This research looks at approaches to Housing with Care (HWC) in England and Wales, and how these communities are being made socially inclusive places to live, based on what older people with high support needs say they value and want.
It found that:
'Promoting supportive relationships in housing with care' was a qualitative study that examined a range of current approaches to helping promote positive and supportive relationships between older people with and without high support needs living in HWC schemes. The initiatives were driven by provider organisations, by residents themselves, or by external groups. Examples include enabling people with sensory and cognitive impairments to take part in the life of schemes such as ‘Hear to Help’ and ‘Hear to Meet’, Action on Hearing Loss, and also the Enriched Opportunities Programme based in Extra Care Charitable Trust schemes.
The project was rooted in the recognition that those with high support needs can find themselves marginalised within communities that are defined by age and where there are people with a wide range of support needs (including those who need no support).
There is much work already being undertaken to ensure that older people with high support needs living in HWC are able to enjoy a better quality of life. It is also clear that communities within HWC settings are unique, diverse, complex and constantly evolving, reflecting the changing lives and different experiences of residents and staff. Despite the diversity, key themes emerged.
Promoting an ethos of respect and tolerance provides the foundation for achieving the things people as individuals want and value. The development of inclusive communities is most successful when this central ethos and culture has been specifically fostered. The examples show that promoting tolerance and respect of individuals helps HWC communities - residents, staff, visitors - to see beyond an impairment, condition or facets of an individual’s identity. Many of the examples highlight techniques and approaches that promote equality and diversity.
One way of developing a culture of tolerance and respect was through awareness raising. This was noted by diverse agencies across a range of issues including dementia, visual impairment and sexual identity. A common theme was the recognition of the role that all staff and residents play in determining how communities work within schemes. Solutions included offering training to everyone working within HWC settings and awareness raising for residents. However, the turnover of staff and residents in schemes reinforces the need for this process to be ongoing.
The examples in the report also illustrated a range of other approaches that organisations could take to create an underlying physical and social environment that provides opportunities for residents to participate in the life of their communities if they choose. These approaches included:
Many examples demonstrated how staff provided or "brokered" opportunities for residents to be more supportive to people with high support needs, as well as ensuring that individuals with high support needs were able to take advantage of activities within schemes. Person-centred approaches were successful in several instances (such as attention to the specific needs of individuals with sight loss). The training and skill sets of staff are important here, as is the recognition that all staff have a valuable role to play in setting the tone and ethos of a scheme.
While organisations and staff within HWC schemes have a crucial role to play in developing supportive communities, residents themselves are key players too. The wider literature, as well as the interviews and stakeholder discussions with residents undertaken during the course of this project demonstrate that for many people living within HWC settings, autonomy, privacy and choice are key aspects to how they want to live their lives. Activities, companionship, friendliness, and neighbourliness may be valued and often welcomed. Active participation, or not, in the community life of the schemes is seen very much as the individual's choice.
In difficult times, with resources becoming more scarce, there are many advantages to making HWC schemes outward looking and receptive to sharing resources located in the wider community. While this may require some negotiation with residents regarding how their privacy is protected, embedding HWC schemes within the local community, or partnering with other schemes or organisations to share resources, offers financial and social advantages to individual residents and provider organisations.
The meaning of 'success' of any initiative or approach needs to be carefully considered. While organisations, staff and residents have roles to play in creating supportive communities in HWC, whether a scheme is ultimately a supportive and inclusive environment will be judged by the individual residents.
The experience of ageing in the 21st century will be very different from what has gone before. We will all have to find new ways to live together and get along as we grow older. This project explored the context of HWC, but offers useful lessons for other settings, such as care homes and developing age-friendly neighbourhoods.