areas – age, health and income

Age and gender

The 2001 Census indicated that the population of England stands at just over 48,000,000; with 25 per cent of the population living in a rural area (just over 12,000,000 people). Of the population of England, 27.9 per cent are aged 55+, however in rural areas this rises to 31.5 per cent of the population compared to 25.2 per cent of the population in urban areas. Thus, the rural age profile is significantly different to the urban age profile: almost 1 in 3 people in rural areas are aged 55 and over, compared to 1 in 4 people living in urban areas.

Looking at gender, 12.8 per cent of the total population of England are men aged 55+, and 15.1 per cent are women aged 55+. However, there are again differences in rural areas, 14.7 per cent of the rural population are men aged 55+ compared to 11.4 per cent in urban areas; 16.7 per cent of the rural population are women aged 55+ compared to 13.8 per cent in urban areas.

If the population aged 55+ is split into 5-year age bands, it seems that the differences between the rural and urban populations in terms of age are largely accounted for by people aged 55-74. This is illustrated in Table A4.1.

141

Table A4.1 England: Older people as a proportion of all people by gender and by age band

Rural/ Urban

55-59 (%)

60-64 (%)

65-69 (%)

70-74 (%)

75-84 (%)

80-84 (%)

85-89 (%)

90+ (%)

All 55+ (%)

N. All people

Rural 3.6 3.0 2.6 2.2 1.7 1.0 0.5 0.2 14.7 12,133,162

Urban 2.7 2.3 2.0 1.7 1.3 0.8 0.3 0.1 11.4 36,114,414 % of all people All 3.1 2.6 2.3 2.0 1.5 0.9 0.4 0.1 12.8 48,247,576

Rural 7.3 6.1 5.4 4.6 3.5 2.0 0.9 0.3 30.1 5,928,275

Urban 5.6 4.8 4.2 3.6 2.8 1.6 0.7 0.2 23.4 17,581,204

Men

% of all men All 6.3 5.3 4.7 4.0 3.1 1.8 0.8 0.3 26.3 23,509,479

Rural 3.6 3.0 2.7 2.5 2.2 1.5 0.9 0.4 16.7 12,133,162

Urban 2.8 2.4 2.2 2.1 1.9 1.3 0.8 0.3 13.8 36,114,414 % of all people All 3.1 2.7 2.4 2.3 2.0 1.4 0.8 0.4 15.1 48,247,576

Rural 7.1 5.9 5.3 4.9 4.2 2.9 1.7 0.8 32.7 6,204,887

Urban 5.4 4.7 4.4 4.1 3.7 2.5 1.5 0.6 26.9 18,533,210

Women

% of all women All 6.1 5.2 4.8 4.4 3.9 2.7 1.6 0.7 29.4 24,738,097

Rural 7.2 6.0 5.3 4.7 3.9 2.5 1.3 0.5 31.5 12,133,162

Urban 5.5 4.7 4.3 3.9 3.2 2.1 1.1 0.4 25.2 36,114,414 Total % of all people All 6.2 5.2 4.7 4.2 3.5 2.3 1.2 0.5 27.9 48,247,576

Source: 2001 Census

Self-reported health status

The Census asked respondents to rate their own health status, asking: ‘Over the last 12 months would you say your health has on the whole been: good/fairly good/not good?’. It also asked whether people had any long-term illness, health problem or disability which limited daily activities or work, including problems due to old age.

Of those aged 55+ in England, 44.2 per cent rated their own health as ‘good’, 37.1 per cent rated their health as ‘fairly good’, and 18.7 per cent rated their health as ‘not good’. Again there are differences between rural and urban dwellers. Of the rural population aged 55+, 48.3 per cent rated their health as good, 37.1 per cent as fairly good, and 15.5 per cent rated their health as not good. The older rural population’s perception of health status can be compared to the older urban population where 41.1 per cent of those aged 55+ rated their health as good, 37.9 per cent rated their health as ‘fairly good’, and 21.1 per cent rated their health as not good.

These data seem to indicate that more older people in rural areas feel well in themselves. A greater proportion, almost 1 in 2 reported good health, and 1 in 6 rated their health as not good. In urban areas however, more older people, 1 in 5 rated their health as not good.

142

As might be expected when the population is split into age bands, differences appear between age groups, however, the more positive perceptions of health status still holds, as can be seen from Table A4.2 below.

Table A4.2 England: General health status by age, by rural and urban population

Health Status 55-59 (%) 60-64 (%) 65-69 (%) 70-74 (%) 75-79 (%) 80-84 (%) 85-89

(%) 90+ (%) All 55+ (%)

GH 61.3 55.9 50.3 42.9 36.4 31.2 25.4 23.1 48.3

FGH 27.7 31.4 36.9 41.3 43.7 44.6 44.8 45.0 36.2 Rural

NGH 11.1 12.7 12.9 15.8 19.9 24.2 29.8 31.9 15.5

GH 53.0 47.4 42.6 36.0 31.6 27.6 22.4 22.4 41.1

FGH 30.1 34.1 39.2 42.8 43.4 43.3 42.9 42.5 37.9 Urban

NGH 16.9 18.4 18.2 21.1 25.0 29.0 34.7 35.2 21.1

GH 56.6 51.1 45.9 39.0 33.7 29.2 23.7 22.7 44.2

FGH 29.1 32.9 38.2 42.2 43.6 43.9 43.7 43.5 37.1 All

NGH 14.4 16.0 15.9 18.9 22.8 26.9 32.6 33.8 18.7

2,769,471 2,377,760 2,137,713 1,922,381 1,596,917 1,035,455 545,472 219,134 12,604,303 KEY: GH = Good Health; FGH = Fairly Good Health; NGH = Not Good Health. Source: 2001 Census

The most obvious point to make regarding self-reported health status is that older people in rural areas appear to feel better generally than older people in urban situations. Health status is related to socio-economic status, and these data may simply reflect greater affluence among rural older people, rather than be related to urban/rural location. However the data may also be interpreted in a number of other ways. A potentially cleaner environment, closer and supportive communities, and less fear or experience of crime and ant-social behaviour are all features of living in countryside that the older people in our consultations noted as being ‘good things’ about living in the countryside. It may be that certain aspects of rural life have a positive impact on older people’s sense of well-being.

It is to be noted that although older people in rural areas self report better health than their urban counterparts, the greatest differences between the urban and rural populations are among the younger-old. The gap narrows as age increases although it does still remain. This comes as no surprise as it might be expected that the very old, wherever they are, are more likely to report poor health. There may also be other factors at play. Again this may be related to socio-economic status in some way – the very old in rural areas are likely to have much smaller incomes than their younger-old neighbours, and are also less likely to have central heating in their homes. They are also more likely to live alone. It may also reflect the numbers of relatively affluent newly retired (younger) people coming to live in the country compared to those who have lived in a rural area all their lives.

143

Life-limiting illness and disability

In terms of life-limiting illness, Table A4.3 shows that 39.4 per cent of all people aged 55 and over in England reported a life limiting illness. However 35.5 per cent of people aged over 55 in rural areas reported a life limiting illness, compared to 42.5 per cent of people aged over 55 in urban areas. Again there are large differences between different age bands, and as might be expected the younger-old report less limiting illnesses. For all age bands, older people in rural areas report less life limiting illness than their urban peers. Nevertheless there is considerable morbidity among older rural residents.

Table A4.3 England: Long-term limiting illness by age, by rural and urban population

Rural/ urban

Limiting long-term

illness2

55-59 (%) 60-64 (%) 65-69 (%) 70-74 (%) 75-79 (%) 80-84 (%) 85-89 (%) 90+ (%) All 55+

(%)

LLI 20.8 27.2 32.0 38.5 48.3 57.3 68.0 75.3 35.5 No LLI 79.2 72.8 68.0 61.5 51.7 42.7 32.0 24.7 64.5 Rural All 100 100 100 100 100 100 100 100 100 LLI 28.2 35.3 39.3 44.9 53.8 61.3 70.9 76.1 42.5 No LLI 71.8 64.7 60.7 55.1 46.2 38.7 29.1 23.9 57.5 Urban All 100 100 100 100 100 100 100 100 100 LLI 25.0 31.8 36.1 42.2 51.4 59.6 69.7 75.8 39.4 No LLI 75.0 68.2 63.9 57.8 48.6 40.4 30.3 24.2 60.6 All All 100 100 100 100 100 100 100 100 100

No. 2,769,471 2,377,760 2,137,713 1,922,381 1,596,917 1,035,455 545,472 219,134 12,604,303 Source: 2001 Census

The SEH also asked respondents whether there was anyone in the household with an illness or disability. More households in the smallest settlements reported an illness or disability compared with larger settlements. In total, 30 per cent of households in the smaller settlements faced this situation compared with 25 per cent in settlements between 3,000 and 10,000, and 26 per cent in larger settlements. Research on the needs of older people in rural areas in Shropshire found that a third of people over 65 in their sample suffered from arthritis of the hand/shoulder, with implications for carrying out domestic chores, with a third also suffering from arthritis of the hips/knees, indicating mobility problems (Nayak and Hodsoll, 2002). The research in Shropshire also reported that only 12 per cent of older people in the sample stated that they were free from physical health problems, which is a higher proportion than that indicated by the results of the SEH, as shown by Table A4.4.

