Specialist and Supported Housing Needs Assessment

Approach: considerations and assumptions

1. The contextual evidence and assumptions set out in paragraphs 2.56 to 2.72 are used as a basis for estimating need for specialist housing and accommodation for older people in Gateshead to 2040.
2. Data about the existing supply of older people's designated housing and accommodation in Gateshead is used as a baseline of current provision. This data is drawn from the Elderly Accommodation Counsel (EAC) and the Care Quality Commission (CQC). This research did not include a qualitative assessment of any of this specialised housing/accommodation, for example existing 'sheltered housing', therefore no assumptions are made about its future 'fitness for purpose'.
3. ONS 2021 census (ONS P02 Census 2021: Usual resident population by five-year age group, local authorities in England and Wales) and 2018, based population projections data are used to identify relevant older populations in Gateshead. (ONS 2018-based household projections for England: detailed data for modelling and analysis). Based on evidence from our advisory work with housing providers and local authorities in relation to specialised housing and accommodation for older people, the following population bases are used for estimating future need for housing and accommodation for older people, reflecting the typical ages of moves to these types of specialist housing and accommodation:

• The 75+ population as the average age benchmark in relation to the need for housing with care (extra care housing), residential care and nursing care.
• The 65+ population as the average age benchmark in relation to the need for housing for older people (retirement housing for affordable rent and for sale).

4. Approximately 65% of households headed by a person aged 65+ in Gateshead are homeowners (table 8). In comparison to local authorities in the north east Gateshead has a median level of relative deprivation amongst the 60+ population based on comparison of the IDAOPI score (paragraph 2.31). We have used this evidence to inform assumptions regarding the tenure breakdown of need for specialist housing amongst older people. Given this evidence estimates of future need are assumed to require around 60% for shared ownership/sale and approximately 40% for social/affordable rent for housing for older people (retirement housing for sale/shared ownership and for affordable rent), however the actual tenure split for new development of specialist housing for older people will be dependent on the socio-economic profile of a locality.

5. In relation to housing with care (extra care housing), given residents will typically have a care/support need as well as a housing need and the council's policy to commission additional extra care housing, including as a direct alternative to residential care for older people eligible for local authority funded care, a tenure split of 70% affordable rent and 30% shared ownership/sale has been assumed.

6.In terms of the health and care profile of the older population in Gateshead evidence indicates that average life expectancy is slightly higher than the average for the North East region, however it is below the England average. The number of people aged 65+ with dementia is projected to increase in Gateshead by 2040. The increasing incidence of dementia is a factor affecting likely need for extra care housing and care home beds.

7. Based on the Housing LIN's previous experience of local authority commissioning and placement funding practice and the views and experience of Gateshead Council commissioners, it is reasonable to assume that up to 20% of placements into residential care could be substituted with living in housing with care (extra care housing). Gateshead Council commissioners estimate that 78 older people placed in care homes could potentially have move to extra care housing as an alternative.

8. Evidence in relation to the preferences of older people to move such as, 'downsizing'/'rightsizing') to types of housing/accommodation designated for older people is an influencing factor in estimating need for housing/accommodation; the Housing LIN has drawn on qualitative (Housing LIN qualitative research with over 1000 older people: focus groups, 1:1 interviews and residents' forums consulted in order to obtain the views of older people with respect to their preferences and needs related to specialist housing, adaptations and later life.) and quantitative research it has conducted with people aged 65+ over the last five years (Housing LIN quantitative research: approximately 1500 survey responses completed by people aged over-60 about their preferences for specialist housing and accommodation for older people.) across England, including with older people in Gateshead. In summary this evidence indicates:

9. Older people are seeking wider choices in the range of housing and accommodation options that will facilitate independent living. Including, for example, level access homes such as bungalows. In some cases, this will be a move to alternative accommodation and for others this is about adapting their current home or bringing in care/support if this is required.

10. Based on the Housing LIN's research, about 25 to 30% of older people aged 65+ are potentially interested in and willing to 'downsize'/'rightsize' and move to specialised housing and accommodation for older people. This evidence from the Housing LIN's research with older people indicates that approximately:

• 50% are interested in moving to a form of specialist age-designated housing (HfOP and HwC), primarily retirement housing (for sale) and modern sheltered housing (for social/affordable rent), followed by housing with care (extra care housing).
• 50% are interested in moving to 'age friendly' housing that meets age related needs but is not age-designated housing.

