UK: How Can The Housing With Care Sector Achieve Its Potential? (Video)

The benefits of housing with care have really been highlighted during the pandemic, and interest in the sector from potential residents, developers, operators, funders and investors has accelerated.

In this latest podcast from our senior living team, Dominic Morris is joined by Sally Ireland, barrister and head of regulation and compliance at ARCO.

We discuss the need for a housing with care government taskforce and legal reforms to ensure growth within the sector, ARCO's Vision 2030 plan and the importance of its consumer code, and what new operators need to have on their radar before entering the market.

Transcript

Dominic Morris: Hello!  I am Dominic Morris, head of the Senior Living team at Gowling WLG.  Today in our Senior Living podcast series, I am delighted to be joined by Sally Ireland, head of regulation and compliance at ARCO, the Associated Retirement Communities Operators.  Hi Sally.

Sally: Hi.

Dominic: Hi.  So let us jump straight in if we can.  For those less familiar with the sector and ARCO, are you able to tell us a little bit about what ARCO does?

Sally: ARCO has been around for about eight years now and it has really a dual purpose.  So, firstly it is a trade association in the classic sense - it brings the sector together and acts as the voice of the sector to government and other stakeholders. Secondly, it also sets standards for the sector. We have a programme of self-regulation and assessments that assess members against the consumer code, which is our code for members that sets out how they should operate and how they should protect consumers.

Dominic: Can you tell us a bit about your membership?  What sort of body are members of ARCO?

Sally: We have 30 members at the moment, plus a number who want to join the sector and this has accelerated.  Our membership is quite broad, and includes the affordable provision, which is actually the majority of provision in this sector. 

It also includes some of the big housing associations you would be aware of and 'not for profit' operators of housing with care, and then we also have the 'for profit' providers, some of the more luxury operators that you would also have heard of.  We do have quite a broad membership, but one of the nice things is that although most of our members are in competition with each other, we have a very good collegiate spirit between members and people are very happy to share best practice with each other and work together to achieve common goals - it works well.

Dominic: Great.  And you personally I think, you are a barrister by trade are you not?

Sally: That is right, yes.  I have a background in public law and social care law, two aspects of which are really useful in this role.  The first thing that I have done quite a lot of, is legislative drafting, which is pretty dry but it does give you a good insight into law reforms and how they should work. The other thing is that I have a background in representing older and disabled people in disputes around their care and public authorities duties towards them.  That obviously gives me an insight into the residents who will be living in housing with care and their needs, from my own experience.

Dominic: So what is on your desk typically, what's a usual day like for you?

Sally: It has two main aspects.  One is the law reform work. We are very active at the moment in trying to bring about the changes that we think we need to grow the sector sustainably in terms of changing the law in a number of areas, and also increasing the amount of regulation for the sector. Then the other side of it is setting standards for members.  As I said, we have the consumer code and we assess members against it, so we have a programme of regular assessments and work with members to achieve compliance in different areas.  I oversee that work as well.

Dominic: Fantastic.  A very varied brief!

Sally: Yes.  Absolutely.

Dominic: Great!  I think quite a good way for people to understand the work that ARCO is doing and indeed, what the priorities are for the wider housing with care sector, is to look at your Vision 2030.  Are you able to talk a little bit about that?

Sally: Yes.  Vision 2030 is articulating the ambition to have 250,000 people living in housing with care settings by 2030 – it is only nine years away now I have realised, talking to you today.  I have not got long to achieve this.  We have about 75,000 about the moment.  We are looking at a really substantial expansion of the sector, to bring it more in line with other countries like Australia and New Zealand, for example, where retirement communities are very successful and lots and lots of people live in them.

Vision 2030 sets out ten areas that need work and attention to make that vision a reality. That is everything from enhanced health and well-being, creating the evidence base to show the benefits of housing with care, looking at tenure – how people own their property - and how we can better set out the rights and responsibilities of residents and operators.  It also looks at workforce, making sure there is a sustainable and suitably skilled workforce for these settings, and funding as well. 

There are lots of different areas in the Vision 2030.  I think the key one now for the next say 12-24 months, is legal reform and policy reform and the proposals that we are putting forward to government and getting political support for, that we think are needed to grow the sector sustainably.

Dominic: Okay!  If we could maybe look a little bit more about how ARCO is leading the charge for the sector in terms of changes in policy.  From my perspective I guess, housing with care as an operational business is impacted by so many different strands of government, so how are you going about grappling with that?