144

Table A4.4

Any household member with disability?

Age Settlements < 3,000 population

Settlements between 3,000-10,000 pop.

Settlements < 10,000 population

Yes (%) No (%) Yes (%) No (%) Yes (%) No (%)

50-64 28 72 30 70 28 73

65-74 39 61 38 62 42 59

75+ 56 44 48 52 53 47

Average (All ages) 30 70 25 75 26 74 Source: 2001 Survey of English Housing: % may not equal 100 due to rounding

The SEH also asked households who reported an illness or disability if their accommodation was suitable for the person experiencing this situation (Table A4.5). It was noticeable that more households in the smaller settlements were likely to state that their home was suitable compared with households in larger settlements.

Table A4.5 Is your accommodation suitable for the person with ill health or disability?

Age Settlements < 3,000

population Settlements between

3,000-10,000 pop. Settlements < 10,000

population Yes (%) No (%) Yes (%) No (%) Yes (%) No (%)

50-64 79 21 79 21 70 30

65-74 91 9 92 8 80 20

75+ 91 9 75 25 86 15

Average (All ages) 84 16 80 21 75 25 Source: 2001 Survey of English Housing: % may not equal 100 due to rounding

Household composition

The Census data indicate that 69.8 per cent of people aged 55+ living in rural areas, live in a couple (either married, or cohabiting), compared to 61 per cent of people aged 55+ in urban areas. Again there are significant differences between age groups. In rural areas, more than 80 per cent of those aged 55-64 live as a couple, and this proportion declines as age increases. Of those aged 75-79, only 56 per cent live as a couple, 43.4 per cent of those aged 80-84, 28 per cent of those aged 85-89, and 15.3 per cent of those aged 90+. These data indicate clearly that it is the very old who are most likely to live alone.

Unpaid care

Older people are the main providers of informal care in the UK. The Census data shows that 15.2 per cent of people over 55 are providing some level of unpaid care, to family,

145

neighbours or others.1 Clearly there may be different interpretations of ‘care’, and some people might consider quite crucial support (for example, regular lifts to shops in a car) as plain ‘good neighbourliness’ rather than unpaid care. Conversely ‘care’ could be interpreted as essential, personal tasks (assistance with bathing, washing) or very simply low-level help, fetching a newspaper or cutting a hedge. These data then can only give a broad indication of levels of unpaid care, and cannot give any indication of the nature of care given, nor of any additional support such as respite care that carers might be receiving. There were no questions on the Census relating to voluntary work or activity, so it is not possible to know whether respondents reported their voluntary activity as ‘unpaid’ care, or interpreted the question as referring only to informal networks within family and friends.

Table A4.6

England: Provision of unpaid care by age and gender

Gender Unpaid care Rural/ Urban

55-59 (%)

60-64 (%)

65-74 (%)

75-84 (%)

85-89 (%)

90+ (%)

All 55+ (%)

Rural 81.6 83.4 86.2 87.8 90.9 94.5 84.9

Urban 82.3 84.2 85.9 87.7 91.3 94.4 85.2 Care not provided

All 82.0 83.8 86.0 87.8 91.1 94.5 85.1

Rural 18.4 16.6 13.8 12.2 9.1 5.5 15.1

Urban 17.7 15.8 14.1 12.3 8.7 5.6 14.8

Men

Care provided

All 18.0 16.2 14.0 12.2 8.9 5.5 14.9

Rural 74.6 78.9 85.1 91.5 96.3 98.0 83.8

Urban 76.5 80.4 85.9 92.1 96.6 98.1 85.2 Care not provided

All 75.7 79.7 85.6 91.9 96.4 98.1 84.6

Rural 25.4 21.1 14.9 8.5 3.7 2.0 16.2

Urban 23.5 19.6 14.1 7.9 3.4 1.9 14.8

Women

Care provided

All 24.3 20.3 14.4 8.1 3.6 1.9 15.4

Rural 78.0 81.1 85.6 89.9 94.3 97.0 84.3

Urban 79.3 82.2 85.9 90.4 94.7 97.0 85.2 Care not provided

All 78.8 81.7 85.8 90.2 94.5 97.0 84.8

Rural 22.0 18.9 14.4 10.1 5.7 3.0 15.7

Urban 20.7 17.8 14.1 9.6 5.3 3.0 14.8

All

Care provided

All 21.2 18.3 14.2 9.8 5.5 3.0 15.2

Totals Care not provided/Care provided

Rural/ Urban/ All

100 100 100 100 100 100 100

N. 2,769,952 2,378,240 4,060,295 2,632,242 545,681 219,168 12,605,578 Base: All people aged 55+. Source: 2001 Census

1 Census question: “Do you look after, or give any help or support to family members, friends, neighbours or others because of long-term physical or mental health or disability OR problems related to old age?”

146

Table A4.6 shows some small differences between the proportions of older people in rural and urban areas giving regular unpaid care. The proportions of men and women aged 55+ giving unpaid care are very similar (14.9 per cent of men, and 15.4 per cent of women). It is to be noted however that there are very different patterns of care giving between the genders at different ages, and this is true for people in rural and urban areas. A greater proportion of men aged 75+ and above give unpaid care compared to women aged 75+. Conversely a greater proportion of women aged 55-64 give unpaid care compared to their male contemporaries.

Voluntary work

The SEH gives some indication of the level of voluntary activity among older people (Table A4.7). Research has highlighted the significant contribution that older people make to the economic and social vitality of rural communities and that too often older people are represented as a problem (Le Mesurier, 2003b). The table below shows that households with people aged between 50 and 75 were more likely to undertake voluntary work than other (both younger and older) age groups. Almost 1 in 4 of those aged between 50 and 74 reported that they had undertaken voluntary work in the last year.

Table A4.7 Any voluntary work in the last year?

Age Settlements < 3,000

population Settlements between

3,000-10,000 pop. Settlements < 10,000

population Yes (%) No (%) Yes (%) No (%) Yes (%) No (%)

16-24 7 93 11 90 9 91

25-49 17 83 15 85 15 85

50-64 19 81 21 79 20 80

65-74 22 79 19 81 22 78

75+ 14 86 19 81 13 87

Average (All ages) 17 83 17 83 17 83 Source: 2001 Survey of English Housing: % may not equal 100 due to rounding

Household income

The Census does not ask questions about income, but the SEH does. Table A4.8 below shows that average levels of income fall steadily as people age. Just under 1 in 10 of households with people aged 50-64 in the smallest settlements earned less than £100 per week. This proportion had risen to just over one-quarter for households with people aged 75 and above. In part, this trend could reflect the rise in 1 person households amongst people in later life.

147

Table A4.8 Household income (gross) per week (£)

Settlements under 3,000 population

0-100 (%)

100-300 (%)

300-500 (%)

Over 500 (%)

16 - 24 24 30 24 21

25 - 49 7 21 25 47

50 - 64 9 24 26 41

65 - 74 14 61 13 12

75 + 27 60 10 3

Average (All ages) 11 31 22 35 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population 0-100

(%) 100-300

(%)

300-500 (%)

Over 500 (%)

16 - 24 36 24 24 16

25 - 49 8 24 22 46

50 - 64 10 27 18 45

65 - 74 13 63 13 12

75 + 20 60 14 5

Average (All ages) 11 34 19 36 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

0-100 (%)

100-300

(%)

300-500 (%)

Over 500 (%)

16 - 24 24 36 22 19

25 - 49 6 24 23 48

50 - 64 10 27 23 41

65 - 74 14 58 18 10

75 + 28 59 9 5

Average (All ages) 11 33 21 35 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Older people in rural areas: tenure and house condition

Tenure

Table A4.9 below shows the type of tenure of older people in rural and urban areas, split by age. Broadly speaking, more people over 55 are owner-occupiers in rural areas (80.8 per cent), than in urban areas (72.9 per cent), although this proportion drops among those aged

148

over 75. A smaller proportion of people over 55 live in social rented housing in rural areas (11.3 per cent) compared to urban areas (21 per cent), and a slightly bigger proportion of people over 55 in rural areas live in privately rented accommodation (7.9 per cent) than in urban areas (6.1 per cent).

