INMUNOHISTOFLUORESCENCIA

The UK government acknowledged the need for special housing for the elderly in 1909 following the ―Royal Commission on the Poor Law‖ (Butler et al., 1983). The term ―sheltered housing‖ is linked to an account in 1944 where it was suggested that appropriate dwellings for elderly people should be sited within easy reach of churches and shops (Ministry of Health, 1944). The development of sheltered housing in the United Kingdom is linked to the Almshouses of the Middle Ages in the form of individual apartments with very small rooms, provision of cooking and washing facilities and the presence of a warden (Butler et al., 1983; Torrington, 2002). During the 1950s and 1960s, the earliest models of sheltered housing were developed with the aim of providing an appropriate dwelling for elderly people following post-war reconstruction when emphasis was placed on family housing (Greve et al., 1981; Butler et al., 1983). Sheltered housing has been available in the UK for well over 50 years. The provision of sheltered housing for the elderly was further acknowledge as a result of Townsend‘s publication of ―The Last Refuge (1962)‖, with its derogatory living standards in homes for elderly people. He wanted an alternative to residential care which often demeaned and

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where, sometimes, physical and mental abuse were meted out to elderly people who lived in residential accommodation (Butler et al., 1979). Townsend view sheltered housing a place where elderly people can live independently and receive some support if needed. In some sense, sheltered housing was being advocated because it was an alternative to the inadequacy and inhumanity of residential care homes (Nocon and Pleace, 1999). It was viewed as a less expensive option for many elderly people who do not require the level of support and care provided in nursing homes and residential care (Heywood et al., 2002).

In the 1970s, sheltered housing became more popular as a result of residential care being undesirable and expensive and; moreover a good number of elderly people who uses it, do not actually require it, as they do not want to move into a home (Neill and Plank, 1977). During the same period, the government encouraged the development of sheltered housing and many local authorities and housing associations built several more sheltered housing. The policy at that period was based on a perceived continuum of care, whereby elderly people can live in their own home and receive little support if needed; move into sheltered housing if they were frail or vulnerable; and only be admitted to residential care if they needed intensive support. The number of sheltered housing units in the UK increase by 69% from 1979 to 1989 (Peace and Holland, 2001) and it was estimated that over half a million elderly people lived in sheltered housing, which was approximately 5% of the UK‘s elderly population (Appleton and Porteus, 2003; Heywood et al., 2002). Table 2.2 provides the list of sheltered housing providers in the UK. The majority of sheltered housing is provided by local authorities (56%), non-profit making housing associations (31%) and the private sector providing (13%). These organisations aim to offer housing to elderly people with housing needs, at rents which are affordable (Housing care organisation, 2004; Appleton and Porteus, 2003).

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Table 2 2: Sheltered Housing Providers in the UK

Organisation Provision Percentage

Local Council Sheltered Housing

This is provided by the local council and it is only available to rent and there is no ‗right to buy‘.

56%

Housing Association Property

This is a non-profit making organisation which manages and provides homes for individuals who cannot afford to buy a suitable home on the open market. A housing association may be a registered trade, provident society or a charity

31%

Private Sheltered Housing

This is sheltered housing that is available to buy and has been built by private companies or developers who are registered with the National House-Building Council (NHBC). Once all the houses or flats have been sold, the scheme is usually run by a separate management organisation rather than directly by the developer.

13%

Source: (Age Concern, 2005)

Since its origin in the 1950s until the early 1980s, sheltered housing was generally perceived as a moderately inexpensive type of housing choice for elderly people. Consequently, the demand for sheltered housing was high during the 1970s, and awareness focused on ensuring that a diversity of types of sheltered housing was provided to reflect the differing needs of elderly people (Heumann, 1981). Sheltered housing remained popular with elderly people, until the late 1980s and 1990s when academic and policy opinion turned against sheltered housing, and many criticisms were raised in both academic studies and official reports (Heywood et al., 2002). There were concerns that it was both expensive, stigmatising and failed to meet the needs of the elderly as they became more physically frail or developed dementia (Oldman and Quilgars, 1999; Phillips and Williams, 2001; Johnson et al., 2010). The high demand for sheltered housing experienced during the 1970s and 1980s decreased in the 1990s and there was a dramatic fall in the number of sheltered housing dwellings constructed during the 1990s (Heywood et al., 2002; Appleton and Porteus, 2003). Also, sheltered housing stock in the UK is fairly dated, has inadequate

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space standards and designs that do not easily accommodate people with physical disabilities, and unattractive small bedsits with shared facilities (Croucher et al., 2006). Furthermore, the lack of lifts, accommodation that is in an inconvenient and undesirable location; far from other accessible services (shops and transports), has made some sheltered housing less appealing to prospective residents who are considering sheltered housing at a later life-stage when compared to earlier in the decades (Appleton and Porteus, 2003). However, in spite of these inadequacies and criticisms, sheltered housing remains a desirable housing choice for some elderly people. The main attraction of sheltered housing for many elderly people appears to be the supportive environment, monitoring and service coordination provided by wardens and floating support workers, the provision of repairs and maintenance services, a sense of security and reduction in social isolation (Nocon and Pleace, 1999; Jones et al., 2010). In spite of these benefits some authors have proposed that there is need for attention to be given to the purpose and specific role of a sheltered housing, as there are varieties of scheme offering different support and services. Whilst sheltered housing may appeal to elderly people looking for some form of companionship and minimum support; others may need the warden and floating support services for personal support, regular contact and the coordination of services. For both groups, sheltered housing schemes can represent a positive housing choice in later life (Nocon and Pleace, 1999; Heywood et al., 2002). Sheltered housing continues to play an important part in housing provision and is the most common form of specialised housing for elderly people. Although many sheltered housing providers are reviewing their stock, sheltered housing is seen as promoting independence, offers full accessibility and, as far as possible, provides a home for life for residents. There continues to be mixed messages regarding its suitability and popularity; however, there is no doubt that this form of housing plays a crucial role in providing support for elderly people.

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