Health and Housing – the Bigger Picture
Care & Repair England has continuously promoted the importance of connecting health, housing and care services. Integration means integrating health, care and housing support to enable older people to live well at home and to return home safely following a stay in hospital.
Housing quality and suitability is a major determinant of health and well-being, and impacts on demand for health services. Older people are the main users of both hospital and primary care and their homes are a particularly important factor in maintaining physical and mental health and addressing health inequalities.
There is a causal link between housing and the main long term conditions (such as heart disease, stroke, respiratory, arthritis) whilst risk of falls, a major cause of injury and hospital admission amongst older people, is significantly affected by housing characteristics and the wider built environment.
Decent, suitable housing for older people can reduce the costs of health care. It can decrease GP visits by older people with chronic conditions, enable timely hospital discharge, extend independence for patients with dementia and provide end of life care at home. Therefore inclusion of housing in health and care is critical to better co-ordinated services for older people and their carers.
Improving and adapting mainstream homes, development of appropriate and specialist housing and provision of housing related support can all contribute to efficiency savings as well as achieving current policy aspirations of integration and prevention. Warm, safe, well designed housing, effective delivery of home adaptations, the provision of supported and appropriate housing (across tenures), aids, equipment and assistive technologies all have quantifiable effects with regard to improved health, well-being and independent living, particularly for older people with chronic conditions.
The prevention of falls is of major importance because they cause considerable mortality, morbidity and suffering for older people and their families, and incur wider economic costs due to hospital and care home admissions. It is now widely accepted that multifactorial intervention which addresses muscle tone (exercise), review medication and modify the home (e.g. adaptations & hazard removal) is the most effective way to reduce falls risk.
Cold homes have a serious impact on older people’s health. On average, over each of the last five years, there have been 27,000 excess winter deaths; more than 90% of these deaths occur in the over 60s age group and can be attributed to cold-related illnesses such as heart attacks, strokes and respiratory conditions.
Unsuitable home conditions can directly cause health problems, and hence hospital admissions. If individuals are discharged to unsafe, cold, unsuitable homes they are more likely to return to hospital. It is generally better for older peoples’ health if they are discharged as soon as they no longer need hospital level medical care. Addressing housing shortcomings is a key element in effective hospital discharge.
Some older patients medically ready to leave hospital may not be able to return to their previous home unless adaptations and improvements are made to it or, in some cases, until a new home can be found. Others can return home and manage with equipment, adaptations and temporary measures in the short term, but need more significant alterations to live independently. Either measure can reduce the risk of future health problems.
Housing is the foundation for good health and care at home but we have more to do to engage policy makers and practitioners in health and social care to work with their housing colleagues to identify and develop solutions in housing that support good health and wellbeing.
Key agencies in this sector came together in Dec 2014 to develop a Memorandum of Understanding on integrating housing with health which is a real step in the right direction. The delivery plan for the housing and health memorandum can be accessed here. We will continue to develop practical solutions and policy proposals that establish and enhance this integration agenda for the benefit of older people.
See our Dec 2016 blog on the importance of making the health and housing links http://careandrepair-england.org.uk/2016/12/dont-miss-the-link-how-housing-supports-health-targets-saves-money-and-promotes-better-care/ which also links to NHS Guidance.
Sustainability and Transformation of NHS – Housing and ageing missing links
Most plans for the future of the NHS make hardly any reference to population ageing or the role of housing in prevention.
A newly published survey by Care & Repair England reveals that the majority of Sustainability and Transformation Plans (STPs) include very few references to older people, even though they are the majority users of the NHS, nor do they identify housing as a potential contributor to NHS transformation.
STPs are required to address how local partners will meet key national commitments set out in the NHS Five Year Forward View, including greater investment in primary care and focusing more on prevention. NHS services are meant to shift away from hospitals, delivering more health care at or closer to home and reducing lengths of stay when hospital care is essential.
The Briefing argues that small, practical housing interventions can play a critical role in this transformation, particularly with regard to older patients, the vast majority of whom live in mainstream housing. [July 2017]