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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.

The main points for each of the speakers is set out below (all include a link to the full presentation)

.Speaker’s presentations:

  • Poverty and disadvantage in later life – Professor Debora Price, Manchester Institute for Collaborative Research on Ageing & President of the British Society of Gerontology.
  • Gender differences by age in respect of marital status, divorce, qualifications, housing tenure, income and poverty identified that the most serious disadvantage was experienced by older women living alone. Reference was made to the recent MICRA publication entitled The Golden Generation? Amongst other indicators this report concluded that the risk of social detachment in the richest group is one fifth of that experienced for the poorest group. Major differences in frailty between these groups was also described.
  • What the health sector wants from handyperson services  – Tom Luckraft, NHS England
  • A description of the Independent Care Sector Programme and the CCG Engagement Programme- Health and Housing were described. To date this has involved a series of webinars and quick guides including one on Health and Housing issued in October 2016. Future projects were described. The speaker considered that many of the objectives of the CCG’s and housing providers are shared but for effective partnerships to operate home improvement agencies must understand local needs, operate flexibly, evidence delivery at scale and pace, evidence return on investment.
  • The importance of practical housing help in later life– Dr Rachael Docking, Centre for Ageing Better
  • The high level message was that for older people wellbeing is the product of good health, financial security and social connections. Home is where older people want to be in later life with 80% of homeowners aged over 65 wishing to stay in their existing home. Thus that home needs to be accessible, safe and warm especially as those over 85 years old spend 80% of their time indoors at home. Home improvement agencies certainly have a role to support older people in respect of assisting in repair, maintenance and modification of the home. A key message is that whilst building appropriate new homes is important the majority of stock occupied by older people already exists and it is in these properties that home improvement agency services are most needed.
  • The impact of housing modifications – emerging findings from the evidence review  – Sheila Mackintosh, University of West of England
  • The aims of the review were to identify outcomes resulting from adaptations, the triggers and barriers to installing adaptations and the costs and savings for the individuals and the state resulting from adaptations. Building an evidence base is vital to the survival of home improvement agency services but there are major gaps in evidence derived from good quality research which need to be filled.
  • Small but Significant – evaluating Preston Care & Repair’s handyperson services – Sue Adams, Care & Repair England and Laura Holmes, Preston Care & Repair
  • The role and contribution of agency services was set out in respect of prevention, reducing risk of hospital admission/readmission, delayed transfers of care and greater independence in the home. The range of services provided by the Preston agency were described but mention was made of tightening eligibility criteria by the commissioner which has, in part, led to the development of paid for services. Funding from the Rayne Foundation enabled continued support of some services including addressing disrepair. The findings of the evaluation involving questionnaires and face to face interviews were described the most notable being that services are a “lifeline” especially for women over 80 living alone. A plea was made for more researchers to undertake further studies in this topic area.
  • Afternoon Session -Innovation in handyperson provision:
    • Faster hospital discharge: West of England Care & Repair’s Dolphin scheme –  Robin Means & Sheila Mackintosh
    • This was a pilot scheme involving close links between agency caseworkers and ward/discharge teams in a local hospital. Caseworkers arrange necessary works to address risks in the patient’s home. An in-depth analysis of just four cases calculated a saving in hospital bed days equivalent to £13526, a cost to saving ratio of 14:1 plus savings of £897 in hospital staff time costs. As a result of the evaluation Bristol City Council introduced 2 capital grant schemes for the costs of necessary repairs but it is likely, due to the local CCG operating in a significant financial deficit environment, that funding for the caseworker is likely to end soon.
    • St Helens Hospital Admission Avoidance Car Project – Lee Norman & Helen Williams, St Helens Council
    • This is a local initiative to address exceptionally high rates of hospital admission resulting from falls in the home. A paramedic and an Occupational therapist from the home improvement agency operate a car in office hours five days a week to assess fallers to identify those who with modest housing interventions could remain at home rather than go to hospital. Works are usually arranged in two hours of the assessment. An evaluation shows positive findings such that the project will continue for another 6 months at least.
    • Integrated prevention: Lightbulb in Leicestershire – Quin Quinney, Blaby District Council
    • A £1m Transformation Challenge Fund award from DCLG help set a hub and spoke model for a range of support services across the County. The model has been tested and evaluated via a number of pilot projects. The headline conclusion is that the £1m per annum costs of delivery confer £2m per annum savings to Leicestershire and the wider health economy.
  • The impact on older people of excess heat in the home – evidence and opportunity – Dr Alan Lewis, University of ManchesterThe speaker concluded that the majority of these findings are equally applicable to mainstream housing not least in getting key messaging out effectively to older people in owner occupation on heat management issues. Home improvement agencies may well need to add such advice/information and support services in this topic area to existing services in an increasing fashion due to future trends in climate change.
  • The key message was that excess heat in the home has had historically much less profile than excess cold. The health risks arising from excess heat which affect older people in particular were listed. A summary of a 14 month research study in care/extra care accommodation in four localities was provided. The findings included that cold is seen as a bigger threat than excess heat, excess heat is perceived as a rare occurrence, opinions vary on what is a comfortable temperature, the level of knowledge amongst operational care staff to manage heat for residents was generally inadequate, there is a major issue of who controls the heating and there was a general practice of leaving the heating system on with windows open, buildings generally have an absence of heat management features.
The aim of Care & Repair England’s Catch 22 project is to forge new partnerships and stimulate fresh research in the health/ housing/ ageing field by bringing together leading researchers. If you have any good ideas, good practice and issues to raise in this field or want to join our virtual network to receive occasional e-mail alerts please contact Martin Hodges martinhodges@careandrepair-england.org.uk or telephone 0751 654 5586. Click here for the Summary flyer about Catch 22