Some initial conclusions as we head home........to be further refined

·      There is no magic bullet. Social housing/housing for poorer, older people needs to be subsidised one way or another by government

·      The “Golden Age” of support for social housing in the UK and Europe is coming to an end

·      Well-planned communities and well-planned housing units maintain options for older people so they can continue to exercise choice

·      Our organisations need to promote mindset change – younger, older people need to plan and act earlier rather than later about their housing choices to maintain their options

·      We can provide much more comprehensive advisory services and practical support to family homes and retirement village units to help people maintain their options for longer

·      We need to press for changes to building and constructions regulations to facilitate cheaper building approaches

·      Assisted living and sheltered housing are better options than low care – providing housing as the primary service and care/support as the back-up service

·      An argument can be made for large scale, “full service” retirement communities – in relation to this we need to make sure we are respecting what customers want and not what we want

·      Where providers co-exist (eg Menora), much greater effort needs to be devoted to offering collectively the fullest range of services possible

·      Stepping outside the system and doing it your way may be the only way to provide people with what they want in the over-regulated Australian setting

·      If we want change/truly believe in what we’re doing, we need to be prepared to disobey and just do it

In Washington DC

This is an impressively planned city, much like Canberra(!). The Capitol Hill district runs between Capitol Hill and the Washington Monument. The green National Mall joins the two book-end monuments and it is flanked on each side by very impressive Government and Museum buildings. It is a very impressive site – the equal of the great European cities. It looks fantastic at night with the buildings lit up.

As grand as the architecture is, the service at times is terrible. I’m still having trouble with cab drivers and waiters etc. It offends me to find people who are so poorly attuned to the needs of visitors to the country, particularly as there are thousands of us. If you know what you’re doing and know exactly how something works, you’re fine. But if you want some explanation or something out of the ordinary, too many people switch off their customer service ”façade” at this point. Or maybe I just expect too much…..

We visited the Capitol Hill Village (CHV). They are a membership-based community association, dedicated to enabling the older people of the Capitol Hill area to remain in their own homes for as long as they can. This organisation is like a NORC (Naturally Occurring Retirement Community) except for the fact that Capitol Hill Village membership is open to all age groups while a NORC is more like a self-help organisation for older people.

CHV raises funds from membership and fundraising and then provides volunteer support to people to take them to appointments, get repairs done to their homes, provide companionship etc. This sort of community association is of interest to me because I was responsible for trying to establish them in the UK before I escaped to Australia. CHV links into other service providers, health facilities etc to try to package together supports for people.

At one level, there is nothing too remarkable about this for us. Our own organisations are providing similar community supports to help people stay at home and we have locally-based community organisations in WA who do something very similar to CHV.

Having said this, there are points of interest here. First, Kathie from CHV pointed out to us that they are essentially supporting people “stuck in the middle”. These are older people who don’t have so much money that they can pay for all the support services they need privately but, unfortunately for them, neither do they have assets that are so low that they qualify for Medicare and Medicaid. So, they are the “asset rich, income poor” group we are familiar with and they have trouble being able to stay put through older age.

Now this segues nicely into the second point of interest. Kathie explained that these older people don’t just want to stay living in their own homes, they want to stay living in their own community. At one level, they could relieve their predicament by divesting themselves of their current assets  so as to qualify for benefits, but that would require them to sell up and move from their own community. Of course, this is a special, if not a unique community, right next to Capitol Hill in Washington.

It was good to visit CHV because it provided a diametrically opposed proposition to that of Erickson Communities. The members of CHV are passionate about staying living near Capitol Hill for as long as they can. Poorly serviced and isolated, as they may be. On the other hand, the people who had moved to the Erickson Communities seemed very happy with their choice, which was delivering so much to do and so many people to mix with.

You can go round the world, but fundamentals remain the same. Choice is the thing or the thang as we say round here.

By the way, that was our last visit and not to put too fine a point on it – Vaughan and I are knackered.

To Washington or DC as we call it (now)

We were transported here from Baltimore by the most delightful man, Eddie, who is a driver for Erickson. He is an older African American, native to Baltimore, and we enjoyed hearing about life in the “real Baltimore”.

We met with David Schless, CEO of the Australian Seniors’ Housing Association ASHA) – the equivalent of ACCA in Australia.

He explained that the construction of seniors’ housing had all but stagnated in the wake of the GFC. He said that the capital markets had become incredibly tight and that people were putting off investment decisions, indeed all decisions while there was so much uncertainty about the US economy. As a consequence, rental housing models were faring better than lease-for-life product as the decision to rent was a more conservative one than shelling out a huge lump sum amount.

