An ancient key to longevity

Their research concludes that a housing model, which could be readily replicated and provides the epitome of a great place to live, gives a “longevity boost” of as much as five years on average.

The Almshouse Longevity report was published this week it shows that the average almshouse resident lives longer than citizens of the same age, gender and socio-economic group in the general population. This is especially significant because it suggests investment in almshouses would help reduce health inequality in older people.

Almshouses are not exactly a recent innovation.

The almshouse model was pioneered in York, during the reign of King Athelstan 924 to 939, who is remembered as the King who created England. The oldest still operational is believed to be the Hospital of St Oswald in Worcester which was founded around 990.  

There are just two surviving in what is now Northern Ireland: the Seaforde Almshouses, Co Down restored in 1980 and  Gills Almshouses, Carrickfergus, Co Antrim.

The idea behind them was to provide, warmth, safety and sanctuary to those in need. And the community spirit they embody is reflected in their architectural design, which often involve a three-sided quadrangle with doors and windows facing each other across a courtyard of communal area, thus promoting a sense of community whilst allowing independence.

Nick Phillips, chief executive of the Almshouse Association said: “This latest research builds on past research pointing, perhaps, to the great value of companionship and strong micro-communities that this unique housing model embodies. I would like to suggest that, if we were to design a housing model which is the epitome of a good living environment today, it would include companionship, community and independent living in almshouses which are designed to underpin these values.” 

The research was commissioned after a 2017 study which of almshouse residents in a development called Whiteley Village in Surrey.  It was carried out in response to astonishing anecdotal evidence that residents there lived longer than expected.

Whitely was established in 1914 and is a charity which provides accommodation for older people on low income. To qualify to live there people must have a defined housing need such as being at risk of being made homeless, an income no greater than £16,000 a year and a maximum of £50,000 assets per couple.

The research confirmed the anecdotes. Despite poorer people generally having lower life expectancy than the general population, Whiteley residents could expect a “longevity boost” of five years.

This is significant. The gap in life expectancy between the most and least deprived areas of England has significantly widened in recent years for both sexes. For males it increased from 9.0 years in 2011 to 2013 to 9.4 years in 2017 to 2019. For females during this period, the gap increased from 6.9 to 7.6 years.

Not surprisingly, the results attracted a large amount of interest from researchers, practitioners, retirement communities and media outlets around the world.

A follow-up study was commissioned to see if the findings can be extended across the almshouse movement more generally and it is this that was published this week.

The conclusion is that they can.

Research involved reviewing decades and in some cases a century’s worth of data and work was enormously complicated  by the fact that almshouses are separate entities and with criteria for residents varying. For example organisations studied include the Durham Aged Mineworkers Homes Association (whose members as implied by the title include former miners) the Royal Chelsea Hospital (set up for war veterans) and Morden College which is primarily for former business leaders/managers who have fallen on hard times.

Further research will be required to establish exactly why almshouses boost longevity, but it seems safe to conclude that it is connected to the levels of companionship on offer.

The findings are especially significant because to date there has been very little research on the benefits of living in retirement communities or villages, social support housing or any other types of community living.

The health impacts of loneliness however, are well known. It is a major contributor to lower life expectancy. Furthermore  older adults from disadvantaged backgrounds tend to be in a spiral whereby declining health means they are less able to take part in  physical and social activity, which increases their loneliness.

Almshouses are run by charities and are the oldest form of social housing. Historically they were affiliated with churches and some continue with this tradition, many have chapels in the grounds. According to the latest statistics there are 36,000  living in 2,600 almshouses in the UK.

Although eligibility criteria vary from almshouse to almshouse, the common criteria include being in need, be it financial, psychological or emotional.  Typically residents will have little to no savings, limited financial means, in need of housing yet able to live independently or with minimal support whilst being in good health.

They are not considered tenants and they do not pay rent. Instead, they are required to contribute a weekly maintenance contribution. Most of these are covered by full or partial housing benefit for residents who are retired or the housing element of Universal Credit for residents under retirement age.

In return events and activities are organized for them and by themselves. Examples would be coffee mornings, lunches, celebrations, day trips, excursions, film and book clubs, gardening, fitness classes, bingo and sporting activities.

Many premises have wardens and/or medical support.

The companionship and professional support means reduced delays in hospital discharges for almshouse residents because the necessary support can be put in place as soon as a patient is ready to go home.

As well as providing a longevity boost, an additional benefit of an almshouse community is that it helps to reduce delays in hospital discharges for almshouse residents (Housing LIN, 2021). This is because an almshouse can provide the necessary support to enable a hospitalised resident to be discharged as soon as they are physically ready.

Almshouses may not be for everyone – in order to get a boost from them you would have to enjoy social interaction and not everybody does.

With that caveat these findings are important and policy-makers should be considering how best this ancient model of social care could be revived and invested in for the future.

Sometimes the solutions to problems we have been wrestling with for decades have been staring us in the face all along.