Sheltered Housing for the Elderly

Policy, Practice and the Consumer

Alan Butler, Christine Oldman, John Greve

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000438468
• Edition: 1
• Topic: Medicine
• Subtopic: Social Work

In the early-1980s, the ten million people of retirement age in the UK figured prominently among the disadvantaged and deprived. They were heavily over-represented in sub-standard housing and among those in most need of support from the personal social services.

One form of social provision which gained rapidly in popularity in the 1960s and 1970s was sheltered housing. It was seen to combine housing with care; provided support while fostering independence; and gave scope for flexibility and experimentation in adapting schemes to local circumstances. By the late 1970s hundreds of schemes were administered, and they were occupied by half a million elderly tenants. Sheltered housing was called 'the greatest breakthrough in the housing scene since the war'. Extravagant expectations were aroused, and sheltered housing was regarded by some as the solution to all manner of complex problems.

Taking the country as a whole, however, relatively little was known about the numbers of schemes and where they were located; who owned them and how they were managed; the aims and assumptions of those who provided or advocated sheltered housing; how the schemes functioned and whether they achieved what they were set up to do; the role, experience and attitudes of wardens; what kinds of people lived in sheltered housing, their history, and how they became tenants; their assessment of the scheme; and much else.

The Leeds study, on which this book is based, originally published in 1983, was the most comprehensive and detailed to have been conducted into sheltered housing. It evoked widespread interest in Britain and abroad at the time. It sought to answer some of the important questions about the growth and proliferation of sheltered housing, to evaluate sheltered housing from different points of view – including those of tenants, and to consider the scope for future development.

While sheltered housing is the focal topic of the book it should be viewed in the broader context of social policy, administration, professional practice and client experience. The book describes in detail an innovatory and evolving form of social provision and, in doing so, illuminates the operation and impact of policy in action at several levels – from the policy-maker to the consumer, from the organisation of policy to its object.

There was significant evidence from the study that many tenants were provided with a service which was not the one they sought, or even needed, but they were given what the agency happened to have – or made – available. Among other topics, the book examines sheltered housing as a response to, or reflection of, myths and prejudices about ageing. It discusses whether elderly people should be compelled to move from familiar surroundings late in life – and how they cope when they do move. The usefulness or otherwise of alarm systems is assessed – with conclusions that throw considerable doubt on their value or reliability. The evolution and modifications taking place in sheltered housing are reported on and the scope for future initiatives is discussed.

Chapter 1 INTRODUCTION AND BACKGROUND

SHELTERED HOUSING

This book is based on a comprehensive study of sheltered housing for the elderly in England and Wales. The study was carried out over a four-year period from the autumn of 1977 by a research team from the University of Leeds.

Sheltered housing for the elderly is but one of many categories of housing, but its characteristics are by no means precisely defined or immutable, as we shall make plain later. Moreover, sheltered housing manifests a considerable – and growing – diversity of types and functions.

We define three elements as distinguishing sheltered housing for the elderly from other categories of housing, namely: a resident warden, an alarm system fitted to each dwelling, and the occupancy of dwellings being restricted to elderly persons. Another typical, but not universal, feature is that the dwellings are grouped on one site whether ‘on the ground’ or in blocks of flats. Sheltered housing has usually been purpose-built, but some has been created through the conversion or adaptation of existing housing – a method which is likely to become more common in the foreseeable future both in response to economic stringencies and as a means of making effective use of the housing stock.

Like other forms of social provision, sheltered housing for the elderly can be better understood when it is placed in the broader political, administrative and economic contexts within which it is shaped and must operate.

THE BROADER CONTEXT

In their formulation and implementation – and, not least, in the form in which they finally reach the individual – social policies are shaped and altered by a multitude of pressures. Some of these pressures, like economic necessity or the changing age-structure of the population, are readily identifiable. The part played by other factors, such as political expediency, may be less easy to determine. Others again are more subtle or more difficult to chart. For instance, variations in administrative practice, differences in the interpretation of policy goals on guidelines by administrators and other personnel, the exercise of discretion, neglect, incompetence, and shortfall in the execution of tasks, all of these also shape and reflect policy as it is transmitted along the networks of organisational processes from conception to delivery.

An important result of the interplay on social policies of the multitude of shaping influences – many of them inconsistent, transitory or unstable – is that there are wide differences in the way people (the ‘target’ groups or individuals) are treated: how their needs are assessed, the criteria of eligibility, and in the nature, quantity and quality of aid they receive.

INEQUALITIES

While policy objectives and administrative intentions may be defined in egalitarian terms, there is abundant evidence that the outcomes of policy and of administrative or professional action are profoundly unequal, and that the operations of the policy delivery system (‘the service’) – the activities of administrators and other key personnel, and the design and nature of the organisational machinery itself – contribute very substantially to the creation and maintenance of these inequalities of outcome.

