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Planning for continuing care retirement communities: issues and good practice

Robin Tetlow

5 April 2006

A guide to planning community care retirement communities.

Continuing care retirement communities are relatively new in the UK.  However, they are increasingly seen as a positive response to the perceived weaknesses of traditional models of care for older people.  This comprehensive manual provides information and advice on the main planning and development issues which arise.

Published in association with the Planning Officers Society and based on UK experience to date, this guide focuses on three key areas:

  • development issues, including demographic and market research, scheme type, consultation and tenure policy;
  • planning policy issues, including a review of local, regional and national policies and best practice;
  • planning application and development control issues, including a review of the way in which various planning issues, such as the Use Class classification (C2 or C3?), design and sustainability, should be approached and balanced.

The guide reviews three operational UK schemes, and includes in a supporting CD extracts from various technical documents, including development plan policies, committee reports, Counsel’s opinion on the C2/C3 issue and key Secretary of State determinations.

The latest update - December 2008 - is now available following changes in policy and practice concerning continuous care retirement communities.

The previous update (PDF, 69KB), published in October 2007, is available here.

To help with downloading, the PDF for this report is available in two parts:

Technical appendices:

Appendix 1 (PDF, 92KB) | Appendix 2 (PDF, 107KB) | Appendix 3 (PDF, 454KB) | Appendix 4 (PDF, 150KB) | Appendix 5 (PDF, 1.5MB) | Appendix 6 (PDF, 3.7MB) | Appendix 7 (PDF, 2.7MB) | Appendix 8 (PDF, 4MB) | Appendix 9 (PDF, 93KB) |  Appendix 10 (PDF, 475KB) |  Appendix 11 (PDF, 4MB)

Summary

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Few continuing care retirement communities (CCRCs) have been developed in the UK, although they are expected to become increasingly common.  As a relatively new concept, there is a general lack of understanding of the characteristics and role of CCRCs and the issues they raise.  This analysis of current and emerging policy and practice is intended to provide practical assistance to those involved in the planning and development process, especially local authority planning officers.  The study, by Robin Tetlow of Tetlow King Planning Ltd., found:

  • Britain is an ageing society and the care and housing needs of older people are becoming increasingly important.  CCRCs are one way of meeting these.
  • Some key features distinguish CCRCs from traditional residential care homes and sheltered housing.  CCRCs are commonly large-scale, cater for a mix of residents, tailor care to individual needs, and often comprise a mix of tenures.
  • National, regional and local planning policies increasingly need to take account of the circumstances of older people and be flexible enough to respond to solutions such as CCRCs.  Local examples of good practice are beginning to emerge.
  • Development considerations include: the nature and extent of likely demand for the scheme; the services already offered locally; the appropriate mix of tenure; likely support from the local authority; and planning policies for the area.
  • CCRCs can provide direct benefits to residents, such as maintaining physical and mental well-being, independence and access to facilities and activities; and to their relatives who may be relieved of the stresses of family care.
  • CCRCs generally fall under planning Use Class C2 (residential institutions).
  • Evidence from UK CCRCs shows they can provide a safe environment for residents and be successfully integrated within the wider community.  CCRCs can therefore meet the key components of the Government’s vision of delivering sustainable communities.
  • CCRCs can integrate with and benefit the wider community, including: enhancing community facilities; creating jobs; and reducing demand on local health and social care facilities.
  • Consideration of planning applications for CCRCs will often require a sophisticated balancing of several material planning considerations, including the benefits of the particular proposal.

Implications of an ageing population with changing requirements

The proportion of the population aged 65 and over increased by over 51 per cent between 1961 and 2001.  This trend is expected to continue as the average lifespan continues to increase.  At the same time the concept of old age is being redefined, with more people seeing retirement as a rewarding and active part of life.  Housing need can no longer simply be equated with a need for care and support as this fails to recognise the preferences of older people. 

The number of residential care and nursing homes available to older people unable to remain in their existing home is diminishing because of rising costs resulting from labour market regulation, wage inflation and new care standards.  Between 1996 and 2001, 50,000 care home places were lost for older, ill and disabled people in all sectors.

In the past, some older people have experienced housing arrangements that they would not have chosen. Often older people who need care live in unsuitable housing; services may not be available for older people who want to be cared for at home.  Traditional models of sheltered and very sheltered housing are being replaced by new models which can better meet the diverse needs of older people. 

Defining Continuing Care Retirement Communities (CCRCs)

CCRCs have been described as “an all-embracing, comprehensive alternative to both sheltered housing and residential care providing for a whole range of needs and individual circumstances” (Department of Health, 2004).

A number of key features distinguish CCRCs from traditional residential care homes and sheltered housing.  CCRCs are commonly large in scale (over 100 units) and are able to cater for a wide mix of residents by tailoring the package of care to the individual’s own needs. CCRCs often comprise a mix of tenures.

