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Community and ageingMaintaining quality of life in housing with care settings$

Simon Evans

Print publication date: 2009

Print ISBN-13: 9781847420718

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781847420718.001.0001

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Diversity, community and social interaction

Diversity, community and social interaction

Chapter:
(p.93) Seven Diversity, community and social interaction
Source:
Community and ageing
Author(s):

Simon Evans

Publisher:
Policy Press
DOI:10.1332/policypress/9781847420718.003.0007

Abstract and Keywords

This chapter explores the extent to which a diverse population is supported in housing with care settings and examines the potential for social exclusion and isolation. Mixed tenure is explored as a scheme for encouraging diversity, as are features such as ‘pepperpotting’ and ‘tenure blind’ that have been employed in these settings. It identifies several challenges to supporting diversity, including a lack of clear information about the nature of such communities, tensions between residents from different socio-economic backgrounds, and a lack of tolerance of different styles. It examines the age-segregated nature of most housing and care environments and the implications of this for the concept of community. It identifies a range of other factors important to diversity such as the siting of community facilities, the availability of inclusive activities, and accessible design.

Keywords:   diversity, community, social interaction, social exclusion, mixed tenure, socio-economic background, age segregation

7.1 Introduction

Retirement villages are widely marketed as ‘communities’ for people from similar backgrounds who aspire to similar lifestyles. For example, Roseland Parc in Cornwall, England, tempts potential buyers with the promise that ‘The village community atmosphere will allow you to forge new friendships with like-minded people who share your interests, your joys and your challenges in life’.1 This emphasis on sameness is even more pronounced in the US, where retirement housing schemes are frequently based around a common interest in golf or other leisure activities. Diversity is seldom trumpeted as a selling point, although extra care housing is often more open about supporting people with a range of care needs, largely due to its roots in social care provision. At the same time there is a recognition that the overall housing sector needs to support an ageing population that is increasingly diverse in terms of age, cognitive functioning, mobility, health status, care needs, lifestyles and aspirations.

This chapter explores the extent to which diversity can be supported in housing with care settings and examines how notions of ‘like-mindedness’ sit with theories of community and government policies that promote ‘mixed communities’ (see for example ODPM, 2003b). A number of challenges to supporting diversity are identified, including a lack of clear information about the nature of such settings, tensions between residents from different socio-economic backgrounds and a lack of tolerance of different lifestyles. I also discuss the age-segregated nature of most housing and care environments and the implications of this for social cohesion and the concept of community. A range of other factors are identified as important to promoting diversity, including the siting of community facilities, the availability of inclusive activities and accessible design.

The chapter finishes with an analysis of the extent to which the relatively limited diversity found in housing with care schemes fits in with the claims made for them as communities. It also explores the nature of community in age-segregated settings and considers whether specialist housing of this type is an indication of a failure to integrate older people into society.

(p.94) 7.2 Diversity and community theory

Much of the body of theory on ‘community’ emphasises sameness rather than difference, focusing as it does on common interests, similar lifestyles, collective goals and shared identities. For example, Campbell (1958) suggested that groups are more cohesive where members pursue a common goal, are interpersonally similar and have shared and stable boundaries. However, more recently some commentators have suggested that diversity and difference are important characteristics of community (see for example Brent, 1997; Hoggett, 1997). Abrams and Bulmer (1986) acknowledged that neighbourhoods are not all about harmony and good relations but also contain an element of conflict due to pressures to conform to social norms. This approach is borne out by the findings of a study on immigration and social cohesion carried out in six UK cities (Hickman et al, 2008). Most people interviewed felt that social cohesion was to do with achieving a balance between difference and unity in local areas, rather than expecting complete consensus on values and priorities. It is also reflected in the policies of New Labour, which aim to reverse the breakdown of community and achieve social cohesion by promoting ‘mixed’ communities of diverse and advantaged/disadvantaged groups. For example, an Urban Task Force report urged the creation of mixed-tenure neighbourhoods to reduce the physical and social barriers between income groups (Rogers, 1999). These, it suggested, are symbolised by the distinctions between social-rented and owner-occupied housing. Similarly, the Sustainable Communities Plan (ODPM, 2003b) identified a number of key features of sustainable communities, including fairness, tolerance, cohesion, respect and engagement with people from different backgrounds, cultures and beliefs. It also suggests that housing can contribute to this mix by encouraging sustainability and promoting social inclusion. The government’s National Strategy for Housing in an Ageing Society (DCLG, 2008) spelt out the role of retirement housing in promoting sustainable communities, including the need to support diversity and social interaction. A further sense of urgency in the government’s drive towards diversity is the challenge of integrating increasing numbers of immigrants into existing communities.

