Inspiring Integration

 Blog by Sue Adams, CEO of Care & Repair England

If I had £1 for every time I’ve heard the phrase ‘integration of health and care’ over the decades, I would be able to fund many handyperson services around the country. Add in extra cash for all the times so many of us have had to say, ‘integration of housing, health and care’ and we can fund the caseworkers too.

So, it’s inspiring to find out about real-world integration efforts that are genuinely embedding housing help into hospital systems. It isn’t perfect – what is – and the pandemic has certainly added to the many challenges faced by everyone in the health, care and voluntary sectors, but it does work.

What am I talking about?

Manchester Care & Repair’s jointly commissioned ‘Home from Hospital’ service, as described in our latest ‘Integration in Action’ brochure. An impressive fact about this service is the scale of the operation – over 20,000 older patients reached by phone after they’ve been discharged from hospital, with more than 12,000 jobs done in their homes, ranging from handyperson minor works to replacement boilers and larger repairs, as well as increasing people’s incomes by over £2 million every year.

What really leaps out for me are the impacts on the lives of individuals based on the two stories told in the brochure, and there were many more tales of transforming lives to choose from when we came to write up this ‘Integration in Action’ profile.

However, a word of caution. One of the reasons that this integration of housing help into hospital discharge systems works is because Manchester Care & Repair has a great toolbox of housing solutions. When they come across someone without savings and little income, whose health is being made worse by the disrepair of their home e.g., broken down heating boiler so no heating or hot water, hole in the roof where the rain comes in (as the song goes) they have access to a brilliant fast track grant so they can turn around the repair in days, or call on a range of loan products for larger works.

This is down to the far-sighted housing policy of Manchester City Council, which (again that word) really is integrated with health, helping disadvantaged residents by tackling poor or unsuitable housing, despite funding constraints.

Finally, possibly uniquely, the range of services offered by Manchester Care & Repair is jointly commissioned by Manchester CCG and Manchester City Council.

This pioneering health and housing integration is taking place in an area that desperately needs it, as nearly 45% of neighbourhoods within Manchester City are among the 10% most deprived areas in England.

So let us hope that more local areas will take up the real integration challenge, that of embedding effective housing interventions into health and care systems so that more older people get the housing help they need to live healthy, safe and independent lives in their own homes for longer.

Good Homes for All

Blog by Sue Adams, CEO of Care & Repair England

What makes a home a good place to live?

Ask a wide range of people and you’ll get many different answers including ‘chance would be a fine thing’ for the many thousands who are homeless. However, common themes do emerge, with housing security, safety and affordability high priorities in these uncertain times.

Adequate space, quality of neighbourhood and access to parks and green areas have emerged as important housing factors, impacting on physical and mental health during the Covid-19 pandemic[1]. With rising fuel prices and awareness of the environmental impacts of domestic energy use, the need to make homes more affordable & efficient to heat is emerging as a top retrofit priority.

So how does our housing stock measure up to the aspiration of ‘Good homes for all’? – Not brilliantly.

Around 10 million people are living in 4.3 million non-decent homes (19% of all dwellings). Half of these non-decent homes (4 million) are lived in by an older person, and the large majority (78%) are homeowners, often living on low incomes and in disadvantaged areas. The number of over 75s living in a non-decent home is actually rising – up from 533,000 in 2012 to 701,000 in 2017.[2]

This dire situation is putting older people’s health at risk, not to mention adding to NHS costs.

As a result of the Covid-19 pandemic many older people spending even more time at home, often alone and becoming increasingly socially isolated. The ‘Perfect Storm’[3] of poor housing and an ageing population really should be a high priority for concerted action to improve homes.

The publication of the findings of the Centre for Ageing Better’s ‘Good Home Inquiry’ is therefore a very welcome step in efforts to stimulate policy and practice improvements in this neglected area.

The recommendations for action include a call for a cross-government housing strategy with a ministerial champion to implement it. It also recommends the creation of a ‘Good Home Agency’ in every local area to provide access to information and advice about repairs, energy efficiency and retrofitting, as well as supporting residents with paying for and finding trusted tradespeople to carry out repairs.