He said that the US had little social housing product or retirement communities for poorer, older people. There was some aged-friendly housing, but for the most part poorer people had to make do as best they could in the private rental market. David’s view was that the USA’s economic circumstances would prevent any expansion of social housing provision in the foreseeable future.

From the various discussions we’ve had here, it is clear that, while housing is considered to be a personal responsibility of people even if they are old, health care and community care are not. At the age of 65, “pensioners” in our terms qualify for Medicare and Medicaid benefits. We have been quite surprised at the level of support that is provided to older “pensioners” in the US. It’s obviously a significant cost burden on government and many people have questioned whether the current level of benefits is sustainable. I’ll return to this subject a bit later when describing Capitol Hill Village.

We took the opportunity to talk to David about how effective his industry group/ association was at influencing government on key issues, noting of course that his association in based in Washington, the seat of government. He said that this organisation was influential and he cited the reasons for this as being the retention of specialist lobbyists and the creation of the Political Action Committee (PAC).

The PAC is interesting. It is used to support the campaigns of sympathetic politicians. It is illegal in the US for organisations to donate to such committees and so it is supported by personal cheques from supporters/influential members. This fund raises up to $500K per annum – now that should purchase some influence!

David stressed that the association’s influence on Capitol Hill is achieved by developing sustained, long-term relationships with politicians. My interpretation of this would be that you can establish such relationships if you are out and about as an association in the seat of government.

Compare and contrast Baltimore

Today was another big day on tour.

We saw another of Erickson's sites, a not-for-profit competitor's site of a much smaller scale (400 people) and a site providing a rental model in the assisted living/residential care space.

The Erickson model and the smaller competitor's approach allowed us to compare and contrast delivery systems. Erickson has road-tested its approach and adapted it continuously to service opportunities and market trends. They have continuously adapted the services offered, the style and size of apartments and do a complete make-over of each site every five years. Because of their massive scale they can also deliver services, undertake construction etc at a much better rate than smaller operations.

The smaller, NFP alternative has found itself in a place not unfamiliar to our NFP providers. It has been running profitably and has built up reserves. Existing residents have been happy and the model has remained in place for decades. However, seemingly, all of a sudden to them, they are experiencing vacancies and their amenity and accommodation units are no longer hitting the mark. They have now entered into a huge and rapid refurbishment program of their common facilities, restaurants etc but from our point of view had not undertaken a full strategic analysis to determine the full picture of what their market wants from them in the future. I asked the question - what's more important to your customers, upgrading the communal facilities or updating the accommodation units? Their response was that they just don't know, but they hope they are doing the right priority first. This is a classic reminder to plan, aim, fire rather than in any other order.

The site offering the rental model in the assisted living/ residential care/ dementia care space is part of the Sunrise group. They are a very large and apparently very successful company that operates facilities of a much smaller scale (100 units) but does not own the sites. They pitch their services to the middle to upper end of the market. On top of the basic rental for the room, they then charge people on a fee-for-service basis for their additional services.

We were generally impressed with the design of the accommodation, the more intimate feel of the operations and the caring approach to their dementia-related customers (in the "Reminiscence" wing)! It seems that the USA is one of the few countries where the rental model has taken off in a big way. Erickson does not see itself in competition with Sunrise in that Erickson is in competition with people who want to stay living in the family home. Erickson's "lease for life" model would appear to provide a better "peace of mind" deal to people than a rental approach where some people live a lot longer than they expect to and actually run out of money to pay the rent.

The Erickson community we visited today was their original one (Charlestown). It is on the site of a disused seminary of historical significance. As part of the approvals process, the chapel in the seminary has been completely restored and it is an unbelievable marble-lined structure of amazing proportions. The chaplains in our organisations would kill for this, figuratively speaking of course.

We also spent a lot of time with John's son, Mark, today and had the chance to discuss philosophical, management and leadership issues with him over dinner. This was interesting. Mark's views are more liberal than many of the older "market is king" people we have met here. He sees a meaningful role for the State in providing safety nets for people and his line on such things as Obama's health reforms is pretty similar to how most Australians see these things.

We found ourselves on a good wavelength with Mark on most issues. However, after a beer and a wine or two, we had a great discussion about "what is the best way for older people to live?" Here, we found we were coming from quite different standpoints. Our view is that people should stay living in their own home and in their own community for as long as possible. Having been asking the questions and doing all the grilling of people for the last 3 weeks, we found the boot on the other foot.  Mark questioned why this is best when so often it is a recipe for isolation and for people to stagnate and become inactive? After all, isn't it true that if you don't use it, you lose it? In this respect, Mark is firmly in the same camp with his Dad - living on a well-resourced community campus gives people 75 plus another lease on life.