As mentioned in the introduction to this chapter, diversity is not seen as a strong selling point for retirement villages. Instead, developers tend to emphasise the fact that potential residents will be sharing their living environment with people from similar backgrounds. For example, Denham Garden village in Buckinghamshire has recently been expanded to provide 326 cottages for people aged 55 or more and is being marketed as a ‘community of like-minded people’ that offers a ‘carefree, active existence in your later years’. However, this can be contrasted with the extent to which developers are keen to highlight the suitability of their schemes for people with a wide range of care needs, presumably because this is likely to maximise their market appeal. The rest of this chapter explores the level of diversity that exists in housing with care settings such as retirement villages and extra care housing schemes.

(p.95) 7.3 Health status

A lack of statistics in relation to retirement villages in the UK makes it difficult to compare the health status of residents. However, much of the provision is based on a continuing care model, whereby residents should not have to move unless they require hospital care. Most developments therefore aim to attract residents with a range of care needs, and villages usually offer accommodation and care packages to cater for three levels of dependency. Terminology varies considerably between developers, but these are sometimes called independent-living, ‘hotel-style’ apartments and nursing care. These are described in Box 7.1.

A small number of research studies have reported on the health status of retirement village residents. The 200 people living in a variety of accommodation at Westbury Fields retirement village in southwest England were found to have a broad range of health care needs in terms of their levels of sensory impairment, mobility problems, mental health needs and continence (Evans and Means, 2007). This is reflected in the fact that a majority of residents cited their own health or that (p.96) of a spouse as the main reason for moving in. A similar situation was reported at Berryhill retirement village in Staffordshire (Bernard et al, 2004), where nearly three quarters of residents reported having limiting longstanding illness, compared with a national figure of 38.5% of people aged over 50.

The Westbury Fields study (Evans and Means, 2007) is of particular interest here because one of the central aims of the village was to support a diverse population in terms of socio-economic background and levels of dependency. In order to achieve this the village comprised a mixture of publicly funded extra care housing, privately owned apartments and a nursing care home. The authors reported widespread awareness among residents of different backgrounds. One described the set-up as similar to ‘a council estate next to a private estate’ and felt that diversity in terms of background was irrelevant to the development of the village as a community. Others felt that the village management was trying too hard to achieve social integration across tenures. However, there was evidence that for some private apartment owners the mix of dependency levels within the village was an issue, as expressed by the following quote:

‘I don’t like being here, I’ll be honest, because I don’t like being surrounded by decrepit old people. With the best will in the world, you talk to some of them and they don’t answer – I’ve given up trying to hold a conversation.’

(Evans and Means, 2007: 45)

However, many residents welcomed the mix of dependency levels within the village, and the research report includes several examples of both formal and informal support taking place between residents in different tenures.

There is a great deal more information available regarding the health care needs of people in extra care housing. An initial report on the evaluation of extra care schemes that received capital funding from the Department of Health2 found that 64% of residents had a care need, just under 30% had moderate or more severe levels of dependency and 4% were ‘severely mentally impaired’. A very small number of residents had no care needs, while 66% were expected to receive home care and 12% were expected to receive more than 14 hours per week. It is interesting to contrast this with retirement villages, where a considerable proportion of residents receive no care package at all.

In the study of social wellbeing in extra care housing (Evans and Vallelly, 2007), it was found that 62% of residents received at least seven hours of personal care per week. In addition 73% used domestic (‘home help’) services and nearly all residents had meals provided. A survey of all the tenants of Housing 21’s 15,000 sheltered and extra care housing schemes (Housing 21, 2007) provided a range of statistics concerning the care needs of residents, including the following:

  • 76% had a social services assessed care service;

  • 32% had more than 10 hours of personal care per week;

  • 82% had some sort of domestic care provision; (p.97)

  • two thirds used mobility aids at least some of the time;

  • 67% had a longstanding illness or health condition that affected their activities of daily living;

  • 35% had various mental health conditions;

  • visual impairment was reported for 11.4% of residents and 39% stated that they had impaired hearing;

  • 27% were diagnosed with or suspected of having dementia.

