The extent to which non-conditional housing programs improve housing and well-being outcomes: a systematic review

Purpose To reduce rates of homelessness, recent efforts have been directed toward developing non-conditional supported housing programs that prioritize the delivery of housing support and individual services, without tenancy conditions (i.e. maintaining sobriety and adhering to mental health treatment). As promising as these programs are, findings generally show that while housing stability is improved, other individual outcomes remain largely unchanged. No review to date has synthesized the collective evidence base of non-conditional housing programs, rather the focus has been on specific programs of delivery (e.g. Housing First) or on specific population groups (e.g. those with mental illness). The purpose of this paper is to evaluate the extent to which non-conditional housing interventions improve housing and well-being outcomes for all persons. Design/methodology/approach A systematic search of the literature was conducted for randomized controlled studies that evaluated the effectiveness of a non-conditional housing intervention in improving housing and health outcomes among any participant group. Findings A total of 31 studies were included in this review. Non-conditional supported housing programs were found to be most effective in improving housing stability as compared to health and well-being outcomes. Policymakers should consider this when developing non-conditional supported housing programs and ensure that housing and other health-related outcomes are also mutually supported. Originality/value This is the first review, to the authors’ knowledge, to synthesize the collective impact of all non-conditional supported housing programs. The current findings may inform the (re)design and implementation of supported housing models to prioritize the health and well-being of residents.

Affordable housing in urban India: a review of critical success factors (CSFs) addressing housing adequacy with affordability for the urban poor

Purpose This paper aims to focus on the housing situation in Indian cities and the various stakeholders involved in the housing sector. This study addresses the conflict in expectations of the supply and demand side of the housing and establishes the factors crucial to making housing successful for all the stakeholders, essential for sustainable urban development. Design/methodology/approach This paper is developed using the content analysis of preceding independent reviews on housing sustainability by authors across the globe, a review of the current housing situation in Indian cities and a Pilot study of the desired qualitative aspects of housing by the consumer group. Findings This paper identifies the challenges and constraints of the various stakeholders involved in the housing sector. A comprehensive list of all the parameters, both qualitative and quantitative, essential for successful housing implementation, focused on the preferences of the demand side, also referred to as the “Critical Success Factors (CSFs)” is generated. The results advocate a strict consideration and integration of these CSFs with the housing policies for all future housing projects. Research limitations/implications Most of the studies conducted in the past have reviewed the housing situation in India from the perspective of the government authorities and the initiatives undertaken by them to improve the housing crisis. However, a gap exists in achieving a balanced understanding of the supply-side constraints, with the demand-side expectations from the housing. Focusing only on the supply without adequately understanding the consumption can only lead to further chaos in the already turbulent housing situation. Originality/value To the best of author’s knowledge, this is among the first attempts to address the housing scenario in urban centers of India, simultaneously from the perspective of both the demand side and the supply side of the housing, giving additional impetus to the expectations of the demand side which are often ignored. This study becomes more relevant in the ongoing pandemic situation to be able to provide appropriate and acceptable housing solutions to all.

The effect of cognitive functioning and affects on the loneliness of elderly people

Purpose The purpose of this study is to verify the effect of general cognitive functioning and positive and negative affects on loneliness in the elderly people and to analyze the mediating effect of positive affects on the relationship between negative affects and loneliness. Design/methodology/approach The sample of this study consists of 61 people with an average age of 83 years who receive specialized institutional support. Study participants answered a set of questionnaires in which their sociodemographic characteristics, characteristics of the support received, cognitive functioning, positive and negative affects and loneliness were assessed. Findings Cognitive functioning did not reveal a significant relationship with loneliness. On the other hand, there was a positive and significant relationship between negative affects and loneliness and a significant marginal relationship between positive affects and loneliness. Negative affects proved to be predictors of loneliness, and there was an influence of positive affects by mediating the relationship between negative affects and loneliness. Originality/value This study showed that negative affects are risk factors for the appearance of loneliness in the elderly people who receive specialized institutional support and should be considered in intervention programs that aim to reduce loneliness and social isolation of the elderly people.