Features which characterise CCRCs include:

  • Self-contained flats or bungalows incorporating design features to facilitate the independence of frail older people and provide a safe environment.
  • Residents usually pay two types of fee, a one-off entry fee or a weekly fee to cover accommodation costs and a regular fee for the duration of the stay.
  • Provision of an appropriate package of care, in the individual’s own home and to a high level if required.
  • Catering facilities.
  • 24 hour staff care and support available on site.
  • Comprehensive and extensive range of facilities such as restaurant, lounge, activity room, library, health suite.
  • Staff offices and facilities, domestic support services.
  • Wide range of social and leisure activities/facilities.
  • Mobility and access assistance.

Development issues

It is important that thorough research is carried out prior to any CCRC scheme being proposed.  This should take into account demographic and market research to evaluate current and future demand for the scheme and the nature of this demand in terms of the type of scheme required.  It is also important to assess the services which are already offered in the area.  The feasibility of the scheme should be assessed to establish such factors as the ability of residents to buy, the mix of tenure, whether the local authority is likely to be supportive and the compatibility with planning policies for the area.

The choice of sites for CCRCs will be extremely limited.  Indicators of better sites for CCRC include:

  • More than one in five people over retirement age living in the locality.
  • Level site, near public transport, shops, church and other facilities.
  • Large area, typically between three and five hectares.
  • Not more than five miles from a major centre of population.
  • For mixed tenure models, house prices no less than half the cost of providing extra care dwelling, depending on the availability of subsidy.
  • Site-specific attractive features, for example, pleasant outlook, near park. 

Planning policy issues

It is essential that planning policies at a national, regional and local level take full account of the circumstances of older people and are flexible enough to respond to innovative solutions such as CCRCs.  A range of recent policy and good practice documents issued by the Government emphasise the need for diversity and equality.

Examples of good practice at a local level are beginning to emerge.  The study recommends that criteria-based policies be included in development plans and supplementary planning documents, phrased in such a way as to enable the development of accommodation for older people in general and CCRCs in particular.

Planning application and development control issues

An analysis of successful CCRC schemes approved by local planning authorities and the Secretary of State reveals that the planning decisions have usually involved a sophisticated balancing of different material planning considerations.

CCRCs have often been held to fall under Use Class C2 of the Use Classes Order, on account of the inherent element of ‘care’.  The classification has important implications in planning policy terms.  Accommodation under Use Class C3 (dwelling houses) falls under general housing policies within development plans and is subject to testing within the parameters of the overall housing requirement.  C2 uses fall under the same special housing policies as nursing homes and other residential institutions. 

Frequently CCRCs are proposed in relatively rural locations; this raises questions as to the ‘sustainability’ of the location.  However, the locational concerns which apply to general housing are different to those applying to CCRCs as travel patterns will be substantially different.  Many residents have no need of a car and specific ‘green travel plans’ can be agreed, including the provision of dedicated bus services for residents.

There is a common perception that CCRCs constitute gated communities, running against the grain of the Government’s sustainable communities agenda.  Evidence from UK CCRCs does not support this.  CCRCs can be successfully integrated within the wider community while providing a safe environment for residents. 

Depending on the specific local development plan policies, CCRCs can directly contribute towards meeting local affordable and special housing needs.  The level and type of contribution will depend on the particular circumstances of the individual scheme. 

Benefits

It is demonstrable that CCRCs can provide a number of benefits to residents, the local community and the local economy.  Examples of such benefits include:

  • Security and freedom from the stresses of family care, to the benefit of both residents and their relatives.
  • Maintenance of the independence and physical and mental well-being of residents.
  • Access to services and activities for residents, including a supportive and stimulating community environment.
  • Job creation.
  • Reduced demands on local health, social care and other health facilities.
  • Provision of facilities for the use of the wider community.

Buildings and layout

CCRCs vary in extent and mix of physical facilities.  Typically they take on one of two layout types: 

  • Core and cluster – a core building contains most of the communal facilities and sometimes a residential care home.  Residents live in their properties scattered around the core building.
  • Dispersed facilities – facilities are spread throughout the scheme.  Communal facilities such as lounges and dining-rooms are located around the scheme catering for a small number of people.

Design

CCRCs should achieve high standards of design, making a positive contribution to the public realm as well as responding to the functional design requirements.  The following issues in particular should be considered:

  • Amenity space.
  • Overlooking.
  • Daylight and visual impact.
  • Ancillary features.
  • Car parking.
  • Density.
  • Sustainable construction.

Overall balance of material planning considerations

As with other types of development there is no one set of typical circumstances in which such applications will be considered.  In reality, the consideration of such schemes will involve a sophisticated balancing of all the material considerations, including the planning benefits.

About the project

This guide was produced by Robin Tetlow of Tetlow King Planning jointly on behalf of the Joseph Rowntree Foundation and the Planning Officers Society.  It is based on an analysis of current and emerging policy and practice across the UK, including an assessment of exemplar CCRCs that have been developed and input from planning officers and developers who have been involved with such schemes. The determination of various CCRC planning applications by Local Planning Authorities and the Secretary of State has been analysed.  The full report includes good practice examples of both policy formulation and development control practice.

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