When it comes to care, is there any place like home?

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Part of Time to Think Differently

Many of us have sometimes felt like voices in the desert proclaiming the role that decent, appropriate housing for older people could play in improving health outcomes while delivering savings across the system.

We already have the blueprints: the 2009 Housing our Ageing Population: Panel for Innovation (HAPPI) report set out design criteria for new 'care ready' housing that would meet the needs of our ageing population, allowing them to retain their independence for longer, match the aspirations of the baby boomer generation and promote good health.

Now we need to get on with implementing the HAPPI proposals, something the All Party Parliamentary Group on Housing and Care for Older People recently sought to encourage with its report calling for a more coherent strategy across housing, health and social care.

This will require stronger leadership, radical new policies and financial incentives to inspire innovation and stimulate growth. The importance of coherence and integration is also emphasised in the Health and Social Care Act 2012. Health and wellbeing boards will have a critical role to play here, and it is promising to see that executive councillors or directors with responsibility for housing will join colleagues from children’s services, adult social care and public health on these boards.

Housing providers and commissioners must also ensure that those around the table are well informed about the role that housing can play in improving older people’s health and producing savings across an increasingly stretched health and social care system. For example, extra care housing, which is designed to meet the needs of residents by offering care and support on site and on call, has been shown to improve health and wellbeing for older people, while delivering cost-effective support outside of residential care.

At this time of year, we also need these boards and clinical commissioning groups to recognise that providing winter fuel allowance for older people and others with long-term conditions will produce savings by avoiding A&E visits and emergency hospital admissions.

What else can be done? Health commissioning strategies must take account of the return on investment that services – such as handyman services and aids and adaptation – can provide. Last month saw some festive cheer on this front with the Department of Health announcing an additional £40 million for Disabled Facilities Grants. This comes on top of the announcement in September of an increase of £100 million – to £300 million – in the Department of Health capital grant to stimulate the building of new specialist housing with care ‘hubs’ for older and disabled people over the next five years.

On the ground, we also need to see housing input into hospital discharge plans. Each local health system should have pooled or dedicated budgets to allow housing adaptations to be put in place swiftly to support recovery and rehabilitation at home, reducing the cost of delayed discharges or readmission.

This is true for the growing number of people with dementia too: relying purely on hospital provision to meet their needs is not only bad for those affected, it’s also frankly impossible for the taxpayer. Virtual ‘hubs’, telehealth, assistive technology and low-level interventions could all help people with dementia stay in their own homes.

Perhaps we can learn something from the progress made in end-of-life care? A national strategy with a key target of helping more people to die in the familiar surroundings and security of their own homes has had some success, though it has taken a lot of work at both national and local levels to get there. Increasingly, people can be discharged home to die in dignity because the multidisciplinary team has assessed and responded to their needs for specialised beds and equipment, such as drips to provide intravenous pain relief.

Investment in housing needs to be more than just bricks and mortar; it must be part of an integrated architecture of building healthier communities and care hubs tailored around someone at home. At a strategic level, this means that housing must be aligned with Joint strategic needs assessments. Operationally, services must be better networked within local health and social care economies. In this way, we can really begin to plan and deliver the health, social care and support that people aspire to in their own homes and neighbourhoods.

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Comments

Dan Gaul

Position
consultant,
Organisation
change3c
Comment date
10 January 2013
It is very pleasing to see the greater focus on partnerships between adult care and housing to support the preventative agenda and older people's wellbeing. Where successful it will also support the integration of services with health.

Sarah T

Comment date
10 January 2013
I find it of some concern that someone in his position doesn't understand that there is no automatic seat at the table of the Health and Wellbeing Board for directors with responsbility for housing. Indeed in some non unitary authorities the District Councils have very little influence over the HWBs in respect of any of the issues for which they are responsible. this is a fundamental flaw in architecture of the HWBs.

Richard Vize

Position
Columnist,
Organisation
Guardian Healthcare and Local Govt Networks
Comment date
10 January 2013
"Housing crisis" talk focusses almost exclusively on the needs of young people and new families, with far too little discussion of the housing needs of older people. With so much talk about integrating health with local government services, it is great to see a strong article explaining what that might mean for dignified care in the community for older people. There are a lot of ideas building around high quality, flexible housing – notably the Future Homes Commission report, and planning minister Nick Boles pushing for more and better development. Councils need to start pushing these ideas in both social and private housing, as well as their own services, with a strong focus on greatly expanding housing suitable for older people.

Liz

Position
community nurse,
Comment date
10 January 2013
I agree whole heartedly with what you say, but wish you wouldn't talk about 'the needs of our ageing population' and 'them' - it is us who is getting older and us who will need this accomodation.

