Promoting Social Inclusion in Housing with Care and Support for Older People in England & Wales.
Lead Research Organisation:
University of Bristol
Department Name: Sch for Policy Studies
Abstract
This research is about the social inclusion of older people from socially diverse backgrounds in housing with care and support (HCS) schemes in England and Wales. By socially diverse, we mean older people (60+ years of age) who identify with social characteristics that are sometimes marginalised or sources of discrimination, such as physical and learning disabilities, LGB sexual identities and trans identities, black and ethnic minority people, and people who identify with minority religions. We want to develop a better understanding of the ways in which housing providers seek to promote residents' human rights and social participation within their schemes and to identify good practices for making residents feel included that we can share with other housing providers, both nationally and internationally. We know that the number of housing with care and support models, such as extra-care, sheltered housing and supported living, are increasing in the UK and are seen as a viable way of supporting older people's independent living with additional support. However, we do not know how these living environments support older residents from social minority backgrounds or seek to ensure that all residents feel equally valued and included. We want to address this knowledge gap through research and develop some helpful learning resources for better informing service delivery in HCS schemes alongside recommendations for improving social policy in this area.
These are the questions we want to explore and address through our research: 1. To what extent do residents currently perceive themselves as included and valued in their home environments? 2. What current approaches and practices support and sustain the social inclusion of residents from social minority or marginalised social backgrounds in HCS schemes? 3. How effective are social inclusion practices and approaches in HCS schemes in recognising and valuing residents' social identities and diverse life-histories? 4. How do residents from diverse social backgrounds experience the relocation and transition into HCS schemes over time?
We intend to address these questions through several different methods which include: 1) a questionnaire for residents across participating schemes in England and Wales; 2) interviews with staff, managers and residents in selected schemes; 3) interviews with stakeholders involved in local commissioning and advocating for the rights of older people in HCS schemes; and 4) longitudinal interviews (three interviews with one person over an 18 month period) with a small sample of 15 older adults (60+) from socially diverse backgrounds who have recently relocated into HCS schemes. Information gathered from across these different sources will provide a good, in-depth and widescale understanding of how older people experience inclusion practices in HCS schemes and the ways in which scheme staff, managers and stakeholders seek to promote social inclusion within these schemes. We anticipate the research will identify good practices that can be shared with other providers in the UK and will be of equal interest to international audiences involved in housing provision for older people. Identifying good practices and identifying ways in which not-so-good practice can be improved will benefit the social wellbeing of older adults in HCS schemes, bolster against feelings of exclusion, social isolation and marginalisation, and promote social cohesion more broadly across these schemes. Based on key findings and important messages from the research we will create a number of resources to inform and improve social inclusion practices in HCS schemes. This includes an online learning resource and accompanying practice guidance that will complement existing learning modules for care and support staff and managers employed within schemes.
These are the questions we want to explore and address through our research: 1. To what extent do residents currently perceive themselves as included and valued in their home environments? 2. What current approaches and practices support and sustain the social inclusion of residents from social minority or marginalised social backgrounds in HCS schemes? 3. How effective are social inclusion practices and approaches in HCS schemes in recognising and valuing residents' social identities and diverse life-histories? 4. How do residents from diverse social backgrounds experience the relocation and transition into HCS schemes over time?
We intend to address these questions through several different methods which include: 1) a questionnaire for residents across participating schemes in England and Wales; 2) interviews with staff, managers and residents in selected schemes; 3) interviews with stakeholders involved in local commissioning and advocating for the rights of older people in HCS schemes; and 4) longitudinal interviews (three interviews with one person over an 18 month period) with a small sample of 15 older adults (60+) from socially diverse backgrounds who have recently relocated into HCS schemes. Information gathered from across these different sources will provide a good, in-depth and widescale understanding of how older people experience inclusion practices in HCS schemes and the ways in which scheme staff, managers and stakeholders seek to promote social inclusion within these schemes. We anticipate the research will identify good practices that can be shared with other providers in the UK and will be of equal interest to international audiences involved in housing provision for older people. Identifying good practices and identifying ways in which not-so-good practice can be improved will benefit the social wellbeing of older adults in HCS schemes, bolster against feelings of exclusion, social isolation and marginalisation, and promote social cohesion more broadly across these schemes. Based on key findings and important messages from the research we will create a number of resources to inform and improve social inclusion practices in HCS schemes. This includes an online learning resource and accompanying practice guidance that will complement existing learning modules for care and support staff and managers employed within schemes.