These figures indicate relatively high levels of frailty among extra care residents. This reflects the fact that extra care housing is largely provided by not-for-profit organisations in collaboration with local authorities and focuses at least as much on care needs as it does on housing provision. The statistics also highlight the fact that an increasing proportion of extra care housing residents have dementia, whether diagnosed or not. Dementia currently affects an estimated 700,000 people in the UK, a figure that is predicted to rise to 1.7 million by 2050. If housing with care settings are to support diversity they need to be able to meet the needs of this group of service users. This has been recognised by the UK government in its National Dementia Strategy (Department of Health, 2009), which promotes an integrated approach across health, housing and social care. In the US, government recognition and support of appropriate housing for people with dementia has been less substantial and varies widely from state to state.

Previous work (Evans et al, 2008) has identified several key challenges to supporting people with dementia in housing with care settings. These include design of the built environment, models of care, staff training, the provision of facilities, social wellbeing, a balanced approach to risk and the appropriate use of assistive technologies. The study concluded that housing with care settings have the potential to support people with mild to moderate dementia, but that there are serious questions about what happens to people when their illness becomes more advanced. This is supported by research findings that worsening dementia was a factor for 41% of extra care housing residents who moved to nursing care settings (Vallelly et al, 2006).

There is an ongoing debate about the best way of supporting people with dementia in housing with care settings, with three models commonly being used:

  • Integrated schemes: these support people with dementia alongside all other residents. Some residents may develop dementia in situ while other schemes will offer vacancies to people who are known to have dementia.

  • Segregated schemes: in this model people with dementia live in a dementia ‘wing’, which usually includes separate care staff and facilities. Residents who do not have dementia live in the main part of the scheme.

  • Specialist dementia schemes: these accommodate only people with dementia.

(p.98) Vallelly et al (2006) recognised the potential benefits of specialist units in terms of targeting services but they also identified a range of disadvantages. In particular, they questioned the impact of segregated arrangements on social interaction for residents with dementia and the extent to which they might enjoy a sense of being part of a community. This issue has been identified by extra care providers as one of the top priorities for further research.

Many retirement villages are less welcoming of residents with dementia, although there are some exceptions. Some accept people with short-term memory problems but specifically state that they cannot support so-called ‘challenging behaviours’ or ‘wandering’. Those that include onsite nursing care homes can be more flexible, but even these tend to find alternative placements for residents with more advanced dementia (Croucher et al, 2003). Two notable exceptions are Westbury Fields retirement village in Bristol and Buckshaw retirement village in Lancashire, both of which include specialist dementia care services. This sort of arrangement has been shown to have benefits for the partners of village residents who have dementia by enabling them to take part in the village social life environment while remaining close to their partner in the specialist unit (Evans and Means, 2007). A new care village due to be opened in North Somerset in 2010 by the St Monica Trust will include a single-storey, 71-bed self-contained care home that is being built as five smaller, interconnected ‘houses’. This design aims to enhance the quality of life for residents with dementia in particular and is based to a large extent on the ‘green house’ concept.3 This model is found in the US and New Zealand and aims to address quality of life issues for people living and working in care settings by providing facilities on a domestic scale. Each ‘house’ accommodates up to 10 people and aims to optimise the size, design and organisation in order to create a ‘warm community’ based around relationships. An evaluation of this model found that it led to significant increases in self-reported quality of life for residents (Kane et al, 2007). This mirrors research findings showing that smaller residential facilities promote greater community integration for adults with intellectual disability (Heller et al, 1998).

The provision of activities that are accessible to residents with a range of physical and cognitive abilities has also been shown to be important in terms of supporting diversity in extra care housing (Evans and Vallelly, 2007). However, the same study also found a lack of understanding and tolerance of diversity among residents with the lowest care and support needs.

7.4 Ethnic background

In general, the provision of services does not reflect the diversity of local populations in Britain. For example, minority ethnic groups make up 22% of the population but only 1% of this group use traditional social services (Bartlett and Leadbetter, 2008). A review by Croucher et al (2006) concluded that there was a paucity of detailed research into housing with care for black and minority ethnic (BME) elders (elders is the commonly used terminology). There is, however, a reasonable (p.99) body of evidence of various types suggesting a lack of provision. For example, Patel (1999) highlights a shortage of residential provision for Chinese elders in London. In terms of older people’s housing this disparity may be partly due to differences in age profiles. For example, in 1991 only 3% of people of pensionable age in the UK were from BME groups. A report by Age Concern (Jones, 2006) identified the potential of extra care housing to promote the inclusion of South Asian elders and called on local authorities and providers to target BME groups specifically as residents. However, there are considerable barriers to achieving this, including addressing the stigma attached to all types of supported housing among South Asian leaders and providing appropriate information about the range of housing available. Jones (2006) identified 12 extra care schemes specifically targeted at ethnic groups. This represented 427 units in total nationally, over half of which were located in the West Midlands. He concluded that overall there is relatively little extra care provision targeted at BME elders. He also described a review of housing for BME elders in Bristol that outlined the need for schemes providing ‘small, shared cultural and language groupings’ as a way of overcoming cultural isolation and social stigma. Several schemes like this have now been developed, including Tia Hua Court in Middlesbrough. This scheme was developed by Middlesbrough Council and Tees Valley Housing Group as part of a plan to develop a ‘mini Chinatown’, to include a new community centre and commercial units alongside housing for older people. Close collaboration with the local Chinese community took place in order to ensure that cultural needs were incorporated in the design. For example, there is no apartment 4, which is seen as an unlucky number, and all apartments are connected to a Chinese satellite TV channel.4