With the arrival today (16.9.21) of a new Minister of State leading MHCLG, Michael Gove, let us hope that this urgent need to act to improve current homes makes it onto his priority list.

______________________________________________________________________

  1. The Kings Fund (2020) Homes, Health & Covid-19, Centre for Ageing Better
  2. Centre for Ageing Better and Care & Repair England (2020)
  3. Home & Dry: The need for decent homes in later lifeCare & Repair England (2010) A Perfect Storm: An ageing population, low income homeownership, and decay of older housing

 

 

Homes for healthy ageing – time to ‘level up’

Blog by Sue Adams, CEO of Care & Repair England

Post-pandemic recovery debates frequently mention ‘levelling up’ or ‘building back better’. Surprisingly, given the extent to which the pandemic revealed the scale of poor housing, there has been little mention of building better homes. The usual debates about quantity, not quality, still predominate.

The effects of substandard, insecure, unsuitable housing on physical and mental health cut across all ages. The pandemic exposed and amplified housing-related health inequalities, bringing the negative impacts of housing conditions on mental as well as physical health into sharp relief during periods of confinement to home. This was clearly analysed by the Kings Fund and Centre for Ageing Better in Homes, health and Covid-19: How poor quality homes have contributed to the pandemic, which highlighted the finding that:

  • Groups in the population who are more likely to live in poor housing are often the same groups who are vulnerable to COVID-19 and other health conditions, including older people, people with existing health conditions, those with lower incomes and people from ethnic minority groups.

Older people were particularly badly affected by the pandemic, with 90% of Covid-19 deaths occurring amongst the over 65yrs age group, three quarters over 75yrs.

As the extent to which the pandemic has exacerbated health inequalities emerges e.g. rates of decreased life expectancy varying significantly in different localities, there are also calls to ‘build back fairer’.

So how can we learn from the experience of the pandemic, and how should we grasp opportunities to tackle the multiple housing and health crises we now face, and which have a particularly significant impact on older people?

As a first step, housing, planning, health & social care policies all need to acknowledge that we are living through a time of unprecedented demographic change. Addressing population ageing in all housing and related planning will ultimately benefit people of all ages.

Levelling up’ needs to include concerted action to bring over 4 million non-decent homes (2 million lived in by an older household) up to a healthy, decent standard, alongside adapting homes to enable safer, independent living. This could dovetail well with emerging housing retrofit plans to address climate change, and NHS preventative healthcare planning.

‘Building back better’ should mean that every new home is designed to be a healthy, sustainable and accessible place to live across the life course. Innovative housing models designed to support independence in later life for a diverse ageing population would also have potential benefits.

These three steps to improve homes for healthy ageing are ‘win-win-win’ actions. They will result in improved quality of life for current and future generations of housing occupants, a health and care dividend benefiting the NHS and Social Services, and a positive impact on climate change through reduced energy consumption.

The Housing & Ageing Alliance continues to make the case for concerted, cross sector and inter-departmental action that will:

  • Enable older people to live independently and and well wherever they choose, remaining in control of their homes and lives. 
  • Create age-friendly homes, neighbourhoods and services that enable people to live healthy, fulfilling lives, involved with families, friends & neighbours and contributing to their communities in later life. 
  • Create integrated housing, health & care policies all aiming to enable people to live safely & well at home as they age.

Time for an Act

Blog by Sue Adams, CEO of Care & Repair England

I doubt if anyone would disagree with the statement that our homes affect our health and wellbeing.

The impacts of housing on physical and mental health have been highlighted by the Covid-19 pandemic, with people living in poor quality, insecure, cramped and badly designed homes some of the worst affected.

The excellent Kings Fund analysis, Homes, health and COVID-19: How poor-quality homes have contributed to the pandemic, sets this out so clearly, concluding that “The COVID-19 pandemic has exposed and amplified housing-related health inequalities.”

So how can we learn from this experience and what action is needed to tackle the multiple housing and health crises we now face?

Soundbites, social media, articles, and reports are littered with post-pandemic aspirations – ‘build back better’, ‘levelling up’,’ reduce inequalities’, ‘focus on prevention’ etc. Thin on the ground are concrete proposals for housing action to improve population health.

