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

Blame culture back with a vengeance

As the crises in hospitals escalate, blame culture is rife. Whether it is older people living too long, migrants and ‘health tourists’ – all are in the firing line. The implication is that the more ‘deserving’ are not getting the NHS treatment that they require because ‘less of deserving’ people blocking their way.

More balanced views are out there. The major funding reductions in social care are increasingly being recognised as one reason why many older people are in hospital for longer than is clinically necessary.

The recent National Audit Office report, Discharging older patients from hospital, concludes that current official data significantly underestimate the scale of the problem, and that …‘health and social care systems’ management of discharging older patients from hospital does not represent value for money‘.

The search is on for solutions. Cue the rising interest in use of the extra funds for disabled facilities grants (DFG) paid into all local Better Care Funds (BCR) this year. One of the additional conditions attached to the BCF is to reduce delayed transfers of care. There are a few emerging beacons of innovation where fast track home adaptations and housing related services are being included in discharge processes, but they remain a small minority, with more preventative provision facing cut backs rather than increases.

Care & Repair England keeps on repeating its message about the housing, health & care links, encouraging the take up of fresh approaches and good practice, Last week saw the publication of our latest Integration Briefing 3 supported by Public Health England. This week our event, ‘Health at Home – The Right Prescription’ takes place in Manchester,  shining a spotlight on the ways in which integrated housing interventions can reduce delayed discharge and increasing independence at home for older people. Yet we do also recognise the massive challenges that those trying to balance the books face, challenged on all sides to do more for less and less.

Nevertheless, without more visionary planning and commissioning of preventative services that fundamentally address the state of the homes and neighbourhoods that people live in as they get older, those queues in A&E are just going to keep on getting longer.  [June 2016]

Rumbling on

Back in February 16 I reflected on the lack of publicity about the 80% increase in the DFG budget, made all the more remarkable in the context of most other local government budgets decreasing.

The big question is how much of that extra money will actually be used for increase DFG delivery and, hopefully, system improvements?

At the moment the answer appears to be ‘who knows?’

Local responses to the DFG increase range from a few ‘That’s great, let’s get on and deliver more and in better ways‘ to the cynical ‘It isn’t really more money because ‘they’ (DH) took away our Social Care Capital Grant so we are not going to increase the DFG budget at all’.

To the latter we can only make the plea – ‘use it or lose it’.

As the Spending Review announcement in 2015 made only too clear, DH are rightly looking for a return on their DFG investment. There are expectations about DFG outcomes including delayed admission to residential care, lower care costs and, as the 2016 Better Care Fund Policy Framework states, in reducing delayed transfers of care.

If the local response to extra DFG money is to not use it for the purpose intended then DH will be well within their rights to review payment and delivery systems in future years.

We urgently need to get organised with regard to evidence of resulting benefits from adaptations. Care & Repair England is working with the Centre for Ageing Better with regard to the commissioning of an evidence review. It is also doing its utmost to support plans for ‘proper’ academic research in the field. However, this will take years, rather than months. Local ‘snapshot’ evaluations will be critical in the short term and we are keen to do whatever we can to help to develop methods and share ideas in this area. [May 2016]

Looking back, looking forward

Care & Repair England is 30 years old.

Little did most of us back in the 1980s think that three decades on we would still be championing the importance of home repairs and adaptations to a decent older age.

One of the visionaries without whom none of the work of home improvement agencies would have happened is Mike Wright, who died recently just short of his 90th birthday.

Mike was an extraordinary character, an army colonel who, on retirement from the army in 1960, set up HACT, alongside a sister charity, Help the Aged Charitable Trust. It was Mike’s tireless fundraising and innovation that underpinned the development of many housing associations during the 60s and 70s, and that same passion which resulted in the creation of Care & Repair England (initially England and Wales).

Jane Minter, now our Head of Programmes, has written a detailed obituary about Mike’s work http://www.hact.org.uk/blog/2016/03/15/remembering-mike-wright which is a great reminder of what a difference one person can make.

Reflection on the past is a useful starting point for looking to the future. There remains a great deal to be done to reach the point where all older people are well housed in homes that are healthy and accessible. Mike will be an inspiration to us all in planning future action to achieve that ultimate aim.  [March 2016]