The Erickson group has a research facility into ageing, a training group and various philanthropic foundations. Mark teaches at the training facility and has learned a lot about management over his short career, partly through adversity. In all fairness, we should point out that the Erickson group got into financial trouble during the GFC by diversifying into untried markets at the wrong time and it was eventually bought out. John retains a role as the R&D man and as founding guru.

It's been a great visit with the Ericksons. It has been provocative for us - see Sarah Mitchell's comments on this blog. At the end of the day, Vaughan and I agree that you can't take a view like John does that there is one best way for older people to live. We stick to our guns that it is all about maximising the range of choices for people. We think that this time spent with the Ericksons has essentially broadened our view of the spectrum of choice that can be offered to older people. Erickson Communities are what you might call "full service communities" that offer a lot more than traditional retirement villages in WA due to their massive scale and core philosophies. Could they be made to work in WA or more likely the Eastern States? We'll need to ponder that one.

Ray

Erickson

Made our way to Baltimore today on AMTRAK. I had some trouble communicating with the locals about the fact that we didn’t understand how the system worked. It was later explained to me that New Yorkers are too busy with their own busy lives to explain to the ignorant how things work. I felt better once I understood that.

We had a fantastic day today hosted by John Erickson, the founder of Erickson Retirement Communities. Where to start? Well, John is a self-made man. He was one of fourteen kids in a poor family and they were in the Guinness Book of Records for the most graduates out of one family. 14 out of 14! I won’t even begin to try to explain the trials and tribulations he went through to get his first project started. He now has 30 of them providing accommodation and care to tens of thousands of older people.

As we’ve stated on the blog before, it’s essential to try to understand the culture of the country and its communities before you can start to talk about and evaluate their various projects. I think the interesting thing here is that John has a very clear and firm view about what is good living for people 75 plus and that is to live in a supportive community with excellent health care, social and developmental opportunities and support. In this context, views about the design of his communities and their degree of institutionalisation become almost irrelevant. Erickson communities are unashamedly institutionalised in our terms, but they believe it is the right way.

Today we visited Riderwood just outside Baltimore. It is a community on a huge site of – wait for it – three thousand people. It is designed as a retirement community for middle America and consists of retirement living, our equivalent of hostels and dementia-specific units, 7 community centres, 7 restaurants, shops, major rehab and restoration centre, pharmacies etc and….a TV station providing internal programming staffed by a co-ordinator and volunteers who have had some background in the media and... the best thing of all…a primary health care facility.

The choice of independent living apartments is impressive. Nothing out of the usual for us but brought to market at half the price. The lease for life arrangements are broadly comparable. The care facilities are also broadly comparable with what we provide.

But there are some amazing things in this community:

·      The sheer scale of it that allows so much to be provided on site

·      The employment opportunities provided to African Americans, some of whom have risen to the very top echelons of the staff group

·      The scholarship scheme offered to young people (almost exclusively African Americans) that provides incentives to young people to continue to work at Erickson Communities in the form of cash support to complete their education. This program , originally supported by the company, has been augmented by support from the residents who also wanted to help these young people.

·      The health care program that provides access to onsite GPs supported by a same day policy for appointments to see a Doctor. This community has 7 GPs employed by the company! We met the Head of this service and he was incredibly passionate about his work there. He was previously very disillusioned about working in the general health system and is quoted as describing that experience as being “I used to be a Doctor”. Once he spent 11 minutes with patients, now he spends up to 25 minutes. John Erickson believes that excellent primary health care is the key to good ageing. They provide very compelling statistics to justify their base proposition that ready access to primary health care substantially improves the health status of the older old,

The very notion of a three thousand strong community of people 75 plus is unacceptable to us in so many ways. I asked John what he thought about creating such a huge ghetto for older people when it would be possible to weave younger people into a mixed community. He argued that we all had a good time when we went to College and that was all people of the same age group! the sites are called "campuses" and that is to designed to convey the feel of the experience. I think the refreshing thing about John is that he doesn’t apologise for what he is doing. He is 100% convinced that what Erickson Communities provide for people is what they want and is the best thing for them.

In a funny sort of way, we reflected on the fact that John Erickson and Hans Becker from Humanitas in Rotterdam could not be more different people but they have very similar leadership qualities in common. They both have an absolute conviction about what is good living for older people and are prepared to buck the system to deliver on their beliefs.