For decades Care & Repair England has highlighted the data and evidence about costs to the NHS of poor housing, demonstrating the links between housing quality and health ageing. It has put forward solutions for tackling the scourge of over 4 million non-decent homes (half lived in by older people) and promoted the crucial need to build all new homes to healthy, age-friendly, sustainable standards.

Sadly, funding to tackle poor housing, in place since 1945, ceased overnight in 2010, whilst exhorting the building industry to adopt ‘Lifetime Homes’ and other quality standards has had little effect unless specific standards are made mandatory.

Which is why Care & Repair England supports the Healthy Homes Act Campaign.*

Building unhealthy homes makes absolutely no sense from either a fiscal or social point of view.

Too many homes and neighbourhoods built today undermine people’s’ health and wellbeing, which is why the Town and Country Planning Association, supported by a wide range of organisations, has developed new legislation, in the form of a Healthy Homes Bill, to stop this.

Care & Repair England’s focus remains on the pressing need to improve current housing for an ageing population, particularly helping the large numbers of low income, older homeowners living in disadvantaged areas. However, it is also essential that we apply knowledge gained of what makes a home a good or bad place to live and age well in order to avoid the costly building design mistakes of the past.

As Winston Churchill famously said, “We shape our buildings; thereafter our building shape us”. It is time to put health improvement centre stage in all government policies, including all MHCLG housing and planning policies, in order to address the underlying causes of poor health.

*For more information on the Healthy Homes Act campaign visit https://www.tcpa.org.uk/healthy-homes-act  or contact Jack Dangerfield at jack.dangerfield@tcpa.org.uk

The gap widens

Blog by Sue Adams, CEO of Care & Repair England

In this strange new coronavirus world we find ourselves living in, ageism is again rearing its ugly head. Most of those who die as a result of COVID19 are older people – nearly 90% are over 65yrs – and the true figure might well be even greater, given the emerging issues around under-reporting, and the true extent of deaths in care homes.

Every day also brings news of the unequal impacts of coronavirus, with higher death rates amongst BAME groups, and those who are living in disadvantaged areas.

Never has housing inequality been so much in the news, albeit for all the wrong reasons.

With most of the population spending virtually all their time at home, the negative impacts of living somewhere cramped or cold, let alone with no outside space, on health and wellbeing is increasingly obvious.

The number of deaths at home has more than doubled in recent weeks, and we know very little about the situations of many frail, vulnerable people, including those discharged rapidly from hospital in order to clear beds ready for the influx of people with coronavirus.

Local Care & Repair agencies are identifying shocking examples of older people left unsupported at home, living in dire situations.

Such agencies (HIAs) have a long history of ‘reaching the people others don’t reach’. With falling rates of referral to HIAs by hospitals and social services, as well as limitations on home visiting, some HIA staff are telephoning past clients to make sure they’re getting the help they need. Whilst many people are fine, others are undoubtedly falling through the cracks. These HIAs are linking such people to critical help, as well offering emergency handyperson services to make homes safer.

Crisis brings out the best and the worst in people. We’ve seen a rise in scams, with older people yet again the main target. On the flip side, the mobilisation of thousands of new volunteers has been extraordinary.

The challenge is to ensure that opportunities are not missed to bring about longer term housing improvements. In the short term, making these enthusiastic volunteers, who are dropping off bags of shopping or phoning isolated older people, aware of housing risks and possible remedies would be so useful. Our new Living Safely & Well at Home ‘self trainer’ can help to raise this awareness, alongside this updated self help guide.

One challenge is to prevent ‘winding back of the clock’ when it comes to housing help for older people and NHS links. Already we’re seeing a return to the bad old days of hospital discharge to single room existence e.g. putting a bed and commode into the living room if people are unable to use the stairs, rather than organising a stair-lift so they can use the bathroom or sleep in their bedroom.

Let us hope that the experience of coronavirus will add impetus to action to make all homes better, healthier, more secure places for people of all ages to live.

[May 2020]

Not much to ask?

Blog by Sue Adams, CEO of Care & Repair England

With so much talk of ‘levelling up’ there were high expectations that the ‘left behind’ areas of the North might see some practical, funded action announced in the March 2020 budget.

