Community Retirement Villages – Innovative Finance

This is a continuation in the series of posts about a new  form of Community Retirement Villages.    It follows on from my introductory post on 9 September.    This post will focus on the most difficult question, which if how they can be financed in revenue and capital terms.

It is first with repeating some home truths, which successive Governments have failed to address :-

  • Increased longevity and improved health care have outpaced the Governments ability to pay for later life support for older people. Over the years an expectation has been created that all health care is free from the NHS — this is no longer the case.   Neither is it realistic to assume that social care will freely be available for all those who need it.
  • Older people themselves, not knowing they were going to live so  long in retirement, have not saved enough to pay for a good later life.   Except that many of them are home owners and have lived through a period of house price inflation, so now have resources locked up in their houses.
  • Until these two issues are faced up to by both Governments, who are afraid to be honest for fear of losing votes and by older people, who are hoping to hang on to a legacy, there will be no release of resources to address the problem.

INNOVATION

Innovative financial models are the key to opening up new opportunities in the retirement housing and care market.    Fluid use of housing capital assets and risk sharing to procure care-for-life reinsurance hold the answer.     They are ideas that have been widely used in the USA, but have only rarely been offered in the U.K. :-

  • down- sizing is the simplest option for releasing capital from your home, but it is only available if your home is of sufficient value.    Shared-ownership needs to be an option for those with lower value homes.
  • in both instances people may subsequently need to release more equity in their home to be able to fund care at a later stage.
  • Ideally, when purchasing a new retirement home you want also to know you have your life time care needs can be funded.  One option  is to pay a non-returnable premium to move in to a new apartment which offers a care-for-life  package.   In the USA this is often called a Continuing Care Community.

The broad concept is that you buy into a retirement community which offers you housing and care for the rest of your life in exchange for a one time payment.    The risks of how long you live and your future care needs are bourne by the retirement village operator.    There has to be a caveat that if your care needs, particularly in terms of mental health require specialist treatment, you may need to move to another home, but this will continue to be funded by the village operator.

This approach was tested nearly twenty years ago by Rowntree in New Earswick Retirement Village in York, but sadly, it was not replicated because of the perceived risk.    More recently The ExtraCare Charitable Trust launched a Care-for-life option on a limited basis, but again it has not been repeated.

It is an option that is completely different to the oughtright sale or even part purchase of properties.    For that reason it would need an open and transparent approach and very careful marketing.    It has the potential to give access to a Retirement Village at a price which is lower than the open market value of the accommodation, with no on going high service charges.     The other big benefit is that you do not have to worry  about the cost of your future care, as that is included in the initial entry price you pay.

After I have covered the other issue of Operational Management, I will bring together all the threads of my posts on Retirement Villages to try to point to a bold way forward.

 

Posted in RETIREMENT HOUSING | Tagged | 3 Comments

Is This Assisted Dying?

I have written a lot about assisted dying almost since I started this blog.    Although not since 2015 when Lord Faulkner’s Bill to legalize it was heavily defeated in the House of Commons.  ( You can see all my earlier posts by clicking on ” Assisted Suicide” in the Topics List)

Recently I was prompted to re-read my blogs on this subject by a special report in the Daily Mail – 4th Sept.    My blogs are full of apprehension about the potential for extension of assisted dying into the everyday care of older people.   Nowhere is this more likely than in hard pressed, under funded, bed blocked hospitals.

The report into Gosport Memorial Hospital in Hampshire would seem to confirm my predictions.   A high level of deaths and excessive use of pain medication typified treatment in the hospital, in a facility which uncomfortably they called “end of line” wards.

There have been several police investigations, Health Service inquiries and  a ‘death audit’ over the years all with no clear conclusion.   Now an independent review led by James Jones, former chairman of the Hillsborough disaster will report in the spring of 2018.

My prediction this time is that he will find that wilful neglect for the sanctity of life of older people is now endemic in the NHS.

COLLATERAL DAMAGE OF INCREASED LONGEVITY.

IN A SUPREME TWIST OF FATE, THE NHS THAT HAS DONE SO MUCH TO EXTEND LIVES, NOW FINDS ITSELF HASTILY ASSISTING THE ENDING OF LIVES.

Posted in Assisted Suicide | 2 Comments

Prescribing en masse !

Solving the Nation’s health problems is a big challenge for the Government, but at last they have begun to come up with the start of a Grand National Health Plan.

