Covid-19: Effect on Retirement Communities

Clive Efford Excerpts

Thursday 1st July 2021 Westminster Hall

[Clive Efford (in the Chair)]

I am sure that Members are acquainted with the new arrangements, and as we are a small group, I will not read out the whole script that I have here to make you aware of the new arrangements. I will just say this. Those participating virtually must keep their camera on throughout the debate and be present; unfortunately, you are unable to intervene virtually. If Members participating virtually have any technical problems, they should please email westminsterhallclerks@ parliament.uk. Could Members participating physically please clean their spaces at the end of the debate? Mr Speaker has also indicated that people should wear masks at all times during the debate.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the effect of the covid-19 outbreak on the retirement community housing sector.

It is an absolute pleasure to lead the debate. I asked for it some time ago, and it came through my constituents. Indeed, everything that I say in this House comes through my constituents. That is how we formulate our thoughts when pursuing legislative change and articulating, in Westminster Hall or in the main Chamber, what the issues are. Over the last year, the covid-19 pandemic has been incredibly difficult, particularly for those in retirement communities and residential homes.

I am very pleased to see the Minister in her place—I look forward to her response—and to see a former Secretary of State for Northern Ireland, the right hon. Member for Staffordshire Moorlands (Karen Bradley), too. We were just talking about languages and accents beforehand, so I hope that I do not talk too fast when expressing myself here in Westminster Hall. I am really pleased to see the shadow Minister, the hon. Member for Leicester West (Liz Kendall). She and I have many things in common. One of those is Leicester City football club; we both support Leicester City. When I saw her coming through the door, I said to myself, “I must make a comment about that,” so I will just put it on the record that we have had a good season and we certainly hope that the next one will be equally good.

The reason why we are here today is to talk about the effect of the covid-19 outbreak on retirement communities. I was reading the background information that the House of Commons Library very kindly always puts together. It refers to it as an “Overview of Retirement Communities”. I want to make these comments early on, because the Minister is not responsible for the issues covered by these comments; she is not responsible for housing, for instance. But according to the Associated Retirement Community Operators, there are currently some 70,000 housing-with-care units in the UK. The sector is an emerging one and currently much smaller than the traditional retirement housing sector, which has 440,000 units. The briefing says:

“There is an uneven distribution across market segments, with 66% of UK Retirement Community properties available for affordable…rent.”

The point that I want to make on that is that there are many people in the retirement community who do great work, but there is a lot more that we need to be doing in partnership with those outside the sector as well.

As I said, the last year has been incredibly difficult. It is nobody’s fault. Government responded as circumstances unfolded, and Ministers found themselves having to respond to things that they had never had to deal with in their lives before. The same applied to residential homes and retirement communities. Quite simply, we were not ever in a place to be able to do very much. There was not an experience and there were not other things—examples—that people could refer to.

In a constituency context, there were issues for staff working in residential homes and retirement communities. There were issues to do with families visiting and access to—I will refer to these things later—personal protective equipment material. Early on, I had dealings with staff who worked through the process without PPE material and protection. And sometimes, early on, people were not quite sure what it all really meant. I pay tribute to the people who worked in residential homes and retirement communities, because they put their commitment to the safety of the residents in the homes above their own health.

The covid-19 pandemic has had enormous effects on the everyday lives of almost all individuals since the early days of 2020. Widespread lockdowns and what can only be described as unnatural and oppressive restrictions meant that people became isolated, and even now some remain in that category. The measures affected the world’s economy and limited our access to our families and friends, and especially our access to physical and mental health treatment from our doctors. Life was just completely different from what we were used to. Although the measures may have been necessary to minimise the spread of covid-19, the negative physical, psychological and social effects were evident right through that 15-month period and even today.

As a society, we had to learn to work, socialise and study in a new way by using technology that many of us—and I use myself as the supreme example—were not familiar with. I love meeting people in person, as we all do. There is nothing that elected representatives like more than meeting people, shaking hands and saying hello to them over a cup of coffee, but we could not do that. Meeting people in person suddenly became meeting people on a screen—on a Zoom call, a virtual call, at a distance. There is something—I say this very respectfully—impersonal about that. We did not have the close contact that we had every other day.

That way of carrying out day-to-day activities in the workplace is still in operation. It has become an important way of life, but it is not really what we want. I certainly do not want to do it all the time, and I hope we can come out of it, perhaps in September—we will see how things go. I respect that some welcome that and prefer it, but personally I long for a return to the old-fashioned way of meeting people in person and shaking their hand, or giving people I have not seen in a long time a hug. Those are the things that mean much more to me.

