the impact of mackintosh housing wellbeing research group...

The impact of housing modifications –emerging findings from the evidence review

Presentation by

Sheila Mackintosh

Research Fellow,Public Health and Wellbeing Research Group, University of the West of England

Date: 13.07.17

Small but Significant Conference Manchester

The role of home adaptations in improving later lifeEvidence Review• Commissioned by the Centre for Ageing Better• University of the West of England - Public Health and Wellbeing

Research Group • BRE

Context• Why evidence is needed• The type of evidence required• Search strategy• Emerging issues

Picture by Emma Brownjohn - used with permission of the artist

Presenter

Presentation Notes

Most people will remain reasonably active until the end of their lives – carrying on working, caring for families, volunteering, traveling, pursuing hobbies and interests. Yes there are increasing problems of multimorbidity, frailty, obesity, diabetes, dementia etc – but these problems mostly affect a small number of years right at the end of life. There are increasing opportunities for people to have many years of good quality of life. Medical advances are happening all the time. Technology is allowing us to do things more easily – driverless cars could soon keep us mobile. There is a lot of work going on to encourage people to exercise more, to eat more healthily and to prevent people becoming socially isolated. But inaccessible and unsuitable homes will have a significant impact on people’s lives because that is where people in later life spend most of their time.

1.What outcomes are associated with the provision of home adaptations for people in later life? What works, for whom, under what circumstances?

2.What prompts people to undertake home adaptations, makes them reluctant, or acts as difficulties and barriers to implementation?

3.What are the costs and savings for individuals/households and for public expenditure (particularly NHS and social care)?

Using the findings:• People considering their own or family members’ needs• People providing information and advice • Practitioners involved in assessment and delivery• Healthcare professionals• Policymakers and service commissioners at national/local level• The supply chain - manufacturers of specialist equipment/supplies• Housing professionals, architects, planners, building design• Academics working in the area of housing, health, care and ageing

Aims of the review

Presenter

Presentation Notes

Understand what works, but also what prompts people to start adapting their home. Can we understand this and use the evidence to encourage more people to improve their homes before crisis hits – to understand the small things that they can do to ensure they and their carers stay safe and that their home works for them rather than against them to make things easier to manage. Also need to raise awareness of the importance of home adaptations to people in health and social care. To make sure there is enough resources in the right areas. To enable people who need help to be identified earlier so that there can be more preventative work – so that it is not just crisis intervention. To make sure that we protect the non-statutory services – the advice and information, the handyperson services, the access to trusted builders and contractors that are so vital to helping people to help themselves.

Source: Family Resources Survey 2013-14

Age range No. older carers 2001

No. older carers 2011

% increase

65-74 582,287 725,251 25%75-84 261,240 377,923 45%85 and over 38,291 87,346 128%Total 881,818 1,190,520 35%

Source: Carers UK and Age UK, 2015

Increase in older carers

Disability by age

Disability in later life

Presenter

Presentation Notes

But disability and frailty rises with age, particularly after the age of 80. A lot of disability is hidden, people don’t acknowledge they are disabled or assume mobility problems and sensory impairment are an inevitable part of ageing, so figures probably underestimate the true extent of disability. Many carers are also older and have their own disability issues. H&SC focussed on the 80+ age group when more attention should be going to the younger old to prevent the need for crisis interventions as they get frailer.

Lack of specialist housing Specialist homes by tenure -sheltered, extra care, retirement

Source: Pannell, J, Aldridge, H, & Kenway, P (2012) Market Assessment of Housing Options for Older People London: New Policy Institute

Source: Elderly Accommodation Council - in Lyons et al (2016) How a greater focus on ‘last time buyers’ and meeting the housing needs of older people can help solve the housing crisis. London: ILC-UK.

Extra care and retirement housing for rent and for sale 1980-2014

Presenter

Presentation Notes

90% of people are in mainstream, ordinary housing – only 4% in residential care and about 6% in specialist housing of various sorts. But focus is on the 10% not the 90% because it’s the people 80+ that are the key issues for H&SC.