This and other developments demonstrate a successful approach to designing extra care housing that meets the needs of specific BME groups. However, it is difficult to find examples of ethnic diversity within schemes and the proportion of residents from BME backgrounds tends to be non-existent or extremely low. For example, one study of eight extra care schemes reported that of the 446 residents only 13 were non-white (Darton et al, 2008). One attempt to provide ethnically diverse extra care housing is Sonali Gardens in the Tower Hamlets area of London. This scheme was primarily developed to meet the needs of Bangladeshi and Asian elders, who make up half the population of the local ward, but was also intended as ‘a mixed community’ for anyone who could benefit from its particular kind of environment and needed at least 12 hours of care a week (Brenton, 2005). The scheme initially suffered somewhat from being misrepresented in the local press as an ‘Asians-only estate’. Another example comes from Colliers Court, an extra care scheme in Bristol, where it was originally intended that 10 of the 50 flats would be allocated to Chinese elders. This proved difficult due to the eligibility criteria for extra care, so eventually the 10 flats were rented to Chinese elders as ‘standard’ sheltered housing. These examples serve to illustrate some of the challenges of providing diversity in extra care housing and the need for commissioners to carry out comprehensive consultation with the wider community.

(p.100) 7.5 Socio-economic background

Another aspect of diversity in retirement housing, and one that has been the subject of considerable debate, is socio-economic background. Many of the criticisms of housing with care in general and retirement villages in particular have focused on equity and choice. For example, Phillipson (2007: 330) suggested that there were ‘significant inequalities between those older people who are able to make decisions about where and with whom to live, and those who feel marginalised and alienated by changes in the communities in which they had aged in place’. Retirement village residents would for the most part seem to fall firmly into the category of those older people who are able to make choices about where they live.

Chapter Two highlighted the UK government’s aspiration to embrace ‘sustainable’ communities that promote social and economic diversity and avoid the perceived negative effects of concentrations of wealth and deprivation. The National Strategy for Housing in an Ageing Society (DCLG, 2008) makes it clear that for retirement housing this means providing mixed tenure in specialist developments. This approach appears to be based largely on the assumption that social mixing through residence in the same place can help to achieve social cohesion while also reducing anti-social behaviour. This is a far from new idea. One of the first planned mixed communities was Bournville estate, established by George Cadbury in 1879, with a mix of owner-occupiers, renters and employees of different statuses. In the late 19th century this new approach to urban planning based on the ideal of self-contained ‘balanced’ communities, often described as ‘garden cities’, became popular in several countries.

Mixed tenure commonly provides three options: outright ownership, shared ownership and rental. However, the evidence base for the impact of mixed tenure on the development of a sense of community is varied. A review of the literature from several countries (Sarkissian et al, 1990) concluded that, while the concept of socially mixed communities is very resilient, the balance of evidence suggests that it is unworkable in practice and can actually discourage meaningful interaction. One study of general housing estates found that, while social contact between residents gradually increased over time, most estates were not characterised by inclusive social networks. It also concluded that the formation of mixed communities was constrained by the physical separation of tenures (Kearns and Mason, 2007). This was largely because most residents only got to know their close neighbours. A review of the literature from Britain and Holland found little evidence of social interaction between residents from different tenures, largely because lifestyle factors were more important to residents than whether they owned or rented (Kleinhans, 2004). Similarly, a review of the literature by Kleinhans (2004) found little evidence of social interaction across tenures.

In contrast, a review of seven UK research studies (Holmes, 2006) concluded that mixed-income communities can be successful in terms of promoting relations between people from different backgrounds and tenure, as well as improving (p.101) enhanced neighbourhood satisfaction and quality of life. A study of housing estates in the Notting Hill area of London supported mixed tenure as a way of promoting social mixing (Page and Boughton, 1997). An interesting exploration of place attachment in Guildford, southern England (Uzzell et al, 2002) suggested that social mix does influence social cohesion but that mixed tenure may only support place attachment in neighbourhoods where home ownership is dominant but not overwhelming. A figure of about 60% home ownership was thought to be optimal.