Our elderly population, however, which has been the worst affected by both the virus and the lockdown measures, has seen the fewest benefits from the shift towards these new digital solutions that, in a short time, have become the new way of doing things. Zoom and Skype do not and never will replace that all-important hug from a wife, husband, son, daughter or friend. How much we miss those things. We have all read of elderly couples—indeed, there is not one of us here who could not give an example of this—who have been married for decades, and were separated physically because one was kept, and I say this gently, locked inside a care home for endless months, and the other could do little other than wave at them through a window, unable to touch them and provide that vital human touch and physical affection that we as humans simply need to thrive. Is it any wonder that some of those people suffered emotionally, psychologically and ultimately physically? Some of those people probably died of a broken heart—that is a fact. I believe that nothing beats being able to speak and be up close.

From early in the pandemic, studies warned us about an increase in anxiety and depression and how that would affect general society, our youth and our children—especially the clinically vulnerable who were facing extended lockdowns. Every time we thought we were getting rid of it, we suddenly found we were back in it again. I give credit to the Government and the Ministers for all they have done in responding. The vaccine roll-out has been incredibly reassuring and has given us some confidence, but we do not really know what the winter will bring. Even now, we face a slightly uncertain future.

The effects, however, are increased significantly in the elderly population because of the stricter lockdowns, the higher threat of illness to them and their loss of social support. Social support is very important to elderly people, and one thing this pandemic has done is raise awareness of those who are isolated in normal circumstances. I am very fortunate to live on a farm, so I was able to go for a walk every night when I was at home and we were not coming here, but what about people stuck in a small flat or a small home, perhaps without a dog or a cat, who just saw through the window the person who left the stuff at the front door, knocked once, told them it was there and got off site?

I have seen wonderful work by many people in my own constituency who organised food parcels and delivered them to the elderly and vulnerable who could not leave their homes. I was greatly encouraged. It might be my nature, but I always see the positives of things. I see the positives of the good things that people did; I do not dwell on the negatives, which sometimes can distort what has happened.

My office issued several hundred food bank vouchers between April and December 2020. I and my staff on occasion collected bags of groceries from the food bank and delivered them to constituents who were self-isolating because of covid-19 or living alone and without transport. We phoned them up before we arrived, we got out of the car and left the stuff at the front door, got into the car, made sure they collected it, and then we went. Life was very different.

A group of motorcyclists in Northern Ireland formed the Volunteer Bikers Group and organised collection and deliveries of prescription medicines, which was very important for those people who could not leave their homes. That organisation was active in my constituency and across the whole of Northern Ireland. I met the guys at the shop one day—I was in the shop and one of the boys came over and spoke to me and told me what he was doing. I said, “You don’t mind if we contact you about this?” He said, “Please do, and make it known widely.” We did that. These were volunteers. More often than not they were ex-police or ex-Army, or individuals who had a deep interest in helping—“We’ve got a bike; we can do those deliveries.” They did that and they did it well.

It was not only prescription medicines, but necessities to the elderly and vulnerable. How active church groups were, too—every one of them. People who cooked, baked scones and pastries, and delivered them. Our local council, Ards and North Down Borough Council, was incredibly helpful and active in responding with food parcels. People swept into action during those difficult days and did what they saw as their civic duty. I pay tribute to them. The goodness of people always come to the fore—the positive actions of people shone through. I believe in a practical method of help and assistance, and that is what I was impressed by. There are a lot of good people out there and they want to help, and they do and they did.

The covid-19 pandemic had a huge negative impact on nursing homes and retirement communities with massive outbreaks being reported in care facilities all over the world, affecting not only residents but care workers and visitors. Many people living in retirement communities and independent living facilities were at risk from the virus because it was established that risk increases with age and underlying health conditions, such as heart disease, diabetes or lung disease.

Many of those in residential or retirement homes have complex health issues—it is the nature of life, when we get older. Most people do not have just one issue, but a number. Speaking personally, it is not just my type 2 diabetes—it is also my blood pressure. I am not quite sure what all the tablets are for, but they are probably all related to diabetes. People have complex health conditions.