 

No-where is new investment more clearly needed than in the existing housing stock in poor areas. Sadly, when the Budget was published there was little to celebrate if you are living on a limited income in a poor quality, low value home in a disadvantaged neighbourhood.

This week saw the publication of our new graphic briefing, Decent homes for ageing well.  This highlights the many reasons why action is urgently needed to improve the safety, warmth and quality of existing homes.

The £1.4b p.a. cost to the NHS must be one of the most frequently quoted figures about health and housing connections. Unfortunately, despite the claims that the NHS is more focused on prevention, it has not resulted in concerted action to make current homes less hazardous, unhealthy places to live.

The housing policy focus is still on number of new homes built – quantity not quality.

Our joint publication with the Centre for Ageing Better, Home and Dry: The need for Decent Homes in Later Life launched at our House of Lords event on 5th March, makes a compelling case for action. We also hope that the linked Data Annex [will encourage more researchers and organisations carry out further analysis and work in this field.

Lets us hope that together we can influence the forthcoming Spending Review and secure fresh action (and funding) to make all homes good places to age well.

[March 2020]

More in Common

Blog by Sue Adams, CEO of Care & Repair England

We are surrounded by so much conflict at the moment, with ever widening divisions and hardening of opposing standpoints on many fronts.

So it is heartening to see signs of consensus breaking out in one area at least – what to do about housing and ageing.

In the light of the recent ‘Spending Round’ announcement and extra money for all Government Departments, two new housing and ageing Manifestos provide useful suggestions for action.

Both also highlight the crucial need to change Building Regulations to improve the accessibility of new homes, a subject about which the SR promises a consultation.

The first Manifesto, Housing Action for Ageing Well from the Older People’s Housing Champion’s Network, calls for better homes for all ages, improvement of existing homes to make them healthy, safe, secure places to live well, universal access to housing information and advice, plus ‘Seven Steps to better housing for ageing’ .

Similarly, the new Housing & Ageing Alliance Manifesto, Time for Action, is calling for changes that will enable older people to live independently and well wherever they choose, creation of age-friendly homes, neighbourhoods and services that enable people to live healthy, fulfilling lives, involved with families, friends & neighbours and contributing to their communities in later life – an intergenerational message if ever there was one.

In addition we have the positive housing work of the Centre for Ageing Better. They too call for action to improve the quality of the existing housing stock for an ageing population, as well as improvements to the design of new homes, better housing information and advice plus action to enable people to age well in place, as engaged, active members of society.

The challenge now is to convey this emerging shared vision to those in positions of power, inspiring them to take up the challenge and make these aspirations a reality.

[September 2019]

Who knows best?

Blog by Sue Adams, CEO of Care & Repair England

One of the things that younger and older people have in common is that someone else thinks they know what is best for them.

As a young person it’s usually your parents, but as you get older the tables can turn and the offspring are now telling the parents what they ought to do.

This is particularly the case when it comes to housing decisions. The retirement housing sector woke up to this some time ago, identifying daughters and daughters-in-law as a key influence in an older person (usually widowed female) moving into specialist accommodation.

Whilst in most instances the ‘influencers’ have the older person’s best interests at heart, this is not always the case. Inheritance of housing equity, family convenience (e.g. closer location), fewer caring responsibilities etc. can also play a part. There is also a growing number of older people ageing without children who don’t have a helpful family member with whom they can discuss their later life housing and care.

Whether it is an individual older person, family and/or friends weighing up later life options, everyone needs good quality, impartial information about what is possible.

A new report from the Centre for Ageing Better warns that people who are making housing decisions, whether about adapting their home or moving so that they can live independently and well for longer in later life, can be hindered by the lack of co-ordinated housing information and advice to help them plan for the future.

I was particularly pleased to read that this report, Home truths – Housing options and advice for people in later life: Learning from communities in Leeds, is calling for improvements to local provision of independent housing information and advice alongside reinstatement of national government funding for a complimentary, specialist national advice service.