Most of the early extra care housing in the UK was developed by housing associations and was therefore for rental only. In comparison, almost half of the extra care schemes approved by the Department of Health in recent years have been mixed tenure, although there still tends to be a far greater proportion of rental properties in extra care housing. This trend is also reflected in the retirement village sector. Although one of the first UK retirement villages, Hartrigg Oaks, was a mixed-tenure model, most early schemes were private developments and tended towards owner-occupier models. There are many reasons for this move towards mixed tenure. One major driver, as already discussed, is the fact that the government sees mixed communities as a force for social cohesion and is therefore encouraging such arrangements through funding criteria and planning permissions. This trend also reflects a desire to meet demand for older people’s housing at a time when the number of owner-occupiers is increasing and the amount of social-rented housing is decreasing. Mixed tenure also offers developers a number of financial advantages, be they private or registered social landlords. For example, the money generated by sales can immediately be used by private developers to reduce borrowing or, in the case of social housing, to subsidise the costs of the rental units. Another recent development is the inclusion of shared ownership in retirement housing schemes through schemes such as HomeBuy.5

King and Mills (2005) suggested that mixed tenure raises a set of new and complex issues for developers and managers. This is partly because housing associations acting as developers often have little or no experience of retirement housing for sale, while private developers frequently lack experience of dealing with older people who are eligible for income support or housing benefits. In addition, there is the added complication of the provision of care, often by an organisation other than the landlord. Several not-for-profit organisations have now moved into the retirement village sector and are starting to offer a range of tenures. However, much of the research carried out so far has focused on single-tenure schemes and there has been very little research into mixed tenure in housing with care settings in the UK.

One exception is Evans and Means’ (2007) study of a retirement village in southwest England. This development aimed to attract a diverse population from different socio-economic backgrounds by offering three different housing tenures: privately owned retirement apartments, a nursing care home and an extra care housing facility. Crucially, the village adopted a segregated tenure arrangement, with owner-occupied apartments situated in small clusters around the village, the (p.102) extra care housing located in a large building in one corner of the site and the nursing care home in another corner. There was evidence of limited cross-tenure interaction of a casual, everyday nature, while much of the social interaction within tenures was based around organised activities, such as the croquet club. There were contrasting views among residents as to whether the village functioned as a community. For example, one care home resident described it as ‘a real community of very diverse people to mix with’ (p 42), while a tenant of the extra care housing commented: ‘I don’t really regard myself as being part of a community, simply because I don’t know any of the other people here’. (p 42)

The interesting point in terms of mixed tenure was that residents tended to identify with the area of the village in which they lived rather than with the village as a whole. For example, one extra care tenant commented: ‘I think this, the sheltered housing [extra care] side, has got quite a community spirit going, yes, but I don’t think we have a real community spirit with the two sides (p 42)’. There was also a recognition that perceived differences in socio-economic background, as manifested in tenure, were the main factor in patterns of social interaction.

It is important to acknowledge that the village was at an early stage, having been fully open for about 18 months. This raises questions about how long it takes for a sense of community to develop and should be seen in the light of a suggestion by Campbell (1958) that members of newly created neighbourhoods tend to focus much more on establishing similarities than on exploring differences. The view of different areas of the village as distinct and separate was widely reflected in the respondents’ expressions. For example, several used the term ‘the village’ to describe the areas containing the owner-occupied apartments rather than the village as a whole. One resident described those living in owner-occupied apartments as ‘that lot up there’ and extra care residents as ‘us down here’ (Evans and Means, 2007 p 42).

In common with other studies (see for example Evans and Vallelly, 2007), communal facilities and spaces were found to be important venues for social interaction. Several village facilities and activities were based in the extra care housing, partly as a way of encouraging cross-tenure interaction. However, this had achieved limited success and had exacerbated feelings of resentment among people living in the owner-occupied retirement apartments, who felt excluded from some of the facilities. This situation was compounded by perceived differences in the financial contribution made by residents of the retirement apartments and those living in extra care housing. The study concluded that achieving the laudable aim of creating a ‘mixed’ retirement village was hampered by the clustering of tenures, which appeared to discourage social interaction between residents from different areas. This was aggravated by the layout of the site, including the positioning of a cricket pitch at the centre of the village, which created a barrier between tenures. This was particularly true for those with impaired mobility, many of whom felt that it restricted their opportunities to access facilities and take a full part in some aspects of village life. In the context of current theoretical debates of community (see for example Gilleard and Higgs, 2000; Forrest and Kearns, 2001), the fact that (p.103) tenures occupied separate physical areas of the village exacerbated the differences in social backgrounds and interests.

