Older Social Housing Tenants’ Experiences of Rehousing Programs: A Systematic Scoping Review

Abstract This review examines the experiences of older social housing tenants who move home through rehousing schemes. These can be either elective, in the case of downsizing or rightsizing, or nonelective in the case of urban regeneration where, typically, houses are demolished and new ones built. Searches of both peer-reviewed and gray literature were carried out using appropriate databases. After screening, two peer-reviewed papers and eight gray literature reports were included in the review. Although limited, the evidence presented here provides some important guidance for providers of social housing. Organizations that provide social housing for older adults should involve older people in decision making in the conception, planning, and delivery of rehousing programs. Particular attention should be given to maintaining social connections in new homes and communities to avoid a serious loss of community involvement and the resulting increased levels of loneliness. The lack of published evidence highlighted by this review, particularly from academia, indicates that greater efforts from researchers and funders should be made to conduct studies that will give social housing providers the evidence they need to improve rehousing programs for older tenants.


Background
The world's population of over-65s in 2020 stands at 727 million.This is expected to more than double to 1.5 billion by 2050.This represents an increase from 9.3% to 16% of the world's population (United Nations Department of Economic & Social Affairs & Population Division, 2020).In the UK, the population is similarly aging.In 1999, around one in six people were 65 years and over (15.8%); this increased to one in every five people in 2019 (18.5%) and is projected to reach around one in every four people (23.9%) by 2039 (ONS, 2021).This changing demographic represents both a benefit and a challenge to society.Older people have accrued knowledge and skills over a lifetime that can benefit society (Carstensen et al., 2016), often act as unpaid caregivers (Kanji, 2018), and often have significant purchasing power with concomitant economic benefits to society (G€ otmark et al., 2018).By contrast, older people are more likely to experience more health problems, including multiple morbidities requiring more health and social care resources (Beard et al., 2016).
A key aspect to a healthy and fulfilling life is adequate housing.What makes for adequate housing changes as people age, and their needs and priorities change (Centre for Ageing Better, 2020).Internationally, there are cultural variations in housing for older people who often live with their adult children, for example, on university campuses in India (Bhattacharyya et al., 2020).Rehousing programs are an important means to support social housing tenants to move to a home that better meets these changing needs.In this article, social housing tenants are defined as tenants who rent their homes from a social housing provider-in the case of the UK, local government or not-for-profit housing associations.A distinction can be made between rehousing schemes designed to facilitate elective moves, where tenants opt to relocate, and nonelective moves, where tenants do not have a choice about relocating per se (although they may well be offered choices regarding the home they will move into).
Electives schemes might support downsizing or rightsizing, where tenants are seeking to move to properties whose size suits their requirements better.This is often presented as a positive option, providing older people with more suitable housing while freeing up larger homes for bigger households.Similarly, elective schemes might support older and perhaps retired adults to move from areas of high housing demand to areas with less pressure on housing.Despite being fundamentally about tenant choice, rehousing through elective schemes is a complex issue that can be limited by financial constraints and often the desire to stay in the familiar surroundings of one's home and neighborhood of many years (Burgess & Quinio, 2021).
Nonelective rehousing commonly occurs through regeneration schemes, which are designed to address issues around inadequate housing and urban decay.Houses, housing blocks, or entire estates and the surrounding area are either refurbished to a higher standard or completely demolished and replaced by new building projects.Neighborhoods are landscaped and efforts are made to bring in investment and local businesses.These are often combined public and private partnerships, and the new housing is usually a mix of private and social housing (Tyler et al., 2013).There is an expectation that regeneration brings about benefits to society through improved health and employment prospects, although the evidence for this is not clear cut (McCartney et al., 2017).Old homes being demolished to make way for new ones can be a source of disruption and distress for residents who may have lived in the area for many years and have built up a social and support network that includes friends and family (Gosling, 2008).
The purpose of this review is to examine the evidence around the healthrelated processes and outcomes linked to older social housing tenants moving home through rehousing schemes.It was carried out as part of a larger research project that examines different rehousing schemes for older social housing tenants in the London Borough of Hackney in England.