Table A4.9 England: Tenure of older people

Tenure Rural/

Urban 55-59 (%)

60-64 (%)

65-74 (%)

75-84 (%)

85+ (%)

All 55+ (%)

Rural 85.6 84.4 81.3 74.1 68.6 80.8

Urban 78.8 77.2 73.9 65.2 58.1 72.9 Owner- occupied

All 81.7 80.3 77.1 69.0 62.6 76.3

Rural 6.7 8.4 11.9 16.6 18.6 11.3

Urban 15.5 17.4 21.0 27.4 30.8 21.0 Social rented

All 11.7 13.5 17.1 22.7 25.5 16.8

Rural 7.7 7.2 6.8 9.3 12.8 7.9

Urban 5.8 5.4 5.1 7.4 11.1 6.1 Private rented

All 6.6 6.1 5.8 8.2 11.8 6.9

Totals Rural/Urban/All 100 100 100 100 100 100

N. 2,769,675 2,378,132 4,059,956 2,632,067 763,935 12,603,765 Base: all people aged 55+ Source: 2001 Census Notes. Owner-occupied includes owners with and without a mortgage or loan, and shared ownership. Social rented includes people renting from their council or other types of social landlord. Private rented includes people renting from a private landlord or letting agency, and those living rent free.

It is to be noted that a greater proportion of all very old people live in social rented accommodation (and this will include sheltered housing or properties purpose built for the disabled) compared to the younger-old. For example, 22.7 per cent of those aged 75-84, and 25.5 per cent of those aged 85+ live in social housing. However, this national figure masks a big discrepancy between rural and urban areas. Only 16.6 per cent of those aged 75-84 in rural areas live in social rented housing, compared to 27.4 per cent of those of the same age in urban areas. For those aged 85+, only 18.6 per cent of those in rural areas live in social housing compared to 30.8 per cent in urban areas. The table shows that a greater proportion of very old people are owner-occupiers in rural areas than in urban areas.

House condition: How far are non-decent homes located in the countryside?

Overall the number of dwellings that are non-decent in urban and rural areas of England (defined as those dwelling which are unfit, in disrepair, in need of modernisation or provide

149

insufficient thermal comfort) has fallen from 9.4 million (46 per cent of all dwellings) to 7.0 million (33 per cent of all dwellings).

The English House Condition Survey (2001) shows that the proportion of non-decent homes in country areas (31 per cent) is marginally lower than in towns and cities (34 per cent). However, there are considerable variations within these areas. Village and isolated rural areas (42 per cent), along with city (48 per cent) and other urban centres (41 per cent), have much higher proportions of non-decent dwellings than suburban (30 per cent) and rural residential areas (26 per cent). Indeed, taking isolated rural areas alone, 50 per cent of the dwellings in these areas are non-decent. The English House Condition Survey notes that this pattern reflects differences between the age, type and tenure profiles of the stock between these different types of area. Dwellings in village centres and isolated rural areas tend to be older, and those in privately rented or local authority tenures in particular have above average proportions of non-decent homes. In contrast, dwellings in suburban and rural residential areas tend to be newer.

Table A4.10, shows the average cost required to make dwellings decent in different types of area. Non-decent dwellings in city centre and in village centres and isolated rural areas have the highest average costs. However, the table also shows the median cost required to make a dwelling decent. This measure indicates the amount per dwelling for which half of that particular non decent stock can be brought up to standard. A low median figure indicates opportunities for a good proportion of the non-decent stock to be brought up to standard relatively cheaply.

This latter measure puts a different complexion on things. The table shows that the most favourable locations for bringing stock up to decent standard relatively cheaply are in suburban and rural residential areas. However, the table also suggests that there is a very wide variation in the costs required to bring dwellings up to standard in village centres and isolated rural areas. Whilst the mean cost of repairs in these latter areas is the highest of any type of area (£9,891 compared with the average mean of £7,181), the median cost drops quite significantly. This drop implies that a larger proportion of the non-decent stock in these areas of the countryside could be made decent for less money than the mean cost suggests.

150

Table A4.10

Costs of repairs to make dwellings decent, 2001

Mean cost (£)

Median cost (£)

City centre 9,142 5,836

Urban 8,585 5,006

Suburban residential 5,983 1,445

Rural residential 5,847 1,290

Village centre and rural 9,891 2,593

All non decent dwellings 7,181 2,314 Source: English House Condition Survey, 2001

The English House Condition Survey (2001) highlights that overall, older people are only marginally more likely than any other part of the population to live in non-decent homes. However, this proportion may increase amongst some groups of older people. In particular, older people are more likely to live in non-decent homes if they live alone, have a low income and live in the private sector, live in a household containing or comprising people over 85, have been long-term resident owners (over 30 years), or are private tenants. Non- decent homes lived in by older people are more likely to fail the standard because they provide insufficient thermal comfort or require modernisation than other non-decent homes.

The English House Condition Survey (2001) defines a vulnerable household as one that receives one or more of a number of income-related or disability benefits and includes the elderly, young children, and people with illness or disability. It notes that vulnerable households who live in the private sector are more likely to live in non-decent homes if they reside in city centres or more isolated rural communities (60 per cent of vulnerable households compared with the overall average of 43 per cent). However, the extent to which vulnerable households are more likely to live in non-decent homes than other households is broadly similar across all types of area.

The Regulatory Reform (Housing Assistance) (England and Wales) Order 2002 gives local authorities wide powers to provide assistance for repairs, improvements, adaptations and to demolish and re-construct homes. This assistance may take the form of a grant, loan, equity release, or more practical assistance such as home surveys or small repairs services. In addition, the Warm Front programme, administered by DEFRA, provides grants to vulnerable households for heating, insulation and draught proofing measures.

In Sustainable Communities: Building for the Future the ODPM (2003) note that an extra £30 million will be available in both 2004/05 and 2005/06 to help authorities support new ways to fund repairs and improvements to the homes of vulnerable households. This will be allocated to the Regional Housing Boards as a separate grant within the single capital pot, which must be spent on private sector renewal. It will be up to the Boards which schemes and local authorities they support with these funds. An important aspect of these developments will be

151

to expand the geographical coverage, and improve the profile, of the network of Home Improvement Agencies. Home Improvement Agencies play a vital role in making vulnerable households aware of the condition of their home, and the assistance that is available to help them bring it up to a decent standard.

However, a review of private sector renewal grant activity from Care and Repair England showed that there will be some way to go before funding on repairs and improvements catches up with the level of spending in the early 1990s (Care and Repair England, 2001). They highlight that the number of renovation grants fell between 1996 and 2000, from just under 36,000 to just over 17,000. Furthermore, increases in expenditure via Home Repair Assistance over this time period did not compensate for the reduction in renovation grant expenditure. However, total expenditure on DFG has grown. In 1992/93, the total value of DFG paid was almost £65 million. By 1999/00 this had grown to over £123 million.

Central heating

Adequate warmth in the home is crucial for health and well-being of older people. The UK has a shameful number of avoidable winter deaths among its older people (Wilkinson et al 2001). The Census asked whether people had central heating in their homes. Table A4.11 below shows that 92.2 per cent of all people over 55 have central heating. Slightly more older people in rural areas (93.3 per cent) have central heating than in urban areas (91.3 per cent).

The most significant difference is again between the younger-old and the very old; 89.2 per cent of people aged 85+ in rural areas have central heating, compared to 94.4 per cent of people aged 50-54.

Table A4.11 Availability of central heating for older people, by age, by rural and urban areas in England

With/without central heating

Rural/Urban 50-54 (%)

55-59 (%)

60-64 (%)

65-74 (%)

75-84 (%)

85+ (%)

All 50+ (%)

Rural 94.4 94.3 93.9 93.0 91.4 89.2 93.3

Urban 93.0 92.6 92.1 90.9 88.9 85.6 91.3 With central heating

All 93.6 93.4 92.9 91.8 90.0 87.2 92.2

Rural 5.6 5.7 6.1 7.0 8.6 10.8 6.7

Urban 7.0 7.4 7.9 9.0 11.1 14.4 8.7 Without central heating

All 6.4 6.6 7.1 8.1 10.0 12.8 7.8

Total Rural/Urban/All 100 100 100 100 100 100 100

N. 3,364,815 2,769,657 2,377,957 4,060,223 2,631,852 764,466 15,968,970 Source: 2001 Census

The SEH shows that households with people aged 75 and over in the smaller settlements were less likely than other groups to have central heating in living rooms and bedrooms

152

(Table A4.12). In total, 13 per cent of this age group in settlements of under 3,000, and 15 per cent in settlements between 3,000 and 10,000 reported that they had no central heating in these rooms compared with the average for all ages of 9 per cent.