Planned Impact
The following groups will benefit from the research in the following ways:
Direct beneficiaries. 1. HCS schemes participating in the research and the staff and residents within those schemes: The insights from interviews with staff, manager and resident will identify areas where HCS staff and management may need to re-evaluate and reform their own organisational practices. This in turn will benefit the social wellbeing of residents, particularly residents from social minority backgrounds who may have concerns about inclusion and equal treatment or perceive themselves as marginalised within schemes. 2. Collaborating providers and HCS schemes across these providers: Qualitative findings will highlight examples of good practice on social inclusion alongside areas for further development. This will help providers of HCS identify how to improve their services, develop more inclusive programmes, and enhance the wellbeing of their residents. 3. Members of our impact advisory group: The delivery of this study will be overseen by an impact advisory group. Group membership will consist of representatives from collaborating providers, Housing LIN, and invited stakeholders from organisations advocating for the rights of older people, including Age UK and Age Cymru. This means that emerging lessons on social inclusion will directly reach many parties working in this area who, as group members, will be more likely to share this information with other stakeholders.
Indirect beneficiaries. 1. Other HCS schemes and housing providers in the UK: Quantitative and qualitative findings will be a useful evidence base for informing the development of care and service provision in HCS schemes across other providers. This in turn can benefit residents within these schemes by driving up standards on equality and social inclusion and increasing avenues for social participation within schemes. Providers can incorporate material from our online learning resource into existing training modules. This information will also be useful for business developers interested in expansion into this market (and thereby improving the supply of this housing). 2. Commissioning groups funding places in HCS schemes in England and Wales: The findings can bring assurances that services commissioned by public bodies are providing equitable, personalised support to residents in accordance with legal requirements while identifying areas for improvement across the sector. 3. Workforce development and information provision agencies: For UK agencies working to improve standards of housing and social care provision (for example, Social Care Institute for Excellent, Skills for Care, Chartered Institute for Housing), the findings and online learning resource will provide a rich information base for integrating into the provision of learning materials and research summaries for care and support staff and managers. 4. Regulatory bodies such as the Care Quality Commission and Care and Social Services Inspectorate for Wales: The findings will provide a valuable evidence base for identifying the extent to and ways in which HCS schemes more broadly are complying with equality standards and what areas need further attention across the sector. The findings can also inform frameworks for carrying out inspections of HCS schemes that are subject to registration requirements. 5. Policy makers: The survey results will contribute to an important gap in existing evidence by providing a snapshot of the characteristics of HCS residents, who are often not included in other large national surveys. This evidence can inform the development of future policy tackling the housing and support needs of an ageing population. 6. Academic audiences: the findings will capture the interest of social researchers in ageing, housing, policy studies and social care and social work with adults. Key findings and recommendations will inform future research directions in ageing, housing and care provision.
Direct beneficiaries. 1. HCS schemes participating in the research and the staff and residents within those schemes: The insights from interviews with staff, manager and resident will identify areas where HCS staff and management may need to re-evaluate and reform their own organisational practices. This in turn will benefit the social wellbeing of residents, particularly residents from social minority backgrounds who may have concerns about inclusion and equal treatment or perceive themselves as marginalised within schemes. 2. Collaborating providers and HCS schemes across these providers: Qualitative findings will highlight examples of good practice on social inclusion alongside areas for further development. This will help providers of HCS identify how to improve their services, develop more inclusive programmes, and enhance the wellbeing of their residents. 3. Members of our impact advisory group: The delivery of this study will be overseen by an impact advisory group. Group membership will consist of representatives from collaborating providers, Housing LIN, and invited stakeholders from organisations advocating for the rights of older people, including Age UK and Age Cymru. This means that emerging lessons on social inclusion will directly reach many parties working in this area who, as group members, will be more likely to share this information with other stakeholders.