Methods
The review comprises evidence from peer-reviewed studies and gray literature reports that examine the experiences and attitudes of older social housing tenants who have moved their home as a result of a rehousing scheme, in either an elected or unelected move.Also included were consultation exercises where tenants may not yet have moved but where their opinions on designing rehousing programs were sought.
A structured PICO approach was used: population, interventions, comparators, and outcome.

Population
Studies with a focus on adults aged 55 years and above, living in social housing, were included in the review.Studies with mixed age groups where the older age group had been disaggregated for subgroup analyses, or where the sample comprised overwhelmingly older people were also included

Interventions
Any interventions where residents moved voluntarily or involuntarily through rehousing programs were considered for inclusion.

Comparators
The comparators for the interventions were absence of the intervention, however defined by studies under consideration for inclusion.Studies with no comparator group were also included.

Outcome
The outcomes were moving the home (including tenants who had moved or were considering a move) via rehousing schemes by social housing providers.
Search strategy for peer-reviewed studies Systematic searches of bibliographic databases, namely, MEDLINE, EMBASE, Scopus, CINAHL, and PsychINFO, were conducted using predefined keywords (Table 1).
Potentially relevant academic studies from the searches were entered into an Endnote database and duplicates were removed.Two reviewers (CM, LB) systematically filtered the titles and abstracts of the saved references according to the inclusion criteria.These were social housing tenants, aged 55 plus, English language, and interventions where residents were rehoused through rehousing programs.
Papers selected for full text review were appraised independently by two reviewers (CM, LB), any discrepancies were resolved through discussion with a third reviewer (SB).
Papers were appraised for quality using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research (Lockwood et al., 2015).There were no quantitative peer-reviewed papers included in the review.
Search strategy for gray literature reports Gray literature was searched using Google and the Web pages of relevant organizations (Table 2).The focus was on identifying reports, primarily produced by local government or not-for-profit organizations.Two Google searches, each with a different filter, were conducted in order to more precisely target relevant reports.The first filter limited results to only sites that ended in .gov.uk (site: .gov.uk "downsizing or regeneration or rehousing and ageing") and pdf files only (filetype: .pdf"downsizing or regeneration or rehousing and ageing").Searches were limited to the first 100 results.One researcher (CM) conducted the initial searches and compiled a database of the resulting promising reports.Two researchers (CM, LB) then screened the reports independently, and any discrepancies were resolved through discussion with a third reviewer (SB).In addition, the webpages of relevant organizations, such as Housing LIN, NHS Evidence, and Open Grey, were also searched using the same search terms (Table 2).

Data extraction and evidence synthesis
Data from each study were extracted using a pro forma based on the Prisma 2009 checklist (see Tables 3 and 4).Due to the small number of included studies, each one was summarized individually.
Information extracted included: 1. Contextual information about the study (author, year of publication, location and setting for the research), the primary aim of the study, and a brief description of the methods).2. Details about the rehousing intervention.3. Details about the population studied.4. Main results (narrative summary).

Peer-reviewed literature
In total, 5,215 potentially relevant references were identified through initial searches of the bibliographic databases (Figure 1).After removal of duplicates, filtering on titles (removal of n ¼ 4,303) and on abstracts, and full The study found that in determining the selfperceived success of relocation the quality of the post-relocation housing was the most important factor.The three most important things in determining a good outcome for tenants reflect characteristics of the location, housing, social networks and contacts, and, for a small number of respondents, lack of choice.
The characteristics of the house were important in just under half of all nominated elements (higher than anticipated); the importance of social networks and contacts was lower than the literature would predict.
The short relocation distances associated with The Parks regeneration project reflect, in part, tenant preferences.However, very few households received housing in their suburb of first choice.Despite this, the relatively short relocation distances seem to have allowed many existing important social contacts to have been maintained.
(continued) review (removal of n ¼ 44), two papers were selected for inclusion in the review.Reasons for rejection of studies based on filtering (titles, abstract and full review) included, for example, studies not including older people or not including social housing tenants.

Gray literature
The initial search of gray literature on Google and individual databases (Table 2) returned 221 potentially relevant references.Filtering on titles (removal of n ¼ 198) and on abstracts and full review (removal of n ¼ 15), eight papers were selected for inclusion in the review.Reasons for rejection were similar to that of the peer-reviewed papers.Table 3 summarizes each included paper from the peer-reviewed literature, while Table 4 summarizes the gray literature reports.