Table A4.12 Households with central heating Settlements under 3,000 population

All living rooms and bedrooms

(%)

Some of these rooms but not all

(%)

Or there is no central heating in these rooms

(%)

16 – 24 83 7 10

25 – 49 87 6 7

50 – 64 88 6 6

65 – 74 82 8 10

75 + 77 10 13

Average (All ages) 85 6 9

Settlements between 3,000 – 10,000 population

All living rooms and bedrooms

(%)

Some of these rooms but not all

(%)

Or there is no central heating in these rooms

(%)

16 – 24 78 3 19

25 – 49 86 6 9

50 – 64 89 5 6

65 – 74 90 6 4

75 + 77 8 15

Average (All ages) 86 6 9

Settlements over 10,000 population

All living rooms and bedrooms

(%)

Some of these rooms but not all

(%)

Or there is no central heating in these rooms

(%)

16 - 24 78 8 14

25 - 49 86 6 8

50 - 64 85 7 8

65 - 74 83 8 10

75 + 80 8 12

Average (All ages) 85 7 9 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

153

Satisfaction with home

The SEH showed that older people were more inclined than younger people to express considerable satisfaction with their accommodation (Table A4.13). Although the large majority of householders of all ages were content with their home, this proportion tended to increase among those over 50. Less than 5 per cent of households with people aged 50 and over stated that they were slightly or very dissatisfied with their home. Unlike other data examined above, this proportion of people did not change as people got older; 95 per cent of people aged 75+ were very or fairly satisfied with their homes. Although it is to be noted that the SEH does not break age down into bands beyond 75+ and consequently does not allow for closer investigations of levels of satisfaction among the very old, who are likely to live alone, not have central heating, and be in poor health.

Table A4.13 Satisfaction with accommodation Settlements under 3,000 population

Very or fairly satisfied (%)

Neither satisfied nor dissatisfied

(%)

Slightly or very dissatisfied

(%)

16 - 24 82 3 15

25 - 49 88 5 7

50 - 64 95 1 4

65 - 74 97 1 2

75 + 95 2 3

Average (All ages) 91 3 6

Settlements between 3,000 – 10,000 population

Very or fairly satisfied (%)

Neither satisfied nor dissatisfied

(%)

Slightly or very dissatisfied

(%)

16 - 24 86 7 7 25 - 49 87 4 9 50 - 64 92 3 5 65 - 74 95 1 4 75 + 94 1 5 Average (All ages) 90 3 7

Settlements over 10,000 population

Very or fairly satisfied (%)

Neither satisfied nor dissatisfied

(%)

Slightly or very dissatisfied

(%)

16 - 24 78 6 16

25 - 49 89 3 8

50 - 64 93 2 4

154

65 - 74 95 2 3

75 + 96 1 3

Average (All ages) 91 3 6 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Older people in rural areas: neighbourhood

The SEH asked a number of questions regarding attitudes towards the neighbourhood where people lived, covering satisfaction with the neighbourhood, whether the area had got better or worse in the last two years, and problems with crime, litter, neighbours, racial harassment, vandalism, and traffic (see Tables A4.14 – A4.14).

What do people think about the area in which they live?

Older people were more likely to say that they were fairly or very satisfied with the area in which they lived than younger people. Indeed, there was a marked increase in the proportion expressing satisfaction with their area with age: older people were more likely to be satisfied with the area in which they live. However, that said, 10 per cent of households aged 75 and over in the smallest settlements stated that they were fairly or very dissatisfied with their area.

Views regarding the extent to which households felt that their area had improved or got worse in the preceding 2 years tended to differ depending on the age of older people. Households between the age of 50 and 74 were more likely to feel that their area had got worse in the last 2 years. In contrast, households over 75 were more likely to say that their area had not changed much or had improved.

In relation to ‘problems’ included crime, litter, neighbours, traffic, racial harassment and vandalism, households in later life (that is people over the age of 75) appeared to be much more sanguine about their home area than younger people. For example, 1 in 5 of people aged between 16 and 24 in the smallest settlements felt that crime was a serious problem, perhaps reflecting that it is people in this age group that are most likely to be the victims of criminal activity. In contrast, just over 1 in 10 of people aged 75 or over in these settlements considered crime to be a serious problem. Nevertheless, a comparison of overall averages between settlements of different size showed that perceptions about crime did not seem to vary between rural and urban areas. The average for all ages demonstrated consistent views on crime in the very smallest and the largest settlements. Slightly fewer households felt that crime was not a problem in settlements between 3,000 and 10,000 population. This finding seems at odds with many respondents’ views in Chapter two, who highlighted that one attraction of living in rural areas was that the countryside is a safer place to be compared with many urban areas.

155

Table A4.14 Satisfaction with area

Settlements under 3,000 population

Very or fairly satisfied (%)

Neither satisfied nor dissatisfied

(%)

Slightly or very dissatisfied

(%)

16 - 24 80 4 15

25 - 49 84 8 9

50 - 64 88 3 9

65 - 74 89 4 8

75 + 89 2 10

Average (All ages) 86 5 9 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

Very or fairly satisfied

(%)

Neither satisfied nor dissatisfied

(%)

Slightly or very dissatisfied

(%)

16 - 24 86 14 0 25 - 49 83 6 12 50 - 64 86 5 10 65 - 74 88 4 8 75 + 94 1 5 Average (All ages) 86 5 9 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

Very or fairly satisfied (%)

Neither satisfied nor dissatisfied

(%)

Slightly or very dissatisfied

(%)

16 - 24 77 11 12 25 - 49 85 6 10 50 - 64 86 4 10 65 - 74 87 4 9 75 + 89 3 7 Average (All ages) 86 5 9 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

156

Table A4.15

Has the area got better or worse over the last two years?

Settlements under 3,000 population

Area has got better (%)

Area has got worse (%)

Area has not changed much

(%)

Has lived here less than two years

(%)

16 - 24 10 4 27 5925 - 49 8 20 55 18 50 - 64 8 26 61 5 65 - 74 7 28 60 5 75 + 10 23 63 4 Average (All ages) 8 22 57 13 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

Area has got better (%)

Area has got worse (%)

Area has not changed much

(%)

Has lived here less than two years (%)

16 - 24 21 4 14 6125 - 49 10 21 53 16 50 - 64 10 34 50 6 65 - 74 8 30 57 4 75 + 10 21 67 2 Average (All ages) 10 25 54 11 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

Area has got better (%)

Area has got worse (%)

Area has not changed much

(%)

Has lived here less than two years (%)

16 - 24 7 11 29 53

25 - 49 9 21 53 17

50 - 64 9 28 58 6

65 - 74 7 29 60 4

75 + 7 23 67 4

Average (All ages) 9 23 56 12 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

157

Table A4.16 Problems in area: crime

Settlements under 3,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 21 39 41

25 - 49 15 43 42

50 - 64 13 46 42

65 - 74 13 46 41

75 + 11 37 52

Average (All ages) 14 43 43 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 15 41 44

25 - 49 17 49 34

50 - 64 14 46 41

65 - 74 18 39 43

75 + 11 43 47

Average (All ages) 15 46 39 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 22 37 41

25 - 49 15 44 41

50 - 64 15 45 41

65 - 74 14 43 44

75 + 11 36 53

Average (All ages) 15 43 43 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

158

Table A4.17:

Problems in area: litter

Settlements under 3,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 14 28 58

25 - 49 16 29 56

50 - 64 15 30 55

65 - 74 14 29 57

75 + 14 29 58

Average (All ages) 15 29 58 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 10 38 52

25 - 49 16 33 52

50 - 64 17 29 54

65 - 74 18 28 54

75 + 7 24 69

Average (All ages) 15 30 69 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 19 33 48

25 - 49 15 31 55

50 - 64 16 31 54

65 - 74 18 30 52

75 + 11 27 62

Average (All ages) 15 30 62 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

159

Table A4.18 Problems in area: neighbours

Settlements under 3,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 4 13 83

25 - 49 5 10 85

50 - 64 4 7 89

65 - 74 1 9 90

75 + 2 5 93

Average (All ages) 4 9 87 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 7 14 79

25 - 49 5 11 84

50 - 64 3 10 87

65 - 74 2 7 91

75 + 1 5 94

Average (All ages) 4 10 87 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 6 13 81

