Safe and comfortable at home – Care & Repair England’s contribution to the Government’s Implementation Plan on dementia

Care & Repair England believes that all older people should have decent living conditions and be able to live in a home of their own choosing. Poor or unsuitable housing has a profound effect on older people’s health and well-being. We welcome one of the key commitments in the Government’s Implementation Plan on dementia which focuses on health and care to enable ‘people to live well in their own homes for longer.’

Here is some of the work we do to help make this happen.

Information for older people and their carers

Last year we produced a series of guides for older people and their carers on making their homes a better place to live with a range of long term health conditions including dementia. Each guide advises on what people can do to their home to make living at home more manageable and life easier so that people can continue to live independently and do the things they want to do. The guides also describe the range of alternative housing options and offer suggestions about where to find more detailed advice.

More recently, and with Carers UK, we are developing a guide specifically for carers who care for older people, including people with dementia, on the housing options available aimed at enabling people to think ahead and know what to consider together. This will be published shortly.

Promotion of responsive services for older people and their carers

As well as guidance for older people and carers we work with local partners to support the development of practical housing solutions, particularly for older people living in mainstream private housing. We also promote great local practice.

A fantastic example of this practical help – and a service we would like to see everywhere – is Homewise Memory Matters based in Lancashire. This project supports people with memory loss and dementia to stay at home continuing to live independently keeping them safe and out of hospital and residential care. It also works with their carers to ensure that they are aware of local services including respite care and have a network of support available to them. Simple innovations in the home can make all the difference whilst advice on care, support and benefits ensures continued independence, good health and wellbeing

Sharing ideas and practice

Care & Repair England believes in sharing ideas and practice and is a committed member of the Dementia and Housing Working Group where we focus on the issues for older people with dementia who live in mainstream housing. We want to see a situation where all older people with dementia can choose to remain safely and with comfort at home for as long as possible [April 2018]

 

Drowning in words and numbers?

The sheer volume of information that we are all expected to process every day really can feel overwhelming. The lists of publications, reports, blogs and comments that we haven’t had time to read grows ever longer so no wonder many people just give up and stop even trying to keep up.

For those of us involved in the field of housing and ageing, constantly trying to reflect the diverse reality of older people’s everyday lives, hopes and experiences, challenging the stream of negative, reductive headlines is increasingly challenging.

But we have to persevere and keep on analysing the reliable sources of information, because without rigorous analysis of solid data and application of evidence we will fail to develop workable solutions to the many housing issues faced by people of all ages.

Pitting the generations against each other, stoking a blame culture with a simplistic ‘the old caused all of the problems faced by the young‘ is profoundly damaging to our society. With regard to housing, the misleading narrative that says if only old people would move out of their homes young people wouldn’t have a housing problem, is not only clearly illogical, but it also fails to analyse the multiple root causes of current housing problems.

Nor is it a simple numbers game, building ‘units’ of accommodation rather than creating decent, affordable, accessible and sustainable homes for the long term good of society.

The reasons why older people are home owners whilst younger people increasingly face seemingly insurmountable obstacles to living in a secure, affordable home, let alone buy one, are multifaceted.

Policies which have supported buy to let or invest, declining numbers of social rented homes, land-banking, rising inequalities, lower incomes & insecure employment resulting limited access to mortgages compared with the 80s and 90s [when home ownership suddenly opened up for a whole generation of working people], not to mention welfare reform are just some of the many reasons that we are in a housing crisis.

So easily lost in all of this maelstrom is the situation of the million or more lower income older home owners living in non-decent homes, who face day to day worry about repairing, adapting – even insuring or heating – their homes. Those with families don’t want to be a ‘burden’, many see the difficulties faced by their grandchildren and want to help, often by passing on even limited equity in their homes. A small amount of practical help can go a long way to reducing not only the health risks that result from living in a cold home, or one with falls hazards, but also the grinding worry.

This is why handyperson, home improvement agency and the associated practical services that they offer are so important and we just have to keep on making the case.

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?

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.