Cllr David Rogers

Position
Chairman,
Organisation
Local Government Association Community Wellbeing Board
Comment date
10 January 2013
We recognise that we must integrate the housing and social care agendas at national and local level to ensure that we can deliver housing that meets the diverse needs of vulnerable and ageing members of the population.

In a period of economic austerity, we believe addressing the housing needs of vulnerable people can substantially reduce demand for, and the cost of, health and social care and enhance quality of life.

What is needed is a change of ethos, a shift of emphasis from providing residential care towards prolonging independence through better public health, leisure and transport schemes, more adaptable housing, new technologies and neighbourhood projects.

Sue Adams

Position
CEO,
Organisation
Care & Repair England
Comment date
10 January 2013
Good to see the important link between housing & hospital discharge mentioned. Have a look at this free resource pack (backed by a wide range of professional organisations from housing, health and care) - Hospital2Home (housinglin.org.uk/hospital2home_pack/). It contains information, suggestions for improving integration of housing and support into the process for discharging older people. For cost benefit analysis and local models google Care & Repair's 'If only I had known...'

Brian Cox

Position
Health and Social Care,
Comment date
10 January 2013
The future for elderly care will have to rely on greater integration, support and value for older people in their locality and the right form of housing provision is crucial. Whilst the place of housing isnt gaurenteed at the HWB table some top tier authorities are showing strategic vision and a broader understanding of well-being by making sure that Housing is part of the action.

Emily Shimell

Position
Video Communications Manager,
Organisation
VideoCentric Ltd
Comment date
10 January 2013
I think it is key to have the right relationships in place between the healthcare sector, decision makers, technology providers and those who will be at either end of that technology. Often I find we speak with the decision makers and healthcare sector (as a technology provider) but don't fully get to understand what the user of the technology in this area will/will not use/understand, therefore resources often being wasted on unnecessary development into a scheme that could have provided many more of the elderly, with a much higher quality service. At the end of 2012, I recall a discussion by Caroline Saunders discussing the problems with the uptake in telehealth including a reminder of the lack of independence, users being scared by mobile phones and the internet, threats to identity etc. and all these issues must be address at every level, especially for care of the elderly, to ensure good quality care whilst making huge savings into the future.

Rekha Elaswarapu

Position
Dignity Adviser,
Organisation
Independent
Comment date
10 January 2013
Agree that a strong need for joined up thinking. many of hospital admission especially for older people are due to inappropriate housing conditions.

Pete

Position
Local Authority Commissioning Officer,
Organisation
A local authority near you
Comment date
11 January 2013
Setting up this blog is a good move - and its good to see the well informed and searching contributions.

I'm one of the people at local level who've never needed to be convinced of the need to incrementally integrate health, social care and housing. There an increasing number of us, but we are not in key positions yet, and given the stagnation in the jobs market, it will take years for us to come through. In the meantime, there is an old-school layer who give lip service to this agenda, but leave housing on the outside. Consequently, the changes required are put back further.

Furthermore, communication protocols in public organisations can prevent the open discussion that is needed. We could perhaps move forward faster if people at local planning level felt more able to openly participate in what is, after all, a quite public and political theme. If you coudl develop appropriate mechanisms for people at that level, it may not seem as much of a desert, but you'd also get some honest inteligence about the pace of change.


Charlie

Position
Development Manager,
Organisation
KeyRing Living Support Networks
Comment date
11 January 2013
Things are shifting in the right direction, but there is still a long way to go. There is indeed ‘no place like home’ but all too often home becomes a lonely place. We all hear stories of older people who haven’t seen or spoken to anyone for days on end, yet on the doorstep there is a community full of people, some of whom are in the exact same position. We need to find ways to draw on that community. Encouraging a supportive community has a multitude of benefits not just for the older person but for the community itself.
Older people have a wealth of experience and skills to offer and by drawing on those skills we can make them feel useful and appreciated, reduce their social isolation and create an early intervention system.
This doesn’t often happen on it’s own but with the right level of coordination and support, can provide a sustainable and cost effective alternative to other support options.
Finally, it’s really important that we keep in mind what older people want and in order to meet these needs we need to be able to offer them a range of options to choose from.

sue

Position
retired Social Worker,
Organisation
Local Authority
Comment date
11 January 2013
None of us know what level of care we may need or when we might need it, therefore it makes sense to make it mandatory for ALL housing developers to build some 'basics' into their new homes. For example, doors wide enough for wheelchairs, no steps at any doors, ground floor cloakrooms which can be simply converted to flat-floor shower rooms. Some developers, for eg, the Taylor Wimpey/Oxley Wood development in Milton Keynes, have already done this. Another example is Crest Nicholson at Oakgrove, Milton Keynes, where some houses have a reinforced roof joist if a lift were ever needed. None of these future-proof plans look 'special' so the houses are homes for anyone, but the design could mean that a householder wouldn't have to move if his/her health changed in the future.