25 - 49 4 11 86

50 - 64 3 8 90

65 - 74 2 6 92

75 + 2 4 95

Average (All ages) 3 9 95 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

160

Table A4.19 Problems in area: traffic

Settlements under 3,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 13 19 68

25 - 49 18 28 54

50 - 64 15 25 61

65 - 74 13 27 60

75 + 9 25 66

Average (All ages) 15 27 58 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 25 32 43

25 - 49 18 21 60

50 - 64 15 31 55

65 - 74 16 22 62

75 + 10 23 66

Average (All ages) 16 24 60 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 15 23 63

25 - 49 16 27 58

50 - 64 15 25 60

65 - 74 12 26 62

75 + 10 21 70

Average (All ages) 10 21 70 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

161

Table A4.20 Problems in area with racial harassment

Settlements under 3,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 5 4 91

25 - 49 2 4 94

50 - 64 1 3 97

65 - 74 1 3 97

75 + 0 3 97

Average (All ages) 1 4 95 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 0 4 96

25 - 49 2 7 91

50 - 64 1 2 97

65 - 74 1 1 98

75 + 0 2 98

Average (All ages) 2 4 94 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 2 8 90

25 - 49 1 4 95

50 - 64 1 2 97

65 - 74 1 1 98

75 + 0 1 99

Average (All ages) 1 3 96 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

162

Table A4.21 Problems in area with vandalism

Settlements under 3,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 14 24 63

25 - 49 10 35 55

50 - 64 7 34 59

65 - 74 12 36 52

75 + 6 36 58

Average (All ages) 9 35 56 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 7 43 50

25 - 49 13 35 52

50 - 64 10 38 52

65 - 74 16 33 52

75 + 11 29 59

Average (All ages) 12 35 53 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

A serious problem in this area (%)

A problem in this area, but not serious

(%)

Or not a problem in this area (%)

16 - 24 17 33 50

25 - 49 11 35 55

50 - 64 11 35 54

65 - 74 11 36 54

75 + 10 29 62

Average (All ages) 11 34 55 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Older people in rural areas: access

Availability of a car

Accessibility and mobility have been identified as key issues in relation to the experience of social exclusion amongst older people in rural areas (Lowe, 2003). For the majority of respondents in Chapter two it was perhaps the key issue facing older people living in the countryside. Linked to the personal mobility of individuals is the extent to which basic

163

services and facilities are readily accessible to them. Trends such as the decline of services located within villages, and the centralisation of services in larger communities throws into sharp relief the dependence of households in rural areas upon their ability to travel to get access to such services and facilities.

Table A4.22 below shows the proportion of people over 55 who have access to one or more cars, broken down by age bands. As can be seen the proportion of people without access to a car gradually increases with age, but suddenly jumps among those aged 75, and obviously this is related to the requirement to re-apply for a license at the age of 75. Clearly access to a car has a different significance in a rural context as there are likely to be few if any alternatives to private means of transport. Access to a car is an essential facet of living in rural areas rather than a measure of affluence. However, what is clear from these data is that although older people in rural areas appear to be more advantaged compared to their urban peers, there are still significant numbers of older people in rural areas who do not have private transport, more than 1 in 6 of people aged 65-74, 1 in 3 of people aged 75-84, and more than half of those aged 85+.

Table A4.22 England: Car or van availability of older people

Number of cars or vans in household

Rural/ urban

50-54 (%)

55-59 (%)

60-64 (%)

65-74 (%)

75-84 (%)

85+ (%)

All 50+ (%)

Rural 4.3 5.2 7.4 14.6 33.7 57.2 14.6

Urban 14.8 16.8 21.1 31.7 53.0 72.1 29.3 None

All 10.3 11.8 15.2 24.3 44.6 65.7 23.0

Rural 30.0 36.5 46.9 57.6 52.9 32.2 44.0

Urban 39.4 44.1 50.3 52.6 39.9 22.2 44.2 One

All 35.3 40.8 48.9 54.8 45.5 26.5 44.1

Rural 65.7 58.3 45.7 27.8 13.4 10.6 41.3

Urban 45.8 39.1 28.6 15.7 7.1 5.7 26.5 Two or more

All 54.4 47.4 35.9 20.9 9.8 7.8 32.9

Totals Rural/ Urban/ All 100 100 100 100 100 100 100

N. 3,364,638 2,769,643 2,378,011 4,060,246 2,631,956 764,487 15,968,981 Base: All people aged 50+ Source: 2001 Census

These data are supported by the SEH that showed levels of car ownership and access to vehicles varied considerably between households in later life (Table A4.23). Households aged between 50-64 in the smallest settlements had some of the highest levels of car ownership. Just over 1 in 10 of these households had access to 3 or more cars. In contrast over half of households aged 75 and over in these settlements had no access to a car. One perhaps surprising finding from the SEH was the similarity in levels of access to cars between rural and urban areas. These results contrast with household car ownership from the National Travel Survey, 2002, which showed that car ownership rose as settlement size decreased (Countryside Agency, 2003).

164

Access to services

The SEH asked households about their ease of access to a range of services, including corner shops, supermarkets, post offices, and health services (see Tables A4.24 – A4.28). What is perhaps surprising about a comparison of views about access to services across settlements of different size is that there is very little difference between them. It might be expected that households in the smallest settlements would report the greatest difficulties in this respect, but the averages between settlements are quite similar. The averages for the largest settlements will include urban areas where access to local services may be problematic, such as inner city as well as peripheral outer ring estates, and research has highlighted the problems facing residents of disadvantaged communities in urban areas with respect to access to a variety of services (Speak and Graham, 2000).

Perhaps what is most noticeable from the SEH data is the increased difficulty that people experience with gaining access to services with age. Households with people aged 75 and over were much more likely to report that it was fairly or very difficult for them to gain access to services. For example, whilst the average proportion of all households in the smallest settlements who reported difficulties with getting to a corner shop was 6 per cent, the equivalent figure for those aged 75 and over was 18 per cent.

Access to health services was more problematic. Whilst 9 per cent of all households in the smallest settlements stated that they found it fairly or very difficult to get to a doctor, this figure increased to 22 per cent for those households containing people aged 75 and over. This issue was more pronounced in relation to access to a local hospital for those living in the smallest settlements. Nearly a third of households of all ages stated that they found it fairly or very difficult to get to a local hospital compared with nearly half of households with people aged 75 and over.

165

Table A4.23 Cars and vans available

Settlements under 3,000 population

None (%)

One

(%)

Two (%)

Three or more (%)

16 - 24 46 44 11 0 25 - 49 15 46 32 6

50 - 64 15 43 31 11

65 - 74 30 53 15 2

75 + 55 39 5 1

Average (All ages) 23 45 26 6 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

None (%)

One

(%)

Two (%)

Three or more (%)

16 - 24 40 31 23 6

25 - 49 23 42 30 6

50 - 64 14 44 32 9

65 - 74 36 46 13 5

75 + 55 40 5 1

Average (All ages) 27 43 24 6 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

None (%)

One

(%)

Two (%)

Three or more (%)

16 - 24 47 36 13 4

25 - 49 16 46 32 6

50 - 64 16 43 31 11

65 - 74 32 52 14 2

75 + 60 35 4 0

Average (All ages) 25 44 25 6 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

166

Table A4.24 How easy is it to get to a corner shop?

Settlements under 3,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 95 5 0

25 - 49 95 3 1

50 - 64 92 7 1

65 - 74 90 6 4

75 + 75 18 7

Average (All ages) 92 6 2 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 93 7 0

25 - 49 97 3 0

50 - 64 91 6 3

65 - 74 92 4 4

75 + 75 18 7

Average (All ages) 92 6 2 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 96 4 1

25 - 49 96 3 1

50 - 64 92 6 2

65 - 74 88 8 4

75 + 72 21 7

Average (All ages) 91 7 3 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

167

Table A4.25 How easy is it to get to a medium to large supermarket?

Settlements under 3,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 85 15 0

25 - 49 94 6 1

50 - 64 92 8 0

65 - 74 88 11 1

75 + 72 26 3

Average (All ages) 90 10 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 90 10 0

25 - 49 94 6 0

50 - 64 92 8 0

65 - 74 92 7 1

75 + 77 21 3

Average (All ages) 91 9 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 89 12 0

25 - 49 94 7 0

50 - 64 91 9 0

65 - 74 88 11 1

75 + 71 25 4

Average (All ages) 89 10 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

168

Table A4.26 How easy is it to get to a post office?

