Older people with high support needs in housing with care

Housing with care (HWC) offers a promising model for improving the quality of life of older people with high support needs, but also poses challenges. This Round-up covers key messages and practice examples from JRF studies into three aspects of HWC: promoting supportive and positive relationships; boundaries of roles and responsibilities; and affordability, choices and quality of life.

It found that:

• HWC is valued by residents. It can enhance quality of life for those with high and increasing needs, supporting independence, privacy and control, as well as many rights.
• Everyone involved has an ongoing part to play in creating conditions where tolerance, privacy and inclusion can thrive.
• Raising understanding of the lived experience of particular groups, and communicating positive messages about diversity, are key to creating a welcoming ethos.
• Providers can facilitate mutual support and resident-led initiatives through background support.
• Some residents benefit from a 'navigator' – a staff member or family carer to help co-ordinate various aspects of their lives.
• Role confusion can adversely affect residents and can be found across organisational models. A clear shared vision and understanding amongst commissioners, providers and residents of what a particular HWC scheme does, and for whom, is essential. Clarity of roles and responsibilities should be balanced by some flexibility.
• Affordability is specific to individual circumstances and partly subjective. In the context of HWC, there are uncertainties, inconsistencies and complexity. Some housing, care and support costs are ineligible for state subsidy, so reducing residents’ incomes below the notional income floor.
• Residents need individualised information about costs, subsidies and state benefits applicable to them, with support and advocacy to navigate the system.