Welcome words – now the action?

Sometimes it can feel as if all of the effort that we put into raising the profile of the wider housing and ageing issues is getting us nowhere, as we hear of yet another great local Care & Repair or similar service closing down.

However, as I read the conclusions in the Communities and Local Government Select Committee Inquiry into Older People’s Housing Report, the work that we put into making representations to this all felt worthwhile.

The list of recommendations are all ones that Care & Repair England had either put forward or endorsed, particularly the critical role of home improvement agencies, handyperson services, information and advice about housing options plus home adaptations, all of which are relevant to the vast majority of older people living in ordinary housing.

We also support building better new homes for future generations of older people, making new homes more accessible and flexible across the life-course, as well as building specialist and innovative new homes to meet specific needs.

The Committee’s recommendation to develop a new national strategy for older people’s housing is also timely, given the current high level policy interest in housing.

Best not to reinvent the wheel, so any new strategy really should build on the excellent work which resulted in the last comprehensive strategy on this subject, Lifetime Homes, Lifetime Neighbourhoods. Whilst I would say that, wouldn’t I (as the Chair of the government’s advisory committee on the subject at the time), this Strategy did receive cross government and multi- party support, as well as attracting international interest and approval.

But let us not get carried away quite yet. A Select Committee report is great – but what really matters is the extent to which the recommended actions are taken up by the Government of the day.

At the front line we are seeing decommissioning of preventative services such as impartial info and advice, independent HIAs and handyperson services at an unprecedented rate, with the resulting loss of skills and knowledge built up over decades.

Rapid action is needed to ‘stop the rot’  now – it will be so much harder to rebuild from scratch.

Perfect Storm?

Some years ago Care & Repair England published the report ‘A Perfect Storm: An ageing population, low income home ownership, and decay of older housing’ to draw attention to the potential implications of the radical shift from renting to owning amongst lower income groups, particularly when those lower income people retired on small pensions.

The report analysed housing stock condition, demographic and tenure trends alongside housing related policy response.

A similar conclusion was reached to that of the House of Lords Inquiry Ready for Ageing? i.e. that the policy response was woefully inadequate.

Last week’s publication of the latest English Housing Survey Headline report 2016-17 data, revealed that for the first time in more than a decade the number of non-decent homes in the owner occupied sector has increased, rising from 2,694,000 in 2015 to 2,912,000 in 2016, nearly a fifth of the private sector stock.

As our report demonstrated (Off the Radar), the majority of those living in non-decent owner occupied homes are older people, particularly those with disability or long term health conditions.

Whilst one has to be cautious about drawing conclusions from a relatively small change, taken with other emerging data about indications of falling life expectancy in poor areas and low income pensioners, this does accord with the difficulties of finding the money for essential home repairs reported by home improvement agencies and others.

The current housing media focus is understandably on the dire situation of homeless people, families living in temporary accommodation and the scandal of a whole generation locked into expensive, poor standard private sector rented property.

However, this is not a good reason to totally ignore the housing and financial difficulties faced by low income older people.

Not everyone over retirement age is living on a high pension in a house in the south east worth millions. We must not lose sight of those who are ‘just about managing’ – or close to not managing.

Failure to make the connection between housing disrepair and health is not only costly to the NHS, but has potentially dire consequences for individual older people.

We have to somehow make the case afresh for the practical, preventative housing help that home improvement agencies and handyperson services can offer, but which seem to be disappearing at a rate of knots [January 2018]

Adaptations work

Crawling up the stairs, being unable to wash properly, not being able to sleep in your bedroom – these are the real life impacts of not having home adaptations done when you need them.

Whilst there is often a response along the lines of ‘isn’t it obvious’ when it comes to measuring the health impacts of such situations, lack of quantified, academic evidence, and particularly of the cost benefits of home adaptations, has been an issue for some time.

This is why the new international review of evidence concerning older people and home adaptations is so welcome.

Commissioned by the Centre for Ageing Better and carried out by the University of the West of England, this is a long overdue and important addition to the armoury of those of us passionate about making older people’s homes good places to age well.

Whilst this review won’t answer all of the questions (and one of the findings is that there really does need to be much more research in this field as all of the key evidence was from non-UK studies), this overview provides some much needed data to help us make the case for adaptations.

The review was preceded by last week’s surprise (and very welcome) budget announcement of additional national government funding for disabled facilities grants this year. What we now need is to see that national money added to by local health, housing and social care inputs (however modest) as well as steps taken to innovate/deliver integration to produce even better results for individuals.

We are delighted to be taking the next steps with Centre for Ageing Better and gathering local examples of the elements of innovation and good practice, particularly features identified as important in the evidence review, such as speed of provision and tailored solutions that listen to the priorities of the individual older, disabled person.


The Importance of Satisfactory Housing for Older People

There is a consensus that older people ideally want to remain in their own homes, with support if necessary, for as long as possible. As the majority housing tenure for older people is owner occupation the “stay put” ambition involves responsibilities for repair, maintenance and, for many, modifications in response to disability.

For those living alone on limited incomes and not able to undertake necessary works themselves these forms of investment are a source of genuine worry and anxiety. If not addressed unsatisfactory housing conditions present risks to the health and wellbeing of older people. Access to low or no cost independent and trustworthy advice/information and assistance services provided through home improvement agencies has been highly valued by this client group.

However due to continuing austerity affecting the public sector local home improvement agency services, particularly those that receive local authority funding, have experienced a reduced level of financial support or had funding removed. Care & Repair England argue that

  • the demise of such prevention and response services really is storing up problems for the future especially to the health and social care sectors and
  • investment in services providing housing interventions for older people constitutes a sound business case for those sectors

The challenge for housing providers is to convince health and care commissioners that investment in housing led interventions can contribute to meeting their outcomes. This is why, with the support of the British Society of Gerontology (BSG) and the University of Manchester’s Institute for Collaborative Research on Ageing (MICRA), Care & Repair England in July 2017 organised a national conference examining the policy and practice framework for this issue. The title of the event was Small but Significant – Innovation, Impact and Evidence: Practical housing interventions to improve older people’s health and wellbeing. It included speakers who have been involved in service innovations that have already been evaluated including handyperson services linked in with ambulance service responses, to hospital discharge systems and pro-active home safety interventions.

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

Care & Repair England are firmly of the view that 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.

Please click here for the Speakers presentations

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?


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]