THE ESSENCE PROJECT

Supported housing

Evidence

A Cost Comparison of Supported Living in Wales: A Swansea Case Study
Nash P, Farr A, Phillips C Centre for Innovative Ageing, Swansea. 2013

The key findings from the data are: •The least expensive environment for delivery of care is in service users’ own homes with the most expensive being residential care. Caveats to this are that residential care supports older adults with higher levels of care needs, so type of care needs to be considered. Further, residential care includes housing costs where neither Extracare nor community based care include rent or mortgage payments, as these are not costs incurred by Social Services (Section 4.2). •The lowest equipment/modification costs were incurred by residents in Extracare with the highest by those receiving care and support in the community. This is reflective of the age of housing stock and support infrastructure, with Extracare having communal aides and ready modified flats, whereas this is not the case for community properties (Section 4.3) In-patient costs were significantly higher in residential care than in Extracare, again reflective of the underlying care need of older adults in each environment. The highest costs were associated with those in receipt of care in the community, which is likely because of delays in enacting assessments, re-ablement and new community support care packages (Section 4.4). •Outpatient admissions and A&E costs were relatively stable across each of the care environments (Section 4.5) •The most common GP services utilised by residents in each of the care environments were telephone consultations, home visits and GP surgery consultations (Section 4.7). •Overall, Residential care appears to be the most expensive for all costs relating to GP activity (Section 4.8).

An Independent Review of Shared Lives for Older People and People Living with Dementia
PPL, Cordis Bright, Social Finance PPL, London. 2018

Shared Lives is based around a Shared Lives carer sharing their home with an adult in need of care, to encourage meaningful relationships, independent living skills and community integration. This review explores how Shared Lives’ respite service for older people and people with dementia compare to ‘traditional’ forms of care for across three areas: outcomes for service users, carer and care commissioners; direct care costs to commissioners; and impact on the broader health system, such as a reduced usage. The review found that Shared Lives model provides positive outcomes for both service users and carers. It found that Shared Lives arrangements were able to reduce social isolation experience by carers and help increase their general wellbeing. Shared Lives also resulted in increased independence, wellbeing and choice for service users. In addition, the study found that the costs Shared Lives approach are similar to ‘traditional’ respite provision and provide an important option for commissioners. Appendices include details of calculations of the cost of providing Shared Lives respite care and day services; the results of a rapid evidence assessment on outcomes of ‘traditional’ respite care; and details of Healthcare service usage modelling.

Care and Support of People Growing Older with Learning Disabilities [NG96]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2018

This guideline covers care and support for adults with learning disabilities as they grow older. It covers identifying changing needs, planning for the future, and delivering services including health, social care and housing. It aims to support people to access the services they need as they get older.

We have produced an EasyRead version and video to explain this guideline, which are available from information for the public.

Recommendations
This guideline includes recommendations on:

overarching principles
organising and delivering services
identifying and assessing care and support needs
planning and reviewing care and support
identifying and managing health needs
end of life care
staff skills and expertise
Who is it for?
Providers of social care, health and housing support for people growing older with learning disabilities
Practitioners in social care, health and housing who work with people growing older with learning disabilities and their families and carers
Commissioners and people with a strategic role in assessing and planning local services
Practitioners in other related services, including older people’s services, adult learning disability services, employment, education and criminal justice services
People with learning disabilities, their families, carers and advocates

Related NICE guideline:
Appendix C2: Economic report Bauer A and Knapp M

Demonstrating the Health and Social Cost-benefits of Lifestyle Housing for Older People
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2017

This report, commissioned by Keepmoat Regeneration/ENGIE, sets out the evidence for the benefits of developing specialist retirement housing for people aged over 55, including cost savings. It focuses on the benefits of age restricted retirement housing or sheltered accommodation, care villages and specialist extra care housing with services and care on-site. Part one lists key facts and figures on the health and social care cost-benefits of lifestyle housing for older people. Part two provides more detailed findings of the potential benefits including the areas of: social connectedness and reducing loneliness; life expectancy, keeping couples together and supporting informal carers, financial savings in adult social care and the NHS, and preventing the need for institutional care. References and links are listed at the end of the document.

Developing your Local Housing Offer for Health and Care
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2016

Updated in 2016, this tool acknowledges the significance of housing as a partner and contributor to achieving the aims of health and social care services. With references to latest policy and practice, it is aimed at helping housing and support articulate and demonstrate the value of their services in terms of their partners’ targets and outcomes.