Culturally, we remain sceptical, but I’ll tell you this. Walking round this community with John, you’d think he’d set it all up. So many residents and staff came up to John and thanked him sincerely for what he was doing. He is held in great reverence by people. He is incredibly wealthy and successful now but maintains a common touch. You can’t learn this or fake it. You either have it or you don’t.

This was a great experience today. Despite yourself, you can't help but admire what John  is doing.

Ray

New York, New York

What a town!

Somewhat jetlagged for our day off in the Big Apple following the flight form Europe. Nonetheless walked half of Manhattan today trying to visit all the streets in the Village and Soho and Tribeca I can remember from Woody Allen films.

The scale and density and diversity of this city is incredible. It has everything you want and the best and worst of it all, with everything in between. You walk past the beautiful people (including Vaughan) and the next step you're walking past a down and out who's just been sleeping in the doorway.

I'm not having any trouble getting a coffee here and my eggs are coming easy over (whatever that means).

Our hotel is pretty lively and funky. The hotel calls its front desk service "Wherever, Whatever" because that's the service they give you. I've only asked for one thing so far. I asked at 7.30 this morning and it still hasn't been done. I passed on my Chairman's wise advice that he sometimes gives to me - under-promise and over-deliver.

Off early tomorrow to Baltimore to start our US visits.

Ray

Humanitas Akropolis

Well, what can you say about this? This is aged care going out on a weird date with Johnny Depp.

This place really works. It's driven by outrageous, narcissistic leadership; a culture that says yes and accepts anything people want to do; brilliant design that looks dog-eared like your favourite book; interior design that is so over the top it continuously assaults your senses AND maintains your interest; in our terms, a huge scale that permits experimentation and risk-taking and the opportunity to make expensive mistakes.

It really does work. We arrived early and plonked ourselves in the space to see what really happens and to avoid any spin. The main area is an internal atrium, a "sheltered village square" as they call it. The affordable housing flats open onto it. It works on the same principle as our new office - you have to walk through the village square to go anywhere so you have to meet people whether you want to or not. Anyway, the village square had a thriving restaurant, a craft and jewellery market, a bar, a pool hall, a convenience store, an internet kiosk space and it was very lively. Most of the people were old, many with walkers and buggies, but there were younger people too.

Not surprisingly, the staff wandering around seemed engaged and happy. They seemed to enjoy working there and no doubt this rubbed off on the residents.

We visited one of the affordable apartments. It was quite large for Europe and had universal design and smart wiring. Incidentally, the building is relatively new (built in 1992?) but it looks bloody awful like the Perth Hyatt. We've seen some stunning, modern design on our travels in Holland. But while most of those seemed sterile and cold, this place looked comfortable - the sort of place you can knock your drink over and it won't matter.

When we left the village square and visited the therapy rooms and the medical suites, it was like putting on your 3D glasses to view the weird and wonderful. It was a sort of menagerie of artefacts and peculiar murals so your mind would be on the stimulation and not on your ailments or your treatments while you sat around to wait or received your therapy.

Finally, we went down to the basement, which is like the size of a city block. This is where the drugs were really kicking in. This is like the greatest social history museum you have ever seen. You walk from room to room where a different aspect of life in Holland over the last 100 years in depicted in minute detail. There are thousands if not tens of thousands of everyday objects laid out there. It is mind-blowing.

Being a small group of very nosey people, we seem to be able to dig under the surface and find out what life is really like. Obviously, having a charismatic, outrageous, reckless leader like Hans Becker would be hard going for the other staff. People like that need the support of very stable and reliable people to focus on the detail and get the job done. They also need ambassadors and interpreters who smooth over relationships with those who are struggling to keep up in the wake of innovation and change.

Let's not kid ourselves - there's no way in the world that any of our organisations could replicate what is going on here. And in the Australian setting, we probably wouldn't want to. But what we can do is - stand up to the boring regulators, dare to be diferent, commit absolutely to a yes culture and the biggest impact of the whole thing for me - create environments for people that are really stimulating and interesting.

Humanitas is very good at marketing itself. They tell everyone how good they are - and they are!

Ray

ISHSUM

the International Social Housing summit

This event has an array of well-credentialled, international experts on panels. The speakers are very good.

It is UK dominated and mostly about generic social housing, but it is still relevant and provocative.

It's a bit like "welcome to our world" with the Europeans moving into an environment where they won't get government grants or massive rent assistance to underpin social housing.

It's clear that the equation is fairly simple here, that there are no magic bullets and that we are not incompetent.