The impact of COVID-19 on research within the homeless services sector

Purpose This paper aims to discuss the challenges of conducting research with homelessness services frontline workers during the COVID-19 pandemic. Design/methodology/approach Between 2015 and 2019, the research team surveyed frontline staff in three cities about their psychosocial stressors and needs. In 2020, the authors replicated the previous study and expanded data collection to seven cities across Canada to determine the extent to which the COVID-19 pandemic impacted the well-being of frontline staff. This report describes how the authors adapted the research methodologies to continue work throughout the pandemic, despite various restrictions. Findings The original studies had very high participation rates because of several methodological approaches that minimized barriers, especially in-person data collection. During the pandemic, distancing requirements precluded replication of these same methods. Research strategies that enabled staff participation during working hours, with designated time allotted for participation, was key for ensuring high participation rates, as access to technology, availability of free time and other factors frequently make online survey research a hardship for these staff. Restrictive interpretation and regional variations of COVID-19 guidelines by some research ethics boards were also a challenge to rapid and responsive data collection. Originality/value Few studies describe the experiences of frontline workers in the homelessness sector, and quantitative reports of their experiences are particularly scant. Consequently, little is known about specific methodologies that facilitate large-scale data collection in the homelessness services sector. The present research advances the field by providing lessons learned about best practice approaches in pre and post COVID-19 front line worker contexts. A strength of this research is the well-controlled design. The authors collected data within several of the organizations that had previously participated. This fortunate baseline provided opportunity for comparison before and during the pandemic; the authors can highlight factors that might have had influence during the pandemic.

Evidence assessment and narrative synthesis of the key characteristics of older people living in service-integrated housing facilities, and their ‘accommodation journey’

Purpose This paper aims to provide an evidence assessment and narrative synthesis of literature regarding the key characteristics of older people living in service-integrated housing (SIH) facilities and their “accommodation journey”. Design/methodology/approach A rapid evidence assessment was conducted: 22 research publications met the inclusion criteria and were analysed using narrative synthesis. Findings The quality of studies in this area is low, but consistency across components of the results of studies included in the review is apparent. Results suggest key characteristics of older people that drive moves into SIH are a decline in health, increased dependency, increased health service use and carer burden. Suggested key characteristics of SIH residents are high levels of health problems, dependency and health service use, but high self-reported health and well-being. Results indicate that the key driver for older people leaving SIH is a lack of workforce competency to manage further declines in health and dependency status. Research limitations/implications Current policy may not realise or account for the complex health and care needs of SIH residents. Investment into integrated care, robust community health services and workforce development to facilitate a comprehensive assessment approach may be required to support residents to remain in SIH and live well. Further longitudinal studies are required to map the progression of SIH residents’ health status in detail over time to provide an understanding of preventative and enablement support, development of care pathways and workforce planning and development requirements. Originality/value This evidence assessment is the first to consider the accommodation journey of older people residing in SIH.

The promises and the reality of smart, digital telecare in England

Purpose This paper asks how the introduction of “smart” digital technologies might affect the goals that can be attributed to telecare for older people, by those coordinating its provision. Design/methodology/approach A total of 29 in-depth, qualitative interviews were conducted with local authorities, housing associations and other organisations coordinating smart telecare provision, as well as telecare manufacturers and suppliers. Interviews were analysed by using qualitative thematic analysis. Findings The analysis reveals discrepancies between the goals and outcomes of smart telecare provision, according to those coordinating service delivery. This study concludes that the goal for smart telecare to be preventative and cost-efficient may be complicated by various organisational and operational challenges associated with coordinating provision. Originality/value New, “smart” telecare technology for older people stands apart from earlier, user-activated or automatic devices. It may have distinct and under-researched organisational and ethical implications.