There was also the higher risk of catching and spreading the virus because of the characteristics of retirement community living, such as daily social activities—which were curtailed—common dining facilities and other communal spaces, community activities and shared transportation. We have a saying back home—I am sure you and others will know it, Mr Efford—that they live cheek by jowl, which they do in residential homes and retirement homes. They live close together, and this virus made that no longer possible.

The more people a resident or worker interacts with and the longer that interaction is, the higher the risk of viral spread. Studies drawn from the United Kingdom of Great Britain and Northern Ireland and around the world in the past year have shown how the pandemic impacted on retirement communities and, even more significantly, how vulnerable they were to this kind of natural disaster. It is nobody’s fault, and we responded to it in the way that we thought was best, but we learned more and responded more. I ask the Minister whether it is possible to fund research on how we can make retirement villages and extra care homes more effectively pandemic-ready.

There is clearly a shortage of specialist housing for older people. Again, this is not the Minister’s responsibility but that of her colleague. However, the Library briefing outlined three things needed for specialist housing for older people: sector-specific legislation, which we need to see in place; clarity in the planning system, because it is not about building houses all over the place but about having the right kind of housing in the planning system; and funding options for affordable housing-with-care provision. We need to get those things right, and there is a reason for doing so. It is quite simple: the UK’s population is ageing, and people are living longer.

In March 2021, a broad coalition of older people’s representatives, policy makers, the private sector and civil society leaders wrote an open letter to the Prime Minister, calling for an increase in the supply of housing-with-care options in the UK. It has been fortunate that a number of people are doing that, and I believe that the Minister for Housing will respond. The questions asked by various Members from the Labour, Conservative and Scottish National parties indicate that there is clearly an issue for us to resolve.

The retirement community market has been steadily growing and is driven by the increase in life expectancy and an older age group who enjoy better health and financial security than previous generations did. As a result, people in that demographic remain active and able to engage in a social lifestyle for much longer. In approximately two weeks’ time, on 14 July, my mother will be 90 years old. I am very fortunate that she is able to tell me every day that I have to listen to her and cannot disobey her. No matter what your age may be, your mum is still your mum, and when she tells you what to do, you jump into line. I say that gently, because my mother is fresh in mind and body. She still drives her car and is very active. My mother is of that generation. My father died six years ago, but my mother is an example of someone who is very active and who does not let her age get in the way. She bakes for everybody in the wee group of houses that she lives in. She visits her friends and is very active socially as well.

Whereas the spread of covid-19 in institutional care home settings was more devastating, retirement communities tended to be safer environments during lockdown, because they offered the ability for residents to self-isolate in their own homes. That was the difference from a residential home, where people were sharing with everyone else. That is where the problems were. Although someone in a retirement community or retirement home was mostly on their own, they were able to self-isolate and had access to a network of support, supervision and social interaction, which was not possible in other domestic or care settings.

The challenges for those living in retirement communities during the pandemic were real, and they provide evidence for how we must prepare for similar events in the future in order to protect such communities. Age UK’s research among older people shows that depression, loss of hope, low mood, lack of support for meal preparation, deteriorating physical health and, in some cases, increased pain due to untreated health conditions—as we get older, our bodies break down—reflect an issue that we cannot ignore.

We are looking for a response from the Minister about the lessons learned and how we respond in the future. I put that forward in a constructive, positive fashion, because I believe that we all must work together and support the Government as we try to get a strategy and policy that will make the situation better next time around. If the pundits are right, we will have more pandemics in the future, and we have to be able to respond and learn from where we are.

Six months into the pandemic, Age UK conducted a poll among over-70s that found that one in three felt less motivated to do the things that they enjoyed. Two in three felt less confident taking public transport and two in five felt less confident going to the shops. For many, that wee trip to the shops is a daily outing to speak to someone and see a friendly face. One in four felt less confident spending time with their family. That is not because people did not want to spend time with their families but because they were not sure whether it was the right thing to do health-wise. Families felt the same.

The dreadful pandemic happened at a time when our ageing population is growing. Retirement communities became in many ways isolated communities, but in seeking ways to mitigate risks in future pandemic scenarios, retirement villages show that they can provide a safer and controlled environment for the elderly. That probably needs to be better worded: “provide a safer and controlled environment” almost sends the wrong message. I say this gently, but it almost sounds like, “Let’s move them into their own ghettos.” I am very conscious that words need to be picked carefully, and the word “control” niggles me a bit.