Settlements under 3,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 95 5 0

25 - 49 96 4 0

50 - 64 93 7 0

65 - 74 91 7 2

75 + 83 14 3

Average (All ages) 93 6 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 96 4 0

25 - 49 95 4 1

50 - 64 92 8 0

65 - 74 93 7 1

75 + 80 18 2

Average (All ages) 92 7 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 93 7 0

25 - 49 95 5 0

50 - 64 94 6 0

65 - 74 92 7 0

75 + 78 18 4

Average (All ages) 93 7 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

169

Table A4.27 How easy is it to get to a doctor?

Settlements under 3,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 90 9 1

25 - 49 93 7 1

50 - 64 92 8 0

65 - 74 89 11 1

75 + 75 22 3

Average (All ages) 90 9 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 79 21 0

25 - 49 91 8 1

50 - 64 90 10 0

65 - 74 89 10 2

75 + 78 20 2

Average (All ages) 88 11 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 82 16 2

25 - 49 92 8 0

50 - 64 90 10 0

65 - 74 88 12 0

75 + 74 23 3

Average (All ages) 88 11 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

170

Table A4.28 How easy is it to get to a local hospital?

Settlements under 3,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 58 39 3

25 - 49 73 26 1

50 - 64 70 30 1

65 - 74 65 35 1

75 + 49 48 3

Average (All ages) 68 31 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements between 3,000 – 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 71 30 0

25 - 49 74 25 1

50 - 64 70 30 0

65 - 74 68 30 3

75 + 54 45 1

Average (All ages) 69 30 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

Settlements over 10,000 population

Very or fairly easy

(%)

Fairly or very difficult

(%)

N/A (%)

16 - 24 65 34 1

25 - 49 73 27 0

50 - 64 70 30 0

65 - 74 66 34 0

75 + 50 47 2

Average (All ages) 68 31 1 Source: 2001 Survey of English Housing; Percentages may not equal 100 due to rounding

171

Appendix 5 Older people in rural areas: local data

This appendix presents a key data in relation the population of older people in the five case study areas, drawing upon an analysis of the 2001 Census.

Table A5.1 below shows the total population of each of the case study counties split between rural and urban districts (the end column on the right). The table also shows the proportion of the population that is aged 55 and above in rural areas, urban areas, and as a proportion of the county population as a whole.

Table A5.1

People aged 55+ as proportion of all people by rural/urban wards in case study counties

County People aged 55+ (%) Total population (all ages)

Rural 31.3 478,508

Urban 27.1 249,283 North Yorkshire

All 30.4 727,791

Rural 30.8 432,403

Urban 24.9 814,736 Lancashire

All 27.5 1,247,139

Rural 36.8 294,151

Urban 30.8 336,150 Dorset

All 34.8 630,301

Rural 31.9 411,423

Urban 27.2 244,571 Suffolk

All 30.8 655,994

Rural 31.9 267,911

Urban 25.2 264,993 Worcestershire

All 29.3 532,904 Source: 2001 Census

This table illustrates a number of differences between the counties. Lancashire has the largest population, however, only one-third live in rural wards. In Worcestershire the population is almost equally split between rural and urban wards. Just over half of the Dorset population lives in an urban ward. In comparison almost two-thirds of the populations of North Yorkshire and Suffolk, live in rural wards.

172

The proportion of the population of each county aged over 55 is also quite different. Dorset is perhaps the most striking where 34.8 per cent of the population is aged 55+. In Suffolk and North Yorkshire about 30 per cent of the population are aged 55+, compared to 29 per cent and 27 per cent in Worcestershire and Lancashire. When the population aged 55+ is broken down into those living in rural wards and those living in urban wards, the differences between the urban and rural population is clear across all 5 counties. In all 5 counties, a greater proportion of the rural population is aged 55+ compared to the urban populations.

We looked at particular districts within each county and sought districts that represented particular aspects of rurality. Table A5.2 below shows the proportion of the case study district populations that are aged 55 and above.

Table A5.2 People aged 55+ as proportion of all people by rural/urban wards in case study districts

District People aged 55+ (%) Total population (all ages)

Rural 36.0 64,973

Urban 31.0 38,490 Scarborough (North Yorkshire)

All 34.0 103,463

Rural 28.6 19,692

Urban 24.9 68,908 Pendle (Lancashire)

All 25.8 88,600

Rural 32.8 58,156

Urban - - North Dorset (Dorset)*

All 32.8 58,156

Rural 34.4 74,347

Urban 31.4 36,294 Waveney (Suffolk)

All 33.8 110,641

Rural 30.6 48,424

Urban 30.0 37,300 Bromsgrove Worcestershire

All 29.8 85,724 Source: 2001 Census *Note: North Dorset has no urban wards

The section below highlights key data about the case study districts’ population aged 55 and above.

173

Scarborough

Table A5.3 below shows a profile of Scarborough’s population aged 55 and above, broken down into age bands, gender and rural and urban wards.

Table A5.3 Older people as a proportion of Scarborough population, by gender and age band, and

rural/urban

District 55-59 (%)

60-64 (%)

65-69 (%)

70-74 (%)

75-79 (%)

80-84 (%)

85-89 (%)

90+ (%)

All 55+ (%)

N. (all people)

Men 7.5 6.6 6.4 5.5 4.4 2.3 1.0 0.41 34.2 31,114

Women 7.2 6.7 6.1 5.9 5.1 3.6 3.0 0.95 37.8 33,859 Rural

All 7.3 6.7 6.2 5.7 4.8 3.0 1.6 0.69 36.0 64,973

Men 6.0 5.6 4.7 4.1 3.6 2.2 1.0 0.40 27.8 18,171

Women 5.8 5.4 4.7 5.0 4.8 3.5 2.1 1.0 32.4 20,319 Urban

All 6.0 5.5 4.7 4.6 4.2 3.0 1.6 0.72 31.0 38,490

Men 7.0 6.3 5.8 5.0 4.1 2.3 1.0 0.41 32.0 49,285

Women 6.7 6.2 5.6 5.6 5.0 3.6 2.1 0.97 36.0 54,178

Scarborough

All

All 6.9 6.3 5.7 5.3 4.6 3.0 1.6 0.70 34.0 103,463 Source: 2001 Census

Census data also shows that 81.8 per cent of people aged 55 and above living in rural wards are owner-occupiers compared to 68.9 per cent in urban wards in the district. Only 9.3 per cent of people aged 55 and above living in rural areas are living social rented housing compared to 21.3 per cent of people aged 55 and above in urban areas.

Census data also shows that 21.5 per cent of people aged 55 and above living in rural wards do not have access to a car. These figures mask a large difference between age bands where 67.8 per cent of people aged 85+ and 40.4 per cent of people age 75-84 in rural wards do not have access to a car, compared to only 9 per cent of those aged 55-54. As noted above, the rural population of Scarborough is dispersed in small settlements across a wide area, and generally poorly served by public transport.

North Yorkshire, particularly the upland areas of the North York Moors, can be particularly cold in the winter. Census data shows that 9.8 per cent of people aged 55+ in rural wards (17.5 per cent in urban wards) did not have central heating. However, 14.9 per cent of people aged 85+ in rural wards (17.8 per cent in urban wards) did not have central heating.

Waveney

Table A5.4 below shows a profile of Waveney’s population aged 55 and above, broken down into age bands, gender and rural and urban wards.

174

Table A5.4

Older people as a proportion of Waveney population, by gender and age band, and rural/urban

District 55-59 (%)

60-64 (%)

65-69 (%)

70-74 (%)

75-79 (%)

80-84 (%)

85-89 (%)

90+ (%)

All 55+ (%)

N. (all people)

Men 7.0 6.0 6.0 5.3 4.6 2.6 1.1 0.35 33.0 35,898

Women 6.8 6.0 5.9 5.4 5.0 3.5 2.0 0.89 35.6 38,449 Rural

All 6.9 6.0 5.9 5.4 4.8 3.0 1.6 0.64 34.4 74,347

Men 6.2 5.6 5.0 4.3 4.0 2.4 1.2 0.33 29.2 17,418

Women 5.6 5.1 5.1 4.4 4.7 3.7 2.4 1.2 33.3 18,876 Urban

All 5.9 5.4 5.0 4.9 4.4 3.1 1.8 0.77 31.4 36,294

Men 6.9 5.9 5.7 5.1 4.5 2.6 1.1 0.35 32.2 53,316

Women 6.6 5.6 5.8 5.4 5.0 3.6 2.1 0.96 35.2 57,325

Waveney

All

All 6.7 5.8 5.7 5.3 4.7 3.0 1.7 0.66 33.8 110,641 Source: 2001 Census

Census data also show that 80.1 per cent of people aged 55 and over in rural wards are owner-occupiers compared to 73.0 per cent of people aged 55+ in urban wards.