These messages have been taken on board in the subsequent scheme by the same developer, a mixed-tenure extra care housing scheme that adopts a ‘pepperpotting’ approach. Under this arrangement, owner-occupier and rental flats are integrated throughout the scheme rather than being clustered together. Although some developers have been concerned that this layout can affect the value of schemes and deter private owners from buying, the evidence suggests that this can work well, particularly if a ‘tenure-blind’ approach is adopted. This involves using the same design for both owned and rented flats so that they are indistinguishable (Rowlands et al, 2006).

7.6 Gender and sexuality

The gender profile of housing with care residents tends to mirror that of the population in general and reflects the differences between men and women in life expectancy. For example, one study of a UK retirement village reported that 69% of residents were women (Bernard et al, 2004), while in another the figure was 61% (Evans and Means, 2007). The resident profile is similar in extra care housing, with one provider reporting that 69% of their residents are female (Housing 21, 2007). Housing 21 also found that increasing numbers of men are moving into extra care housing. Our study of social wellbeing (Evans and Vallelly, 2007) highlighted the reluctance of men to take part in social activities and identified some examples of good practice in terms of providing for their interests.

Sexual orientation is one area in which there are few if any figures for the residents of housing with care. Chapter Five included an exploration of the increasing interest in gay and lesbian retirement villages in the US. This reflects figures indicating that there are 3 million gay and lesbian seniors currently living in the US, a number that is expected to more than double over the next 25 years. It also suggests that many gay seniors find traditional retirement communities unprepared or unwilling to meet their needs. The research evidence into the experiences and aspirations of GLBT groups is limited but some studies have been carried out in the US. Cahill and South (2002) reported a survey carried out in New York State that found that openly gay and lesbian older people were not welcome in state-funded senior centres. They concluded that current policies and practices in all sectors, including housing with care, compromise the quality of life for GLBT elders in their retirement years. Amendments to the US 1968 Fair Housing Act banned anti-GLBT discrimination in retirement housing. A survey of older gays and lesbians in the US found that a large majority were interested in planned retirement housing specifically sensitive to their needs and many expressed a willingness to relocate significant distances in order to live in such schemes (Lucco, 1987). Interestingly, the respondents were more likely to (p.104) live alone, to be still working and to have a higher socio-economic status than the general older population. Another US study (Johnson et al, 2005) reported that GLBT adults indicated a strong desire for the development of exclusive GLBT, or GLBT-friendly, retirement care facilities. This was largely due to perceptions of retirement care facilities as potential sources of discrimination on the part of the administration, care staff and residents.

There is much anecdotal evidence for practices that discriminate against gay and lesbian groups. Cahill and South (2002) quote the following shocking example: a nursing assistant enters a room without knocking and sees two older male residents engaging in oral sex. The assistant notifies her supervisor and the two are separated immediately. Within a day, one man is transferred to a psychiatric ward and placed in restraints. A community health board holds that the transfer was a warranted response to ‘deviant behaviour’. A series of articles in an American magazine describes some of the discrimination and social isolation experienced by gay people in retirement housing and care environments (Ochalla, 2007).

The first US gay retirement village opened in the 1990s. An article (Shankle et al, 2003) described five such developments in 2003 and several have been opened or planned since then. However, as Cahill and South (2002) point out, most of these are only an option for people with a high income level. There are recent reports that some GLBT retirement schemes are experiencing difficulties attracting sufficient residents and have rebranded themselves as ‘gay-friendly’ in an attempt to broaden their appeal. This has led to some concerns among gay and lesbian residents (Colker, 2007), who now worry that they might be outnumbered by heterosexual residents. The picture is further complicated because some states bar housing discrimination based on sexual orientation.