Sally: What we are calling for is a housing with care taskforce, and the idea for a taskforce comes from exactly that, that this is housing with care, which is something that goes across different government departments.  The main departments that we deal with are the Ministry of Housing Communities in Local Government, which obviously has the housing brief and the Department of Health and Social Care, which has the social care brief and obviously for our members, both are important.

But there are also other departments, so for example BEIS which looks after consumer regulation.  The Treasury – obviously always important in terms of funding - and others.  What we are asking for is a cross government taskforce to look at what the levers are that need to be pulled, as it were, in order to free the sector to expand further. And the three levers that we have really identified are sector specific legislation, including attention given to leasehold reform, charity in the planning system and then in the affordable side of the sector, looking at the funding options so that the model can remain accessible to older people who perhaps have not accumulated housing wealth in their life.

Dominic: Okay. The government has got quite a lot on its plate at the moment, so what sort of traction are you getting?

Sally: We have got cross party support for this now and we are being well heard in government.  We have not got the taskforce running yet, but we are hoping that will happen.  We are also working with government in a number of areas and actually during the pandemic I think we have worked quite closely with the Department of Health and Social Care, for example on things like care guidance, the needs of our sector, infection control, how to get vaccination to our residents and all those things.  I think it has actually shown government the value that the sector brings and established closer working relationships, which we hope will continue post pandemic.

Dominic: Yes.  It would be good to come on and talk a little bit about those COVID learnings in a bit actually.

Sally: Yes.

Dominic: Housing with care, retirement communities, the list of labels goes on and on.  I think one of the struggles for people looking at sector every day - investors, operators or indeed the general public – your potential residents and purchasers, is understanding the products they are getting?  You have a concept of living options for older people and if we have, on the one hand retirement housing, downsizer models and the other hand, care homes/nursing homes/housing with care/retirement communities sort of sits in that middle space.  How do you see and deal with that interface?

Sally: Yes.  I mean there is two aspects to this question really.  One is about the definition and one is, where are the gaps in provisions?  On the definition, it is no doubt a difficult/thorny issue because it is quite a broad category at the moment.  As ARCO, we have a definition in the consumer code of what you have to offer to be an ARCO member.  The core services that you have to offer are: your community has to be primarily for older people, you have to have 24 hour staffing, communal facilities and a social programme, offer meals and domestic services and make personal care available.

And all that helps to differentiate our members from the more traditional retirement housing sector where you really have your age specific housing.  You might have a lounge, but you do not have a great deal else in terms of communal facilities and services.  But I think the need for a legal definition is really clear now, both in planning terms, where we do not have a specific planning category for housing with care and that can create some issues.

But also in lots of other areas where the sector can either be overlooked or just lumped in with general housing, when actually it is a very different kind of business.  This is primarily a service-based business.  We are considering options for better definition of the sector and in terms of the relationship with other types of provision, I think care homes – everybody knows what a care home is - whereas not everybody knows what housing with care is or a retirement community. 

What we see now is that some care home operators are moving towards the more high needs/acute model of provision and away from that kind of more traditional, just residential care model.  We think that is the right thing because where the gap arose is in that lower needs category from the 90's onwards really, where the emphasis on community care allowed people to stay in their own homes for longer, which can be great if it goes well but obviously there can also be problems. 

Both in terms of people staying in unsuitable housing.  For example, the Centre for Aging Better has done really good reports on that.  The number of older people who are still living in unsuitable housing that can be damp, just cannot meet their mobility needs and so forth.

And then also problems with provision of housing with care for people in their own home.  If you live in a rural area for example, it can be really difficult to set up a care package that is going to meet your needs.  There are also well known problems with funding for people who cannot afford to pay for their own care and need.  Local authorities help.  That community care model cannot really fill the gap and has led to many people being sent into care homes, when that is perhaps not the best option for them.

What we are doing is providing another option where people can have their needs met but also they can have the autonomy and independence of staying in their own home.

Dominic: That was very neatly put!  Thanks.  I guess leading on from that, there are a lot of people enquiring/looking to participate in the sector, be they prospective operators, investors or funders.  What would you say are some of the key things that they need to have on their radar when they are making those decisions?

Sally: We have seen really renewed interest in the sector, probably since the onset of the pandemic, and I think that is not just due to COVID-19's impact on social care provision, but also on lots of other areas as well, with operators of perhaps care homes or even hoteliers thinking about what else they could offer and what other sectors they could enter.

I think the key thing is that this is a long-term operational business and while there is an important development side to things, that it is not a pure housebuilder model.  Are you wanting to be in it for the long run, running this community and do you want to provide services and a community to these residents, because that is the most important part of the business.  People need to think about that carefully.