The simple equation is that if people can't afford housing on the open market, then someone subsidises it. In the UK, it has been the welfare state and in our micro setting, it is our organisations that have provided that subsidy through making surpluses elsewhere. Our ability to do this has been severely compromised in recent years through inadequate funding of residential care and hey presto we are in trouble providing more "mission housing".

It's been useful to be part of a process of looking at how you can improve the equation. For example, through lower building costs and through mutual or maybe collective approaches to accessing funds at lower interest rates. I was rather interested in the Housing Finance Corporation in the UK and Glenn is dusting off his previous banking experience. Maybe ACSWA/ACSA could broker a collective debt proposition to lenders?

Learnt a great new acronym today. BANANAs. Build absolutely nothing anywhere near anyone.

Another theme crystallising in our minds is - avoid the system. Find your own way - avoid Departments of Housing, delicense residential care beds and find different ways of bringing them to market.

Saw Hans Becker, the former head of Humanitas yesterday. An eccentric to say the least and a total individualist - "I" did everything not "we". But, I love these outrageous characters and we have to give them credit for bucking the system and driving change. What he did reminds me of Nunzio Gumina breaking the mould and putting tables and chairs out on the footpath for the first time in once boring Freo. Hans has just retired and become the Chairman. Rest assured, or curse your bad luck - none of the three of us will be applying for the job of CEO at Humanitas with Hans still there as Chair. We are visiting Humanitas tomorrow as just a threesome and we are looking forward to this.

Hotel update - the lifts broke down this morning. Not a problem - only 8 floors. Last night, the waiter poured the entire bottle of wine into the first 3 glasses leaving none for the fourth person in our group. Basil F is alive and well in Den Haag.

Ray

Holland in a day

Well, we didn’t quite do that, but we covered a lot of territory, going from the Hague south to Rotterdam and then north to Groningen (near the border with Germany) and back to the Hague.

The experiences were breathtaking in terms of design, architecture and scale but the extent of the difference from our local setting left us wondering what we could learn and apply.

Oranjehof in Roterdam is the equivalent of a UK extra care facility (independent living, community facilities and services delivered to apartments from in-house). It had beautiful, minimalist design with very tasteful colour schemes. The sheer design brilliance had eradicated the dreaded instituionalising handrails form the apartment corridors and gave the effect of being in a hotel.

The apartments were unbelievable - huge and stunning with brilliant light streaming in. These were way out of the league of any social housing proposition in Australia.

The apartments and care facilities were separated into two wings with the restaurant and offices in the middle. Although this meant that the apartments were accessed through the "institutionalising" common entry, the design was so good here that the residents would merely feel they were entering a hotel lobby.

This structure was perfectly integrated into the surrounding built form so that its use was indistinguishable from surrounding apartment blocks. This was great, but really begged the question as to why you would want to group all of the older person's apartments into the one building rather than distribute them across the various local apartment blocks.

The next stop was de Plussenburgh, which I loved and was an architect's wet dream. It is a funky tower block for wealthy occupants and therefore had no real relevance for us. Some of the residents served us coffee in their amazing community room with the world's most colourful, yet tasteful, carpet. They looked happy living there and why not!

Finally, we travelled 5 hours round-trip to visit de Rokeade/Maartenshof in Groningen. This complex has a commercial tower block, a social housing wing, various levels of extra care and residential care, restaurant, fitness centre, child care centre - basically the lot. The funding and construction of the housing was the first example we've seen so far that was the same as our system. The extremely groovy tower block was built on land bought at commercial rates and built with no government subsidy. The apartments were then sold and the profits used to construct 51 social housing units on the same complex. Anyone can buy into this block although there is obviously more incentive for older people. There is a covered "secret passage" that takes you discretely from the partment block to the community centre/care complex. I don't know what to think of this. It means the apartment block residents never need to see the care facilities if they don't want to, but can access them direct and under cover if they do wish to. It makes sense but it somehow suggests that it is "shameful" to go to the community facilities.

The foyer area to the complex is like a larger than life architect's fantasy. It is decorated with huge signage letters, huge standard lamps and a library wall with a huge book motif. It really seems to work as it was the best used foyer and restaurant area we'd seen. We felt its design must have made the facility interesting and welcoming to younger members of the community and must compensate in their eyes for the fact that the space is dominated by old people, walking frames etc.

I asked the facility manager whether whether this wonderful design actually appealed to the generation of residents who had to use it. She was sympathetic to this question and responded that she was working on some plans to make the space warmer and more intimate for older people.

The care facilities were very spacious and beautifully appointed. The funding model must be very different! There are two staff for each cluster unit of 8 residents. The standard of care is fantastic with these ratios. The staff were cooking meals with the residents around the kitchen. Our inspectors would not let us do this due to our "duty of care" or "not to care" as it actually works out.

