ARCO has launched a new report, Putting the ‘care’ in Housing-with-Care. During the launch event, there was information about the quality of the care provided in Integrated Retirement Communities (IRCs), with 97% of the domiciliary care agencies run by ARCO Members in IRCs rated ‘Good’ or ‘Outstanding’ by the CQC. There was also evidence presented about the effectiveness and efficiency of care provision in IRCs, which could save up to 60,000 social care staff if our sector grows to the size of that seen in New Zealand, Australia and the US. The take-home message from the event was that an expanded IRC sector is crucial for reducing NHS costs and supporting healthcare.
The report introduces the findings from the research on the care provided in integrated retirement communities. These findings are:
- Integrated retirement communities provide high quality are
- Residents greatly value, high-quality, flexible care
- Efficient care delivery frees up care workers
- High-quality care helps bring widespread health and wellbeing benefits
- Health and wellbeing benefits save billions for the NHS and social care
- The benefits of IRCs have been shown during the pandemic
- High-quality IRCs should be supported and expanded
The evidence in the report suggests that we need a concerted effort from Government to expand the sector and bring benefits to many thousands more older people across the country. The calls to action in the report and at the event – including for specific commitments in the forthcoming social care White Paper, and a cross-department task force on housing-with-care – have never been more important.
NCF were happy to be in attendance at the report launch. Information about the launch and key talking points are presented below.
Report Launch Information Summary
The speakers at the event were Nick Sanderson, ARCO’s Chair and Chief Executive of Audley Group; Rt Hon Damian Green MP, Chair of the All Party Group on Longevity, Natalie Reed, the CQC’s Interim Head of Inspection; Simon Bottery, Social Care Fellow at The King’s Fund, and Joanna Grainger, Executive Director of Operations at the ExtraCare Charitable Trust.
Sam Dalton, Policy & External Affairs Manager, ARCO – Report Summary
The report focuses on managing a dysfunctional housing market. We now have a new housing minister and they will need to come up with new options to downsize/right-size. In extra care, there is the provision of support in an individual’s own home and it is an alternative to residential care. Integrated retirement communities should play a huge role in the future.
Conclusions from the Report
There are three main conclusions from the report
- There is a provision gap in the social care system, integrated retirement communities can fill the gap
- There will be good outcomes if we can fill the gap
- We can avoid bad outcomes in the social care system
The system has evolved – today geriatric hospitals have been phased out. In nursing and care homes, there are high levels of care needs. There is an 18-month average stay in care homes and a provision gap.
Benefits of filling the gap
- There is high-quality care in integrated retirement communities – in the IRCs of ARCO members, 97% of domiciliary care agencies are rated good or outstanding by the CQC compared to 88% more widely
- Increase in health and wellbeing when living in IRCs, cut down in GP and hospital visits
- Better outcomes in IRCs that when living in the wider community
Care is important and that is why some people choose to move into IRCs. There are two key things that IRCs do:
- Increases the efficiency of the providers of care – 15% of the costs of domiciliary care in the wider community are travelling from home to home. This can be saved if care is provided in IRCs
- Health and wellbeing improvements – 20% of people need less care after they move into IRC. High-quality care is received, but less care and fewer social care staff are needed as a result.
If the sector grows to 250,000 over 65s in IRC, 20,000 social care staff will be saved. Given the scale of the challenge, we can not afford to not expand the IRC sector.
Rt Hon Damian Green, Chair of the All Party Group on Longevity
APG on longevity, the Government aim is around the concern that everyone should have 5 extra years of healthy life. The NHS is always at the top of the mix, not social care. There are people in the hospital who don’t need to be there. We need places to receive people. This means that there is a role for IRC, we more places that are better. In the short term, we need to cure the existing issues. In the long term, we need to focus on how we expect and hope for people to live in their later years – prevention is better than cure.
Only 8.7% of residents have to move into a residential home after living in IRCs. Social care won’t be fixed without fixing the housing issue. Changing demographics mean that there are more acute problems. The white paper needs the provision of appropriate housing if it will be a success.
Natalie Reed, CQC Interim head of inspection and strategic lead for housing– Care in the Community
Natalie worked for a provider before moving to the CQC, so she knows about quality and how important it is. The figures revealed in the report are stark – 100% of ARCO members are good of more in their CQC ratings. It is powerful to hear the benefits that are talked about in the report. Peoples lived experiences provide feedback and this is one way that providers can move from good to outstanding. If models are supported to be comfortable this is a safety net. The CQC are limited in looking at people in receipt of regulated activity.
Simon Bottery, Social Care Fellow at The King’s Fund
Evidence – The DHSC asked for a care and support in specialised housing evaluation framework. It was easy to find good evidence for extra care housing. There were benefits for individuals including a reduction in loneliness and depression. Benefits for public policy include a reduction in usage of other types of care. There is not enough extra care housing – there is an undersupply and a mismatch between what the market provides and what it supplies.
Joanna Grainger, Executive Director of Operations at the ExtraCare Charitable Trust.
There is unsung support for IRCs. There is a housing crisis because older people stay in their houses. IRCs can lead to the prevention of a requirement of personal care. People move into IRCs because care is there, not because they need care. As the staff are under one roof, more flexible than in a community setting. IRCs are about flexibility, knowledge, relationships building, continuation, retention levels.
Discussion
Q: There is a disparity between the political will and what will be delivered in the white paper. What can you do in your role for the APG to get this on the agenda?
A (DG): How to get housing into the practicality of the housing debate. The way that Whitehall is organised, there are classic policy areas where bits fall between the gaps. We need a whole Government approach. If we leave it to departments, we will get a departmental view. Apparently, the white paper does address the housing issues, but the question is what is on the white paper and what will happen afterwards.
Q: We are trying to get health and social care and housing as an integral approach. How much will be about a shift vs how much is about the NHS transferring funds for prevention?
A (SB): The policy answer is the development of IRCs. This is a debate to be had in a real way. ICS leadership should have the questions, we need to think about wider government, in localities. We have not seen the level of integration that we would like to see.
A (DG): One issue that is internal to the NHS is that 5% of the budget is spent on prevention and this should increase by 1% each year. NHS needs to think long term as there are problems today and if they would want to focus on prevention how much can be devoted to IRCs.
A (NR): Regulation in IRCs is in the white paper and local authorities move towards system working. We need to ensure that prevention is high on the agenda.
A (NS): Housing is hard to get older people on the housing agenda as they are believed to have wealth that they have accumulated over their lifetime. Draw the line at releasing housing especially and under occupation.
Audience Member Comment: Health has no understanding of the importance of housing. It is an untapped field that could take it forward, but don’t understand enough. They could be allies.
Audience Member Comment: Based on a list of hurdles that stop people from buying retirement properties, awareness is considered the number 1 hurdle.
A (JG): There is a lack of understanding amongst older people. We need to invest in how the market thinks.
A (NS): New generation of older people are more engaged.
A (SB): The new cap is an opportunity for local authorities to know who needs services and they should use this to offer advice and information and to talk about the options and choices available.
Q: The concept of prevention and integrated care. We should be keeping people out of hospital not pulling them in. We need to drill down and build a clear definition of what to do and have personal care records so that social care and doctors have the same information. GPs should prescribe social care packages at home rather than send them to A&E. How can we break this down and ask the right questions?
A (DG): Different question, is about the incentives in the system for people to take part. If it is possible for people to do an activity, they will do it. If people are paid to keep people in hospital then they will.
A (NR): There are basic barriers to share information, information in the government systems. For example, social care providers do not have NHS emails. Highlights the discrepancies and impacts on people.
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