Sometimes a disruptor is needed to transform opinion, change attitudes, and for society to truly embrace innovation. Whilst it may feel too soon to start looking at what we have learnt from the COVID-19 pandemic and too raw to look for positives that can be salvaged from the devastation left behind; those of us working in the design and delivery of accommodation for the elderly, can’t help but consider the ramifications Coronavirus is likely to have for the sector, and how we approach the design of projects in the future. Has the COVID-19 pandemic been the disruptor needed to change the way we look at housing our ageing population?
The current pandemic has highlighted the importance of communities across the globe. Nationally hundreds of thousands of volunteers are proactively supporting our shielded and elderly population who remain either in their own homes, care homes or other specialised elderly accommodation shut off from the outside world in a way not seen before. Whilst issues surrounding isolation, loneliness, and depression amongst our elderly population were well documented before, COVID-19 has magnified the issue in a way that no one could have predicted.
Care homes which look after some of our most vulnerable elderly have been affected catastrophically whilst they balance the need to provide one to one personal care with government guidelines on social distancing, PPE supplies and additional cleaning regimes. In extra care and supported living schemes non-essential visitors have been banned, communal areas closed, and external provider activities suspended, all the things designed to maintain the health and well being of residents. As the period of lockdown continues for our most vulnerable age group one cannot help but feel the casualties of COVID-19 will extend far beyond those who contracted the virus.
In May 2020, 6 weeks after the Prime Minister announced the country was in lockdown, Paddock Johnson Partnership invited a number of specialists in the field to join a virtual round table discussion, to openly share their thoughts on what is and isn’t working with the current models for elderly accommodation and how things might change in light of the current pandemic.
One Size Fits
All Since the emergence of the first nursing homes close to a century ago the essential ingredients of most elderly housing models remains relatively unchanged: residents rent a room or a bed space within a shared room and meals, care and support are provided communally. What has changed significantly in this period is the size of the elderly population and life expectancy rates. Close to a century ago the average life expectancy for a man was 60 years, today it is just over 85.6 an increase of more than 20 years. Similarly, the population of the UK has almost doubled in the last century and by 2050 it is projected that 1 in 4 people will be over 65, making the elderly a huge proportion of the housing market.
Despite life expectancy rates increasing, the definition of ‘elderly’ has been somewhat surprisingly redefined as 55, in part due to pressures in the housing market for family homes and down sizers being seen as part of the solution. The result has been the pigeon holing of a huge section of society, with everyone over 55 being lumped in together in an approach which assumes the needs and aspirations of someone aged 55 are the same as someone age 105.
This simplistic categorization of a whole section of society is misguided and short sighted and yet it remains the predominant approach in this country. Diana Martin, Manchester Urban Co-housing Group commented, ‘Not enough consideration is given during planning to allow a mix of rented and owned homes. Its very difficult to move into a neighbourhood that has been planned with rental and owned homes and this exacerbates inequalities in society.’ Graham Flynn from Box Clever Consulting added ‘Even within city centre PRS schemes people don’t want to be Pigeon holed by a group or demographic’ so why would people over 55 want to be.
Within the over 55’s market options remain very limited with a proliferation of low key, low cost, uninteresting new build apartment and bungalow schemes alongside tired, outdated and under maintained housing stock. Whilst there have been positive changes in the sector with new models such as extra care; ‘extra care was a game changer from traditional sheltered housing’ commented Sarah Houghton Grimshaw, Supported Housing Commissioning Manager at Torus, the full potential of these schemes is often difficult to realise through current procurement models. The size of communities created and the numbers of apartments in extra care is largely driven by the viability appraisal not what works from a social, community perspective. Similarly, hugely beneficial shared amenities such as bistro’s and cafes, which offer some of the best opportunities for increasing social interaction are often very hard to sustain and maintain as viable businesses. As Sarah highlighted ‘what commonly drives demand and style and size of extra care is cost’.