Over the past two or three decades evidence of inequalities in treatment and outcome has been mounting and is now formidable in volume. Indeed, the extensiveness and persistence of unacceptable (in social policy terms) inequalities among the ‘target groups’ – the elderly, the sick, people on low incomes, the poorly housed, and the educationally disadvantaged -have become one of the major causes for concern in the social policy field.

Elderly people figure prominently among the disadvantaged and deprived. They are heavily over-represented in sub-standard and inadequate housing, among low-income groups, and among those needing help from the personal and health services. But while, proportionately, their need for assistance in respect of income, housing, health care or social care, may be greater than that of younger age-groups, people over the age of 60 or 65 differ from each other as much as do those of under pensionable ages. This is something which society should take into account in its attitudes towards ‘the elderly’ and which should inform the personal, health and housing services in dealing with old people.

THE ECONOMY AS A FACTOR

Among the factors determining the scope and level of provision within the broad framework of social policy, the perceived state of the national economy is the most potent. Accordingly, the most rapid and extensive development of social provision has occurred in times of prosperity and economic growth, such as the 1960s, and, correspondingly, the most stringent measures to reduce social expenditure have been applied during the prolonged economic recession since 1973.

It is notorious that housing has been used by successive governments in this country as, alternately, economic brake and accelerator to govern the pace and consumption of the economy. Since the early 1970s public sector housing has suffered greater proportionate – and, perhaps, absolute – reductions than any other area of social expenditure. New construction has been sharply reduced, to the extent that housing ‘starts’ recently fell to their lowest level in fifty years. But throughout most of this period of cut-back in housing construction, sheltered housing for the elderly has been a notable exception. From around 1979-80, however, new building in sheltered housing was also reduced substantially.

Nevertheless, from small beginnings in the 1950s, sheltered housing for the elderly now takes a major share of local authority and housing association output and provides homes for about 500,000 elderly persons in England and Wales. In the past year or so private developers have also begun to take an interest, and the first schemes (for sale) have been completed.

Sheltered housing has quickly become a prominent feature of the housing scene, and is a manifestation of a shift in the balance of housing priorities over the past twenty years. Underwood and Carver (1979) went so far as to assert

We do not think it too extravagant to say that the concept of sheltered housing has been the greatest breakthrough in the housing scene since the war.

That is a substantial claim, and there is room for argument about the degree of its validity. It would be more accurate to say that the breakthrough was through the rapid expansion of the volume of construction, rather than in the concept of sheltered housing which, as we indicate in Chapter 5, has a relatively long history. Be that as it may, there can be no doubt that the scale of the emergence of sheltered housing for the elderly has been of major significance in the fields of housing provision and care in the community.

Sheltered housing for the elderly and the range of services associated with it are important in themselves, but, taken together, they also offer an example of social policy in action which can be examined as a case-study at different levels of operation from policy-making to consumer reaction. Thus, while the study discussed in this book focused on sheltered housing for the elderly, we believe that it also throws additional light on the processes of policy and administration in relation to social provision

- primarily at the local level – showing the diversity of aims, organisation and practice, reflecting the exercise of local autonomy, generating questions and identifying issues, which are of wider applicability. We return to these aspects towards the end of this chapter.

HOUSING FOR THE ELDERLY

For two decades or so after the war policies in housing, health and welfare were, to a large extent, characterised by a ‘general needs’ approach. Much was achieved, across a broad range of policies, but resources and services for certain groups, such as old people, the mentally handicapped, or preschool children, fell short both in terms of their manifest needs and measured against the criteria of social justice – and this was always true with regard to elderly people. As we have noted, there was nevertheless a substantial growth from the late 1950s in the provision of various types of housing for elderly persons – sheltered housing, individual dwellings, or small schemes of ‘unsupported’ housing. Chapters 5 and 6, below, examine these developments in some detail.

By the mid-1970s there were some 9-5 million people of retirement age or older in the United Kingdom, and their numbers were increasing more rapidly than the population as a whole. Moreover, numbers in the highest

- and most dependent – age groups were rising fastest. Meanwhile, as we describe in Chapter 3, independent and official surveys, including the decennial censuses, had shown that in spite of the massive addition of new housing to the total stock since 1945, and the demolition or improvement of many hundreds of thousands of others, disproportionately large numbers of old people were still living in housing which was substandard, unfit, or otherwise unsuitable or burdensome in relation to their needs and physical capacities.