Financial Benefits of Investment in Specialist Housing for Vulnerable and Older People
Frontier Economics Frontier Economics, London. 2010

This report recommends that the HCA should continue to prioritise investment in specialist housing provision, to include making the best value of existing stock. In addition, it states that the needs of vulnerable and older people should be embedded in the Agency’s Local Investment Planning process and that older and vulnerable people should be considered contributors to, and customers of initiatives and programmes outside of specialist schemes

Health at Home: A New Health and Wellbeing Model for Social Housing Tenants
Peabody Peabody Group, London. 2018

The report from Peabody is based on research with some of their general needs residents aged 50 and focuses on helping them to improve their understanding and confidence around managing their own health. It looked at how:

services can be delivered effectively at lower cost?
self-care can be encouraged for the most vulnerable customers and reduce dependency on direct support?
partnerships with other agencies can ensure a coordinated response to support residents’ complex and multiple health needs?

The report shows how housing associations can play an important role in empowering residents to stay healthy and also demonstrated the value of a person-centred approach to build more system resilient.

Home from Hospital: How Housing Services are Relieving Pressures on the NHS
Copeman I, Edwards M, Porteus J National Housing Federation, London. 2017

This report shows how housing services are helping to relieve pressure on the NHS by reducing delays in discharging people from hospital and preventing unnecessary hospital admissions. It features 12 case studies to show the positive impact these services have on people’s lives and the cost benefit to the NHS. The case studies highlight services that will benefit people most at risk of delayed discharge, such as older people, people with mental health problems and people experiencing homelessness. The case studies also demonstrate a diversity of housing and health services including: ‘step down’ bed services for people coming out of hospital who cannot return to their own home immediately; hospital discharge support and housing adaptation services to enable timely and appropriate transfers out of hospital and back to patients’ existing homes; providing a new home for people whose existing home or lack of housing mean that they have nowhere suitable to be discharged to; and Home from Hospital services to keeping people well at home who would otherwise be at risk of being admitted or readmitted to hospital. The report also considers the impact and additional savings that could be made by housing providers if this work were to be scaled up.

Housing, Prevention and Early Intervention at Work: A Summary of the Evidence Base
Porteus J Housing Learning and Improvement Network, London. 2011

This Viewpoint provides an overview of the evidence base and personal account of the key housing and housing with care and support issues relating to prevention and early intervention. It was written to help inform priority area 4 of the Department of Health’s Caring for our Future: Shared ambitions for care and support consultation and the work of the NHS Future Forum

How can Local Authorities with Less Money Support Better Outcomes for Older People?
Centre for Policy on Ageing Joseph Rowntree Foundation, York. 2011

Research shows that older people want and value low-level support – ‘that bit of help’ – but the benefits of investing in this are realised over many years, making it harder to prove impact and protect funding in the face of severe pressure on spending.

This ‘Solutions’ published by Joseph Rowntree Foundation provides examples of imaginative, affordable and effective ways of supporting older people’s health, well-being, social engagement and independence. It highlights projects with some local authority involvement whether as lead commissioner, subsidiary partner, or through small grants or seed-funding.

The projects demonstrate the importance of:

involving people who use support and services in shaping them;
investing in collective solutions, small grants or seed-funding for self-help groups, and developing local markets to provide the support people want and value;
greater emphasis on the assistance that older people need and choose, and their experiences rather than on conventional social care and/or services;
developing place-based approaches that reflect the whole of people’s lives, and delivering value for money, for example by including transport

Innovative Funding and Delivery Options in Extra Care Sheltered Housing
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2012

Housing LIN ‘Get Smart’ Guide – Public sector capital investment constraints necessitate the need for innovation and radically different ideas to come forward to meet the proven need for new older peoples housing. The guide seeks to summarise and assess new financial options available to local public sector and not for profit organisations that may be available for new build extra care accommodation arising from Housing Revenue Account reform; the anticipated introduction of Real Estate Investment Trusts; Tax Incremental Financing; and other options. ‘Get Smart’ brings together a number of experts involved in procuring, designing, constructing, funding, costing and developing extra care housing and captures their personal views to drive inward investment and innovation in the sector. They include:

Extra care: unlocking the market potential by Melville Knight, Castleoak
Private sector investment into older persons housing by David Dent, Elliott Dent
A long-term game for an old age problem by Darren Crocker, Gleeds
Extra care housing – financed by institutional investment by Niall Henderson, independent consultant
Funding structures for extra care housing by Coralie Foster, PKF Accountants
Delivering extra care housing – the Local Authority route? By Steve Partridge, Chartered Institute of Housing
Innovation in extra care housing – capital investment by Charlotte Cook, Winkworth Sherwood LLP, and
Extra care housing: innovative funding approaches & support for development by Tina Hothersall, Homes and Communities Agency

Investing in Recovery: Making the Business Case for Effective Interventions for People with Schizophrenia and Psychosis
Knapp M, Andrew A, McDaid D, et al Rethink Mental Illness, London. 2014

