Summary of the impact

A key challenge for UK Government is to identify how older generations can continue to live independently in their own homes. The UK's changing demographics, recent increases in the cost of institutional care coupled with its declining availability make this a priority for policy makers. A twelve stage research programme undertaken by Professor Tinker has investigated how improved home care and assistive technologies including aids and adaptations could be employed to enable older people to remain at home longer. It examined and costed these options and provided recommendations on how they, and other specialised housing types such as sheltered housing, could be provided. Central government, local authorities and housing associations have employed her findings in revising their approaches to housing support for this rapidly growing population. Her findings have recently been employed by governments in Europe, Canada, the USA, Australia and the Far East in their reappraisals of policy on assisted living in later life.

Underpinning research

Professor Tinker (Professor of Social Gerontology) undertook the first national study of ageing at home initiatives in 1984 and has since led eleven major multidisciplinary studies on how to maximise older people's ability to live independently in their homes, the most recent in 2012 and 2013. All have been undertaken collaboratively with key stakeholders: government departments and public sector providers and conducted with multidisciplinary teams comprising social scientists, architects, engineers, economists and occupational therapists.

Identifying the perceived benefits and burdens (including financial) of owner-occupation in later life: This study found that owner-occupation enhanced feelings of control but that these were counter balanced by concerns over the cost and servicing of repairs. Such findings highlighted the importance of providing affordable maintenance, preventive and other services to help older people remain in their own homes. Results also revealed that older people have considerable equity in their homes but remained sceptical about schemes to generate income from this (see 1).

Research funded by the Royal Commission on Long Term Care: Assessed a range of staying at home options including a comparative analysis of economic and social costs of alternative models of care (2).

A study of `difficult to let' sheltered housing: This national survey elucidated the complex reasons why sheltered housing, although popular with government, has been unable to meet the needs of frail older people. It highlighted the unsuitability of many schemes and showed creative ways of overcoming the problems (1).

The feasibility, costs, and acceptability of assistive technology to enable older people to stay in their own home: Using case studies based on nationally representative criteria, research examined the feasibility of introducing Assistive Technology into older people's existing homes and challenged widespread assumptions concerning the ease of having technology installed (3).

Adapting sheltered housing to provide extra care housing: This study examined the feasibility of remodelling sheltered housing and residential care homes to provide "extra care housing and facilities" insitu. Architects, builders, surveyors and professional clients were asked to evaluate the strengths and weaknesses of such schemes; support and care staff provided information on how well they worked in practice; and the older tenants themselves described their experiences of living in such housing. The accessibility and availability of assistive technologies was examined and an economist assessed the costs of conversion (4).

Revolutionising long term care: A study was carried out for the Technology Strategy Board which examined alternatives to institutional care in the UK and Europe and included examples of effective extra care housing and a case study of the Netherlands. (5)

Living at home: Design and Mobility: Research on Mood and Mobility (6) This programme of research established that remodelled homes provided better accommodation and more care than conventional sheltered housing or residential care homes giving most residents a better quality of life. However, for older people to remain in their own homes many factors need to be acknowledged and addressed by policy makers; for example the research demonstrated that a full financial and social commitment to remodelling was necessary if older people were to remain socially integrated in their communities.

References to the research

Key research grants

1) Tinker, A and Askham, J (1994 -1996) Joseph Rowntree Foundation (JRF) Difficult to let sheltered housing £67,583; The financial costs of owner occupation in later life £57,740 and Perceptions, attitudes and behaviour of older home owners and their families, £68,336.

3) Tinker, A (2001 - 2003) EPSRC Introducing Assistive Technology into older people's existing homes £153,096 (GR/N33249/01 - in conjunction with GR/N33270/01 and GR/N33218/01) The REKI project. This was ranked as `Tending to outstanding' overall, `Nationally outstanding' for potential scientific impact in research quality in the EPSRC review.

4) Tinker, A (2005 - 2007) Remodelling sheltered housing and residential care homes to extra care housing. £260,214. EPSRC (EP/C532945/1). Ranked `Outstanding' overall and `Internationally leading' for both potential scientific impact and research quality in EPSRC review.