It’s not just a lack of choice of type of property but also location, again all too often assumptions about where people will want to live for the last 30 years of their lives is made by planners and developers with no real understanding or connection to the end user. There may be many people in their 60’s who would welcome the opportunity to move back in to our town and city centres, to be closer to restaurants, theatres, shops and museums now they have more time to enjoy what they have to offer, and yet the presumption is that accommodation for older people should be located in suburbia or on the fringes of settlements. Manchester City Council have a policy off ageing in place but as Pam Flynn, Manchester Urban Co-housing Group, commented, ‘ageing in place policies are a good idea but retrofitting brings considerable expense.’ As a society we want people to give up their large family homes, properties they have spent years personalising and adapting and move into uninspiring featureless alternatives, often away from the place they have spent most of their lives, and we wonder why people are resistant. Asking people to shrink their horizons and narrow their expectations is unfair; we all deserve better.
Learning from our European neighbours
You don’t have to look very far to see how things can be done differently, many of our European neighbours have a more creative approach to looking after their ageing population, whether that be through multigenerational housing, innovative schemes such Humanitas in Deventer, Netherlands where students live rent free alongside elderly residents in return for providing help to their neighbours or the design led Orestad Retirement Home in Copenhagen which is focused on providing a safe, healthy, non-clinical environment whilst at the same time being of the highest design quality. ‘Where our European colleagues do well is in designing residential above high street shops and restaurants, we need to be much more imaginative. We could reawaken our high streets and fill them during the day by having more socially connected vibrant high streets’ commented Sara McKee from Evermore. Perhaps it’s a freedom from the UK’s obsession with home ownership or a more respectful attitude towards their elders, one thing is certain there is room for improvement in the UK’s approach.
So, what needs to change? Firstly, we need to build better housing, not better housing for the elderly, just better housing in general, ‘By just designing for older people we are missing the trick, we need to design for everybody’, Steve Wood from Alpha Living highlighted, many of the issues faced by individuals which forces them into specialist accommodation arise out of the properties they live in not being fit for purpose as they age. An obvious example being space standards; apartment and houses sizes have been driven down by developers and house builders, with schemes frequently delivering properties below the NDSS, the result is a proliferation of homes which have insufficient space to adapt if someone needs to start using a Change So, what needs to change? Firstly, we need to build better housing, not better housing for the elderly, just better housing in general, ‘By just designing for older people we are missing the trick, we need to design for everybody’, Steve Wood from Alpha Living highlighted, many of the issues faced by individuals which forces them into specialist accommodation arise out of the properties they live in not being fit for purpose as they age. An obvious example being space standards; apartment and houses sizes have been driven down by developers and house builders, with schemes frequently delivering properties below the NDSS, the result is a proliferation of homes which have insufficient space to adapt if someone needs to start using a wheelchair or requires carer visits. With the size of the ageing population increasing it will not be feasible to have everyone move into specialist accommodation we therefore need to build housing suitable for a lifetime.
Secondly, we need to give greater consideration to the communities we are creating. Whilst it can be argued that there are economies to be had from grouping the most vulnerable elderly together, creating more diverse communities which offer different lifestyle choices and natural support networks has the potential to offer greater benefits. There will always be a place for specialist accommodation but there needs to be more options in between.
We also need to think more creatively about the locations deemed suitable for over 55’s and elderly housing. If we are to provide people with the option of growing old in the communities they know, perhaps we need to look beyond allcoated housing sites and consider edge of greenbelt, town centre and change of use sites.
Thirdly, more pressure needs to be applied at a planning policy level to ensure diversity within new developments, Tracy Gordon from Liverpool City Region Combined Authority commented ‘We need to convince mainstream developers the right things to build and be specific through the planning system about what is needed’. Incorporating standards like Lifetime Homes and HAPPI principles into planning policy is the only way to ensure developers deliver housing which is suitable for all not just those in the first 50 years of their life.