Quality appraisal of literature
Both peer-reviewed papers were of generally good quality, according to the Joanna Briggs Society checklist (Lockwood et al., 2015).See Appendix for more detail.
Gray literature was appraised using the ACCODS checklist, which comprises six domains: Authority, Accuracy, Coverage, Objectivity, Date, and Significance.Each domain is scored as either Yes or No, where one point is given for Yes and zero points for No. Therefore, the maximum score is six (high quality), and the minimum is zero (low quality) (Tyndall, 2010).Table 5 contains the results of the quality appraisal.

Discussion
This review found only two peer-reviewed studies that examined the experiences of older social housing tenants who had moved their home through regeneration schemes and none who moved through downsizing schemes.

Peer-reviewed literature
The two peer-reviewed studies concerned regeneration and interviewed tenants before and after a move, and tenants who had moved and those who had not.Morris (2017) interviewed tenants who were yet to move and tenants who had moved and reported that tenants were deeply affected by both the announcement of the regeneration and subsequent requirement to move.There was a profound sense of regret at the loss of what was perceived by tenants before and after the move as a close-knit and supportive community, and this tended to be more pronounced in the older residents Although some areas had undergone regeneration, the primary aim was not to assess how well people's moves had gone.
Regeneration projects across the UK.
Interviews were with people who had and had not moved through regeneration but there was no way of easily distinguishing between these.
While common themes emerged from the work, the interpretation of those themes, together with specific priorities, often differed across the neighborhoods, revealing the relationship between aging and the urban environment to be nuanced and complex.Understanding these experiences is important to developing interventions and solutions at national, city, and community levels.
Age UK (p.18) UK Retired people (no age range given) Downsizing to retirement homes.
The report is designed to encourage wider policy engagement with older residents on the management and future delivery of sheltered and retirement housing in England.

Downsizing-retirement housing
The inquiry shows the complexity of the retirement housing sector and the difficulty of suggesting changes that benefit both existing and future residents.Despite this, throughout the inquiry, we have highlighted many common themes and principles that deserve further consideration.
Who should have access to sheltered and retirement housing?
How can we guarantee the delivery of affordable and integrated housing support?
What can we do to promote "transparency" in the sector, both before and after moving into a scheme?
How can we protect the rights of isolated and vulnerable older residents and prevent them from being exploited?
If housing advice is so important to (continued) When asked what were the best features of the properties, the answers given were "the amount of natural light and accessibility around the home," "the look of the property from the outside," "the way the patio doors open onto the back garden," "the properties are spacious, light, and in an excellent location."Newcastle City Council: feedback from qualitative research with residents and their families has been very positive, specifically: Tenants welcomed living in an environment designed to ensure they are able to live safely and securely; they can live more independently and avoid a "crisis" move into institutional care; quality of life had improved in terms of being more able to pursue interests and activities and combatting social isolation.(Morris, 2017).Baker & Arthurson (2007) interviewed tenants before and after relocation and reported that what determined good outcomes for tenants were characteristics of the location, the housing itself, and maintaining social networks and contacts.It was also reported that the importance of characteristics of the new housing was higher than anticipated, while the importance of social networks was lower than anticipated (Baker & Arthurson, 2007).Neither paper discussed the process of moving in detail and what support was offered to residents, so it is difficult to make firm conclusions about what processes and program designs work for older tenants moving through regeneration schemes.However, it is clear that the disruption of social networks is a major source of stress for residents, which needs to be considered by local authorities and housing associations who are involved in the noelective relocation of tenants.