Indirect beneficiaries. 1. Other HCS schemes and housing providers in the UK: Quantitative and qualitative findings will be a useful evidence base for informing the development of care and service provision in HCS schemes across other providers. This in turn can benefit residents within these schemes by driving up standards on equality and social inclusion and increasing avenues for social participation within schemes. Providers can incorporate material from our online learning resource into existing training modules. This information will also be useful for business developers interested in expansion into this market (and thereby improving the supply of this housing). 2. Commissioning groups funding places in HCS schemes in England and Wales: The findings can bring assurances that services commissioned by public bodies are providing equitable, personalised support to residents in accordance with legal requirements while identifying areas for improvement across the sector. 3. Workforce development and information provision agencies: For UK agencies working to improve standards of housing and social care provision (for example, Social Care Institute for Excellent, Skills for Care, Chartered Institute for Housing), the findings and online learning resource will provide a rich information base for integrating into the provision of learning materials and research summaries for care and support staff and managers. 4. Regulatory bodies such as the Care Quality Commission and Care and Social Services Inspectorate for Wales: The findings will provide a valuable evidence base for identifying the extent to and ways in which HCS schemes more broadly are complying with equality standards and what areas need further attention across the sector. The findings can also inform frameworks for carrying out inspections of HCS schemes that are subject to registration requirements. 5. Policy makers: The survey results will contribute to an important gap in existing evidence by providing a snapshot of the characteristics of HCS residents, who are often not included in other large national surveys. This evidence can inform the development of future policy tackling the housing and support needs of an ageing population. 6. Academic audiences: the findings will capture the interest of social researchers in ageing, housing, policy studies and social care and social work with adults. Key findings and recommendations will inform future research directions in ageing, housing and care provision.
Publications
Beach B
(2022)
The Impact of Living in Housing With Care and Support on Loneliness and Social Isolation: Findings From a Resident-Based Survey.
in Innovation in aging
Cameron A
(2019)
Using longitudinal qualitative research to explore extra care housing.
in International journal of qualitative studies on health and well-being
Vickery A
(2023)
The impact of COVID-19 lockdown measures on older residents' social connections and everyday wellbeing within housing schemes that provide care and support in England and Wales
in Journal of Aging Studies
Willis P
(2022)
Diversity in Care Environments Learning Resource Tool
Willis P
(2023)
"There isn't anybody else like me around here": the insider-outsider status of LGBT residents in housing with care schemes for older people.
in Frontiers in sociology
Title | DICE podcast series |
Description | In collaboration with radio producer Mark Smalley, we produced a series of six podcasts about the study that feature the voices of five diverse older residents currently living in housing with care and support. The podcasts are hosted on the Housing LIN website and are aimed at informing the work of housing providers, housing managers and frontline staff working with and supporting older people. |
Type Of Art | Artefact (including digital) |
Year Produced | 2022 |
Impact | These have only been published so it's difficult to comment on this at this early stage. |
URL | https://www.housinglin.org.uk/Topics/browse/loneliness-and-isolation/DICE/podcasts/ |
Title | DICE research study: about the study |
Description | A short digital video was produced to convey to a general audience the aims and objectives of the study, its importance, and some of the key findings. |
Type Of Art | Film/Video/Animation |
Year Produced | 2022 |
Impact | It is too early to comment on this. |
URL | https://www.housinglin.org.uk/Topics/browse/loneliness-and-isolation/DICE/About-DICE/ |
Description | The Diversity in Care Environments project was a mixed-methods study into the social inclusion of older residents (60+ years) in housing with care and support schemes in England and Wales. There are four key findings to highlight. 1) Loneliness and isolation: Our survey findings (n=741 residents) show that residents in schemes are less lonely than they would be if they were living independently in the community - this is based on comparative analysis with data from the English Longitudinal Study of Ageing. 