Care & Repair England has worked for decades to support an evidence based model of a combination of national and local housing information and advice, including the successful initiative delivered through the Elderly Accommodation’s First Stop programme. Our own Silverlinks project also provided people with self help information and supported action by older volunteers working with local agencies.

Sadly, access to such help has declined significantly in recent years, as funding for housing information and advice has been cut to the bone and all national funding ceased.

The MHCLG Select Committee’s Housing for Older People Inquiry Report also recommended that:

  • The existing FirstStop Advice Service should be re-funded by the Government to provide an expanded national telephone advice service, providing holistic housing advice to older people and signposting them to local services.

Let us hope that the new Housing Minister will review this report and act on this and other recommendations.

Making Connections

Blog by Sue Adams, CEO of Care & Repair England

I am a great believer in learning from history, using hard data and basing decisions on solid evidence.

Always asking why, what, how is a good rule of thumb if you want to bring about useful change. Why do we do things this way? What is being achieved by doing x, y, z? How can we do things better?

Which is how our Catch 22 project (download brochure here) got started. This aims to connect researchers, service providers and older people to improve the evidence about the impacts of various aspects of housing on older people’s lives. Our particular focus is on the connections between adapting/maintaining ordinary mainstream homes to extend a healthy, independent later life.

It can be tough on front line practitioners who see the benefits to individuals of improved housing on a daily basis (why should we have to keep proving the obvious is a common refrain). However, in these days of austerity, quantifying gains is the name of the game. To be blunt – what does your housing service save the NHS is the number one question.

We absolutely have to work together if any practical housing services for older people are to survive, and we need all the help we can get.  Evidence of impact won’t save every good service, but it might tip the balance in some decision making.

Which is why we are so grateful to the academics and researchers who go out of their way to do what they can to carry out research in this underfunded, neglected area, and which all too often falls between the cracks of health, social care, housing and ageing.

The British Society of Gerontology has been a great supporter of Care & Repair England’s work, and so I am profoundly honoured to have been chosen for the 2019 BSG Outstanding Achievement Award. As well as being wonderfully affirmative at a personal level, it will, I hope, also help to raise the profile of the importance of housing and ageing research.

So a huge thanks to BSG, and to everyone out there who is making those important housing, health, care and ageing connections at every level [July 2019]

Better Together

Blog by Sue Adams, CEO of Care & Repair England

 

 

The sun might be shining and the temperatures have been topping 30C, but just a couple of weeks ago some places were experiencing a months’ rain in an afternoon, and in March we were snowed in.

What does this ramble about the weather have to do with older people and housing?

Everything. If you have a home that is not weather resistant –  in a poor state of repair, with a leaking roof, rotting windows or faulty heating – these increasingly extreme weather patterns are going to make life even tougher.

Add to this the additional risks that a home with falls hazards (uneven stairs, slippery bathroom floor etc.) poses to you as you become older and less agile.

Just some of the reasons why making the current housing stock ‘decent’ is such a pressing issue in terms of good, healthy ageing.

Which is a long winded way of setting the scene for our great new partnership with the Centre for Ageing Better.

Older people, and older owner occupiers in particular, are over-represented in non-decent homes, with direct consequences for their health and well-being. The Building Research Establishment’s calculation of the costs to the NHS of £1.4b p.a. in first year treatment costs alone is often quoted, but what is less often highlighted is that nearly half of this cost arises from older householders.

Unfortunately, in recent years retrofit of current homes has fallen off the housing policy agenda, even though most of the homes we will be occupying in the foreseeable future are already built (80% of the homes that we will be living in by 2050 are already out there).

There is now increasing recognition that disrepair and degeneration of current homes is, in some areas, an even more pressing housing issue than supply.

Care & Repair England and the Centre for Ageing Better are going to work together to address their shared aim of improving the quality of existing housing for an ageing population.

This will include updating data and evidence around decent homes, working with a wide range of stakeholders to define ‘what works’ with regard to improving homes in order to create and promote the most effective approaches to reducing the number of non-decent homes.

The housing stock (of all tenures) is a precious national resource and there is a rising concern about current homes’ impacts on occupants. I have noticed an increasing interest in re-opening the debate about the state of existing homes and the need for policy and practice innovation, so watch this space.

[July 2019]