Care and Place (CAPE)

Many older people in England do not get the support they need for their long-term mental or physical ill health, cognitive problems or disabilities. There is variation in whether and how people receive the care they need, both between and within different geographical areas. In this study we will look at how local amenities and support (such as transport, local shops and voluntary sector organisations) help people to get the care they need, are a source of care and support, and/or reduce the need for care. We will also look at how these amenities could be improved and how there could be fairer access for all. 

Our previous research explored the relationship between housing and care. While doing that research we heard about the importance of the ‘local environment’ in addition to housing. Funding for such provision is often insecure. It is important that the impacts of these local amenities are understood so that they can be retained and/or improved where they are contributing to older people getting the care and support they need. 

• Aims (CAPE 2.0)

  In this new study we will explore, for people aged 65+: 

  • what inequalities in care use and unmet need exist, how this varies by local area, and how this has changed over time
  • what aspects of local areas are connected with older people’s care use or unmet need
  • what seems to account for local differences in who benefits, and how, from this local provision (who is excluded and why)
  • what scope is there for improving local provision and access

• Methods (CAPE 2.0)

  To address these issues we will use various sources of data including:

  • existing survey data from the English Longitudinal Study of Ageing (with more than 40 thousand respondents)
  • written-out transcripts of 72 interviews with older people with care needs or their carers (from our previous study).
  • 20 new interviews – either second interviews with people involved in the previous study so we can find out what has changed and the role of local amenities and organisations, or interviews with new people where we need a greater variety of experiences.
  • 20-25 interviews with Bangladeshi older people with care needs. This is to explore the experiences and perspectives of a particular population group who are less likely to use care services.

  We will use all these sources of information to explore how local support and amenities can help reduce inequalities in support for older people. 

   

  We will involve older people with care needs, carers and practitioners in planning how the findings can be put into practice, making sure we ask the right questions and t

• Planned outputs

  Outputs will be developed, designed, and produced by researchers and the public involvement and engagement groups, other older people’s groups, and practitioners.

  Informed by the findings and with public involvement, we will produce a range of outputs and activities aimed at different audiences, designed to be inclusive, and aligned with key planning, spending and strategy reviews locally and nationally.

  Outputs may include interim finding reports; feeding into reviews, guidance and/or legislative changes; policy and practice briefs; national and local organisations’ websites and newsletters; events in CAPE and CAPE 2.0 study sites and nationally; sharing of good practice; contributing to existing advisory and information materials and/or new guides; and journal papers. Easy read, multiple language, audio and visual versions of these outputs and activities will be produced where possible.

  Depending on the findings, we will also produce an output based on combined findings from CAPE and CAPE 2.0 to give a holistic picture of housing, the wider local environment, and care use.

Most older people wish to live in their own homes as they age and to have choice over their housing and care situation.

However, currently many older people’s own homes are not accessible (for example, people cannot move around them or use all the rooms easily or safely) or are in poor condition. This may affect whether, how soon and how quickly social care needs such as difficulties with mobility develop. Older people’s housing may also affect whether they can receive care at home, who they receive this care from, and how long they can live independently in the community. 

This study (CAPE 1.0) looked at non-specialist (mainstream) housing which is where most older people currently live. It explored the different characteristics of housing in combination, reflecting the ways in which people live in real life, including type of housing (e.g. flat or house), how many rooms and how many people live there, whether the home is rented or owned, and whether the home is in good condition. 

• Aims (CAPE 1.0)

  This study looked at how these housing characteristics are linked to people’s social care needs, use of care services, and care received from family and friends. It focused on people aged 50 and older in England.

  Five main questions were explored:

  • What are the links between housing characteristics and when and how quickly care needs develop?
  • What is the link between housing characteristics and people’s use of adult social care services and care from family and friends?
  • If some of these housing characteristics were to be changed, would this change the number of older people who have care needs and how much we need to spend on social care for them?
  • How do older people experience the links between housing characteristics and how their social care needs are met? What choices are available and how are these choices made?
  • How can improvements in adult social care and housing practice help older people to have more choice over their current and future housing and care situation?

  This project was also in receipt of further funding from NIHR SSCR. The main objective of this work was to understand the experiences of older persons with care needs from the Bangladeshi Sylheti community on: 1) the link between housing condition and characteristics and when and how care needs develop, as well as use of formal or informal care; and 2) choices and preferences with respect to housing including how decisions are made, barriers to this and what would help increase choice. 