11. There is very limited interest in a move to residential care or nursing care as a choice of specialist accommodation; most moves to these types of accommodation are as a result of, for example, an acute health and/or care episode or crisis. This evidence is based on qualitative and quantitative research carried out by the Housing LIN, where participants typically only support a move to a care home where this is dictated by health-related needs.

12. A comparative analysis has been undertaken that compares the current supply or 'prevalence' of different types of housing and accommodation for older people (older people's housing for social/affordable rent, older people's retirement housing for sale, extra care housing for social/affordable rent and for sale, residential and nursing care) in Gateshead with other local authorities in the north east along with the all-England averages for supply of older people's housing and accommodation. This identifies how supply in Gateshead compares to other north east local authorities and across England generally. This is shown in the tables below.

Table 10. Prevalence rates (such as, the number of units per 1,000 population aged 65+) Housing for Older People in Gateshead, alongside the north east average and all-England prevalence rates. (2022 prevalence).

Source: EAC/Housing LIN 2022

Table 11. Prevalence rates (such as, the number of units per 1,000 people aged 75+) Housing with Care in Gateshead, alongside the north east average and all-England prevalence rates. (2022 prevalence).

Source: EAC/Housing LIN 2022

Table 12. Prevalence rates (such as, the number of bedspaces per 1,000 population aged 75+) of residential and nursing care in Gateshead, alongside the north east average and all-England prevalence rates. (2022 prevalence).

Source: Care Quality Commission/Housing LIN 2022

13. The comparisons show that for:

• Housing for Older People, Gateshead's level of provision is below the North East comparator average, however, is higher than the English prevalence rate.
• Housing with Care, Gateshead's level of provision is in line with the North East average prevalence, however slightly higher than the English prevalence rate.
• residential care, Gateshead is slightly higher than the North East average prevalence and higher than the English prevalence rate.
• nursing care, Gateshead is significantly below both the North East average and the English prevalence rate.

14. In relation to the impact of the Covid-19 pandemic, any assumptions based on emerging evidence are tentative given that the impact of the pandemic on the specialist housing and accommodation sector for older people is not yet clear. At this stage considerations based on tentative evidence could suggest in the medium to longer term:

• There is potential for a downward shift in preference for use of residential care amongst older people.
• There is potential for a preference amongst older people for remaining in their existing home, with care if required.

15. However, in Gateshead in the short-term post pandemic, use of residential care has temporarily increased due to hospital discharge pressures and significant issues in recruiting and retaining social care staff to provide care to people in their own homes.

16. In relation to each of the types of housing and accommodation for older people, assumptions are summarised below:

Housing for Older People:

Need is likely to increase as a consequence of:

• an increase in the 65+ population;
• relative undersupply of housing for older people for shared ownership/sale compared with housing for older people for social/affordable rent;
• research conducted by the Housing LIN over the last five years with older people, including in Gateshead, which indicates an interest in moving to housing better suited to older people.

Housing with care:

Need is likely to increase as a consequence of:

• a significant increase in the 75+ population;
• council policy intent to offer extra care housing as an option for older people with care needs, including in place of residential care - the council's Market Position Statement states that the council's intends "to support new extra care developments across the borough";
• research conducted by the Housing LIN over the last five years with older people including in Gateshead, which indicates an interest in moving to housing better suited to older people;
• increasing prevalence of dementia related needs and other health/care needs amongst the 75+ population.

Residential care and nursing care

The council's Market Position Statement states that the council's "approach is to increase resources in enablement and preventative services to reduce future demand on long term statutory services in the next three years. It is expected the number of older people who are eligible for long term services to remain constant over the next three years due to the enablement and prevention", and "to reduce the number of long term general residential care placements ".

Whilst the 75+ population is increasing over the period to 2040, in this policy context need for residential care may flat line or potentially decrease, however the need for nursing care is likely to increase, as a consequence of:

• the potential for the impact of the Covid-19 pandemic to reduce demand in the longer term for residential care (particularly amongst local authority funded placements and self-funders for residential care);
• the unsuitability of some care homes to cater for people living with dementia and other complex care needs, care home capacity will need to be able to support older people with complex care and health needs;
• an increase in the demand for housing with care, in part due to council policy intent to offer extra care housing as an option for older people with care needs, particularly in place of residential care.
• however, the need for nursing care is likely to increase due to projected growth in the 75+ population and a commensurate increasing prevalence of dementia related needs and other complex health/care needs amongst the 75+ population.

