Older UK sheltered housing tenants' perceptions of well-being and their usage of hospital services

Abstract

The aim of this study was to examine sheltered housing tenants' views of health and well-being, the strategies they adopted to support their well-being, and their use of health and social care services through a Health Needs Assessment. Sheltered housing in the UK is a form of service-integrated housing for people, predominantly over 60. The study used a parallel, three-strand mixed method approach to encompass the tenants' perceptions of health and well-being (n = 96 participants), analysis of the service's health and well-being database, and analysis of emergency and elective hospital admissions (n = 978 tenant data sets for the period January to December 2012). Tenants' perceptions of well-being were seen to reinforce much of the previous work on the subject with strategies required to sustain social, community, physical, economic, environmental, leisure, emotional and spiritual dimensions. Of the tenants' self-reported chronic conditions, arthritis, heart conditions and breathing problems were identified as their most common health concerns. Hospital admission data indicated that 43% of the tenant population was admitted to hospital (886 admissions) with 53% emergency and 47% elective admissions. The potential cost of emergency as opposed to elective admissions was substantial. The mean length of stay for emergency admissions was 8.2 days (median 3.0 days). While elective hospital admission had a mean length of stay of 1.0 day (median 0.0 days). These results suggest the need for multi-professional health, social care and housing services interventions to facilitate sheltered housing tenants' aspirations and support their strategies to live well and independently in their own homes. Equally there is a need to increase tenants' awareness of health conditions and their management, the importance of services which offer facilitation, resources and support, and the key role played by prevention and reablement.

Well‐being and thriving in sheltered housing versus ageing in place: Results from the U‐age sheltered housing study

“…As the cross‐sectional nature of this study limits the possibility to determine which features of sheltered housing may be associated with thriving, previous international research may provide insight into the features that are seen as beneficial among residents in sheltered housing. Although international comparisons between sheltered housing are challenging due to the current conceptual ambiguity concerning accommodation models for older people, there seem to be considerable similarities in sheltered housing in Europe, such as the intention of independent living, increased accessibility of apartments, shared facilities, and the provision of opportunities to social interaction (Cook et al, ; Herbers & Meijering, ; Iecovich, ; van Bilsen et al, ), which is why the studies selected for comparison are based in Europe. A UK study from 2016, based on group interviews with 96 sheltered housing tenants, has shown that those residing in sheltered housing in the UK feel a heightened responsibility for their own health, which is attributed to the social support received in sheltered housing (Cook et al, ).…”

“…Although international comparisons between sheltered housing are challenging due to the current conceptual ambiguity concerning accommodation models for older people, there seem to be considerable similarities in sheltered housing in Europe, such as the intention of independent living, increased accessibility of apartments, shared facilities, and the provision of opportunities to social interaction (Cook et al, ; Herbers & Meijering, ; Iecovich, ; van Bilsen et al, ), which is why the studies selected for comparison are based in Europe. A UK study from 2016, based on group interviews with 96 sheltered housing tenants, has shown that those residing in sheltered housing in the UK feel a heightened responsibility for their own health, which is attributed to the social support received in sheltered housing (Cook et al, ). A questionnaire study from the Netherlands, with a sample of 317 older people at risk of institutionalization, out of which 179 were living in sheltered housing, showed that those residing in sheltered housing reported experiencing greater autonomy, as well as feeling safer and less vulnerable when being outside and home alone, compared with those ageing in place (van Bilsen et al, ).…”

“…Studies on the health of residents in sheltered housing have been based on small samples and have shown little difference in health and mobility between those living in sheltered housing and ageing in place; only one older study from 2002 found high rates of depression and activity limitation among a sample of residents living in sheltered housing (Field, Walker & Orrell, ; Fox et al, ; van Bilsen, Hamers, Groot, & Spreeuwenberg, ). In a qualitative focus group interview study from the UK, where residents of sheltered housing were asked to define well‐being, adaptation and maintaining a positive attitude towards health and well‐being despite decline in physical capabilities was emphasized (Cook et al, ). The participants also reported that they felt a personal responsibility for their well‐being and the communal environment of sheltered housing supported them in this strive; the ability to adapt their property according to individual needs in sheltered housing also provided a sense of safety and security (Cook et al, ).…”

“…In a qualitative focus group interview study from the UK, where residents of sheltered housing were asked to define well‐being, adaptation and maintaining a positive attitude towards health and well‐being despite decline in physical capabilities was emphasized (Cook et al, ). The participants also reported that they felt a personal responsibility for their well‐being and the communal environment of sheltered housing supported them in this strive; the ability to adapt their property according to individual needs in sheltered housing also provided a sense of safety and security (Cook et al, ). A previous Swedish study showed that residents living in sheltered housing in Sweden report lower levels of self‐reported health, health‐related quality of life, functional status, and higher depressive mood compared with those ageing in place, implying potential healthcare needs existing or arising among those residing in sheltered housing (Corneliusson et al, ).…”

“…A study on experiences of quality of life among older people showed that social participation was underlined by older people as a contributor to quality of life (Borglin et al, ) and social participation has been associated with better self‐reported health and well‐being among older people (Litwin & Stoeckel, ; Pinquart & Sörensen, ; Taube, Kristensson, Sandberg, Midlöv, & Jakobsson, ). A study from 2011 showed that mobility and functional ability were associated with well‐being among older people, as physical mobility facilitates independence and possibilities for social participation (Ziegler & Schwanen, ), but as physical capabilities decrease, adaptation to declining mobility is often present in older peoples descriptions of well‐being, resulting in older people emphasizing psychosocial and environmental factors as contributors to well‐being (Cook et al, ; Levasseur, Desrosiers, & St‐Cyr Tribble, ; Siren & HakamiesBlomqvist, ). Although sheltered housing is expected to increase resident well‐being (Äldreboendedelegationen, ), research related to well‐being and thriving in sheltered housing is scarce, particularly compared with ageing in place.…”