It has just been announced that all men over 60 and women over 75 should take statins.     This could prevent 290,000 heart attacks and strokes over the next 10 years.   Of course there are a few side effects but the Government is not worried about that because this new blanket approach could save the NHS millions of pounds in less strokes and heart attacks.

GP’s are concerned that many more people —- it could be over 11,000,000 people — will need to see them to get prescriptions.    But the Government has an answer for that too — statin dispensers will be  conveniently located on every street corner, just like parking meters.   They will be painted in blue NHS colours and be as recognisable as your public telephone box.     It will only cost you 10p a day for you daily fix.    You won’t need to see your own GP, because the Government says it is OK.

The cartoon shows my heroine Pilly Galore trying out the new system, she says “It is a lot easier to get an appointment with a parking meter”. (You can see earlier blogs about Pilly by clicking on “PILLS” in the TAG CLOUD).

As the Government learns more and more from the big friendly pharmaceutical companies, it intends to do more national prescribing.  Aspirins are likely to become Universally Required Drugs by 2020.    Diet pills will be compulsory for everyone over 10 stone, as soon as the Government introduces a National Maximum Weight Limit.   Anabolic Steroids will be a URD for very thin people.

Snake Oil is being trialed in Swindon, with the expectation that it will be introduced into the Nation’s reservoirs in 2018, providing nobody much dies in Swindon before then.

The lesson from all this is:-

P. S.  Don’t take any notice of this I have no medical qualifications, just a sense of humour 😀

Posted in HEALTH, N.H.S. | Tagged | 2 Comments

Community Retirement Villages

I have built some ground-breaking Retirement Villages in my working career at ExtraCare Charitable Trust.  I am pleased to say that many retirement villages have followed in their footsteps.   But, are they transforming the understanding of housing and care for older people in this country?    The honest answer is not yet, or at least only for some of the people who were lucky enough to move in.

So what has to be done to make this model more widespread throughout the UK and sustainable in financial and managerial terms?  There seems to me to be four basic issues that have to be resolved:-

  • There needs to be a focus on later-lifestyle opportunities, not housing and care.     Housing and care tend to be the focus of developers, but they are not the key interests of the residents when they first move in.     They are more interested in finding a new lifestyle in retirement and indeed, the lack of this in new villages is the reason that many people don’t contemplate moving.  Encouraging this understanding is central to the marketing of new villages, but it is often overlooked, or not acted upon when the new village is opened.
  • This is not a small-scale problem.   (See my earlier blog which you can find by clicking on this link – https://grumblesmiles.co.uk/2017/08/29/yes-we-need-more-homes-with-care/).    To deliver a lifestyle transformation for many older people in communities throughout Britain, will need substantial capital investment and adequate on-going revenue funds.      Realistically, successive Governments have failed to do this for years and I can only see sufficient future funds coming mainly from residents’ own resources.     This will need new and innovative financial approaches, which are not dependant on public funds.     It will also need honest, transparent and forthright explanation to residents and their families !
  • An holistic community wide approach with voluntary sector support.   The new village needs to reach deep into its surrounding neighbourhood and not in any way be exclusive or gated.   This idea is not always welcomed by the village residents themselves, who once they have paid to get inside like the idea of exclusivity. Nonetheless,  there are many older people in the wider community who could enjoy the village facilities and bring in additional revenue.
  • Enlightened management, listening and acting on residents comments and needs, is an essential ingredient of village sustainability.    Much of the day to day running of village facilities will be supported by the residents as volunteers.    They will in return be entitled to play a key role in the governance of the village,

OVER THE NEXT FEW WEEKS THERE WILL NOW FOLLOW A SERIES OF BLOGS ON INDIVIDUAL ISSUES AND HOW TO FUND AND MAKE THEM SUSTAINABLE.

Posted in RETIREMENT HOUSING | Tagged | 7 Comments

Aimlessness

This is a new type of blog which I intend to write occasionally.  It’s just a series of random thoughts off the top of my head which is nothing to do with the elderly.  Or perhaps it is because I now qualify as elderly myself.

Today is a rainy day in the garden.  A dank, drizzly kind of day.

A day full of excuses

(Outside)

  • The garden bins are full, I can’t do anymore autumn pruning;
  • Anyway, everything is wet;
  • And the floor is slippery underfoot;
  • And the ground is muddy;
  • It’s too early to plant spring bulbs.

(Inside)

  • There is nothing in the newspapers;
  • There is nothing on the tele;
  • There’s no fire in my belly.

(So?)

  • Today is the day to stay in and read a book;
  • One of the many I have bought and then not read.

