Given the evolving nature of extra-care housing and retirement villages, this book makes an important contribution to our understanding of the potential benefits of these housing-with-care settings as valued communities, together with their limitations as regards clarity of purpose, inclusiveness and sustainability. The book's chapters explore: the concept of community and its meanings to us as we age; an overview of housing-with-care settings inside and beyond the United Kingdom (UK); ways in which community is promoted and experienced in such settings; the extent to which provision supports diversity as well as its potential for social exclusion; and possible future developments that may impact on housing-with-care settings as communities of choice.
Evans argues that a significant motivation to move to housing-with-care settings is the availability of community, which is increasingly defined by older people in terms of shared interests and identities rather than by place and neighbourhood. The evidence that older people choose such settings primarily for social reasons is rather limited, however, and may therefore be overstated by Evans. It is certainly true that a sense of community is sometimes hard to find in neighbourhoods that have become unsafe, under-resourced or inaccessible through depletion or the closure of amenities that older people rely on, such as post offices, libraries, shops, hospitals and affordable housing for their children. Evans suggests that housing-with-care provision can, to some extent and for some older people, mitigate these losses by offering facilities such as an on-site shop, restaurant, hairdresser, computer suite, gym facilities and regular health clinics, as well as support staff. Initiatives are also taking place to integrate housing-with-care schemes with their local neighbourhoods so that older residents inside and outside a scheme interact and build a mutually supportive community, but it is far from clear whether the pull of such developments will be sufficiently strong to attract future cohorts of older people to housing-with-care given the dichotomies outlined in this book.
A key strength of this book is its even-handed and realistic appraisal of contradictions that are almost built into the social fabric of housing-with-care provision in the UK. For example, Evans argues that although providers commonly market housing-with-care schemes as communities-in-waiting for a homogeneous population of older people, communities are in fact generally characterised both by the sharing of interests and identities and by experiencing difference, diversity and conflict. While it may be true that housing-with-care schemes meet older people's needs for interaction within a socially safe and purposeful framework, they are also environments where ‘fit’ residents can be intolerant, dismissive and excluding of those who are ‘frail’, impaired or who otherwise have care needs. This feature of social life can be a struggle for both residents and staff, and it is often insufficiently understood by providers of housing-with-care.
One area in which housing-with-care has shortcomings that dent its community credentials is the lack of diversity among the residents. On the one hand, the development of mixed tenure and affordable housing-with-care provision, encouraged by recent government policy, is likely to result in a more socio-economically diverse population, but on the other hand, the residents are living in an age-segregated setting: a defining feature of housing-with-care provision that inevitably casts doubt on its scope for increased diversity and which may also affect its sustainability, particularly if future cohorts of civicly-active and discerning retired ‘baby-boomers’ opt for age-proofed mainstream services. Housing-with-care provision often promotes itself as offering a community that is balanced in respect of the abilities and support needs of residents. For those residents with higher care needs, as well as those with few social contacts, their relationship with individual members of staff can make a significant contribution to quality of life. Evans emphasises that the care regimes in these housing settings need to be flexible enough to provide staff with the time to engage socially with such tenants and to sustain meaningful relationships. He is right in this context to raise a concern that task-centred care and allied charging systems could undermine such relationships, raising further questions about the efficacy of housing-with-care in regard to sustainable, balanced communities.
This book will be of use to social care practitioners, housing providers and researchers, as well as to social policy makers and academics. It provides further impetus to inform ourselves more closely about daily life in housing-with-care settings. This is especially true with regard to the meanings attributed by residents to their ‘community’ and their views on the maintenance of esteem and social motivation in the age-segregated environment, as well as their expectations and preferences in regard to a scheme's social life, given individual lifestyles and previous patterns of valued social interaction. Evans reminds us that whether or not housing-with-care settings can be accurately referred to as communities, older people's experiences of living in close proximity with each other, and the dynamics involved, have implications for quality of life and emotional wellbeing that merit as much consideration as the provision of physical care and on-site facilities.
