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It's half past nine in the morning, and a crowd of German tourists has come to look at Elsie Avery's home in Canterbury. She is 88, a retired Margate patisserie worker, and the reason 30 Dusseldorf schoolteachers are taking photographs of her front door is that she lives at St John's Hospital Almshouses - built in 1084 to provide housing for the elderly, and still fulfilling that function some nine centuries later. 

Like all the other 33 residents at St John's, Elsie has her own key to her own flat, looking out over a courtyard that is altogether more Oxbridge than OAP. From one window, she can see the spires of Canterbury cathedral; from the other, the lopsided Tudor gatehouse - through which she pops to the shops - and the Norman refectory and 11th-century privy. 

She appreciates the photogenic surroundings, but what she really likes about living at St John's is that it allows her to retain her independence, while at the same time feel part of a community. "I've got my own place, my own things - and plenty of company if I want it", she says. "The great thing is, though, there's no one telling me what to do." 

Such enthusiasm is increasingly echoed elsewhere. Almshouses are far from a thing of the past: the number of places they offer is rising by 5-10% a year. "The majority of almshouse charities in this country are in a state of expansion or refurbishment," says Anthony Leask, assistant director of the Almshouse Association. "We expect to see that increase continuing, given that the number of pensioners will go up by 50% over the next 30 years." 
The word "independence" keeps coming up among residents. Elsie Avery and seven fellow residents are at the weekly coffee morning not because they have been herded into the common room, but because they have chosen to come. They're not big on organised activities here. 
"We made a conscious decision not to put a television in the common room," says St John's bursar, Richard Akister, a former bank manager. "People have TV sets in their own flat. We are very much not a nursing home, and very much not the kind of place where people are wheeled in front of the box and left there all day." 

The kind of place it is, though, is a peculiar mixture of modern commercial concern and medieval charity. St John's brings in £50,000 a year from renting out the dozen shops that line the almshouse frontage, in the city's busy Northgate. It also gets interest on money that has been invested for five centuries; it even gets £13.33 annually from Henry II, who granted it 25 groats a year in perpetuity as a kind of royal community service following his part in the Thomas à Becket murder in 1170. 

The upshot of all this is that, like the other 1,750 almshouses in Britain, St John's offers residents private sheltered accommodation at a distinctly subsidised rate. The weekly rent of £46.50 (£72.50 for the more modern flats) is less than half of what people would pay on the open market. And if they were to try to buy a leasehold flat in a sheltered scheme, it would cost £50,000-£90,000 plus up to £5,000 a year in service charges. 

For their rent, the residents of St John's get to live in an environment which is not only safe, friendly and picture-postcard pretty, but also has a care manager (to help liaise with health and social services departments) and a gate leading straight into Sainsbury's. In fact, the St John's trustees helped fund a new £1m residential wing by selling some of the back garden to the supermarket. 

There are three main qualifications for residence: you must be over 65, have some link with Canterbury (work or family) and be unable to afford proper housing. A church connection can come in handy. Resident Anne Green, 89, was the warden of a clergy house throughout her working life, while Pat and Joyce Barry, both 85 and the scheme's only married couple, ran a diocesan retreat. 

Indeed, there is a well-attended medieval chapel at St John's - as at its fellow almshouse, St Nicholas, in nearby Harbledown, which was set up in the 12th century as a hilltop community for lepers. Its church was built with a sloping floor to aid sluicing and disinfecting following a service. 

In 1276, there were as many as 100 lepers living at St Nicholas, known then as the Hospital of the Wood of Blean. But as leprosy began to die out towards the end of the 14th century, the community admitted those whose afflictions were limited to old age and poverty. Today, St Nicholas has just 14 residents, who look out over rolling Kent countryside. The ancient church bell summons them the 50 yards to services. "You don't have to be a Christian to live at either St John's or St Nicholas," says Akister. "But you do need to feel comfortable in a group of people who are." 

You don't need to be female, either, but women outnumber men by three to one - a figure mirrored throughout the estimated 40,000 almshouse population in the UK. 

One notable exception is Sutton's Hospital (with the medieval connotation of hospitality rather than illness), in London's Charterhouse Square. All 40 of its residents - or "brothers", as they are called - are men, aged between 60 and 96. They pay £130 a week for their own Tudor bedsit, meals and laundry included. 

The almshouse is less than 100 yards from the plush Barbican estate and Smithfield meat market, but it is set in beautiful, cloistered surroundings. It is funded by the bequest of Elizabethan industrialist Thomas Sutton, who made a fortune from coal mining and money lending. Before his death in 1611, he arranged that all his worldly wealth should be used to set up a school for bright young boys (Charterhouse, now in Godalming, Surrey) and an almshouse for needy old gentlemen. Among the first to take up residence was George Fenner, one of Francis Drake's sea captains. 

Such was the extent of Sutton's wealth that, for four centuries, the trustees have been able to run the almshouse on the interest earned. Likewise, St John's in Canterbury has made good use of the lands and property it was given by its founder, Archbishop Lanfranc, in the 11th century. It also did well in the 20th century, when it sold off 75 acres for the University of Kent to be built on. 

Because of their private incomes, many almshouses do not qualify for public sector money unless they can show they are doing work for which the state might otherwise pay. An example was when Trinity Hospital almshouse, in Salisbury, built a new development for frailer residents (designated "very sheltered" accommodation) and got half the £1.1m cost from the district council and the housing corporation. 

The guiding principle at Trinity is that residents should remain under the charity's umbrella until they die. The same applies at Sutton's Hospital, where 24-hour nursing care is provided for those brothers who can no longer look after themselves. At St John's, however, as at many other almshouses, there is no such option. 

"We have just built a new wing to house those residents who are finding their old flats hard to cope with," says bursar Akister. "The older properties are so narrow it's impossible to get a Zimmer frame round the corner, and extremely difficult to fit two people into the bathroom at the same time - which makes it hard for care assistants to give residents a bath. 
"But we make it clear to everyone who comes here that we are not a hospital or a nursing home, and that when they can no longer look after themselves they will have to leave." 

Opinion at the coffee morning is that totally care-dependent residents would compromise the principle of independent living. "This is a lovely place, just as it is", says one woman. "We all just hope we'll go before we have to leave - if you see what I mean." 

Age-old help 

The first recorded almshouse was set up in 937, by King Athelstan, at York. Today, 1,750 almshouse charities operate in the UK, some with just three cottages, others with as many as 1,000 properties. Altogether, they provide about 30,000 homes, mostly flats or one-storey houses. 
While many of the early ones were set up by the Church, after the 16th century city livery companies, mayors and landowners stepped in. In the 19th century, industrialists also did their bit.