Key role of home adaptations• Apart from London (all Part M Cat 2 and 10% Cat 3) only

3% of English local authorities had policies to deliver and monitor the number of accessible homes built1

• Very little choice for owners with low income/equity –the households most likely to be disabled

• Homes already built that people will occupy in later life • 65% of all emergency admissions due to falls in people

aged 65+ are falls that occur in peoples homes -• Need effective ways to identify need and adapt and

repair homes – before people reach crisis point

1. Freedom of information request by Habinteg 2016 (returned by 82% of English local authorities)

Changing policy environment England• 70% health/social care spending on long-term conditions• Fundamental shift beginning - away from focus on single

diseases, to co-ordinating care around the individual• Patients over 75 assigned named GP – better care planning• New Care Act; Health and Wellbeing Boards; pooled health

and care budget - includes DFG, but not Community Eqpt• More effective discharge, reablement, social prescribing • Health and social care to be fully integrated by 2020/21• BUT - Sustainability and Transformation Plans (STPs) - no

mention of home environment or need for adaptations/repair• Some excellent good practice, but localism, fragmented

services, fragmented IT systems/lack of data, no single profession involved, lack of respect

Presenter

Presentation Notes

Huge changes underway driven by the ageing of the population. But in most areas housing not seen as a central component. This is why we need better evidence. There are opportunities to influence the direction of change.

Evidence gap – policy gap

Presenter

Presentation Notes

Home adaptations/Handyperson services fall into a no-man’s land between all the major services. Service transformation a slow process. Got to have strong evidence that adaptations prevent falls/accidents, improve levels of independence and save money for H&SC

Integration –putting the person and the home at the centre

Presenter

Presentation Notes

Integration is currently focussed on joining up services around the person – needs to also include the home.

Building the evidence baseBetter Outcomes, Lower Costs (Heywood and Turner, 2007)• Improved outcomes eg. falls reduction, ADL, mental health • Some evidence of financial savings:

o reducing or removing existing outlay – faster hospital discharge, return home from residential care, reduced care package

o prevention – A&E, hospital admission, residential care, injury to carers o prevention of waste – delay in installation of adaptation

Cochrane Reviews:• Turner et al (2011) Evidence for prevention of falls inconclusive• Gillespie et al (2012) Home safety assessment and modification

interventions effective in reducing the rate of falls and risk of falling – especially if someone had already fallen. Increased effectiveness in combination with exercise and if home safety interventions delivered by an occupational therapist

Evidence Review 2017 - Centre for Ageing Better

• English language, Jan 2000-Dec 2016, people 65+• Home adaptations – minor and major (not equipment or

assistive tech)• Black and grey literature from online search, genHOME

repository, genHOME members, other academic, policy and practice contacts, and snowballing

• 60 papers – reviewed for relevance and quality• 11 randomised control trials – most in relation to falls• Realist synthesis - real world, complex social interventions

are dependent on context and implementation.

Evidence locations

Main issues

Presenter

Presentation Notes

Unable to go into detail at this point – report will come out in due course.

Using the evidence• Transformation of services - possibilities for prevention/

early intervention• Increase in DFG funding – opportunities to change the

way services are delivered through the RRO• Learning lessons/overcome reluctance to innovate/learn

from good practice• Getting people to plan ahead – barriers/facilitators – role

for HIAs/Handyperson services• Need for better design – rising expectations

Contact detailsSheila MackintoshPublic Health and Wellbeing Research GroupDepartment of Health and Social SciencesUniversity of the West of England, [email protected]

UWE Team: Professor Jane Powell, Emma Bird, Janet Ige, Professor Selena GrayBRE: Helen Garrett and Mike Roys

PublicationsCameos of good practicehttps://homeadaptationsconsortium.wordpress.com/good-practice/

The DFG before and after the introduction of the Better Care Fund http://www.foundations.uk.com/resources/home-adaptations/the-dfg-then-and-now/

mailto:[email protected]

https://homeadaptationsconsortium.wordpress.com/good-practice/

http://www.foundations.uk.com/resources/home-adaptations/the-dfg-then-and-now/

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