The other thing is, what is your market?  We talked about the types of provision that are out there, and two thirds is in the affordable sector.  There is a smaller but well established luxury or high-end market, particularly in the south of England.  Mid-market is where the gap is.  That is an important thing to look at, but then obviously you have got to make sure that what you are offering is genuinely affordable and not just at point of purchase, but throughout the older person's life.

We know that older people, they like to have certainty around the affordability of where they are moving, so they can age in place and not have to risk moving again and the third thing is – how are you going to compete?  Not so much with other retirement community operators but with the older person's own home because really what you have got to persuade them to do is downsize.  So how are you making it easy for them to move in to the community?  Some people think about moving into a retirement community may not have bought a property for 40 years and may have just owned a freehold house or a bungalow for all that time, and you might be presenting them with a fairly complex proposition with different fees and charges. How are you going to cut through all of that, so that they understand the offer and are confident that it is going to work for them, and what is your pull factor going to be?  Is it your stunning leisure facilities, your gardens, your social programme?

We often find that a lot of marketing works by word of mouth in this sector, so people who are already living in the community bring their friends to see it and their friends think it is amazing and then obviously they start looking. One of the films that we show sometimes at events is from Australia, where a new operator is establishing itself in a town.  They went out and reached out to the older people, went along to the local bowls club and befriended people and started talking about it, so you have got to be quite innovative with your marketing I think.

Dominic:  I would agree with all of that and I think the profile and the benefits that housing with care can provide has been massively demonstrated to be honest in the challenges of the last year, with dealing with the pandemic and the response of the sector to it.  Are you able to talk a little bit about that?

Sally:  Yes absolutely. It has obviously been massively challenging for this sector as for many others.  Our residents are vulnerable at the end of the day.  Our course work changed a lot in the last year and we have been offering a lot of support to members around COVID-19 and bringing them together to share their best practice, their policies and their procedures, and working with government on things like PPE and infection control, so it has been very important I think. 

The last year or so has really shown the benefits of this model. You have got self-contained accommodation where just by its nature it is easier to control the spread of the virus and for people to isolate, but also has the support and the services that our members have been able to offer for their residents like delivering meals to the door, video communication and things to enhance their wellbeing like balcony exercise programmes. There have been lots of different things and I think in your last podcast Nick Sanderson from Audley Group mentioned the value that has had not just to residents, but also their families who may be living at some distance and desperately worried about their older relatives - you know if they are in a retirement community that somebody is going to be looking out for them, and I think that is incredibly valuable.

So we have also seen a spike in demand of people wanting to move into retirement communities and some of them have managed to move in during the pandemic because the housing market has largely kept moving throughout, so we have adapted by helping our members with resources to allow for sales and marketing to take place purely remotely.  Obviously a lot of the older materials are based around visits and documents you should give to consumers on a visit, so we have had to adapt to the fact that is going to be done largely remotely and that may continue after the pandemic as well. So I think it has been challenging but I think that our members have worked very hard to keep their residents safe and continue to offer support.

Dominic:  I think living in these communities where the res on detra is really to promote the wellbeing and independent lifestyle of the residents, and all the focus is on looking after their residents as opposed to living out in the wider community and relying on wider social support, it is very clear there are great rewards for those that are able to do it isn't it?

Sally:  It just means that you are not going to get overlooked or have to put your hand out for help. That can be really challenging to some older people who have been living fairly isolated lives and I think it has really shone a spotlight on the isolation that is experienced unfortunately by a lot of older people in the community. This shows there is an alternative out there at all levels, you do not have to be wealthy and downsizing from a big house to move into a retirement community. 

Dominic:  I think between us we are agreed that housing with care is a very good thing, so with your legal hat on, what are the legal reforms that you are looking to promote to help encourage the growth of the sector?

Sally:  So the three main areas that we are concentrating on in the housing with care taskforce are sector specific legislation and regulation that includes leasehold performance. That is an area that I personally do a lot of work on and this is really about that definitional question we were talking about earlier, but also what is the specific regulation that is needed for our sector that will provide a greater level of legal certainty to allow it to grow, so whether that be on event fees, whether that be making sure that the broader leasehold reform agenda does not sweep up this sector along with ordinary leasehold housing and make inappropriate reforms for us. So commonhold for example, which may work really, really well in an ordinary block of flats, for people to come together in a commonhold company and manage their properties.  In this sector the operator / resident relationship is really, really important and we have even had residents writing saying we do not want commonhold, the whole point of moving here is so we would not have to worry about things like fixing the heating or whatever it is.  So I think we are looking for some specific treatment there. 

