Remodelling sheltered housing and residential care: methodological challenges

1
Remodelling sheltered housing and residential
care methodological challenges

• Professor Julienne Hanson
• University College London
• Symposium
• Capturing daily life in retirement developments
  methodological issues
• 36th Annual Conference of the British Society of
  Gerontology
• Sheffield Hallam University, 6-8 September 2007
• (Presentation on behalf of the research team)

2
What this presentation will cover

• Introduce the interdisciplinary project
• Generic and specific methodological issues
• Implications for the relationship between
  academic research and policy
• Implications for carrying out interdisciplinary
  projects

3
The project and the problem

• EPSRC funded response mode project, May 2005 to
  July 2007. Not a specific call - research team
  chose to work together on the basis of previous
  successful collaborations
• Only social housing - a sample of schemes which
  had been converted to extra care since 2000 (five
  LA and five HA, five sheltered and five
  residential care)
• Examining what the building, care and support
  and AT changes were and what is likely to be
  needed in the future
• Investigating the remodelling process itself and
  how it took place
• Obtaining the views of older people and staff
  post-occupancy of the remodelled building, to
  look at the advantages and disadvantages of a
  remodelled scheme
• Costing the changes to the schemes
• Providing guidance, based on the findings

4
Interdisciplinary nature of the project
Architecture
Social Gerontology
Extra Care Remodelling
Assistive Technology
Economics
5
The interdisciplinary research team

• The architects - Professor Julienne Hanson,
  Hedieh Wojgani Flora Margeti, University
  College London, Faculty of the Built Environment
• The social gerontologists - Professor Anthea
  Tinker and Dr Fay Wright, Kings College London,
  Institute of Gerontology
• The rehabititation engineer and the OT - Dr Ruth
  Mayagoitia-Hill and Els van Boxstael, Kings
  College London, Centre of Rehabilitation
  Engineering
• The economist - Dr Alan Holmans, University of
  Cambridge

6
Generic methodological issues that impacted on
the project team

• Defining what is meant by extra care
• Selecting an appropriate sample of case studies
  in terms of original proposal obtaining a
  representative sample
• Talking to one another - developing a shared
  framework and an understanding of key terms -
  importance of good communications between team
  members
• Negotiating professional boundaries - overlaps,
  gaps and demarcations - willingness/flexibility
  to work in new areas
• Information exchange - what kind, how much?
• Balance and appropriate use of quantitative and
  qualitative data in the project as a whole
• Appropriate disclosure of sensitive information
  obtained through interviews

7
Architectural issues

• Remodelling versus refurbishment - two schemes
  turned out to be refurbished - comparing like
  with like
• No two schemes were alike - the heritage
  building
• Making contact with the original design team
  architects, contractors, quantity surveyors,
  professional clients
• Willingness or otherwise to participate on the
  part of the design professionals
• Tracing and obtaining accurate plans of the
  original building
• Obtaining accurate and up-to-date plans of the
  remodelled building
• Anonymising the schemes, drawings photos
• Translating and communicating architectural data
  in lay terms

8
Preserving anonymity in the drawings
Ground Floor
First Floor
9
Preserving anonymity in the photographs
Ground Floor
First Floor
10
Using graphics to show architectural information
Total area added 1283 sq m, about 64 of which
is for new flats.
Communal Facilities
Staff Facilities
Flats
Circulation
Other
Bed sit to one bed flat, 33 sq.m.
11
Sociological issues

• Making contact with housing, support and care
  managers - churn among senior managers
• Data Protection Act - obtaining access to older
  interviewees through gatekeepers
• Cognitive ability of older interviewees - is
  consent genuinely informed?
• Distressing interviews with older people / staff
  in unsatisfactory circumstances / accommodation
• Comparing criteria that are very different in
  different schemes admission, the amount and type
  of care provided (personal care or chores), hot
  meals, home for life etc.

12
Rehabilitation engineering issues

• Team working in practice - visits to schemes and
  tenants flats by the project team, sharing the
  workload
• How to deal with fixed technology is it the
  domain of the architect or the rehabilitation
  engineer?
• What can be learned about remodelling from the AT
  that is specific to the individual tenant?
• Finding out about who provides and pays for AT?
• Addressing the question, Are care costs
  building neutral?

13
Use of photos to illustrate good / bad practice
Bathroom of a true wheelchair user in an extra
care scheme that kept baths in half of the flats
after remodelling
Bathroom wash hand basin that is too deep (too
low) to fit a wheelchair under it, and where the
waste is not back far enough for access
14
Financial issues

• Obtaining (commercially) sensitive financial
  information
• Difficulty in obtaining accurate, comparable and
  complete maintenance / running costs
• Whose cost is it anyway - older residents or
  housing care providers?
• Comparing capital costs that are recorded in
  different ways
• Comparing the capital costs of remodelling with
  those of new build
• How to quantify value for money?
• How to report complex findings?

15
Relationship of academic research to policy

• Differentiating the findings that are general to
  extra care schemes from those that are specific
  to remodelling
• Balancing the good and bad news remodelling
  looks like an quick, easy and inexpensive option
  but it is a far from straightforward process and
  the solution is usually a less than ideal
  compromise
• Reporting findings that are undiplomatic or
  that portray older people in a less than perfect
  light
• Translating the research findings into advice
  /good practice guidelines
• Looking to the future translating the research
  findings to predictions. Is remodelling a
  sustainable solution?
• Feeding the findings back to the case studies

16
Implications for carrying out interdisciplinary
projects

• Inter-disciplinary research is not easy but it is
  extremely rewarding and worthwhile
• Publishing interdisciplinary research findings is
  not easy consequences for the RAE and for the
  careers of individual researchers
• Generally speaking, the practitioners who are
  remodelling sheltered housing / residential care
  to extra care welcome the findings and are eager
  to share their experiences and to learn from
  research and from one another
• Trust and mutual esteem, a mature attitude and
  team spirit are essential message for research
  councils in respect of consortia