Small But Significant

Whatever our age, keeping on top of home repairs and maintenance is never ending.

For the ‘busy and better off’ we see an emerging service sector linked to the tech industry that will sort out just about any aspect of your home, from just finding plumbers to also being there to let them in when you are out at work and cleaning up afterwards.

If you are living alone, ‘just about managing’ on a low income, and no longer able to do small jobs yourself because you are older and less mobile, home repairs can become a major source of worry and anxiety.

This is why, for more than three decades, Care & Repair England has pioneered and promoted the critical role of affordable, trustworthy handyperson services as a key element in enabling lower income home owners to live safely and well at home as they age.

Local services that receive local authority support continue to decline in the face of the reducing council funds, and anything that seems to be a ‘useful to have’ rather than a mandatory duty is first in the firing line.

Unfortunately, the demise of prevention really is storing up problems for the future, and the inevitable consequence will be more and more crises, with NHS services in the front line.

This is why the focus for our recent national event was Small but Significant – Innovation, Impact and Evidence: Practical housing interventions to improve older people’s health and wellbeing

With the support of the British Society of Gerontology (BSG) and the University of Manchester’s Institute for Collaborative Research on Ageing (MICRA), this national conference examined the cutting edge practice, evidence and related policy in relation to increasing safe independence at home for older people through practical housing interventions, such as handyperson services.

We heard how handyperson services are being linked in with ambulance service responses, to hospital discharge systems and pro-active home safety interventions.

What is striking in all of the cutting edge practice is its fragility. It is based on small scale, fixed term pilots, short term contracts, stop-start funding, with constant uncertainty for providers and practitioners.

A coherent new national initiative is urgently needed that will once and for all firmly embed handyperson services into preventative, integrated health, care & housing systems.

After all, Small Things [really do] Matter

[August 2017]

Integration Inaction

The gap between day to day reality compared with Law and Guidance is nowhere more stark than in relation to the Care Act 2016.

This well received legislation and the associated Guidance was significantly influenced by practitioners working across the social care, health and even housing sectors. Wellbeing was defined to include considerations of housing, prevention was high on the agenda, as was more integrated working.

What do we see happening to care in reality, from our particular housing perspective which concerns older people living in mainstream housing?

Fragmentation.

We are seeing service contracts ‘salami slicing’ the elements of our longstanding integrated vision, which was the very foundation of the idea of ‘Care & Repair’.

We see separate contracts (and hence different providers) for DFG/non DFG adaptations/help with home repairs (with these disappearing entirely in many places)/ handyperson services (now often grab rail installers rather than rounded enablers of independent living)/information and advice about later life options/casework/financial advice/ wider issues support/ trusted trader listings.

The poor service user instead of having a single point of contact can be faced with dealing with a plethora of non-specialists, where once the Care & Repair agency was their one-stop-shop.

From the perspective of an outsider, the integration of care and health is a very long way from reality, whilst the inclusion of housing is patchy at best.

Our new survey of Sustainability and Transformation Plans is hardly a cause for celebration, with housing, let alone ageing, hardly getting a mention in all but a few areas.

We clearly have a long road to travel before the vision of integration is anything like reality. [July 2017]

The Thirst for Knowledge

At just about every event for older people that Care & Repair England has been involved with about housing decisions in later life, impartial information and advice (I&A) come out as key issues.

This priority is reflected in the titles of our I&A projects, such as ‘If only I had known’,

It underpins our Silverlinks initiative, which aims to ‘spread the word’ about later life housing and care options through older people talking to each other (‘peer to peer information transfer’, to give it a technical description).

It is therefore worrying to hear of the demise of so many independent voluntary sector information and advice services for older people, and to this week read about the poor quality of online advice and information being provided by nearly half of local councils.

In their national survey, ‘Better Connected’ (which regularly assesses local authorities online performance) found that 49% of councils provided an unsatisfactory or poor service in terms of information for the public about finding local care and support for older people.

