Why is housing tenure associated with a lower risk of admission to a nursing or residential home? Wealth, health and the incentive to keep 'my home'

Background Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors.
Aims To analyse the probability of admission to residential and nursing home care according to housing tenure and house value.
Methods Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of approximate to 28% of the population of Northern Ireland.
Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters.
Conclusions The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers.

Working across boundaries to improve health outcomes: a case study of a housing support and outreach service for homeless people living with HIV

This paper reports the findings of an evaluation of the ‘Housing Support, Outreach and Referral’ service developed to support people living with HIV who were homeless or at risk of homelessness. The service was set up as part of the Supporting People Health Pilot programme established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper considers the role of housing support in improving people's health, and considers the challenges of working across housing, health and social care boundaries. The evaluation of the health pilot employed two main sources of data collection: quarterly project evaluation reports, which collected process data as well as reporting progress against aims and objectives, and semi-structured interviews with professionals from all key stakeholder groups and agencies, and with people who used services. Over the course of 15 months, 56 referrals were received of which 27 were accepted. Fifteen people received tenancy support of whom 12 were helped to access temporary accommodation. At the end of the 15 months, all of the tenancies had been maintained. In addition, 18 people registered with a general practitioner and 13 registered with an HIV clinic. Interviews with professionals emphasised the importance of the local joint working context, the involvement of the voluntary sector and the role of the support workers as factors that accounted for these outcomes. Those using services placed most emphasis on the flexibility of the support worker role. Importantly, interviews with professionals and those using services suggest that the role of support worker incorporates two dimensions – those of networker/navigator as well as advocate – and that both dimensions are important in determining the effectiveness of the service.

Urban housing and the role of 'underclass' processes: the case of Ireland

Rising levels of urban deprivation and a perception that poverty has become more concentrated in such areas and has taken on a qualitatively different character have provoked a variety of popular and academic responses. The potentially most fruitful set of hypotheses focuses on the unintended of weak labour force attachment and social isolation is perceived to lead to behaviour and orientations that contribute to a vicious circle of deprivation. In examining the value of this conceptual framework in the Irish case we proceed by measuring directly the social-psychological factors which ave hypothesized to mediate the 'underclass' process.

A significantly higher level of poverty is found in urban public-sector tenant households. This finding cannot be accounted for entirely by socio-demographic differences. It is the assessment of this net or residual effect that is crucial to an evaluation of vicious circle explanations. Controlling for the critical social-psychological factors we found that net effect was reduced by less than a quarter and concluded that the remaining effect is more plausibly attributed to the role of selection than to underclass processes. Analysis of the changing relationship between urban public-sector tenancy and poverty provides support for this interpretation.

For the main part the distinctiveness of social housing tenants is a consequence of the disadvantages they stiffer in relation to employment opportunities and living standards. Ultimately it is these problems that policy interventions, whatever the level at which they take place, must address.

Assessing Lifetime Homes Standards and Part M Building Regulations for Housing Design in the UK

The aims of this article are to examine Lifetime Home Standards (LTHS) and Part M of the UK Building Regulations and to discuss how relevant and successful they are. The UK government expects all new homes to be built to LTHS by 2013. This is increasingly important with an ageing population. The home environment can enable independence and provide a therapeutic place for everyone. As Part M of the building regulations are compulsory in all housing and LTHS are mandatory for public sector housing, a review of research articles was undertaken on these standards. The paper begins with a brief background on accessibility regulations, followed by a critical review of the standards that takes the body of literature that has been written around them into account. This review suggests that the standards should be improved and that designers and architects face challenges to creatively incorporate them into housing design.

Cities and The Spirit Level: Reasserting the Public Interest in Planning Governance

Urban planning in Europe has its roots in social reform movements for reform of the 18th and 19th centuries and in the UK evolved into the state-backed comprehensive planning system established as a pillar of the welfare state in 1947. This new planning system played a key role in meeting key social needs of the early post-war period, through, for example, an ambitious new town programme. However, from the late 1970s onwards the main priorities of the planning system have shifted as the UK state has withdrawn support for welfare and reasserted market values. One consequence of this has been an increased inequality in access to many of the resources that planning seeks to regulate, including affordable housing, local services and environmental quality.
Drawing on evidence from recent literature on equality, including Wilkinson and Pickett’s The Spirit Level this paper will question the role of planning in an era of post-politics and a neo-liberal state. It will review some of the consequences for the governance and practice of planning and question what this means for the core values of the planning profession. Finally, the paper will discuss the rise of the Healthy Urban Planning Movement in the US and Europe and ask whether this provides any potential for reasserting the public interest in planning process.

The Governance of Mandated Partnerships: The Case of Social Housing Procurement

Partnership working is nowadays a seemingly ubiquitous aspect of the management and delivery of public services, yet there remain major differences of opinion about how they best work for the different stakeholders they involve. The balances between mandate and trust, and between hard and soft power, are crucial to current debates about public service partnerships. This paper explores the example of social housing procurement in Northern Ireland, and the requirement to form mandated procurement groups. The research shows that the exercise of hierarchical power is still important in network governance; that mandated partnerships alter the balance between trust and power in partnership working, but the impact is uneven; and that these relationships are (re)shaping the ‘hybrid’ identity of housing associations. The balance between accountability for public resources and the independence of third sector organisations is the key tension in mandated partnerships. The Northern Ireland experience suggests that trust-based networks could provide more productive working relationships in partnerships for service delivery.

