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

This content relates to the following topics:

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.

Related content

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.


Add your comment