It is worth noting that when Care & Repair England worked with older people in the North West of England to undertake a mystery shopping exercise, looking both at online materials and phoning up to seek practical housing help, results in the majority of places were also disappointing.

The Care Act 2016 and associated Guidance include specific requirements concerning information and advice to enable self help/ prevention. Clearly not all authorities are taking this on board.

We all realise how tough the financial situation is for local councils, but when you consider the benefits that result from enabling self help and informed decision making, this does seem short-sighted.

The cost benefit ratio in the independent evaluation of the EAC FirstStop ‘Housing & Care Options Info and Advice’ programme was 1:23. In the recent in depth evaluation that we carried out of one of the local First Stop I&A projects run by Age UK Warwickshire, our even more cautious methodology found an £8 pay back for every £1 spent – the savings for just one of the older people interviewed would have more than covered the annual cost of the adviser.

We urgently need a new national initiative to crack this info and advice issue once and for all. Let us hope that when it finally emerges the Government’s Social Care Consultation will come up with great new proposals. [July 2017]

When are we ‘old’?

As I struggled to set out the case for a more holistic view about housing for ‘older people’ to the DCLG Select Committee Inquiry, I am again struck by the weaknesses in analysis, and the shortcomings in some of the underlying data, with regard to a period of life which for many people now lasts for 30- 40 years.

Last week saw the publication of the DWPs ‘Family Resources Survey 15-16’. This is an important source of information on a range of trends*, including housing, disability and income.

As I poured over the report I was suddenly truck by the age divisions in the data presented for virtually every field except income (where age deciles are applied up to 85yrs +).

Whilst for all pre-retirement age groups a 15 year age span is used (e.g. 16-29, 30-45 etc.) for older people there is a single cluster i.e. 65yrs and over.

In looking for data and thinking through the implications for housing based on later life trends e.g. disability, housing type, caring responsibilities etc, this clumping together of everyone of 65yrs and over is not at all helpful.

For the majority of people (though obviously not all) there are significant differences between their experience of being a ‘younger old’ person  in their 60s and 70s – fairly newly retired, often active and involved, compared with being over 80/85 years.

Happily, some people do remain fit and active throughout their later years, but for the majority there are significantly greater risks e.g. of health decline, loss of mobility, dementia, loss of life partner etc after 80. These factors can all impact on housing and care needs.

Undoubtedly, recognising later life diversity & inequality (e.g. healthy life expectancy, income etc) is an important starting point, but we do need some overarching figures on headline trends too.

These valuable national data sources need to look again at the assumptions underpinning approaches to age division, to recognise the implications of increased longevity and develop more nuanced thinking about later life.

* The Family Resources Survey is a continuous household survey which collects information on a representative sample of private households in the United Kingdom. Detailed information is recorded on respondents’ income from all sources; housing tenure; caring needs and responsibilities; disability; expenditure on housing; education; pension scheme participation; childcare; family circumstances; child maintenance.

Care & Repair England Response to the White Paper

Care & Repair England has welcomed the reference to older people in the Housing White paper, ‘Fixing our broken housing market’,  particularly with regard to the need for information and advice in order to make informed decisions.

However, we remain concerned about the lack of acknowledgement of the importance of adaptation and repair of the existing general housing stock to meet the needs of an ageing population.

The maths are simple – there are around 27 million existing homes and 9.5 million older households. There is very little housing demolition and even if 200,000 new properties are built each year, the homes that are already built are where the vast majority of us will age for the foreseeable future.

Most importantly of all, ‘ordinary’ homes are the places where the majority of people wish to live as they age. Specialist retirement and supported housing is a valued resource and a lifestyle choice for a minority, but it is currently only 4% of older households, with 96% living in mainstream stock. Even if the sector more than doubled, 90% of older households would still be in general needs housing. To fail to recognise this in housing policy will spell disaster for health and care.

It is certainly very important indeed to build all new homes to be inclusive, healthy places to live at any age and the White Paper comment concerning production of …..guidance for local planning authorities on how their local development documents should meet the housing needs of older and disabled people…(Clause 4.42) is welcomed.