Meeting the private sector housing condition and adaptation needs of older people: responses from London’s environmental health and allied services

Purpose This study aims to explore the environmental health role in meeting the housing condition, adaptation and associated needs of older people living in private sector housing in London, including those living with and at risk of dementia. Design/methodology/approach A multi-method approach was adopted. First, relevant public-facing websites in London were scrutinised. Second, a Qualtrics online survey was designed and circulated to capture relevant information around relevant services offered. Third, seven face-to-face interviews were conducted with front-line practitioners involved in providing housing services to private sector owners and tenants. These were transcribed verbatim and analysed using NVivo software before categorising into themes arising. Findings An erratic picture emerged around the meaning of “older people” and the services offered. A mixture of organisational arrangements and types of assistance available was reported, with different ways of access and referral to services, with a range of discretionary grants offered including for dementia. Some local authorities offered minimal specialist services, with others providing highly integrated and client-led, flexible interventions to meet a range of needs. Limited inclusion of research, evidence and evaluation of the effectiveness of interventions was reported overall, although client feedback was noted as good where services were provided. Originality/value There is very little published around environmental health work in supporting older people living in London and their housing, health and social care needs. This paper captures a snapshot of current and proposed services offered across London for owner-occupiers and private sector tenants, as a basis for further research for evidence-based, effective front-line services going forward.

Pandemic preparedness and response in service hub cities: lessons from Northwestern Ontario

Purpose Responding to the needs of homeless and marginally housed persons has been a major component of the Canadian federal and provincial responses to the COVID-19 pandemic. However, smaller, less-resourced cities and rural regions have been left competing for limited resources (Schiff et al., 2020). The purpose of this paper is to use a case study to examine and highlight information about the capacities and needs of service hub cities during pandemics. Design/methodology/approach The authors draw on the experience of Thunder Bay – a small city in Northern Ontario, Canada which experienced a serious outbreak of COVID-19 amongst homeless persons and shelter staff in the community. The authors catalogued the series of events leading to this outbreak through information tracked by two of the authors who hold key funding and planning positions within the Thunder Bay homeless sector. Findings Several lessons may be useful for other cities nationally and internationally of similar size, geography and socio-economic position. The authors suggest a need for increased supports to the homeless sector in small service–hub cities (and particularly those with large Indigenous populations) to aid in the creation of pandemic plans and more broadly to ending chronic homelessness in those regions. Originality/value Small hub cities such as Thunder Bay serve vast rural areas and may have high rates of homelessness. This case study points to some important factors for consideration related to pandemic planning in these contexts.

The impact of a refurbishment programme on older people living in sheltered housing

Purpose This paper aims to explore residents' perceptions of a refurbishment programme to sheltered housing schemes and its impact on their well-being. Design/methodology/approach The methodology draws upon a realist evaluation framework. Four participatory appraisals (PAs) and 19 interviews with residents were conducted in the sheltered housing schemes. Ages of participants ranged from 50 to 99 years. Findings Two categories of residents were identified: healthy active older adults and older frail adults (or over 85+). Residents said their social and emotional well-being improved from the provision of indoor and outdoor communal areas. Older frail residents only accessed the new communal spaces when staff took them in their wheelchairs. The physical changes increased opportunities for social connections for residents. Conservatories and sensory gardens were most popular. Residents felt that structured activities in the new spaces and digital training would improve their social activities. Research limitations/implications The participatory methods spanned over an hour, and some residents felt too tired to complete the full session. Practical implications A practical limitation was that some sensory rooms were not fully completed at the time of the evaluation. Originality/value This paper adds the following: Perceptions of residents of a refurbishment programme in sheltered housing and the impact on their well-being. Perceptions of residents about social activities after a refurbishment programme. Perceptions of residents about the impact of physical changes to their sheltered housing schemes and impact on their internal accessibility to the improvements.