Only 12.1 per cent of people aged 55 and above living in rural areas are living social rented housing compared to 18 per cent of people aged 55 and above in urban areas.

Census data also shows that 17.6 per cent of people aged 55 and above living in rural wards do not have access to a car. These figures mask a large difference between age bands where 64.7 per cent of people aged 85+ and 35.6 per cent of people age 75-84 in rural wards do not have access to a car, compared to only 4.9 per cent of those aged 55-64. Census data shows that 6 per cent of people aged 55+ in rural wards (15.5 per cent in urban wards) did not have central heating. However, 11.3 per cent of people aged 85+ in rural wards (21.5 per cent in urban wards) did not have central heating.

Pendle

Table A5.5 below shows a profile of Pendle’s population aged 55 and above, broken down into age bands, gender and rural and urban wards.

175

Table A5.5 Older people as a proportion Pendle population, by gender and age band, and rural/urban

District 55-59 (%)

60-64 (%)

65-69 (%)

70-74 (%)

75-79 (%)

80-84 (%)

85-89 (%)

90+ (%)

All 55+ (%)

N. (all people)

Men 7.3 5.6 4.6 3.9 2.6 1.5 0.8 0.45 26.9 9,769

Women 7.2 5.2 4.9 4.2 4.3 2.5 1.5 0.56 30.1 9,923 Rural

All 7.2 5.4 4.7 4.0 3.9 2.0 1.2 0.51 28.6 19,692

Men 5.5 4.7 4.0 3.5 2.8 1.5 0.7 0.31 23.0 33,637

Women 5.2 4.5 4.4 4.2 3.9 2.5 1.4 0.59 26.8 35,271 Urban

All 5.3 4.6 4.2 3.9 24.9 3.4 2.0 1.0 0.46 68,908

Men 5.8 4.8 4.4 3.9 3.4 2.0 1.1 0.47 25.8 43,406

Women 5.6 4.7 4.5 4.2 4.0 2.5 1.4 0.59 27.6 45,194

Pendle

All

All 5.8 4.8 4.4 3.9 3.4 2.0 1.1 0.47 25.8 88,600 Source: 2001 Census

Census data also show that 85.1 per cent of people aged 55 and over in rural wards are owner-occupiers compared to 80.0 per cent of people aged 55+ in urban wards.

Only 9 per cent of people aged 55 and above living in rural areas are living social rented housing compared to 13.6 per cent of people aged 55 and above in urban areas.

Census data also shows that 16.5 per cent of people aged 55 and above living in rural wards do not have access to a car. These figures mask a large difference between age bands where 65.7 per cent of people aged 85+ and 41.4 per cent of people age 75-84 in rural wards do not have access to a car, compared to only 4.8 per cent of those aged 55-64. Census data shows that 12.5 per cent of people aged 55+ in rural wards (19 per cent in urban wards) did not have central heating. However, 24.9 per cent of people aged 85+ in rural wards (22.3 per cent in urban wards) did not have central heating.

Bromsgrove

Table A5.6 below shows a profile of Bromsgrove’s population aged 55 and above, broken down into age bands, gender and rural and urban wards.

176

Table A5.6 Older people as a proportion Bromsgrove population,

by gender and age band, and rural/urban

District 55-59 (%)

60-64 (%)

65-69 (%)

70-74 (%)

75-79 (%)

80-84 (%)

85-89 (%)

90+ (%)

All 55+ (%)

N. (all people)

Men 7.7 6.2 5.2 4.5 3.0 1.8 .87 0.19 30.0 42,058

Women 7.4 5.8 5.5 4.6 3.9 2.5 1.4 0.63 31.7 24,669 Rural

All 7.6 6.0 5.4 4.5 3.4 2.2 1.1 0.41 30.6 48,424

Men 7.1 5.6 4.6 4.2 3.0 1.8 .73 0.32 27.6 18,303

Women 6.8 5.7 4.8 4.3 3.8 2.6 1.5 0.59 30.0 18,997 Urban

All 7.3 5.8 5.0 4.4 3.4 2.1 1.1 0.44 30.0 37,300

Men 7.4 6.0 5.0 4.4 3.0 1.8 .80 0.26 28.6 42,058

Women 7.1 5.8 5.1 4.4 3.9 2.5 1.4 0.61 30.9 43,666

Bromsgrove

All

All 7.3 5.8 5.0 4.4 3.4 2.19 1.1 0.44 29.8 85,724 Source: 2001 Census

Census data also show that 85.5 per cent of people aged 55 and over in rural wards are owner-occupiers compared to 86.9 per cent of people aged 55+ in urban wards. Among the case study districts, Bromsgrove is the only district where there is a greater proportion of homeowners aged 55+ in urban wards than in rural wards.

Similarly 10.3 per cent of people aged 55 and above living in rural areas are living social rented housing compared to 8.6 per cent of people aged 55 and above in urban areas. Again, Bromsgrove is the only district in our case studies where a greater proportion of people over 55 are living in social rented housing in rural wards than in urban wards.

Census data also shows that 12.5 per cent of people aged 55 and above living in rural wards do not have access to a car. These figures mask a large difference between age bands where 53.5 per cent of people aged 85+ and 33.5 per cent of people age 75-84 in rural wards do not have access to a car, compared to only 3.2 per cent of those aged 55-54. Census data shows that 4.7 per cent of people aged 55+ in rural wards (4.3 per cent in urban wards) did not have central heating. However, 9.0 per cent of people aged 85+ in rural wards (9.2 per cent in urban wards) did not have central heating.

North Dorset

Table A5.7 below shows a profile of North Dorset’s population aged 55 and above, broken down into age bands, and gender (note that there are no urban wards in North Dorset).

177

Table A5.7 Older people as a proportion North Dorset population,

by gender and age band, and rural/urban

District 55-59 (%)

60-64 (%)

65-69 (%)

70-74 (%)

75-79 (%)

80-84 (%)

85-89 (%)

90+ (%)

All 55+ (%)

N. (all people)

Men 6.7 5.6 5.3 4.9 3.8 2.60 1.3 0.4 30.7 28,265

Women 6.7 5.7 5.3 5.5 4.8 3.36 2.2 1.0 34.7 29,891 North Dorset Rural

All 6.7 5.6 5.4 5.2 4.4 2.96 1.8 0.7 32.8 58,156 Source: 2001 Census

Census data also show that in North Dorset 80.8 per cent of people aged 55 and over are homeowners, and only 12.0 per cent live in the social rented sector.

Census data also shows that 14.4 per cent of people aged 55 and above do not have access to a car. These figures mask a large difference between age bands where 55.3 per cent of people aged 85+ and 29.7 per cent of people age 75-80 do not have access to a car, compared to only 3.6 per cent of those aged 55-54.

Census data shows that 6.0 per cent of people aged 55+ did not have central heating. Unlike the other districts, there is very little difference between the age bands - 6.5 per cent of people aged 85+ did not have central heating.

178

179

Appendix 6

PENDLE OLDER PERSONS’ STRATEGY ACTION PLAN – Aims and objectives 1. STRATEGIC AIM – WORK IN PARTNERSHIP TO STRATEGICALLY ADDRESS BOTH THE SHORT AND LONG-TERM NEEDS OF THE OLDER POPULATION OF PENDLE

2. STRATEGIC AIM – PROMOTE AND MAINTAIN THE INDEPENDENCE OF OLDER PEOPLE IN PENDLE

2.1 OBJECTIVE ONE – Reduce the level of reported crime within the borough

2.2 OBJECTIVE TWO – Improve access to services

2.3 OBJECTIVE THREE – Enhance community services to reduce admissions to hospital, residential and nursing homes

2.4 OBJECTIVE FOUR – Ensure that the needs of carers are identified and addressed

3. STRATEGIC AIM – ENSURE THAT OLDER PEOPLE ARE TREATED AS INDIVIDUALS WITH RESPECT AND DIGNITY

3.1 OBJECTIVE ONE – Address the needs of the Asian community

3.2 OBJECTIVE TWO – Promote equality and diversity

4. STRATEGIC AIM – PROMOTE THE ACTIVE INVOLVEMENT OF OLDER PEOPLE IN THE PLANNING AND DEVELOPMENT OF QUALITY, INTEGRATED HOUSING, HEALTH AND SOCIAL CARE SERVICES

4.1 OBJECTIVE ONE – Increase and widen adult participation

5. STRATEGIC AIM – COMBAT SOCIAL EXCLUSION AND HEALTH INEQUALITIES

5.1 OBJECTIVE ONE – Reduce the level of accidents in the home

5.2 OBJECTIVE TWO – Provide high quality health facilities

5.3 OBJECTIVE THREE – Seek to reduce the level of coronary hearth disease within the borough’s Asian community

5.4 OBJECTIVE FOUR – Create programmes to encourage people to follow healthier lifestyles including promoting healthy eating and encouraging smoking cessation

Housing is built into the different objectives of the action plan. Examples are given overleaf, using the action plan structure.