Homes with basic access standards are also more ‘visitable’. Inclusive design can enable older people to stay with family & friends for short periods, including to be cared for when they are ill/ recuperating, the virtue of which has recently been extolled by government ministers.

So yes, let us build new homes that are also good for ageing.

However, there still needs to be an acknowledgement that moving home in later life is neither the aspiration (94% of older people are happy with their home and neighbourhood) nor a realistic option for many older people, particularly those with fewer assets, and at the bottom of the housing ladder.

Mrs Jones in her two bedroom terraced house in Stoke on Trent is in a very different situation when it comes to ‘later life housing choices’ to Mr Brown in a similar sized property down in Henley upon Thames – although both may be perfectly happy where they live if surrounded by good neighbours, with access to shops, public transport and able to maintain/adapt their home.

We need a mix of housing solutions for the wide diversity of later life situations – there really is no silver bullet. The sooner we start to base housing and planning policies on the reality of older people’s lives, move on from a simplistic ‘either move or adapt’ dichotomy, let alone the negative ‘older house-blocker’ narrative, the closer we will be to coming up with workable solutions.    [Feb 2017]

 

Don’t miss the link: how housing supports health targets, saves money and promotes better care

‘Imagine leaving your home abruptly and never returning to it again. Or being told that you are moving house tomorrow and you have no control over where you are moving to and how much it will cost.’

These are the opening words of the previously published NHS England’s Quick Guide: Discharge to Assess and benefits for older, vulnerable people. With the words ‘home’ and ‘house’ right there at the start the value of including housing services in health systems is made clear.

We therefore welcomed and endorsed the NHS England Quick Guide on Health and Housing published this October which identifies how housing and health can work together to ‘prevent and reduce hospital admissions, length of stay, delayed discharges, readmission rates and ultimately improve outcomes for people’.

Housing quality and suitability are major determinants of health and well-being. There is a quantified evidence base which models the costs to the NHS of a range of specific housing features. There is a causal link between housing and many of the most prevalent long term conditions whilst risk of falls, a major cause of injury and hospital admission amongst older people, is significantly affected by housing conditions and the wider built environment.

Decent, warm, suitable housing can reduce the costs of health care. It can decrease GP visits by older people with chronic conditions, enable timely hospital discharge, and extend independent living at home. Addressing housing shortcomings is a key element in effective hospital discharge and prevention and true service integration means integrating health and care AND housing.

The national Memorandum of Understanding to Support Joint Action on Improving Health through the Home is supported by many agencies including NHS England. Starting with the shared statement that ‘The right home environment is essential to health and wellbeing, throughout life‘ it recognises housing’s contribution to: addressing the wider determinants of health; health equity; improvements to patient experience and outcomes; ‘making every contact count’; and safeguarding. Developing a local Memorandum is a useful first step in setting out a shared commitment and action plan.

What are key elements of housing provision that can improve health and enable faster hospital discharge?

Offering timely information, advice and support to patients that looks at their home situation as early as possible after admission can help to address potential housing issues that may prevent safe, timely discharge. Our report summary on housing advice and information services in hospitals demonstrates too the savings that can be made across a range of housing services reducing the risk of future health problems.

With around 18% of patients in social housing (council and housing association) local connections between these providers and health are important – in connection to allocations priorities and housing related support services, for example. And as the vast majority of older patients live in ordinary, mainstream homes, practical adaptation and repair provision, such as those delivered via home improvement agencies and fast track handyperson services, are crucial components.  Streamlined medium and larger home adaptations, including innovative use of the increased national funding for Disabled Facilities are another key element. Care & Repair England’s briefings, supported by Public Health England, on home adaptations offer advice and case studies in this field.

If we see all CCGs engaging with housing service providers locally to improve discharge and prevent unnecessary hospital admission not only will this improve patient care but also save money in the long run. [Dec 2016]

Taking Stock – the outlook for housing & ageing

Hardly a day goes by without there being another story about housing from every side of the political debate. However, nearly all of these are about property price trends, affordability and supply shortages for first time buyers.