Gray literature
The searches of the gray literature found a small number of reports, divided equally between downsizing and regeneration.These reports were produced by either local authorities or third sector organizations.The quality of the reports was varied although, in general, it was of moderate to good quality.The reports also demonstrated heterogeneity in research questions, methodology, and reporting of outcomes, and in some cases the research questions were not explicit.The research methods varied and often lacked detail.Similarly, the level of detail and depth of discussion of outcomes also varied.Some of the reports were based on consultation exercises with older participants who might not have moved via a rehousing program, where the exercises were designed to shape guidelines and policy recommendations (Age UK, 2012;Kavanagh et al., 2020;Riseborough & Jenkins, 2004;Titherington & Turner, 2021), rather than interviews with older people who had moved (Copeman & Porteus, 2017;Lawson & Kearns, 2017;Waters & Massey, 2017).Although this makes synthesizing the findings of the reports difficult, some general themes are apparent.Some residents who had moved through regeneration reported feeling a sense of pride in their new homes, particularly in comparison to their old homes.This facilitated some changes in health behaviors and outcomes, such as eating family meals together and stopping smoking indoors, and even reducing overall levels of smoking (Lawson & Kearns, 2017).By contrast, other residents, particularly those with health issues, reported feelings of isolation and loneliness after moving and this had the added effect of further reducing their desire to go outdoors (Lawson & Kearns, 2017).Another report indicates that the design of housing for older people may be important in helping to successfully combat feelings of isolation and loneliness when moving to new housing (Waters & Massey, 2017).A number of the reports of consultation exercises emphasized the complex nature of urban regeneration (Woolrych et al., 2019) and the advantages of working with older people, and related the successes where partnerships between older people, local authorities, and regeneration partnerships had been established.There was, however, concern that older people were not being consulted on decisions relating to the local economy or larger infrastructure and transport projects (Riseborough & Jenkins, 2004).These reports suggest that the key to successful regeneration projects for older people must include consultation throughout the whole process in conjunction with careful thought being given to the design of housing, neighborhoods, and any plans for economic regeneration.
The reports on downsizing represent a series of consultation exercises and interviews intended to inform local authorities and housing associations on how design, access to housing, and protecting the rights of vulnerable older people could all help in tenants' decision-making process when considering a downsizing move (Age UK, 2012).Working in partnerships to help people cope with the inherent complexity in decision making was considered key.Local aspirations, making use of existing housing stock, and community involvement are some of the important factors in designing downsizing projects (Titherington & Turner, 2021).Finally, specific features of the houses and local environment, such as a spare bedroom for visiting family, the aesthetics of the home, manageable gardens, and the fact that "rightsizing" needs to be an aspirational move for older people to consider such a move, were important (Copeman & Porteus, 2017).

Conclusions
The lack of literature in this area demonstrates a gap in the knowledge around the rehousing experiences of older people living in social housing.Much of the gray literature, while of good quality, was written with the aims of the report's authors in mind and, as such, could often be narrow in their examination of the issues affecting older people.The potential learning from the experiences of older people who undergo such moves in later life is vital in providing social housing providers with the information to better shape their house moving programs in order to optimize the experiences of older residents.Given the impact of housing on health, further and scientifically robust studies that examine the effects of rehousing on the mental and physical health and well-being of older people, and on how well the process of moving works, are urgently needed.It is therefore recommended that greater efforts should be made by the academic community and funders to conduct and support research into the experiences of older social housing tenants in order to better characterize their needs and preferences, motivations for moving, experiences of the process of moving, and health outcomes.By understanding these, local authorities and housing associations will be able to implement policies and programs that will give older tenants the confidence and support to consider moving to a home that better suits their needs and that will give support for tenants in nonelective moves.This will help foster improved health outcomes to allow them to remain independent in their own homes for longer (Oldman, 2014).

Disclosure statement
No potential conflict of interest was reported by the author(s).

Reviewer
CM, Date 5th November 2021 Author Morris et al., Year 2007 the research ethical according to current criteria or, for recent studies, is there evidence of ethical approval by an appropriate body?Overall appraisal: Include x Exclude w Seek further info Comments (Including reason for exclusion) JBI critical appraisal checklist for qualitative research Reviewer CM, Date 6th November 2021 Author Baker et al., Year 2007 the influence of the researcher on the research, and vice versa, addressed?the research ethical according to current criteria or, for recent studies, is there evidence of ethical approval by an appropriate body?Overall appraisal: Include X Exclude w Seek further info w Comments (Including reason for exclusion)

Table 1 .
Keywords used in search strategy of bibliographic databases.

Table 2 .
Results of specific organizations searched for gray literature reports.

Table 3 .
Summary of peer-reviewed literature.

Table 4 .
Summary of gray literature.

Table 5 .
Flowchart outlining the filtering of peer-reviewed and gray literature.AACODS score for gray literature.