Projections: estimates of future need for housing and accommodation for older people

Table 13 shows the anticipated likely need (prevalence rate) and the associated estimated need (units/bedspaces) for each type of housing and accommodation for older people:

• 2022 current provision. The number of units for that type of housing/accommodation, using data from the Elderly Accommodation Counsel and the Care Quality Commission about specialised housing and accommodation provision.
• 2022 prevalence rate. The prevalence rate, such as, the number of housing units/beds per 1,000 older people (Population 65+ for housing for older people; population 75+ for housing with care and residential/nursing care), based on population data from the ONS 2021 census and ONS 2018, based population projections. It is also based on data from the Elderly Accommodation Counsel's and Care Quality Commission's specialised housing/accommodation data (for units/beds).
• 2040 anticipated prevalence rate. An estimate of the likely need (prevalence rate) based on the considerations and assumptions that are set out above.
• 2040 estimated gross need. An estimate of the total number of units/bedspaces of housing and accommodation for older people that will be needed, based on estimated need (prevalence rates) for 2040 and the applicable projected 65+ or 75+ population for 2040.
• 2040 estimated net need. A calculation of the additional number of units/bedspaces that are estimated to be required by 2040, in order to meet the estimated need for that type of housing/accommodation. It is the 2040 estimated need minus the 2022 current provision.

Table 13. Current provision and estimated need for specialist housing and accommodation for older people, to 2040 in Gateshead.

Note. Figures may not sum due to rounding

The estimated gross need for housing and accommodation for older people is shown for 2023 (current need), 2025, 2030, 2035 and 2040 in table 14. The estimated net need is shown in table 15, which shows the estimated need additional to the current supply. Net need is not cumulative.

Table 14. Estimated gross need for housing and accommodation for older people to 2040, in Gateshead.

The estimated net need for housing and accommodation for older people is shown disaggregated for 2023 (current net need), 2025, 2030, 2035 and 2040 in table 15. This shows the estimated number of homes/bedspaces required to meet estimated need in 2023 and by 2025, 2030, 2035 and 2040. Net need is not cumulative. Estimated need for housing for older people and housing with care are shown by locality at Annexe 3.

Table 15. Estimated net need (such as, net of current supply) for housing and accommodation for older people to 2040 in Gateshead.

Note. Figures may not sum due to rounding

In summary, the estimated net need requirements for specialist housing and accommodation for older people for Gateshead by 2040, are shown in table 16.

Table 16. Housing and accommodation for older people, net estimated need to 2040, in Gateshead.

Housing for older people (retirement housing for sale and for social/affordable rent). The estimated housing for older people net need to 2040 is about 670 homes of which around 270 homes are estimated to be required for social/affordable rent and around 400 are estimated to be required for shared ownership/sale. Based on the qualitative evidence about older people's housing preferences (paragraph 2.62) it is assumed that potentially up to 50% of this estimated need could be met through the provision of mainstream housing that is designed for and accessible to older people even if it is not technically 'designated' for older people, for example housing that is 'care ready' and suited to ageing as distinct from 'retirement housing'. This may include mainstream housing to accessible and adaptable standards M4(2) and M4(3).

Housing with care (extra care housing). The estimated housing with care net need to 2040 is around 435 homes of which 305 homes are estimated to be required for social / affordable rent and about 130 homes are estimated to be required for shared ownership/sale. This will meet the housing and care needs of older people who are self-funders as well as older people who need rented accommodation and are eligible for social care funded by the council. This need could be met in part through mixed tenure development of extra care housing.

Residential care and nursing care. The estimated residential care net need is not anticipated to increase over the period to 2040. It is likely that residential care bed capacity will need to be increasingly focussed on older people with more complex social care needs, such as people living with dementia. The estimated nursing care net need to 2040 is approximately 230 bedspaces. It is likely that nursing care bed capacity will need to be increasingly focussed on older people with more complex health and social care needs, including people living with dementia. This is aligned with the council's integrated residential/nursing care delivery model.