This study provides economic evidence to support the case for investing in effective, recovery-focused services for people with schizophrenia and psychosis. Drawing on a wide range of data, it sets out the evidence for the cost-effectiveness for a range of interventions and service. Those discussed are: Early Detection (ED) services; Early Intervention (EI) teams; Individual Placement and Support (IPS); Family therapy; Criminal justice liaison and diversion; Physical health promotion, including health behaviours; Supported housing; Crisis Resolution and Home Treatment (CRHT) teams; Crisis houses; Peer support; Self-management; Cognitive Behavioural Therapy (CBT); Anti-stigma and discrimination campaigns; Personal Budgets (PBs); and Welfare advice. For each intervention the report provides information on the context, the nature of the intervention, the evidence on effectiveness and cost-effectiveness, and the policy and practice implications. The report finds evidence to suggest that all of the interventions contribute to recovery outcomes, reduced costs and/or better value for money. Examples of the savings incurred through particular interventions are also included. The study was undertaken by a team from the Personal Social Services Research Unit (PSSRU), at the London School of Economics and Political Science (LSE), the Centre for Mental Health, and the Centre for the Economics of Mental and Physical Health (CEMPH) at King’s College London.

Learning Disabilities and Behaviour That Challenges: Service Design and Delivery [NG93]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2018

This guideline covers services for children, young people and adults with a learning disability (or autism and a learning disability) and behaviour that challenges. It aims to promote a lifelong approach to supporting people and their families and carers, focusing on prevention and early intervention and minimising inpatient admissions.

This guideline should be read alongside the NICE guideline on challenging behaviour and learning disabilities: prevention and interventions.

We have produced an EasyRead version and video to explain this guidance, which are available from information for the public.

Recommendations
This guideline includes recommendations on:

strategic planning and infrastructure
enabling person-centred care and support
early intervention and support for families and carers
services in the community
housing and related support
services for children and young people
carers’ breaks services
making the right use of inpatient services
staff skills and values
Who is it for?
Commissioners and providers of health and social care services for children, young people and adults with a learning disability and behaviour that challenges
Health and social care practitioners working with children, young people and adults with a learning disability and behaviour that challenges
Providers of related services, including housing, education, employment and criminal justice services
Practitioners working with children, young people and adults with a learning disability and behaviour that challenges in other services or settings, including education, housing, voluntary and community services, employment and criminal justice services
Children, young people and adults with a learning disability and behaviour that challenges and their families and carers, including people who pay for their own care

Related NICE guideline:
Service models guidance: individuals with intellectual disabilities and behaviour that challenges Trachtenberg M and Knapp M

Living Well for Longer: The Economic Argument for Investing in the Health and Wellbeing of Older People in Wales
Edwards RT, Spencer LH, Bryning L, et al Centre for Health Economics and Medicines Evaluation, Bangor. 2018

This report by the University of Bangor makes the economic argument for investing in prevention at different stages of the life course, in particular, older people.

Commissioned by Public Health Wales, it brings together robust international and UK evidence on the relative cost-effectiveness and return on investment of devoting public sector resources to programmes and practices supporting older people.

In relation to housing, it notes that the Welsh Government spends around £50 million per year on adapting the homes of older and disabled people, helping them to live safely and independently.

For every £1 invested in Care & Repair there is £7.50 savings to the taxpayer. It comes to the conclusion that it is cost-effective to improve housing by providing heating and insulation for high risk groups of over 65s.

Local Area Impact Assessment of Retirement Living and Assisted Living Developments
Institute of Public Care at Oxford Brookes University McCarthy & Stone, Bournemouth. 2014

This report by the Institute of Public Care at Oxford Brookes University considers a local area economic impact assessment of Retirement Living and Assisted Living Extra Care developments across England, Wales and Scotland. Commissioned by McCarthy and Stone, is aims to provide independent, objective and robust evidence about the extent to which there is a case for Retirement Living and Assisted Living Extra Care schemes in terms of the local economic and wider social impact of these schemes.

Shared Lives Costs and Effectiveness (SLiCE)
Brookes N Personal Social Services Research Unit, Kent. 2018

In the Shared Lives model, an adult who needs support and/or accommodation moves in with or regularly visits an approved Shared Lives carer after they have been matched for compatibility. At present there is a limited evidence base for Shared Lives. The proposed research will mean that a thorough exploration of how successful the model is and whether it represents a good investment can be explored. An outcome evaluation will include: collection of data including service user characteristics, risks and needs, case management information, service use, quality of life and well-being measures; data collection from a comparison group of Shared Lives-suitable, non-participating service users; interviews with service users and Shared Lives carers focusing on outcomes; and use of other administrative and survey data.