Some Local Authorities have started to introduce requirements for a proportion of new homes to be Part M4(3) complaint (wheelchair accessible) however this is applied as an arbitrary % of new homes across all new sites, a superficial target nothing more than tokenism. Ian Copeman from housing LIN added ‘there is no excuse for poor design. There are masses of examples of good quality design providing different lifestyle options but we are lacking the government policy in England [to insist upon it]. People will move [out of their large family homes] if the right product is put on offer’. Two such examples are New Ground Cohousing, High Barnet and the Courtyard Housing Project, Barking both in London.
New Ground is the realisation of OWCH’s (Older Womens CoHousing) vision to create a small community where people can live independently but together with the aim of promoting neighbourliness, combating isolation and offering mutual support to enable residents to remain in their own homes as long as possible. A unique and inspiring design of light filled apartments arranged around an enclosed communal garden, New Ground has proved hugely successful and the group are inundated with enquires from people who would like to move in.
The Courtyard Housing project for the London Borough of Barking and Dagenham is a collection of 27 L-shaped single storey dwellings arranged around communal gardens, in addition each has its own private courtyard orientated to take advantage of the sun. Designed as a contemporary take on the traditional almshouse, the use of high-quality traditional materials and forms, combined with contemporary details and large windows make the schenme unrecognisable as a local authority social housing scheme.
The Impact of Technology
If COVID-19 has taught us anything it’s how slow, we had all been to embrace the technologies available to us. Video calls were reserved for communicating with family living abroad and Microsoft Teams was an app that sat on your desktop that you never opened. Now within the space of 8 weeks Zoom has gone from 10million users to 300million and even our most tech illiterate elderly relatives are getting online to stay in contact with children and grandchildren.
Tech in the elderly care sector has advanced rapidly in recent years but as with the other technologies, uptake has been relatively slow. Advances in sensor technology, where by heart rate, movement, temperature amongst other metrics can be detected via wireless sensors and uploaded in real time to software which will automatically alert a nominated person or organisation should an issue be detected, offer huge potential for allowing people to remain in their own homes for longer.
Similarly, the mainstreaming of video communication systems which can be used through the TV or large easy to use touch screens is already proving beneficial in models such as extra care, allowing staff and residents to stay in contact more readily and providing another way to encourage social interaction for less confident and introverted neighbours. ‘Digital can be a great means of connecting neighbours particularly in the darker winter months.’ Commented Carol Rodgers, National Museums Liverpool – House of Memories. Perhaps the current pandemic will expediate the acceptance and application of new technologies in the sector.
Post Pandemic Communities
In times of crisis we pull together, we put aside differences and we remember to look beyond our own lives and consider those in greater need. The current pandemic has shown the extent to which we are willing to go the extra mile and help those around us. If we can harness this underlying desire and willingness to be part of a something beyond our own household and combine this with a variety of high quality, well designed housing types, the communities created will allow people to remain in their own homes for longer and not be forced to move away from the places they feel connected to. Choice, social inclusion and diversity must be the focus.
We need to learn from successful projects both in the UK and overseas, embrace technology, reimagine our communities and importantly reform our planning system to support a more inclusive approach. Victoria Alderton, Director - Paddock Johnson Partnership
Creating world class housing for an ageing population is the 2nd in a series of Round Table Discussions hosted by PJP, held via Zoom during lockdown. The event was attended by;
- Carol Rogers, National Museums Liverpool – House of Memories
- Diana Martin, Manchester Urban Co-housing Group
- Graham Flynn, Box Clever Consulting
- Ian Copeman, Housing LIN
- Pam Flynn, Manchester Urban Co-housing Group
- Sara McKee, Evermore
- Sarah Houghton Grimshaw, Torus
- Simon Halliwell, Paddock Johnson Partnership
- Steve Wood, Alpha Living
- Tracy Gordon, Liverpool City Region Combined Authority
- Victoria Alderton, Paddock Johnson Partnership