• Methods (CAPE 1.0)

  To answer these questions, the study:

  • Held Theory of Change workshops and carried out interviews with stakeholders to develop the theory of change for the study, help set priorities, provide valuable early insights, identify sub-groups who may have different experiences, and foster early engagement with stakeholders;
  • Undertook secondary analyses of longitudinal data to investigate onset, level, and trajectories of (a) care needs as measured by functional capabilities (as defined by ability to perform activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs)); (b) care utilisation (formal/unpaid) over time, how trajectories of care needs and utilisation differ and their association with housing conditions; and (c) geographical and/or socio-economic inequalities in these patterns;
  • Built a ‘simulation model’ to estimate and project (i) the number of older people with care needs currently living in various specified housing conditions based on existing housing practice and policy (i.e. base case / no policy change scenario); and (ii) the number of older people with care needs if a range of social care and housing practice changes aimed at improving housing for older people (practice change scenarios) were implemented;
  • Carried out in-depth qualitative interviews with older people with care needs and unpaid carers about their experiences.

   

• Findings (CAPE 1.0)

  Care and Place Findings

  Key messages include:

  • In non-specialist housing occupied by older people, higher number of housing problems is associated with earlier age of onset of care needs, being more likely to have care needs, and a steeper increase in care needs over time.
  • Key housing problems associated with developing or worsening care needs are cold, damp and fuel poverty.
  • Other problems associated with care needs are disrepair and difficulties keeping the home clean and clutter-free, non-ideal space, access into and around the home, and housing tenure.
  • Housing improvement to remedy housing problems could reduce formal care costs by £1.1 billion a year by 2027 and unpaid care costs by £3.5 billion.
  • Housing problems increase care use overall mainly via increasing care need but for some people are a barrier to care use leading to unmet need for care.

   

• Resources and publications (CAPE 1.0)

  Link to the CAPE toolkit website

   

  Associated LSE blog 

  Cartagena Farias, J., Brimblecombe, N., & Hu, B. (2023). Early onset of care needs in the older population: The protective role of housing conditions. Health & place, 81, 103007. https://doi.org/10.1016/j.healthplace.2023.103007

  Hu, B., Cartagena-Farias, J. & Brimblecombe, N. (2022) Functional disability and utilisation of long-term care in the older population in England: a dual trajectory analysis. Eur J Ageing 19, pp. 1363–1373. https://doi.org/10.1007/s10433-022-00723-0

  Cartagena-Farias, J., Brimblecombe, N., Hu, B. et al. (2025) Long-term Care Needs and Fuel Poverty among Older People: Beyond Energy Consumption and Affordability. Soc Indic Res 179, 1221–1240. https://doi.org/10.1007/s11205-025-03653-3

  Hu B, Cartagena-Farias J, Brimblecombe N, Jadoolal S, Wittenberg R. (2024) Projected costs of informal care for older people in England. Eur J Health Econ, 25(6):1057-1070. doi: 10.1007/s10198-023-01643-1

  Brimblecombe, N., Stevens, M., Rajagopalan, J., Hu, B., Cartagena Farias, J., & Pharoah, D. (2024). What is the Relationship Between Older People’s Housing Characteristics and Their Care Needs? Journal of Aging & Social Policy, 1–18. https://doi.org/10.1080/08959420.2024.2422664

  Brimblecombe, N., Cartagena-Farias, J., Stevens, M., Rajagopalan, J., & Hu, B. (2025). Housing quality and suitability and older people’s use of formal and unpaid care. Housing Studies, 1–21. https://doi.org/10.1080/02673037.2025.2565233

  Hu, B., Brimblecombe, N., Cartagena-Farias, J. & Silva-Ribeiro, W. (2025) Projected costs of long-term care for older people in England: The impacts of housing quality improvements, Health Policy, 152. https://doi.org/10.1016/j.healthpol.2025.105246

  Hu, B., Brimblecombe, N. & Cartagena-Farias, J. (2025) Social Care Costs of Depressive Symptoms in the English Older Population: The Role of Housing Quality Improvements, Innovation in Aging, 9(4). https://doi.org/10.1093/geroni/igaf017