“Essentialism – the disciplined pursuit of less”

See my next blog>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

“A little nonsense now and then 

is cherished by the wisest men”

– Roald Dahl

Posted in SMILES | 2 Comments

Back to School

At last some imaginative ideas about involving older people with young children.   From Wales where else!

In Gwynedd, North Wales, four day centres for older people have invited in some nursery school children, with some very positive experiences for both the children and the older generation.

  • The childrens’ confidence and understanding increased;
  • An elderly stroke sufferer’s speech improved;
  • An 82 year old lady with dementia had singing lessons with a toddler and then spoke more lucidly afterwards;
  • Another octogenarian lady who was blind, taught a four year old to make jam tarts.

The experience ended with a sports day where the older residents and the young children teamed up to compete in races and other events.  Concerns about frailty and the childrens’ lack of confidence all went out of the window.  Better to focus on fun than frailty.

The project is being studied by researchers at Bangor University.

As I was writing this blog, there were two programmes on Channel 4 which documented the experience of a nursery school group of children visiting St Monica’s Trust Retirement Home.  They followed a similar path to the residents in Wales with equally encouraging results.

This sounds like two good news stories, with benefits all round.     If repeated across the country it could provide better support for nursery schools and build a positive bridge between generations.

Posted in SMILES | 2 Comments

Baby Boomer Plasters

There are 15 million older people in the U.K. and that number will increase by 24% by 2040.   So it represents the fastest growing sector of the population.     In marketing terms it is the least well understood part of the market.  It is full of stereotypes:- older people are a quiet consumer; compliant and conservative.   The baby boomer generation will change much of that.   They are likely to be more adventurous, more demanding and most importantly, more affluent.

So I have decided to follow up on a number of products which I have blogged about previously and for various reasons are certainly not “age friendly”.

The first product I’ve decided to follow up is plasters, because with impaired eyesight and slightly arthritic hands, they are not at all easy to unwrap and use.    “Baby boomer plasters” would need to be innovative, easy to unwrap and easy to use.      Below is a letter I have written to a number of plaster manufacturers.

Letter to Elastaplast

We always have a box of your plasters in the house.  As the brand leader, yours is the first name that comes to mind.  I recently had a minor accident in the garden where I cut my finger and reached straight away for one of your products.  Only to be reminded of how difficult it is to open your double protected packaging with one arthritic hand.  It drew me back to a similar experience a year ago which I wrote about in my GrumbleSmiles blog.

You can read about my earlier difficulties with your product by clicking on the link below:

https://grumblesmiles.co.uk/2016/07/11/getting-plastered-to-be-edited-cartoon/

I write a well read blog about improving later life for older people.   One of the issues that I have frequently written about is the difficulties older people have with many modern products and particularly their packaging.    The grey market is often overlooked and yet it is the most rapidly growing demographic sector of society.    Older people also have the largest disposable incomes.

I realise that from a hygiene point of view, your plasters may need to be sealed.  However, in a first aid situation, older people need relatively quick access which is difficult, given their more limited dexterity.   I would be very interested to know if you have any plans to develop more “age friendly” products?  If you do already have or plan to have in future more suitable products, I would happily include your reply in m blog.

Many thanks; I’ll await your reply.

P.s. The email I was actually able to send to Elastaplast Customer Services on their standard reply form, only allowed me to send 512 characters  and no cartoon so doesn’t contain everything in the above note.

I will publish their reply when I get a response.

Posted in ELDERLY MARKET, Grey Products | 2 Comments

Yes, we need more Homes with Care !

My last blog looked at the demand for more Care Homes.    With the exception of specialist homes for dementia, psychiatric support and small group homes for learning difficulties, I would not agree we need more residential Care Homes.     In my view they create dependency and only offer an institutional lifestyle.

I do accept we need more Housing with Care, to meet the growing need to better support frail older people to continue to live independently.    The Newcastle University study suggested an additional 71,000 older people will need support in the next 10 years.     I suspect the figure will be much larger even than that!

My previous blog suggested that this would need in the order of £15 billion of capital investment to develop around 300 new retirement villages.     That level of new investment by Government is usually reserved for aircraft carriers or ridiculous railways.      Currently all the Nation’s  available capital will be needed to compensate the European Union for Brexit.      So the likelihood of finding investment for older people from the State seems rather remote.

The good news is, older people themselves  have a huge amount of assets locked up in the homes they own.     The options they have for getting the money out of their homes are unfortunately not very good value.     Equity release products are still expensive and come with all sorts of limitations.     Downsizing from a larger family home into retirement housing is probably a better option, but unfortunately most retirement housing offers little more than sheltered housing and emergency pullcords.