Thoughts from the day:

Excellent design can overcome barriers to providing a true sense of independent living co-located with care;

While there is a lot of money to throw at good design here, the build cost in Holland is dramatically cheaper than in Australia partly because new construction methods using concrete frames and panels keep the build cost low. It's clear that cheaper construction does not mean the buildings don't look good. Quite the reverse.

Dutch society is different from ours. The housing and care environments seem very sterile to us. People here lead a more ordered life with a lot less privacy. Furnishings and finishes are very minimalist, but to us come across as cold and unwelcoming

Another observation. Never critiicse the Perth Convention and Exhibition Centre again. OK, it looks terrible from the outside, but it's very good on the inside. The World Forum in the Hague is terrible on both counts and is like a morgue most of the time. It's nowhere near any shops or cafes and I want to go back to Amsterdam. No such luck, the World Conference has begun!


Ray

Holland

Amsterdam was fabulous. Cuter than our dog and much cuter than our kids. A wonderful combination of history and modern funkyness. A very liberal society too by the look of things.

Alas, we only had one night there before swapping the gentle elegance of Amsterdam for what looks like the suburban concrete of the Hague at the World Forum.

In Amsterdam, we noticed how dense the population was and how comfortable people seemed to be living virtually in other people's laps. In the pubs and cafes, out on the front steps of apartment buildings - every square inch of space is used and people live with each other in what looked like a very civilised way. We imagine this will be significant when we start looking at housing projects tomorrow.

It is literally and metaphorically a world away from Western Australia here.

On a culinary note, I recommend the soup here and Vaughan likes the Argentinian steaks. Glenn prefers the canal boat rides to everything.

From the big smoke

 

On Friday, we made our way back to London via Suffolk with our architect friends.I literally made my way back with them as I rightly saw that a trip down in the Audi would be a superior option to more knee crunching in the back of the people mover looking at the back of Glenn's head. 

First, we visited an extra care facility for people living with dementia in a village in Suffolk that had been designed by the architects. Then we had a look at a "scheme" (the word "project" has been abandoned some time over the last 30 years) the architects had designed and was nearly built in leafy Highgate in London. We finished off the day , spending time with a different firm of architects (PTE) in their wonderful converted factory looking out over the canal in the Angel Islington.

Rather than describe the actual visits, I think it would be better to expand on what was discussed at the two sessions. We spent most of the time at the extra care facility "grilling" the assistant manager and the designing architects over how "independent" the extra care facility really was. We were told that the facility should be read as an apartment block where there were communal areas and where services were provided to the flats. However, to all of us, the facility read as an institution almost identical to one of our own hostel facilities.

To be fair, the apartments were much more than our hostel rooms plus ensuite and, even though it was a dementia facility, the front door was not locked. It had been designed with security in mind, but the residents were free to "escape".

The debate developed by exploring the ultimate duty of care. In our system, we are unequivocally accountable for what happens to a resident. In the extra care system, the providers are theoretically not accountable in the same way. However, when we pressed the issue and asked how the local paper would view one of the residents being run over after wandering from the facility, it was clear that this would be an embarrassment for the home. The fact that social services departments take responsibility for vulnerable people in the UK further clouds the issue.

Our conclusion was that extra care homes are not designed, do not present themselves and are not in practice run as just apartment blocks with facilities and services, but we nonetheless believe that the model is a good one and needs to be explored to see whether it provides some options for what to do with our increasingly unpopular and unviable low care facilities.

Our discussions with PTE architects were interesting and wide-ranging. We found ourselves discussing whether shared housing wasn't the only way to solve the issue of providing age appropriate housing for poorer people. They pointed us to some European models, some of which we will see shortly in Holland.

We also discussed how greater flexibility could be built into housing design so that floor plans and functionality could be adapted to changing needs. The architects were very enthusiastic about a concrete framed tower block I think we're going to see where the floor plan is completely adaptable and each floor is laid out differently to every other.

All in all, a very interesting day. The architects enjoyed and valued the grilling we gave them (so they said!) and it was a day of lively discussion.

recurring themes:

how do you design to avoid institutionalisation of independent living units where care and facilities are also provided?

how does design serve both de-institutionalisation and community building when they can exert contradictory forces?

is shared housing an answer for people with limited means?; how could it be designed and delivered?; would it appeal?

how can we get the build cost down for housing for older people?

An interesting and exhausting week. Looking forward to a recovery day in London.