John Archibald

Position
Chief Executive,
Organisation
Victory Housing Trust
Comment date
11 January 2013
"Providing an Alternative Pathway" - new publication from the National Housing Federation - shows how people’s lives have changed when housing associations are involved in aftercare decisions with councils and local hospitals. Publication available here: housing.org.uk/our_regions/east_of_england_region/east_of_england_news/care_pathways_launch.aspx

The Government’s own analysis shows that housing related support services save the NHS around £315m in a year. Government-supported research also shows that investment in specialist housing results in a net cost benefit to the public purse, equating to £639 million overall in a year.

Amy Swan

Organisation
National Housing Federation
Comment date
14 January 2013
Integrating good and adapted housing with health services can dramatically improve the health and wellbeing of older and vulnerable people and prevent them from needing more care. It can bring independence to those with physical disabilities, dignity to older people and provide a safe and secure environment for people with mental health illnesses.

We want the Government to set out clear proposals on the funding of social care reform, and to include explicit guidance on integrating housing and healthcare in the draft Care and Support Bill.

But for housing associations to develop the right type of homes for older and vulnerable people, they also need places where they can build. The Department of Health can help by encouraging the NHS to consider specialised housing when distributing their surplus land.

As John has kindly mantioned above, we have recently launched a new report on the value of integrating housing with care and support. Have a look and let us know what you think! housing.org.uk/publications/find_a_publication/care_and_support/care_pathways.aspx

Ilona Haslewood

Organisation
Joseph Rowntree Foundation
Comment date
16 January 2013
Housing can contribute to improving health in many ways, including better design across all housing (Jeremy points to the HAPPI standards), adaptations and good quality extra care and other supported housing.
Operationally, there are already examples of good partnerships between health and extra care schemes: jrf.org.uk/publications/housing-care-research-practice-examples (p 8)
But over and above this, meaningful relationships, as well as being connected to the local community is just as important: being part of mutually supportive networks, for example (Charlie from KeyRing discusses the advantages of a supportive community). There are promising housing approaches based on mutual support as well, such as Home Share and co-housing (jrf.org.uk/publications/widening-choices-high-support-needs) which will appeal to some.
And finally, just to underline Liz’s point: this does indeed concern all of us.

Jeremy Butler

Position
Mental Health Act Manager,
Comment date
18 January 2013
We also need to consider the needs of patients, not only the elderly, who, suffering from a mental disorder, are detained under the Mental Health Act in the interests of their own health or safety. Some of these patients remain 'sectioned' and in hospital under the Act because their home circumstances present the danger that their mental health condition will deteriorate and their safety is likely to be compromised. Supported suitable housing is necesssary for these people.

Dr Malcolm Rigler

Position
GP North Somerset PCT with Special interest in Public Health,
Organisation
Partners in Health ( Midland) Ltd.
Comment date
20 January 2013
As a GP I have found myself involved in housing issues when problems occur - frail elderly people intimidated by noise and the perceived threatening behaviour of young people "hanging out together" in all winds and weathers for the lack of a place to meet other than on the street, Lonely people of all ages needing to share the "ups and downs of life" but finding no one to talk to in our densley populated towns and cities because there are no "neutral places and spaces" where new relationships can be forged.I could list so many more examples of how housing is undermining peoples health and well being. Housing is not just about a safe ,warm place to live but also about "community development". Sir Liam Donaldson when Chief Medical Officer of Health a few years ago wrote that "GPs need to become experts in Public Health" and GPs should get fully involved with "Community Development" . This aspect of GP work and Primary Health Care is not yet even on the horizon of the GPs developing Commissioning Groups to the best of my knowledge. To try to ensure that this aspect of GP work is not sidelined maybe Health and Well Being Boards should think of having a GP with a Special Interest in Public Health as "one of the team"?

Sue Garwood

Position
Independent social care and housing consultant,
Organisation
N/A
Comment date
11 February 2013
Just to build on Ilona's point. It is not only well-designed housing and the physical or environmental aspects of it that need to be recognised as enhancing or undermining health and well-being. It is also housing-related services such as home improvement agencies, housing-related support, and generally the staff working within the housing sector, who, if included at a macro strategic and service development level, and at a micro support planning level, can make a significant contribution. While the physical environment is important, "housing" is braoder than that.

Dr. Erik J. Fransen

Position
CMO,
Organisation
Vitaphone
Comment date
26 February 2013
I could spend a lot of words here, but let me put it simple:

I could not agree more!

Kind regards,

Dr. Erik J. Fransen

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