If we are to genuinely transform retirement housing to make it an attractive proposition for a large number of people, then we need a much bolder approach which goes beyond retirement housing and offers a much more attractive lifestyle in later life.

If the Government isn’t going to be able to provide the capital, then older people will have to take control of their own resources and use them creatively to buy a new life in older age.

My blogs next week will begin to outline how that can be done.

 

Posted in RETIREMENT HOUSING | 4 Comments

Do we need more Care Homes ?

A recent report by Newcastle University looked at the forecast levels of frailty in the older population and reached the conclusion that there is a need for 71,000 new care home places in the next 10 years.

I don’t doubt that their figures are correct.  It is just their conclusion that is wrong !

As the population ages the number of older, older people requiring some degree of support is certainly set to increase.   The more critical questions are :-

  • ” Where do they want to receive the care ?”
  • ” Who do they want to be cared for by ?”
  • ” How can they or their family pay for it ?”

The Newcastle study didn’t seek to answer these questions.   They are the £64,000 questions and therein lies the problem.

I will attempt to move the discussion along:-

Firstly, most people would like to be looked after at home.   This is relatively expensive and quality control is difficult.    However, there are certainly psychological benefits from being in your own familiar environment.   Since the State has largely totally withdrawn from this area, you have to be fairly wealthy to afford this solution.

Secondly, they want help from a stable (not ever-changing) and trained support team.   People they know and trust and people who know them as an individual not just a set of tasks.     For many people this may be little more than domestic help initially.    Later some will need more hands on care at times during the day.  They would also benefit from a regular review of their support and health needs by a nurse ideally on a monthly/quarterly basis.    Preventative  well-being checks have proven value.

Thirdly, paying for this kind of care at home has been under-valued by the expectation that health care is free for those that need it.     It never has been free, we have all paid for it in taxes, but we have not paid enough.     No one foresaw the big increase in longevity, nor the improvements in medical care that have kept us alive for longer, albeit with the frailties of old age.     The good news for many older people is, they are living in an asset that has over their lives accumulated in value.      Now they must use the value of their house to secure their future care and support needs.

What I have just outlined in housing and support terms is a retirement village.     But to deliver 71,000 new homes  would amount to around  300 retirement villages, at a capital cost in the order of £15 billion.

I will figure out how to do it in my next blog 😀

Posted in Residential Care, RETIREMENT HOUSING | 3 Comments

Care Home Confidence ?

At a time when lots of Care Home companies are on the verge of collapse and many homes have already closed, one company is moving in the opposite direction.      HC- One is company that grew out of the ashes of Southern Cross.  (You can see my posts on the Southern Cross storey by clicking on it in the Tag Cloud)

HC-One was set up  by Chi Patel, a doctor who moved into merchant banking.     Not an obvious career path, but one which led him to later switch to developing and managing nursing and residential care homes.     Now his  most recent incarnation has bid to takeover BUPA’s clutch of former Southern Cross homes, at a reported cost of up to £450 million for 150 homes.     This will make HC-One the largest residential care provider in the U.K. with 22,000 beds.

This, in a market full of gloom.    Squeezed Local Authority funding for Social Services, a jump in staff wages on the way and a vendor in BUPA  that has reached the opposite conclusion about its Care Homes.    Generally thought to be ” low quality”, they have been trying to sell them for more than a year.

So is Chi Patel a fool or just foolhardy ?

Well he has made himself a fortune out of running Care Homes, so I don’t think he is a fool.      But he is taking a big risk, probably with other people’s money.

The things in his favour are :-

  • the demographics of the older population and their increasing frailty won’t go away;
  • NHS hospitals are being swamped with older people who can’t be discharged;
  • later stage dementia cannot easily be coped with at home, but neither is hospitalisation a solution;
  • capital funding should be able to be secured against the homes, at relatively low rates compared to the past;
  • many residents will have homes that can be eventually used to fund their care, which would suit future Governments.

He is betting on older people’s lives, but I wouldn’t bet against him.    In the aftermath of the Southern Cross demise there were many lessons learned :-

  • the Regulaters can precipitate a collapse, but they can’t prevent it;
  • lenders have no easy exit routes, once they are in, they are in for the long haul;
  • the residents may be in for a bumpy ride if things start to fail, but they are also locked in, probably literally.

Even though I don’t favour Care Homes as answer, at least he is trying to do something.

 

Posted in Nursing Homes, Residential Care | 2 Comments