Some gay-friendly schemes are starting to emerge in other countries. For example, a British newspaper (Smee, 2008) reported on an old people’s home in Berlin that caters exclusively for gays and lesbians, reflecting the fact that ‘most gay and lesbian residents keep themselves hidden’. The first Australian retirement village of this type received planning permission in 2008. Given the relatively small number of retirement villages in the UK, it is perhaps not surprising to find that this market has not yet been catered for. Research commissioned by the DCLG (Croucher, 2008) did mention future care and housing as an issue for older lesbians and gay men, partly due to concerns about possible homophobic attitudes among staff and residents of specialist housing. However, the report concludes that very little research has explored the needs and aspirations of older people from the GLBT community in England. This is an area that deserves a great deal more research interest in the future. Meanwhile, it is logical to conclude that the residents of housing with care settings reflect the general population of older people in terms of sexual orientation, although there is no attempt so far to meet their specific needs.

(p.105) 7.7 Age segregation and diversity

Perhaps the most obvious criticism that can be aimed at retirement housing in terms of diversity is its age profile. The fact is that most if not all retirement villages and extra care housing schemes have a lower age limit of around 55, although in some cases it is slightly lower for people who are disabled. In many schemes the leasehold and tenancy agreements are strict about this, with some even specifying a maximum numbers of days a year for which younger people can stay as guests. There are several reasons for such age restrictions in retirement housing. The first of these applies mainly to the US, where the age discrimination law makes an exception for housing that is classified as being exclusively for seniors. In some states such developments are also exempt from planning restrictions and local taxes, such as contributing funds to local schools. For extra care housing the age limit has come about partly as a result of funding arrangements, whereby schemes are developed in collaboration with local authorities and are tied in with older people’s strategies and housing-related support budgets. However, one of the main justifications for age-segregated retirement housing is often the perception that it is what older people want. The evidence for this assertion is mixed. An analysis of national data from the US showed that all age groups expressed a preference for social interaction with other age groups (Daum, 1982).

A body of evidence for the impact of age segregation is being developed. One UK study found that whether the effect of age segregation in sheltered housing was positive or negative depended on how it affected residents’ self-esteem (Percival, 2001). However, a US study comparing age-segregated and age-integrated housing found that there were differences in contact patterns (Sherman, 1975). In particular, age-segregated residents had less interaction with their children, grandchildren and other relatives, while fewer had friends younger than 40. They also visited neighbours and same-age friends more often. Certainly, the potential benefits of intergenerational contact within society are evident. For example, grandparents are by far the largest source of childcare, accounting for 26% of the total, compared with 10% by family and friends and 17% as formal day care (Prime Minister’s Strategy Unit (PMSU), 2008). The economic benefits of this are enormous, but so too are the positive effects on older people in terms of a sense of purpose (Lee, 2006). A study of intergenerational programmes in a range of settings across Spain identified personal and social benefits for both young and old, as well as for the community and society in general (Sanchez, 2008).

A study of housing decisions in later life reported mixed views concerning the advantages and disadvantages of living alongside other older people (Clough et al, 2004). While there was a widespread desire for some of the features of age-segregated settings, such as feelings of safety and less daily worries, some older people wanted to enjoy these features in an intergenerational setting. For others, not wanting to be a burden to their children was a factor in choosing an age-segregated environment. Evans and Means’ (2007) study of a UK retirement village found that some residents felt that the lack of younger people prevented (p.106) the village from being a community. One resident commented, ‘It still doesn’t feel like a community. It can’t, can it, when it’s all one age?’ (p 46). Another described how, when her grandchildren visited her and played outside, other residents had complained about the noise. However, some saw the age restrictions as a positive feature of the village, including one who said:

‘If you’re not 100%, you know that the other person isn’t 100%, so you can talk about it and tell one another and we don’t want to be interspersed with lots of young people who wouldn’t understand.’

(Evans and Means, 2007: 46)

Fear of crime is frequently mentioned as a reason for the popularity of retirement villages and this was also one of the factors mentioned by residents of this village. This perception is not supported by the facts, which record that statistically young people suffer more crime by adults than the other way round (Brown, 1995). It may be, however, that such perceptions are fuelled by media portrayals of young people – often described as ‘hoodies’ – as perpetrators of crime and therefore responsible for the disintegration of community values. One thing that is clear is the need for more research in this area. A range of projects have aimed to increase intergenerational contact in housing settings. For example, the Thinking Village project used the community philosophy approach in order to encourage conversations between young and old people in a neighbourhood of York. Porter and Seeley (2008) commented on the potential benefits of this approach, including increased understanding and tolerance. However, they also concluded that considerable resources are required in order for these benefits to be reflected in everyday life.