Food and necessities can be delivered to residents, thus minimising contact. The flow of people in and out of those facilities can be reasonably controlled and exposure to a dangerous contagion thereby greatly reduced. There are ways of doing it. That is why the opportunity to have retirement communities is so important.

However, the risks of having large groups of elderly and possibly unwell people living in close proximity are evident, and it is important to consider now how we can better mitigate them for the future. In Canada, research showed that retirement homes in Ontario impacted by the pandemic were those with more residents—the more residents in the homes, the greater the possibility of being struck down with covid-19—those connected to a nursing home, and those owned by large corporations or offering many on-site services. The study found that retirement homes with more than 100 residents had a more than fivefold increase in the risk of outbreak.

Retirement communities in the United Kingdom of Great Britain and Northern Ireland can include public housing for low to moderate-income older adults, assisted living homes that do not provide medical services and extra care retirement communities, which have a variety of housing options, including independent living. The residents in those communities depend on social engagement and community and personal activities for their continuing health and mental wellbeing. Those areas of their lives were impacted negatively by covid-19 because social activities were stopped, creating social isolation, communal areas were closed and visits were restricted or completely stopped. That restriction on interaction with other people has been difficult to comprehend.

In England alone, some 75,000 people live in retirement villages and extra care housing schemes, and it is important to understand how their lives were affected. In January 2021, a national survey, the RE-COV research project, was launched, led by the St Monica Trust. The aim of the project was to better understand the experiences of retirement communities and the extra care housing sector during the pandemic, including the effectiveness of measures taken to protect the health and wellbeing of residents and staff. I wonder whether the Department has had an opportunity to see that research. I do not think we should ignore stats—they give the data, which help us to forecast a strategy and a way to do better. Has that happened?

Those findings were delivered in April 2021 and this valuable project has, to a great extent, informed us how the retirement village and extra care housing sector responded to the task of managing the protection of the lives of many extremely vulnerable older residents during lockdown. We have learned that operators acted to lock down swiftly before 23 March, residents were asked to remain on site, and spaces and facilities were redesigned where services and communal areas had to be closed down because strict action was needed. Weekly food boxes were delivered to residents and residents were helped with gaining access to digital technology, which changed how social activities and social contact took place. That is critical. Many people in those homes do not have access to modern, digital technology or, like me, do not have an ability with that technology. I am fortunate that I have a number of staff who are all very good at that. Indeed, I have grandchildren who can do it, although their grandad struggles with it.

The pressures on the operators of retirement communities were enormous. The research tells us that lack of access to PPE for staff and the task of identifying those who needed to shield, had increased vulnerabilities and lacked an effective support network were issues that had to be addressed in a fast-moving situation. That is what the Government were doing as well. The Government and Ministers were reacting to an unfolding situation, and trying to learn and do their best. The job of the Opposition is to challenge the Government, so that the Government can learn, but the Government were also on a learning curve as to how to deal with the situation.

Maintaining morale among staff and residents was also a huge task, not to mention maintaining staff. Some staff were falling sick with covid-19 and finding themselves unable to attend work. The mental pressure was incredible. I pay tribute to the staff and operators of retirement communities. Some of them put their commitment to residents above their own personal health.

I am not sure if other hon. Members have noticed when they walk along the Embankment and over Westminster Bridge, towards the Park Plaza hotel, that there are a lot of red hearts on a wall that represent the people who have died due to covid-19 in the past 15 or 16 months. Some of those are staff, so I am ever mindful of their sacrifices. Fewer village and scheme residents died from confirmed covid-19 than expected, some 0.97% compared to 1.09% in the same age-profile people in the general population of England.

It was a massive undertaking and, what is more, the survey tells us that the residents benefited from their communities and from the special support and care provided by the villages and schemes. However, it is clear that their job could have been made easier. Guidelines changed from week to week and access to testing for staff was not quick enough, and perhaps could have been done better. This debate is meant to be positive and not meant to be critical, but the Government must do some self-reflection and consider how better our leadership through this pandemic could have been. We are all leaders in the community, we have a job to do and we have to set an example. We should be able to look back and learn from the covid-19 pandemic, to improve and do better. I hope that is something that we can all do.

There is no doubt that the covid-19 pandemic has changed our society. Looking at how retirement communities have come through the crisis, there is no doubt that the landscape for retirement communities has been redrawn. Covid-19 has done that. We must now look to the future because future pandemics are a matter of when, not if. What steps will the Minister take to fund later-living accommodation so that it will be secure and residents will be safe? I know that accommodation is not the Minister’s responsibility, but how can the Minister and my Government respond in a way that means they can help with those things?