2) Discrimination and marginalisation: While nearly two thirds of survey respondents indicate that their scheme provides positive opportunities for social inclusion, discrimination remains a problem. One in eight survey respondents report they have witnessed discrimination from other residents, more so than from staff. Our qualitative findings, based on interviews with 72 residents from eight schemes, suggest pockets of isolation exist amongst residents from minority groups (including black and minority ethnic groups, LGBT groups and adults with physical and cognitive disabilities). Furthermore, the findings suggest residents from minority groups are not fully integrated and experience boundary-making in their schemes where residents belonging to majority groups convey negative and stereotypical sentiments towards minority groups. 3) Inclusive scheme life: Our findings highlight key social, physical and organisational dimensions to providing inclusive environments. These include: the role of supportive neighbours and active participation of residents in scheme life; the importance of residents maintaining social connections within the wider local community; the presence of scheme staff on site for building consistent and durable relationships with residents; and, for those residents receiving care, the close connections forged between residents and carers who get to know individuals and can spot changes in their wellbeing. The presence of onsite staff is a notable finding as many providers, including those taking part, have recently shifted to a 'floating support' model where staff presence is significantly reduced. Staff who located are on site and know residents are integral to supporting resident involvement and responding rapidly to patterns of marginalisation and isolation. 4) Built environment and physical infrastructure: inclusive living environments are bolstered by inclusive design considerations. This was evident in our study through the provision of shared communal areas; the involvement of residents in green care and the scheme's natural environment; and the provision of good digital infrastructure (this was paramount during the 2020 pandemic lockdowns). We found that ill-designed communal spaces and walkways could contribute to resident isolation and, in some cases, exclusion, for example some communal areas not being wheelchair-accessible or no communal spaces being provided. Finally, the abrupt shift to remote fieldwork in March 2020 afforded us space to explore residents and staff members' experiences of the Spring pandemic lockdowns. One key finding is the ethical and political tensions that housing staff had to negotiate daily in balancing resident autonomy and independence in schemes as 'micro-neighbourhoods' against overarching duties of care to reduce risk of infection and harm to resident health. This speaks to wider tensions in providing housing that is 'independent-focused' while care and support-driven. |
Exploitation Route | Our outputs are of high relevance to two key audiences - 1) policymakers within local, devolved and national governments and in peak bodies for older people's rights, and 2) housing providers, managers and staff. Through our collaboration with the International Longevity Centre (ILC) UK, we have hosted two knowledge exchange events with members of both audiences and in January 2022 we launched a policy report that speaks to policy-makers and commissioners of housing with care. Over the next 12 months we will work with ILC-UK to push our recommendations to these audiences. Already we have had interested parties contact us to discuss how the findings may inform their work, for example the Alzheimer's Society. Through our collaboration with Housing LIN (peak learning body for providers) we have launched a learning resource and podcast series targeted at housing management and staff to enhance their understanding of inclusive environments for diverse residents. We will continue to work with Housing LIN to bring resources to providers' attention, for example hosting HAPPI-hour events online. In addition we will be reaching out to key providers in the sector to discuss how the outputs can complement and enhance their current work in enhancing resident life and wellbeing |
Sectors | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
URL | https://www.housinglin.org.uk/Topics/browse/loneliness-and-isolation/DICE/ |
Description | Evidence submission to UN call for inputs |
Geographic Reach | Multiple continents/international |
Policy Influence Type | Citation in other policy documents |
URL | https://www.ohchr.org/en/calls-for-input/2022/call-inputs-report-older-persons-and-right-adequate-ho... |
Description | Evidence submission to the UK Parliament Committee on Human Rights Call for Evidence on 'Protecting human rights in care settings' |
Geographic Reach | National |
Policy Influence Type | Contribution to a national consultation/review |
URL | https://committees.parliament.uk/work/1495/protecting-human-rights-in-care-settings/publications/wri... |
Description | Collaboration with Housing LIN |
Organisation | Housing Learning and Improvement Network |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | We have provided input on Housing LIN's HAPPI series of webinars in 2020 (Housing our Ageing Population Panel for Innovation) |
Collaborator Contribution | The Chief Executive Jeremy Porteus has worked with our team and supported our early knowledge exchange activity by inviting us to present initial findings at the HAPPI Cymru webinar in November 2020, and has assisted us by identifying stakeholders to approach for stakeholder interviews (Phase 2 fieldwork activity). Porteus has also led on the project's communication and dissemination plan and is a member of the project advisory group. |