The current plight of ‘generation rent’ is undoubtedly a pressing issue as thousands of younger people struggle to find a place to live at all, let alone pay their ever increasing rents. However, homes really are more than bricks and mortar to those who live in them, and it is critical that we don’t lose sight of quality in the race for quantity.

Every home built will be there for much longer than its first occupiers – it is a resource for the future, hence the critical importance of creating sustainable, inclusive and flexible places to live, designed to meet current and future generations’ needs for healthy, accessible places to live.

There are real worries about a ‘race to the bottom’ with regard to space and design standards. The long term consequences of building extremely small, low design quality and inflexible homes are both costly to society and also to individuals.

A quieter but no less important housing issue is growing, and receiving far less attention – the wider social impacts of housing shortcomings for an ageing population. At a time when the fastest growing age groups in society is the over 80s and over 55s this seems remarkably short sighted to neglect housing for these generations, not to mention a missed opportunity by the private sector given that home ownership amongst older households is 75%.

And what of the adaptation of the current stock where most of us will live as we get older? The great news in 2015 of national government increasing its funding for adaptation grants [paid through the Better Care Fund] does not yet seem to have prompted local innovation in integrated delivery or adequate budget setting in most localities.

The full effects of the Housing and Planning Act 2016 are yet to be felt, but just some of the worries of housing providers are the future financial viability of sheltered and supported housing and the potential loss of the more suitable and adaptable stock for older and disabled people as a result of the new Right to Buy. In the case of the latter, there are specific concerns about the scope for financial abuse of more vulnerable older tenants, particularly in high equity areas.

Meanwhile the potential effects of future welfare reform are also giving social landlords sleepless nights, particularly the planned introduction of Local Housing Allowance (LHA) cap. With health and social care already under pressure, these sectors can ill afford to deal with the problems that could arise if older people, living in both supported and also general needs housing, start to face housing costs difficulties.

The Housing & Ageing Alliance is keen to stimulate debate about all of these and more issues that will impact on both individuals and also those involved in the ageing, housing, health and social care fields. It is organising a related policy seminar and will be inviting a range of sector leaders to share their ideas and thoughts in future blogs, so watch this space.

Also published on  the Housing and Ageing Alliance website. [Dec 2016]

Street Design for Age Friendly Neighbourhoods

In a meeting with some local authority members about housing in later life, the councillor with responsibility for regeneration made the comment, “We’re planning some redevelopment work in a neighbourhood centre. Can you give us any suggestions on how we could make that more Age Friendly?”  From this throw away question, Care and Repair England’s leaflet on Street Design for Age Friendly Neighbourhoods was written.

Looking at the WHO Age Friendly cities gave us some starting points and in the UK, the work of Newcastle Elders doing neighbourhood ‘Age Friendly Audits’ was also a help. On further exploration, a number of government and academic bodies have also done work on Lifetime Neighbourhoods and the built environment but when you take a walk around your own neighbourhood, you can’t always see the evidence of that work.  So that was the starting point for this publication.  Taking a look at my own street, seeing where older people were, then looking at why they might go to some places rather than others, helped to focus my research and has all gone towards informing this publication.

Living and working in Greater Manchester, gave me the additional opportunity to consult with Age Friendly Manchester Design Group.  Taking initial drafts to them, with their backgrounds in community, planning and access helped bring the issues to life and keep the leaflet on track.

Our hope is that it is useful in highlighting those elements of our streets which enable and encourage older people and to notice those things which hinder their use, engagement with and enjoyment of their neighbourhoods. (This blog first appeared on the Age Action Alliance) [Sept 2016]

 

 

Challenging a culture of blame

In a week which saw an Institute for Fiscal Studies report highlighting the growing disparity of wealth/ poverty between young and old, we also saw tabloid headlines about ‘Millions of older people failing to adapt their homes’ in response to ILC-UK’s latest report.

Why did I publicly object to this latter headline? Does such language actually matter?

