Adaptations work

Blog by Sue Adams, CEO of Care & Repair England

 

 

 

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.

[November 2017]

Importance of Satisfactory Housing

Blog by Sue Adams, CEO of Care & Repair England

 

 

 

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

[October 2017]

Small But Significant

Blog by Sue Adams, CEO of Care & Repair England

 

 

 

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 In Action

Blog by Sue Adams, CEO of Care & Repair England

 

 

 

Integration In Action

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]

Thirst for Knowledge

Blog by Sue Adams, CEO of Care & Repair England

 

 

 

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’?

Blog by Sue Adams, CEO of Care & Repair England

 

 

 

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.

Response to the White Paper

Blog by Sue Adams, CEO of Care & Repair England

 

 

 

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]