5) Tinker, A Technology Strategy Board (TSB) (2012) Revolutionising Long Term Care in the UK and Europe £25,000 and TSB (2013) Revolutionising Long Term Care: Learning from the Netherlands £10,000

6) Tinker A, (2013) EPSRC Mobility, Mood and Place: A user centred approach to design of built environments to make mobility easy, enjoyable and meaningful for older people. CI Catharine Ward Thompson PIs Richard Coyne, Niamh Short, Jamie Pearce, Gillian Mead, Ian Deary, Jenny Roe, Peter Aspinall, Anthea Tinker, Neil Thin, Iain Scott, 1.9.13 - 30.8.16 £1.262,844.

Key Publications & underpinning research: where DOIs are not given, hard copies are available on request.

Details of the impact

There are more than 1.5 million over-85s currently in the UK; by 2030 there will be more than 3 million and by 2050 over 5 million, a dramatic change in UK demography. The recently published House of Lords Select Committee Report on Public Services and Demographic Change `Ready for Ageing? suggests this could induce a "series of crises" in the public service provision of health and social care, pensions and housing, but notes that there is growing evidence that with better planning, by both the state and individuals, some of the economic and social burden of state care can be reduced. The main impact of the research described here has been to identify impediments that prevent older people from maintaining their capacity for independent living in their own homes, to identify effective mechanisms for overcoming these, and to indicate how these might be built into long term care and policies in the UK and abroad.

In the UK, this research first informed the 1999 Royal Commission on Long-Term Care (see Alternative Models of Care for Older People). This led to Tinker's longstanding advisory roles with the then Department of Communities and Local Government, the Department of Health and key national consultative bodies including the Housing Corporation, the National Housing Federation, the Audit Commission and Elderly Accommodation Counsel. At the end of each research project, Tinker and associated stakeholders were invited by government to discuss the implementation of their findings and recommendations. The findings on extra care housing contributed to the creation of guidelines for such schemes and a greater understanding of the implications of their adoption for older residents. This research demonstrated that extra care housing schemes provided a better quality of life for older residents than conventional sheltered housing or residential care homes. The findings from the remodelling research informed the creation of a set of recommendations and guidelines for implementation targeted at those responsible for the development of such schemes: central and local governments, housing associations and other service providers and funders, and occupational and rehabilitation engineers. These were discussed at a presentation in 2002 at the House of Commons. This fed directly into the policy making process on revision of housing for the older community through their dissemination to over 2000 stakeholders in the UK such as local authorities and housing associations with copies distributed to some 300 other key advisory bodies such as the Audit Commission. In 2008 a national conference sponsored by the Department of Health was held to promote the findings of the later research.

These findings informed the Government's 2008 National Strategy for Housing in an Ageing Society (1) and informed the Ministerial Group's thinking on sheltered housing and the House of Lords Select Committee on Ageing. Further guidelines on extra care housing were subsequently published by the Department of Health's Housing Learning and Improvement Network in 2008 (2) and then sent to all local government authorities, many of which including Gateshead, Swindon and the London borough of Kensington and Chelsea have since adopted these, directly changing their housing policies as a consequence. In addition, many other charities such as the Almshouses Association have also adopted these guidelines in revising their approaches to the provision of sheltered housing. The findings were disseminated in the UK at the 2009 Laing and Buisson Extra Care Annual Conference; 2009 Joseph Rowntree Foundation Consultation on Extra Care Housing; 2008 Health Investor Conference; 2008 Department of Health Care Services Improvement Partnership, and through the 2006 Age Concern England Advice, Information and Mediation Services. In 2010, Prof Tinker presented her research to the Academy of the Social Sciences Seminar on the Impact of the Social Sciences on Ageing policy to MPs, members of House of Lords and policy makers (3). In March 2013 her research findings on extra care housing were directly cited in the Government's most recent report on housing for older persons: The House of Lords Select Committee on Public Services and Demographic Change `Ready for Ageing? Report.(4)