Planning is another area, where again we need more sector specific treatment, whether that be a specific use class for the sector or just a recognition of the social benefits that come with building housing with care. The Kings Fund and University of Work have done a really good report recently looking at how housing with care reduces reliance on NHS services and also provides specific mental and physical health benefits to older people themselves living there.  I think there can be a perception amongst planners that they do not want a retirement community being built in their area because it will cause extra pressure on our NHS services in the local area for example, or it will cause a burden rather than a benefit as it were, and there is that famous case recently about it not being a vibrant choice for town centres. We would say that what you are doing is you are moving in people who have lots of time to spend, lots of social capital of their own and lots of potentially disposable income to spend in your town or your area and that also you are actually providing health benefits to people, which means that there is likely to be less reliance on the local NHS. So there are a lot of misunderstandings amongst planners.

The final thing is about funding. On the affordable side of the sector it is just making sure that the funding framework is right so that the affordable sector remains accessible to people at all income levels and so that everyone can move into a housing with care community and they have that chance to do so.

Dominic:  There is a lot of material there, that is a really good synopsis. I think it is fair to say the model works now within the legal framework that we have at the moment, but with the winds of change and the landlord and tenant reform that the government is promising reforming other areas, as you say it is almost a defensive position to make sure that housing with care is not caught up with unintended consequences from that wider reform, as well as promoting its own agenda to help really see a change in growth for the sector.

Sally:  Absolutely.  You know leasehold was never designed with this sort of community in mind. There is something very logical about using a 175-year lease for somebody's resident in the retirement community that might live in the property for 10 or 20 years and all the other services that the community is providing that did not really have anything to do with the property.  People have made it work and the sector has made it work, and it has worked well, but I think leasehold reform takes things in a certain direction and the sector will need to look at other models of tenure and whether there is anything else that we should be promoting to Government. We also need to be looking comparatively at other jurisdictions where there is more retirement community provision and what are the things that they are using that we could look at and model our own sector specific legislation on, so that is definitely something we are considering for the future. 

Dominic:  Absolutely, that is really interesting.  Before we finish off I think one of the things that I find really striking and I guess very positive is the consensus from various parts of society about the benefits and the advantages of housing with care as a model. You have recently published your grey paper as you call it on housing with care, can you tell us a little bit about that?

Sally:  Yes so the housing with care grey paper is a collection of essays and writings by figures from across the political spectrum, talking from quite a personal perspective, often about their own experience of relatives who perhaps have developed needs and might have lived in a retirement community, or if that was not an option for them, how it could have improved their lives. I think that you are right in that it is one of the policy areas that is genuinely across party.  It is supported across the political spectrum because the social benefits are clear to see for all, but also because personally we have all had perhaps an elderly relative who has developed care needs or we have known somebody who has needed to go into a care home or has had a fall at home, and perhaps we would have liked to have seen other options for them.

I think that has led to a lot of commitment to this sector from a range of different people due to their own personal experience. When you go to retirement communities, and one of the sad things about the pandemic is that we have not been able to go into our members retirement communities for over a year now, but when you do go, you do see the benefits of this provision in terms of people's wellbeing and you can imagine that you would like your older relatives to consider that move. We do usually have quite a busy programme of taking MPs to see their retirement communities in their constituencies - obviously that has been on hold but that is one of the things we are looking forward again to doing once the pandemic eases.

Dominic:  That is great.  I think that the more of these schemes that there are, the more and more people can actually see what it is like and it will grow its own momentum.  That has been a really interesting walk though work of ARCO and your work within ARCO.  It looks as though you have got an absolutely packed agenda for the next few years.  Is there anything most people are interested in finding out more about ARCO that you would like to flag?

Sally:  Yes so a couple of things we have not had time to talk about are our partnership programme. We have a number of commercial partners, an advisory council and an affiliate network and lots of different kinds of organisations on there including Gowling WLG that contribute their expertise to the sector. There are lots of opportunities to get involved there, and for those considering entering the sector as an operator we have an accelerator programme that allows you to join ARCO without becoming a full member, but gives you access to expertise, the opportunity to talk to our existing members and hopefully decide if it is the right thing for you, and then get the support from us if you do want to go ahead with launching a business. 

We also have our conference that we are hoping to do in person, which will be on 3^rd and 4^th November 2021, but in the meantime just get in touch with us and we will be happy to help.

Dominic:  Fantastic.  It has been really interesting to talk to you about the great work you are doing at ARCO and thank you very much for joining me today.

Sally:  Thanks Dominic.  It has been great.

Dominic:  Thank you very much Sally.

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