Ray

back down the M1

Yesterday was a less intensive day from a visits perspective, but we still managed to do a fair bit of driving. For some reason, we're trying to find places on google maps rather than with a GPS. The poms have always been intrepid explorers.

This was a fascinating day visiting what can only be described as a social experiment conducted by the Joseph Rowntree Trust at Hartrigg Oaks near York. Joseph Rowntree was a chocolate manufacturer and philanthropist extraordinaire. He established a company town because he wanted his workers to live in comfortable surroundings.

In more recent times, the Joseph Rowntree Trust has established next to the company town a retirement community of some 150 "bungalows" (villas in our terms), a well-appointed community centre including restaurant plus a 40 bed care facility.

There are a couple of really interesting things about this village.

From a design perspective, it is laid out like a garden suburb with extensive "greens" separating blocks and streets of houses and with generous gardens attached to the units.

From a social perspective, this village is run like a commune in that people pay a contribution towards care whether they need it at that point or not and, at such time as they do need it, they are entitled to care at the care home or up to 21 hours of in-home support. This scheme has been worked out on actuarial principles so that the overall contributions and expenses will balance out.

The costs to live at this development are steep given that the entry cost is higher than the median house price and the actuarially-based service charge is quite high.

The capital for the project was originally put up by the Trust as a loan to be paid back from profits.The properties are acquired on a "lease for life" basis with the ingoing price being returned to the estate and with no share of capital growth to be enjoyed. Since the village's inception, house prices in that part of England have appreciated considerably, giving the project a  windfall profit. Our impression was that this had cross-subsidised the care system, which we doubted could break even, actuaries or no actuaries.

This is a real community, albeit a well-to-do one. A lot of informal caring goes on there. The very significant achievement here is that the care facility is very under-utilised (not a problem in this system as it would be for us). This means that the village residents are very successfully cared for in their own units. The residents spoke of using the care facility for respite and rehab rather than as the end of life point of call.

Fascinating.

We drove back down to Newmarket, the home of racing, near Cambridge where we have spent the night in a converted mill with great design and pretentious food. We were joined for dinner by architects from PRP, the brand leader in UK architecture for the aged. We are visiting two of their facilities today and they will accompany us - a clever idea.

Got to go

Ray

heading North

Another tough day's travelling. I spent so many hours cramped in the back of the car next to Mr Harding that I had to coin the phrase "deep vaughan thrombosis". The distances may not be far in the UK by our standards but the traffic is unbelievable and you get stuck on the ring road of every town.

We started in the beautiful heritage city of Bath and then contrasted that with our first visit in the industrial North. We visited Heald Farm Court run by a major nfp called Helena Living. It was an extra care facility (independent living with in house support services) where some 90 units had been developed. It was architecturally beautiful with great outdoor courtyards. The units were OK by our standards. They had done a good job of balancing a sense of security for residents with welcoming in the outside community.

Once again, this development had been supported in the main part by government grants of various forms. They had a rent revenue of 180 pounds per unit versus our likely revenue of one hundred and forty pounds for a rental unit BUT they only have to service a small proportion of the capital cost.

They don't seem to be getting the design of extra care facilities right. The idea is that they are independent living with in-house support as opposed to our hostels which are supported living with some independence. These extra care facilities still seem institutional with some long corridors and prominent handrails and this undermines the proposition that this is really independent living.

I do like one design aspect that is emerging. In extra care facilities, some places put those with greater care needs closer to the hub and those with lower needs further away. This helps provide people with the balance between peace of mind and independence that they might like.

We then drove up to a slum area of Burnley, a very depressed town in Lancashire. We visited a 40 unit new sheltered housing development - that's independent living with support from a warden. In this case, it is a virtual warden who doesn't live on site.

This place is interesting because it is part of an urban renewal program where the classic rows of northern terraces are being demolished.

The design is modern and funky. The process of design was highly consultative and the outcome very reflective of prospective residents' wishes. Again, this development was supported by significant government grants. Following consultation with the intended users, a community room was not included but rather an inner courtyard area for each grouping of 4 flats. People wanted to socialise in small groups and not en masse.

Amusingly here, the Police security improvement unit had insisted that external railings be fitted. Before the railings were there they had no problems and then, once they were erected, the kids had a challenge and started jumping over them.

We finished off at the unbelievable historic city of York. I must have spent the first thirty years of my life in the UK with my eyes closed.

We were buggered by the time we got there and my knees would not bend back into the stright position.

Bye for now.

Ray

London and beyond

The front end of this tour has been intensive and not exactly helped by the tube strike in London.