Impact | As detailed above. |
Start Year | 2019 |
Description | Collaboration with Housing LIN |
Organisation | Housing Learning and Improvement Network |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | We have provided input on Housing LIN's HAPPI series of webinars in 2020 (Housing our Ageing Population Panel for Innovation) |
Collaborator Contribution | The Chief Executive Jeremy Porteus has worked with our team and supported our early knowledge exchange activity by inviting us to present initial findings at the HAPPI Cymru webinar in November 2020, and has assisted us by identifying stakeholders to approach for stakeholder interviews (Phase 2 fieldwork activity). Porteus has also led on the project's communication and dissemination plan and is a member of the project advisory group. |
Impact | As detailed above. |
Start Year | 2019 |
Description | Collaboration with ILC-UK |
Organisation | International Longevity Centre (ILC-UK) |
Country | United Kingdom |
Sector | Charity/Non Profit |
PI Contribution | Access to software and dataset. |
Collaborator Contribution | Dr Beach's time on the study, specifically on survey design and analysis |
Impact | Dr Briam Beach (co-investigator on the study) is a Senior Research Fellow with ILC-UK. Dr Beach has led on survey design and analysis of survey data (Phase 1 fieldwork activity) and facilitated our first knowledge exchange event online in July 2020 - the event was hosted by ILC-UK. We will be working with ILC-UK throughout 2021 to develop planned outputs and on further dissemination activity (including a second knowledge exchange event and launch). |
Start Year | 2019 |
Description | Knowledge exchange event July 2020 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Third sector organisations |
Results and Impact | On 16th July 2020 we hosted our first knowledge exchange event online (via Zoom) in partnership with ILC-UK - ILC hosted the event titled 'In it together: Making housing more inclusive for older adults'. Description: Providers of housing schemes for older people face a unique challenge to promote the social inclusion of their residents from socially diverse backgrounds. New lessons from the Diversity in Care Environments (DICE) project are been developed to provide resources to improve the social connections of such residents, bolster against social exclusion and social isolation, and promote social cohesion in housing with care and support schemes in England and Wales. This webinar will present key findings from the first phase of the DICE project, a 2.5-year research study based at the University of Bristol in collaboration with ILC and the Housing Learning and Improvement Network (Housing LIN). This phase covers a survey of 700+ residents aged 60+ currently living in housing schemes across England and southeast Wales. Findings will inform housing practitioners and officers, providers, professionals in health and social care working with older adults, and policymakers. The webinar will also feature a panel discussion with Housing LIN and Brunelcare, a Bristol-based housing provider, to discuss the implications of the research findings for the housing with care sector, including in the context of the challenges due to COVID-19 Speakers included: Dr Paul Willis, Senior Lecturer in Social Work with Adults, University of Bristol Dr Brian Beach, Senior Research Fellow, ILC Jeremy Porteus, Chief Executive, Housing LIN |
Year(s) Of Engagement Activity | 2020 |
URL | https://ilcuk.org.uk/in-it-together/ |
Description | Knowledge exchange workshop November 2021 |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | 48 people attended our second knowledge exchange event, hosted online by our collaborators the International Longevity Centre UK. The research team presented draft findings and facilitated small-group discussions which fed into the final policy report and project recommendations. |
Year(s) Of Engagement Activity | 2021 |
URL | https://ilcuk.org.uk/knowledge-exchange-workshop-creating-inclusive-communities-social-inclusion-in-... |
Description | Policy report launch event |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | 100 people attended our policy launch event, hosted online by the International Longevity Centre UK, which sparked much interest in the project findings and recommedations and generated some industry press interest/ publications. |
Year(s) Of Engagement Activity | 2022 |
URL | https://ilcuk.org.uk/inclusive-neighbourhoods/ |
Description | Presentation of findings at research forum event |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | 50 people attended the Bristol Research Forum on Ageing event titled 'Housing Options for Older People: Staying Connected and Keeping Independent'. The research team presented key findings from the project and fielded numerous questions about the study's findings and implications for housing providers. |
Year(s) Of Engagement Activity | 2021 |
URL | https://www.eventbrite.co.uk/e/housing-options-for-older-people-staying-connected-and-keeping-indepe... |