Unsettling modernity: Shifting values and changing housing styles in the Kathmandu Valley

Abstract

Culture has always been important for the character of the cities, as have the civic and public institutions that sustain a lifestyle and provide an identity. Substantial evidence of the unique historical, urban civilisation remains within the traditional settlements in the Kathmandu Valley in Nepal; manifested in houses, palaces, temples, rest houses, open spaces, festivals, rituals, customs and cultural institutions. Indigenous knowledge and practices prescribed the arrangement of houses, roads and urban spaces giving the city a distinctive physical form, character and a unique oriental nativeness. In technical sense, these societies did not have written rules for guiding development. In recent decades, the urban culture of the city has been changing with the forces of urbanisation and globalisation and the demand for new buildings and spaces. New residential design is increasingly dominated by distinctive patterns of Western suburban ideal comprising detached or semi-detached homes and high rise tower blocks. This architectural iconoclasm can be construed as a rather crude response to the indigenous culture and built form. The paper attempts to dismantle the current tension between traditional and contemporary ‘culture’ (and hence society) and housing (or built form) in the Kathmandu Valley by engaging in a discussion that cuts across space, time and meaning of architecture as we know it.

Housing, Regeneration and Community Asset Transfer

Community asset transfer enables local groups to own or manage a government owned facility and/or related services. For critics, it is merely an extension of roll-back neoliberalism, permitting the state to withdraw from welfare and transfer risk from local government to ill-defined communities. The paper uses quantitative and case study data from Northern Ireland to demonstrate its transformative potential by challenging the notion of private property rights, enabling communities to accumulate and endanger forms of cooperative consumption. It concludes by highlighting the implications for more progressive forms of social economics in relation to public and private markets and government sponsorship of its own development.

Policy Transfer and the Sustainability of Public Private Partnership in Ireland::A conceptual analysis

There has been private sector involvement in the delivery of public services in the Irish State since its foundation. This involvement was formalised in 1998 when Public Private Partnership (PPP) was officially introduced. Ireland is a latecomer to PPP and, prior to the credit crisis, was seen as a ‘rapid follower’ relying primarily on the UK PPP model in the procurement of infrastructure in transport, education, housing/urban regeneration and water/wastewater.  PPP activity in Ireland stalled during the credit crisis, and some projects were cancelled, but it has taken off again recently with part of the Infrastructure and Capital Investment Plan 2016 – 2021 to be delivered through PPP showing continuing political commitment to PPP.  Ireland’s interest in PPP cannot be explained by economic rationale alone, as PPP was initiated during a period of prosperity. We consider three alternative explanations: voluntary adoption – where the UK model was closely followed; coercive adoption – where PPP policy was forced upon Ireland; and institutional isomorphism – where institutional creation and change was promoted to aid public sector organisations in gaining institutional legitimacy. We find evidence of all three patterns, with coercive adoption becoming more relevant in recent years. Ireland’s rapid uptake of PPP differs from other European countries, mostly because when PPP was introduced in 1998, the Irish State was in an economic position where it could have directly procured necessary infrastructure. This paper therefore asks why PPP was adopted and how this adoption pattern has affected the sustainability of PPP in Ireland.  This paper defines PPP; examines the background to the PPP approach adopted in Ireland; outlines the theoretical framework of the paper: transfer theory and institutional theory; discusses the methodology; reports on findings and gives conclusions.   

Building public policy on shifting sands: the case of the National Asset Management Agency

Over the last thirty years, there has been an increased demand for better management of public sector organisations (PSOs). This requires that they are answerable for the inputs that they are given but also for what they achieve with these inputs (Hood 1991; Hood 1995). It is suggested that this will improve the management of the organisation through better planning and control, and the achievement of greater accountability (Smith 1995). However, such a rational approach with clear goals and the means to measure achievement can cause difficulties for many PSOs. These difficulties include the distinctive nature of the public sector due to the political environment within which the public sector manager operates (Stewart and Walsh 1992) and the fact that PSOs will have many stakeholders, each of whom will have their own specific objectives based on their own perspective (Boyle 1995). This can
result in goal ambiguity which means that there is leeway in interpreting the results of the PSO. The National Asset Management Agency (NAMA) was set up to bring stability to the financial system by buying loans from the banks (which were in most cases, non-performing loans). The intention was to cleanse the banks of these loans so that they could return to their normal business of taking deposits and making loans. However, the legislation, also gave NAMA a wide range of other responsibilities including responsibility for facilitating credit in the economy and protecting the interests of taxpayers. In more recent times, NAMA has been given responsibility for building social housing. This wide-range of activities is a clear example of a PSO being given multiple goals which may conflict and is therefore likely to lead to goal ambiguity. This makes it very difficult to evaluate NAMA’s performance as they are attempting to meet numerous goals at the same time and also highlights the complexity of policy making in the public sector. The purpose of this paper is to examine how NAMA dealt with goal ambiguity. This will be done through a thematic analysis of its annual reports over the last five years. The paper’s will contribute to the ongoing debate about the evaluation of PSOs and the complex environment within which they operate which makes evaluation difficult as they are
answerable to multiple stakeholders who have different objectives and different criteria for measuring success.