On Monday, we met and discussed housing issues with James Berrington, Senior Policy Manager for the Government's Homes and Communities Agency. In addition, we visited two sites in London. An aged persons' housing project attached to a community centre in a poorer part of London and a boutique "sheltered housing" complex close to the City of London.

Today, we left London and visited a huge 332 unit housing and aged care services facility in Buckinghamshire, close to London and then the equivalent of one of our hostels in Bristol.

I think it's become apparent that you can't just look at social housing without looking at the total housing-care continuum and also that the care systems in the UK and Australia are radically different.

The UK is much further down the track of providing aged care services in the home or at least outside of what we call residential care and, very significantly, invests huge sums of money into funding the capital development of facilities and into providing the level of care people actually need. Perhaps this is why the country is in such trouble with its budget deficits and is about to engage in a serious austerity program.

In relation to the housing developments we've seen, it's significant that capital funding has been provided either by massive charitable trusts or by central or local government. This means that the housing operators don't have to recover the capital cost of building the apartments. In addition, the government provides people with minimal assets with significant housing assistance to pay their rent which has the effect of enabling them to pay a reasonable rent to housing providers.

I think the other significant difference we've noted is in the concept of sheltered housing. This form of independent living provides the support of a "warden" who lives on site to respond in an emergency and provide advice and support. It is apparent that in Australia we don't provide sufficient support to people living in retirement villages to provide peace of mind and to facilitate service delivery.

Finally, it is clear that aged care operators in Australia carry a much greater level of responsibility for their customers than they do in the UK. While we in Australia are the ultimate gatekeeper at least in relation to residential care and community care clients, in the UK the local authority plays that role and ultimately the buck stops with them rather than the aged care provider when problems arise and suitable care is not being provided to promote the customer's welfare.

So, it's all very interesting and we are getting a lot of value out of bouncing our reflections of each other. To some extent, it is quite validating in that we haven't yet found an organisation that has been able to provide a high standard of social housing relying on the limited capital and operating funding base that we have. But we'll keep looking.

I'm writing this in the "withdrawing room" at our little hotel in Bath. It was once the Duke of Wellington's residence so for me it is typecasting.

Ray

Starting touring

Have been catching up with some friends and family and enjoying more rain last night than we've had all winter. My nephew took me yesterday to a very trendy part of town (Shoreditch) that was the pits when I was growing up and I got an excellent dose of cafe and lunch society.

Preparing today for tomorrow's start to the Glenn-Ray-Vaughan world tour. Just to get us off on a good foot, there is tube strike tomorrow so I have no idea how we will get to the places we are visiting. But I fear not because Glenn and Vaughan are incredibly resourceful and so I will put my faith in them.

London

Back in the place of my birth. This long-haul flying caper is not as hard as it used to be. What's so bad about having people bring you food, serve you drinks and show you movies for 12 hours? The biggest improvement to travel these days is having your own entertainment system. Qantas was very good all round on this leg.

My friends picked me up at Heathrow and got lost on the way back into London! We ended up going the wrong way up the M1. If it had been a taxi, I definitely wouldn't have paid that bill.

London is wet and rather wintry. I'm not exactly staying in a touristy area (Cricklewood). Compared to pristine Perth, it is very rough and ready. Cricklewood doesn't exactly have the cafe society I'm used to. I went into a place called "Sandwiches Plus" for coffee and something to eat. I asked for a sandwich but they don't sell them!?

Time to get some sleep.
'

Singapore

There's a Qantas lounge at Changi airport. Very civilised. I realise that comments like the following from someone like me can make or break an airline, but here is my assessment of the Qantas flight to Singapore. Aircraft - A330, spacious, landed safely. Service - good. Food - OK. Movies, booze - good. Have been drinking a lot of water. Feeling pretty good so far. Once I get to London, I might feel differently.

Perth airport

Well, Vogon and everyone else.... I've now made it to Perth airport. I never I thought I would, what with work and Boards and a modest contribution to the family. I never would have made it without my PA, Jodie. At least that's what she tells me and she's probably right. My short-term goal is to survive the trip. My long-term goal as at the moment is to see if there is a way to develop low cost housing for older people in the current climate. Providers currently can really only afford to build lease-for-life housing for the middle income bracket and above. There must be a way.We must find it! Time for a Qantas glass of wine Ray

Vogon's post

I now consider myself completely blogged but feel safe travelling under the crafty disguise of Vogon!

Good luck

Have a great trip!
Pete

Almost on our way

There's a fair bit to do (!!) before I actually get on the plane, but having set up this blog, it feels like a start. Glenn and Vaughan, I'm looking forward to your first foray into blogland.