The impact of this work was also felt abroad. For example, some countries such as Canada, the USA and Australia were experiencing similar problems with their unsuitable sheltered housing and care homes and sought advice from Tinker and her research collaborators. Her recommendations on alternatives to institutional care — particularly the role of assistive technologies — have been presented in numerous international plenary presentations including since 2007 Australia and Taiwan (2007), Canada (2008 and 2010), Spain (2010) the Netherlands (2012).The research relating to housing and assistive technology informed the 2002 United Nations Valencia Forum on Ageing (for the report on housing including technology) which led to the UN 2002 Madrid Plan on Ageing (5), and OECD research on provision of long term housing and care in 2005 (6). Moreover, Tinker accompanied the Minister to advise Singapore on their strategy on long term care in 2001; and in Hong Kong (1999, 2001) and later was personally invited to give advice to the government of South Korea in 2006 (7) and Japan on extra care housing. In June 2013 she was invited to give further policy advice on long term care, on overcoming social isolation, and on the use of assistive technologies in the home to the Centre for Housing, Regional Planning at the University of Adelaide, and to the Ministerial Advisory Group on Ageing, the Commissioner for Equal Opportunity and the Executive Director of Health for the Government of South Australia.

This programme of research has directly changed the culture of policy towards older people by providing creative and effective solutions and alternatives to long term institutional care by actively promoting technologies and adaptations that will allow large sections of the older population to maintain their independence in later life. Key institutions of government such as the Houses of Commons and Lords, local authorities, housing associations and leading economists (8) in the UK have drawn upon the research in significantly revising their policies on the provision of housing in later life whilst the reach of the impact of this research resonates internationally with its adoption in Europe, Canada, the USA, Australia and the Far East.

Sources to corroborate the impact

(hard copies available on request)

1. Department of Communities and Local Government, Department of Health. Department of Work and Pensions, (2008) `Lifetime Homes, Lifetime Neighbourhoods: A national strategy for housing in an ageing society', p. 141. Confirms contribution to report.
2. Tinker, A. (2007) Remodelling sheltered housing and residential care homes to extra care housing: Advice to housing and care providers 2007,
   http://www.kcl.ac.uk/content/1/c6/02/96/45/remodellingadviceversion151007.pdf).
   Department of Health Housing Learning and Improvement Network (28.1.08); letter from Director, Housing Learning and Improvement Network, confirms impact on government and local authorities' ability to make the case for improved housing provision.
3. The Remodelling of sheltered housing and residential care homes to extra care was chosen by the Academy of Social Sciences (2010) and by King's College London (2011) as examples of the Impact of research and presented to MPs and members of the House of Lords at Portcullis House, Houses of Parliament, 20.7.10: letter from Assistant Director, Academy of Social Sciences confirms Tinker's case study on remodelled sheltered housing was part of the booklet series 'Making the Case for the Social Sciences'; confirms contribution at launch event.
4. House of Lords Select Committee on Public Services and Demographic Change 14.3.13. `Ready for Ageing?' Stationery Office pp. 23, 85, 86, 88; letter from Chairman of the Select Cttee confirms impact of Tinker's work on government policy.
5. United Nations (2002) Valencia Forum on Ageing Researchers, Educators and Providers Contribution to the Second World Assembly on Ageing, UN 2002 and United Nations (2002). The Madrid International Plan on Ageing, UN, 2002. Confirms contribution to forum & plan.
6. OECD (2005) Long-Term Care for Older People, OECD, p. 44; letter from former administrator, OECD, confirms Tinker and colleagues' work on assistive technology was an important source for the conclusion that there was considerable scope for making homes of older people better able to support either self-care or care by others.
7. Tinker was asked by the President of South Korea to advise on housing policies in the light of UK experience in (2006) (Tinker, A `Housing policies for older people in the UK, Policy Forum on Low Fertility and an Ageing Society, Seoul, 14.9.06).
8. Frontier Economics (2010) `Financial benefits of investment in specialist housing for vulnerable older people: A report for the Homes and Communities Agency', p. 29 confirms Tinker's contribution to report.