180

ACTION PLAN STRUCTURE AND HOUSING EXAMPLES

BASELINE POSITION

WHAT WE WILL DO WHEN WE WILL DO IT BY

WHO WILL DELIVER

WHY WE HAVE CHOSEN TO DO IT

WHICH OTHER STRATEGIES WILL THIS SUPPORT?

RESOURCES

Asian Housing & Social Care Survey undertaken in 2001

Publish an Action Plan as a result of the findings of the Asian Housing and Social Care Needs Survey

April 2004

Pendle Borough Council SSD

To address identified need within the Asian community

Housing Strategy SSD Race Equality Action Plan NSF

Pendle Borough Council

No provision of Extra Care accommodation within the borough

Secure the provision of Extra Care accommodation through the ADP process

2005 Pendle BoroughCouncil

To enable older people to remain in their homes where possible

Registered Social Landlords Social Services

Supporting People Strategy Housing Strategy District Commissioning Plan for Older People

ADP SSD

No Best Value Review of Sheltered Housing undertaken

Subject Sheltered Housing to a Best Value Review

2005/ 2006

Pendle Borough Council

Government requirement

Housing Strategy Supporting People Strategy

Pendle Borough Council

Home visit services limited

Extend the home visit service to more vulnerable, disabled and elderly clients

2005 Pendle BoroughCouncil

To enable tenants to remain in their own homes where possible

Housing Strategy Supporting People Strategy NSD

Pendle Borough Council SSD

Limited opportunities for social interaction in rural areas

Increase the opportunities for social interaction for older people in rural areas

2005 LCCPendle Borough Council Voluntary Agencies

To combat social isolation

NSF Housing Strategy

SSD Pendle Borough Council Voluntary Agencies

181

BASELINE POSITION

WHAT WE WILL DO WHEN WE WILL DO IT BY

WHO WILL DELIVER

WHY WE HAVE CHOSEN TO DO IT

WHICH OTHER STRATEGIES WILL THIS SUPPORT?

RESOURCES

No self-assessment process for aids and adaptations in place

Develop services which encourage self-assessment for minor pieces of equipment

2005 Pendle BoroughCouncil

To reduce the waiting times for minor equipment

NSF PCT Pendle Borough Council

Limited written advice available for older people in need of accommodation

Work in conjunction with the Best Value Review of advice services to ensure that the housing needs of vulnerable elderly people are met

2004 Pendle BoroughCouncil

Ensure the provision of a comprehensive and effective advice service for older people

Housing Strategy Homeless Strategy

General Fund

182

Structure

Forum of older people

Older People’s Strategy Group

Multi-Agency Steering Group

Strategy development/ implementation group

Service Development Groups

Service Development Groups

Service Development Groups

NSF LIT LSP

183

• churches and places or worship

Appendix 7 Older People’s Interview Schedule

THE HOUSING AND SUPPORT NEEDS OF OLDER PEOPLE IN RURAL AREAS:

TOPIC GUIDE FOR OLDER PEOPLE INTERVIEWS

Introductions

Could you tell me a little bit about yourself? How long have you lived here? How did you come to live in this particular village? What was the most important thing that attracted you here?

Living in the countryside

In terms of your own experience, what are the best things about living here? For example:

• – home – location – amenities

• social life, Pubs and clubs • activities, leisure and hobbies

• regular community activities eg, village show – family/friends.

What is not so good about living here?

Home and neighbourhood

Have you had to make any major decisions about your housing in the last five years? What kinds of decisions? Is there anything that concerns you about your present housing situation? Is there anything that concerns you about living in a rural area? For example:

• shops/ travelling shops, deliveries – post office – GP – hospital or other health services

184

– care including helping support people who are caring for others

• what about getting out and about? –public transport, Dial a Ride, community bus services –driving.

Options

Thinking about the future, do you think you would like to stay here or do you expect to move? What would influence this decision? For example:

• accommodation • access to services and facilities • transport • family and friends • environment • social life • health and care.

What kinds of things could be provided that would make a real difference for older people living in the countryside? Type of housing available:

• Ordinary house or flat for rent • Ordinary house or flat for sale/lease • Bungalow for rent or sale/lease • Properties adapted for use for people with disabilities for rent or sale • Sheltered flat for rent • Sheltered house or flat for sale/lease • Sheltered accommodation plus care and support on hand if needed, for

rent or sale • residential and nursing care accommodation

Practical help with:

• gardening • cleaning/heavy cleaning • odd jobs • repairs and maintenance • decorating • having shopping delivered • getting to the shops • adaptations, equipment

– help with getting around/transport • meals on wheels, a lunch club • help to give carers a break • other things?

185

Overall, how far do you feel that older people already get the kind of help that they need around here from, say, the council or voluntary organisations or from within the community (family/friends/neighbours)? – What about people approaching retirement? – People in their 80’s or over? – People who don’t enjoy very good health?

Advice/information

If you wanted to know more about the kind of services available, where would you go to find out? What would be the best way for any advice or information to be made available for people around here? We’ve covered a number of issues, do you think there is anything important I’ve missed out, or anything you would like to add? Many thanks.

186

187

Dorset Supporting People Team

Help and Care

Appendix 8 List of participating agencies

Participating organisations:

Age Concern Bromsgrove

Age Concern Dorset

Age Concern Worcester

Age Concern Worcestershire and Herefordshire

Age Concern Lancashire

Age Concern Suffolk

Blackpool Primary Care Trust

Bromsgrove District Council

Child Okeford Parish Council

Community First Worcestershire

Dorset Social Care and Health

Droitwich Older People’s Forum

Eskdale Abbeyfields Society

Flagship Housing Group

George F White Estate Agents

Helping Hands Care Cooperative

Lancashire County Council

188

NORDCAT

Lancashire Housing Improvement Agencies Forum

Morecombe Bay PCT

North Dorset Carers Group

North Dorset District Council

North Dorset PCT

North Dorset Rural Housing Enabler

North York Moors National Park

North Yorkshire County Council

North Yorkshire Supporting People Team

Orwell Housing Association

Pakistani Welfare Association, Pendle

Pendle District Council

Redditch and Bromsgrove PCT

Rossendale Borough Council

St. Vincents Housing Association

Scarborough Borough Council

Scarborough,Whitby and Ryedale PCT

Signpost Housing Association

Suffolk ACRE

Suffolk Housing Programme Group

Suffolk Rural Housing Enabler

Suffolk Social Care and Health

Suffolk Supporting People Team

Sycamore Rise Care

189

Waveney District Council

Waveney PCT

Whitby Caring Together

Whitby Community Transport

Worcestershire County Council

Worcestershire Supporting People Team

Wychavon District Council

Yorkshire Rural Community Council

190

191

IN RURAL AREAS: INTERVIEW TOPIC GUIDE

• How was the assessment undertaken and who was involved?

Appendix 9 Service Providers Interview Schedule

This appendix illustrates the kind of questions that were asked of organisational respondents. Each topic guide differed slightly depending on the agency involved. The topic below was used with representatives of housing departments in the case study areas.

THE HOUSING AND SUPPORT NEEDS OF OLDER PEOPLE

Background

Can you tell me about your role and the service provided by the council? How would you describe the housing market in your district? How do older people in rural areas find out about your services?

Needs

Have any studies or surveys of housing need been conducted in your district? If yes:

• What were the outcomes, particularly in relation to the housing and support needs of older people?

• How were older people involved? • How confident are you that the needs of older people have been

uncovered in rural parts of district? If no:

• What are the housing and support needs of older people in the rural areas of your district?

• What housing and support options are available, (or planned for development in the near future) for older people in the rural areas of your district?

192

• Are there some groups of older people who are well served/less well served?

• Are there any service responses to older people’s needs that are particular to rural areas?

• How are the housing and support needs of older people assessed at an individual level?

• How well do you think housing and support services currently meet the needs of older people living in more rural areas?

Strategies

Can you tell me about any strategic links that the district housing service has with other agencies, (for example, the Supporting People team, PCT) and how the strategic plans of other organisations have been informed by housing strategies? How do you engage with older people in rural areas with regard to identifying needs/developing services and strategies?

Challenges and responses

What are the most significant challenges for agencies providing services for older people in rural areas? How have these challenges been addressed? Apart from housing and support, what so you think are the main concerns of older people in rural areas? What do think are the main challenges for providers in rural areas?