7.8 Conclusion

The picture is mixed in terms of the ability of housing with care settings to support diversity. Most retirement villages and extra care housing are based on a continuing care model whereby residents have a ‘home for life’ and only have to move if they require hospital care. The limited amount of evidence available suggests that most retirement villages do support a range of levels of care needs across a range of accommodation. One exception to this is people with more advanced dementia, who are seldom well supported in such settings and frequently move to nursing care. This situation is slowly changing with the growing interest in new innovations in dementia care, particularly the ‘green house’ model. Extra care housing tends to target older people with higher levels of care needs, largely because it is often developed in collaboration with local authorities which have social care responsibilities. Most schemes therefore include a minimum number of care hours in their entry criteria. This means that the overall dependency level is higher in extra care housing schemes than in retirement villages, which are almost exclusively private developments and where a significant proportion (p.107) of residents have no care needs when they move in. This is increasingly the case because of a trend towards people moving into retirement villages at a younger age, particularly in the US, where many schemes are based around leisure interests such as golf.

The limited statistics available suggest that housing with care settings are less successful in supporting diversity in terms of ethnic background. Even after taking into account the different age profiles of BME groups, there appears to be a lack of provision. As already discussed, some recent attempts to target these groups have raised a number of challenges, including the stigma attached to non-family forms of caring. Another increasingly important diversity issue is meeting the needs of older people from GLBT groups. Although there are indications of considerable demand for housing with care settings that are gay and lesbian friendly, this is a relatively new niche market for retirement villages in the US. Provision remains low there and virtually non-existent elsewhere, but this is an aspect of diversity that is likely to see increased attention.

There has been a major drive in recent years to promote neighbourhoods that are mixed in terms of the socio-economic backgrounds of residents, largely as a way to increase social cohesion and reduce anti-social behaviour. This strategy has been reflected in housing with care settings by a shift towards developing schemes that incorporate a mix of tenures, including rental, owner-occupying and shared ownership. This approach has some financial advantages for developers but it also brings new challenges in terms of scheme management. However, the evidence base for promoting mixed communities is weak and there is a particular dearth of evidence in relation to housing with care settings. The little research that has been carried out suggests that the design of the built environment is a key element in promoting cross-tenure social interaction, particularly for residents with poor health or restricted mobility.

The aspect of diversity in housing with care settings that has attracted most criticism is its age-segregated nature, including the now infamous labelling of retirement villages as ‘glorified playpens for older people’ (Kuhn, 1977). Not surprisingly, the evidence suggests that age segregation leads to less interaction on the part of residents with children, but more interestingly this also extends to other relatives. There is evidence from studies of both extra care housing and retirement villages to suggest that diversity is not welcomed by all residents, while others see it as crucial to being a ‘real’ community. The data I have presented in this chapter lead to the conclusion that there is less diversity in housing with care settings than in the population in general and therefore, by implication, less than for older people living in the wider community.

The crucial question for this book, then, is how does this affect the potential for such settings to function as communities? Low and Altman (1992) argue that attachment to place is central to social cohesion because it provides a sense of security, helps maintain individual and group identity and fosters self-esteem. The relative homogeneity of housing with care settings does tend to lead to common interests and goals among residents, both factors that are suggested by the research (p.108) literature as contributing towards cohesive groups. Similarly, many of the factors that promote place attachment, which is also often mentioned as a key factor in promoting a sense of community belonging, can be found in retirement villages and extra care housing. These include opportunities for social interaction, well-defined physical boundaries, good-quality housing and a stable population of older people. A study carried out in England concluded that people factors were more important than place factors in explaining an overall sense of attachment (Gosschalk and Hatter, 1996). The obvious question is whether any age-limited community can be truly diverse. Several writers have argued that age segregation is closely connected to ageism, both as cause and effect.

If we adopt a perspective that views broad diversity, including ethnic and intergenerational mix, as important to a sense of community, then housing with care settings struggle to qualify. However, it is much easier to argue that they are successful as neighbourhoods where social cohesion is based on perceived similarities rather than difference. This argument makes sense in the context of evidence for the increasing importance of neighbourhood attachment as people grow older. It also complements the conclusions of two recent studies of retirement villages: first, that attempts to place people from different backgrounds together and expect them to interact socially could be seen as misguided (Evans and Means, 2007); and second, that equating the success of retirement villages with achieving a balance between fit and frail residents is simplistic and erroneous (Bernard et al, 2007). Finally, it supports suggestions from the literature that the interest in achieving social mix within neighbourhoods stems from nostalgia, utopian ideals and a belief in diversity for diversity’s sake.

If we accept that housing with care schemes are best conceived as neighbourhoods, the key question then becomes, how do housing with care schemes as neighbourhoods relate to the wider communities in which they exist? This issue is explored in the concluding chapter of the book.

Notes