I strongly believe that it does matter as it contributes to a growing culture of blame and intolerance.

The more that the narrative around ‘older people’ is a portrayal of the negative (houseblockers, bedblockers, failing to save for/ plan for retirement) the greater the risk of simplistic and crude attribution of fault to individuals for complex and difficult social issues. We risk pitting ‘young’ against ‘old’ when the reality is so much more nuanced.

For starters, just as at all other stages of life, there is great diversity of the experience of older age, including significant inequalities – of wealth and income, quality of home and neighbourhood, healthy vs unhealthy life expectancy and so on.

Add to this the reality that the current built environment, and housing in particular, is not well designed for an ageing population. Whereas the Disability Discrimination Act has brought about a revolution in accessible public space (no-one thinks twice now about dropped curbs, level thresholds and automatic doors into and out of shops) this is not the case with regard to the housing stock. The perspective of the disability movement of the 80s and 90s was clear – people are disabled by the world around them and so the built environment should be changed to be more accessible. So why don’t we apply the same ideas to accommodate population ageing?

The reasons why most people ‘fail’ to adapt their own homes in advance of possible physical decline in later life are many and various.

For most of us, there is the hope that loss of physical function may never happen – and indeed for many it doesn’t, with only half of those over 65yrs reporting mobility problems (albeit that this increases significantly after 75yrs and 85yrs).

Even for people who are finding day to day living harder (most commonly, difficulty with stairs/ steps/ getting in and out of the bath) there are emotional and financial barriers to installing adaptations.

In a culture where youth and fitness is all, with ‘stay young forever’ the popular culture backdrop, no-one wants to admit that they are getting old and that infirmity is setting in.

Even when people do want to adapt their homes, many home modifications are expensive and unaffordable to lower income people. Even for those with money, faced with a high level of intensive marketing it can be hard to choose the most appropriate adaptation – it is not easy to find impartial, independent information and advice.

For those who can’t afford to pay (both tenants and home owners) there are considerable barriers-  few people have even heard of Disabled Facilities Grants, let alone have any idea how to get this help.

Hence my annoyance at a headline which says older people are failing to adapt their homes.

A revolution is needed both in the design of all new homes and also in the design and mainstreaming of accessible design features in general housing (think fashionable wet-room vs ‘adapted’ bathroom). The ‘public image’ of home adaptations needs a make over. These have to become less of an outward manifestation of losing mobility [and by implication, control] and be seen as a positive way of creating a good place to live that enables independence. We can but try. [July 2016]

[this Blog has also been published by ILCUK, click here]

A Glimmer of Hope?

One of the consequences of the recent tumultuous events is a sense that everything else in the political and policy arena is on hold.

This includes housing policy, where the focus is on speculation about a possible market crash.

However, life does move on, people need homes and the issue of decent housing for an ageing population still needs a radical policy response.

This week saw two long awaited reports of relevance to this subject published. The first to come along was the preliminary report of the Local Government Association’s Housing Commission, ‘Building our Homes, Communities and Future.’

At this point I declare an interest as I have been acting as one of the two ‘ageing and health section’ expert advisers to the Commission and our detailed input has been into the sub-section on ageing. However, we have tried to make the case that consideration of population ageing and building homes that support healthy living and well-being across the life course, need to woven in throughout the Commission’s report. I hope that others will support this bigger picture vision for design of an accessible, inclusive built environment.

The second report is the culmination of many years of important research, debate and deliberation about the necessary policy response to demographic change and an ageing society. This is the Government Office for Science’s summary report of its ‘Foresight’ Project into ageing, ‘Future of an Ageing Population’.

This report has an extensive section about housing and notes that building suitable new homes and supporting the adaptation of the existing housing stock will be critical as the population ages. The section also reflects how interconnected housing is to all of the other considerations – wealth/ assets/ health/ work/ transport/ neighbourhoods and technology.

We can only hope that in the latter case the evidence, conclusions and recommendations will be taken up whoever eventually takes up the reins of government.

 

8th July 2016