Sheltered housing was a relatively new and rapidly spreading form of provision which offered accommodation and supporting services to large numbers of people – albeit still only a small minority of the elderly. But its significance lay not only in the totals of dwellings supplied or people housed. It was also a special form – or, more precisely, forms – of housing which involved an integration or co-ordination with other services concerned with the welfare and health of elderly people. In addition, if was a concept which appeared attractive from the different viewpoints of service and cost. It seemed to combine the advantages of various components of care, while fostering independence, and also giving scope for flexibility and experimentation. All of this in a period, from the 1960s, when the needs and expectations of elderly people were drawing the interest and stimulating the imagination of policy-makers, administrators, service practitioners and commentators to an extent not previously experienced. In part, this was a by-product of the large general needs programmes referred to earlier, but another important factor was the production and release of new resources created by a long period of economic growth -notably in the late 1960s – and the optimistic and expansionist attitudes which this generated and sustained.

LACK OF INFORMATION

In the mid-1970s it was evident that there had been a rapid expansion in the provision of sheltered housing for elderly people and that substantial numbers of people now lived in local authority and housing association schemes. But not a great deal was known about the schemes, the providers or the tenants. Subsequently, our study and that conducted by Oxford Polytechnic (1980) on behalf of the Department of the Environment and Welsh Office, showed that the numbers in sheltered housing had been underestimated. Various studies had been carried out prior to our own – which took place in the period 1978-81 – but they were scattered in time and coverage, limited in scale and focus, and most were out of date, especially having regard to the expansion in provision that had occurred and was still in progress.

In a comprehensive sense, looking at the country as a whole, surprisingly little was known about

• the numbers of schemes, their size and age
• who owned or managed them, and the management set-up
• who occupied the schemes (their ages, family and housing background, social and economic characteristics, health and mobility)
• how tenants were selected
• the nature of tenants’ needs, and what help they were receiving
• the warden and his or her role
• the purposes and objectives perceived by the advocates and providers of sheltered housing
• whether sheltered housing was fulfilling the objectives set for it
• how the tenants viewed, experienced and evaluated sheltered housing.

Preliminary work, before carrying out the main parts of the study, showed that certain general assumptions were called in support by those who advocated or provided sheltered housing. These assumptions – or assertions – related to a variety of matters including independence, dependence, well-being, welfare, the quality of life, satisfaction, fulfilment, organisational efficiency and cost. On the other hand, sceptics could marshal counter-assumptions or claims on at least as many subjects. Such assumptions and some of the evidence are reviewed in Chapter 4. But the comprehensive study of sheltered housing which is the principal source of this book was substantially concerned with testing the key assumptions which were voiced in or which influenced policy-making, administration, management and professional practice in relation to sheltered housing and those who live in it.

THE STUDY

Briefly expressed, the purpose of the study was to account for the development and proliferation (in variety as well as numbers) of sheltered housing for the elderly, to evaluate the provision from the points of view of the interested parties – not least the tenants – and to determine the scope for further development. The study sought to examine sheltered housing for the elderly in England and Wales as a whole. In the main, however, this was by means of intensive empirical research, comprising several sets of interview surveys complemented by other forms of investigation, conducted in a representative sample of twelve areas. More than 800 tenants were interviewed in local authority and housing association schemes to record and discuss their history, experience, attitudes and their assessment of sheltered housing and other services. Extensive interviews with administrators, housing managers and wardens of schemes also formed an important feature of the inquiries.

The Leeds study is the most comprehensive and detailed to have been carried out into sheltered housing and it has evoked widespread interest in Britain and abroad.

BROADER IMPLICATIONS AND ISSUES

While sheltered housing for the elderly is the focal topic of the book it should be viewed in the broader context of policy, administration, professional practice, and client experience. The study which is reported and discussed in the chapters that follow has a wider significance and application which is not restricted to understanding and assessing the roles, purpose and utility of sheltered housing. In particular, the study may be considered as an investigation of the functioning of what might be termed the social policy of special provision. The book describes in detail an innovatory and evolving form of provision and, in doing so, examines and illuminates the operation and impact of social policy and administration in action at several levels or stages, from the policy-maker to the consumer, from the organisation of policy to its object.

An elderly person in sheltered housing is the focus of a variety of administrative and professional decisions and actions and the recipient of a range of services. Elderly tenants share this status – at the receiving end of decisions and actions – with innumerable other clients and client groups across the wide and only partially mapped field of social provision.

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Table of contents

• Cover
• Half-Title Page
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Foreword
• Acknowledgements
• List Tables and Figures
• 1 Introduction and Background
• 2 The Problems of Evaluation
• 3 Housing and the Elderly
• 4 Sheltered Housing – the Conventional Wisdom
• 5 The Development of Sheltered Housing
• 6 A Housing Provision
• 7 The Management of Sheltered Housing
• 8 Financial and Economic Aspects
• 9 Extra-Care Sheltered Housing
• 10 Alternative Forms of Tenure
• 11 Alternatives to Sheltered Housing
• 12 The Warden
• 13 The Tenants
• 14 Conclusions and Recommendations
• Bibliography
• Index