The most important thing for administrators of retirement communities and independent living facilities to do now is plan and prepare. If there were a headline for this debate it would be “Plan and prepare for the future.” I know that the Minister will respond very positively to that. No matter the level of transmission in a community, every retirement community and independent living facility should have a plan in place to protect residents, workers, volunteers and visitors from a future pandemic. This should be done in collaboration with local public health departments, local regulatory agencies and other stakeholders. We must focus on the components of the plans that address infectious disease outbreaks.

I want to ask the Minister about the direction of the strategy and the response that came from Westminster to all of us in the regions we represent, in my case Northern Ireland, but Scotland and Wales were the same. What discussions has the Minister had with the devolved Administrations to ensure that the Scottish Parliament and the Welsh and Northern Ireland Assemblies have learnt the lessons regionally? We have all learnt lessons regionally that we can share with each other. That is the wonderful thing about debates here. If all the four regions of the United Kingdom of Great Britain and Northern Ireland come here, we all share our input in the debates and we all have a perspective on something that we have learnt. It is good to be able to learn things and take them back home. It is important that we can improve things across the United Kingdom of Great Britain and Northern Ireland.

I will close by suggesting that the impact of covid-19 on retirement communities will be that it will shape how we live later in life—not because I am getting closer to that later in life category, but because it is important in the role that we play here to prepare for the future. More of us are ageing, so more and better models of care will need to be put into place. I probably look back more than others, and I wonder where the past 30 years of my life went. They went so quickly. Now that we have all experienced and have a much better understanding of social isolation, important conversations will need to take place to find ways to support and promote the benefits of living in retirement community settings and how they can be made pandemic-ready for the future. We can then use those to improve care home settings, because that is where the scale of the pandemic was felt the most, and that is why this debate is so important.

--- Later in debate ---

[Helen Whately]

I thank the hon. Member for his point. I completely agree. I will come to that, if he will just bear with me. I will continue, but I will pick up on exactly that.

As a Government, we know that we need to review housing holistically, looking at existing stock, which is clearly the vast majority of the housing in the country, as well as new builds, and looking at the wide range of housing options that we want to be available to meet all the health and care needs of our population—the growing number of people who are living longer and what that means for us. Whether people are living with or without home care support, it is important that we remember that not everyone will want or be able to stay in their current, lifelong home. That means that we need to think very broadly about having the right specialist housing options, including those with extra levels of care and support.

In England, both my Department and the Ministry of Housing, Communities and Local Government provide capital grant subsidy to assist with delivery of specialist and supported housing for older and other more vulnerable people with care and support needs. Speaking for my own Department, we provide funding to build specialised housing, through the care and support specialised housing fund, for older people and adults with learning and physical disabilities and mental ill health, and £71 million has been provided for that fund in 2021-22. Furthermore, 10% of delivery under MHCLG’s £11.5 billion affordable homes programme will be used to increase the supply of much-needed specialist and supported housing for a range of people with care needs, including older people.

That is what we are doing now, but I think that we are in agreement in this debate that we need to do more and we need to increase the supply of retirement housing and extra care housing and have a broad range of the kind of housing that helps people to live with their own front door—in their own home—for longer. Therefore I am working with MHCLG Ministers, and my officials are working with those officials, on how we can best achieve that. We are working across Government and also working with stakeholders, with the sector, on how we can achieve it. We are indeed considering the proposal for a taskforce, which was referred to by my right hon. Friend the Member for Staffordshire Moorlands. Yes, the partnership approach is absolutely one on the table.

I will come to a conclusion, but I want to say that one highlight of this debate for me has been hearing about the mother of the hon. Member for Strangford. It is a highlight because it is a reminder to all of us that this is about people. It is about real people and about their homes, which matter so much. I have been to brilliant homes; I have been to wonderful specialist retirement communities. I have been to housing and care settings and everything in-between. We need a mix of provision, and we need that mix so that individuals like the hon. Member’s mother, family members of all of us, whether it is grans, grandads, mothers, fathers, brothers or sisters, and, in due course, we ourselves have the homes that we need where we can live the best possible life and live our life to the full for as long as we can.

[Clive Efford (in the Chair)]

We have until a quarter to 5, but this will be a summing-up, not another speech—[Laughter.] I just point that out gently. I call Jim Shannon.