Six Innovations in Social Care
Think Local Act Personal Think Local Act Personal, London. 2018

A group of innovators in social care have produced a summary of six innovations.
The innovations covered are:

Community Catalysts
Community Circles
Local Area Coordination
Shared Lives
Homeshare UK
Wellbeing Teams

Each innovation is presented as a one- page summary which cover:

the problem they are aiming to solve
the solution they have created
their evidence base and expected impact
the stage they are at currently
what else is needed to support it
and what would stop the innovation from happening successfully

This document is useful for anyone who is interested in new models of care and support, and would like to find out about different innovations that are being developed across the UK

The economics of housing and health: The role of housing associations
Buck D, Simpson M, Ross S King's Fund, London. 2016

This report, based on work commissioned by the National Housing Federation from The King’s Fund and the New NHS Alliance, looks at the economic case for closer working between the housing and health sectors. The authors demonstrate how housing associations provide a wide range of services that produce health benefits, which can both reduce demand on the NHS and create social value.

The report concludes that there is no one piece of economic analysis that will persuade health providers or commissioners to work with or commission housing associations. However, the case studies in the report illustrate the economic benefits that housing association can provide through:

providing safe, decent homes that enhance wellbeing. This has health impacts that are valued, and can save the NHS money
alleviating the overall cost burden of illness and treatment
helping to offset and reduce costs of delivering health care to individuals
demonstrating cost-effectiveness in helping to meet the objectives of the NHS and of improving health more broadly
demonstrating the cost–benefits of their interventions in terms of the value of improvements to people’s health and savings to the NHS.
The report is one of a set of three commissioned by the National Housing Federation; the second report focuses on how housing associations can develop a business case that will be better understood by the health sector and the third explores how the health and housing sectors differ in their approach, language and terminology, roles, and use of evidence.

The Lightbulb project: switched on to integration in Leicestershire
Moran A Housing Learning and Improvement Network, London. 2017

A case study of the Lightbulb project, which brings together County and District Councils and other partners in Leicestershire to help people stay in their homes for as long as possible. The approach includes GPs and other health and care professionals and relies on early at home assessment process at key points of entry. This is delivered through a ‘hub and spoke’ model with an integrated Locality Lightbulb Team in each District Council area and covers: minor adaptations and equipment; DFGs; wider housing support needs (warmth, energy, home security); housing related health and wellbeing (AT, falls prevention); planning for the future (housing options); and housing related advice, information, and signposting. The Lightbulb service also includes a cost effective specialist Hospital Housing Enabler Team based in acute and mental health hospital settings across Leicestershire. The team work directly with patients and hospital staff to identify and resolve housing issues that are a potential barrier to hospital discharge and also provide low level support to assist with the move home from hospital to help prevent readmissions.

The Long Term Care Revolution
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2013

This Housing LIN Report comprehensively outlines the case for a revolution in long term care and captures some of the supporting material that has aided the development of the TSB’s Assisted Living Innovation Platform’s, ‘Long Term Care Revolution’ programme.

It sets out a vision for an alternative to institutional care, drawing on substantial evidence about the views of older people and their carers in the UK, lessons from abroad, the implications for industry/providers and makes recommendations to government and industry leaders on key factors for revolutionizing long term care for older people, including mainstream and specialist living environments.

The Social Value of Sheltered Housing: Briefing Paper
Wood C Demos, London. 2017

In February 2017, Demos carried out research to explore and quantify thesocial value of sheltered housing, as a form of housing for older people distinct from other housing with care or generic retirement housing options. This was to help Anchor,Hanover and Housing andCare 21consider the implications of the proposals put forward by the Government, that by 2019, the core rent and service charges for a variety of forms of supported housing will be funded through Housing Benefit or Universal Credit up to the Local Housing Allowance (LHA) rate. The Work and Pensions Committee and the Communities and Local Government Committee launched a joint inquiry into these proposals in December 20161. This paper provides a review of the existing evidence regarding the impact of sheltered housing, and then draws on this to make some initial estimates as to the cost savings it can achieve in a range of fields.

Total Transformation of Care and Support: Creating the Five Year Forward View for Social Care
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2017

Adult social care has repeatedly demonstrated its capacity for transformation: pioneering de-institutionalisation, personal budgets and more recently, asset-based approaches.Health and care systems will not provide good services that meet rising demand without realigning around people and communities.There are five areas where transformation needs to take place: 1Helping all people and families to stay well, connected to others and resilient when facing health or care needs.2Supporting people and families who need help to carry on living well at home.3Enabling people with support needs to do enjoyable and meaningful things during the day, or look for work.4Developing new models of care for adults and older people who need support and a home in their community.5Equipping people to regain independence following hospital or other forms of health care. If the sector scales up promising practice, economic modelling shows that outcomes can be improved and costs reduced.The sector needs to have difficult, challenging and creative local conversations involving people who use services and others, which create space to move forward together. Further research and economic modelling is needed on the promising practices to build a business case for proper and effective investment in truly integrated care and health.

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