At the heart of Britain's NHS and Social Care crisis is an increase in demand for services from our ageing population. The right housing models can play a critical part in preventing a cycle of demand from starting and allow older people to return to their own homes after treatment, thus freeing up NHS and social care resources.
Social Care services are insufficient to provide the care that older people need in their homes. This leaves many older people without the crucial support that could stop avoidable health conditions from escalating into emergencies that unnecessarily drive them towards NHS services unable to deal with demand.
Once an older patient is in hospital they often cannot be discharged because they're unable to care for themselves at home whilst they recover. The inability of a hospital to discharge an older patient blocks a bed and costs the NHS hundreds of pounds per patient per day.
Often the only solution is to discharge the older person to an expensive residential care setting, taking them away from their home. This causes great distress and a loss of confidence and skills. The resulting strain on social care budgets reduces the resources available to care for older people in their own homes, and the cycle is set in motion again.
Here are five housing models that can help to break the deadlock and which I hope will receive support in the upcoming budget:
1. Adapted personal homes
Poor quality and unsuitable housing impacts on older peoples' physical and mental well-being and can directly lead to injury through slips and falls, costing the NHS an estimated £1.4 Billion a year.
750,000 older people's homes in the UK require adaptations because of a medical condition or disability. For older people who cannot afford to make adaptations there is help available from the Disabled Facilities Grant. However, take up of adaptations - both self-funded and supported by the DFG - is far lower than it could be. The reasons for this are hard to pin down, but one pre-eminent barrier is the stress and anxiety caused to older people when work disrupts them in their homes. There is an undoubted fear of being unfairly treated by 'cowboy builders'.
One innovative solution has been developed by the Home Improvement Agency of the Year, WE Care & Repair, who offer a service that takes all the stress and anxiety away from older people having to deal with builders. WE Care & Repair will assess home adaptation needs, commission the adaptations and manage the payment to the builders on behalf of the customer, but only once the work has been inspected by one of their assessors.
2. Sheltered housing
Sheltered housing is a model operated by a range of housing associations and almshouses across the country. The model offers affordable housing with support in the form of housing officers who either float between schemes or are based on site. Sheltered homes typically provide an emergency alarm system in the form of a pull cord or a wearable pendant and many employ further assistive technology.
Multiple benefits of sheltered housing have been identified by National Housing Federation research, including:
• Lower levels of social isolation
• Better physical and mental health
• Help to downsize homes, freeing up larger homes
• Reduces and delays the need for primary care and social care
• Reduces hospital admissions
• Enables timely discharge from hospital and prevents re-admissions
3. Extra Care Housing
Extra Care is the provision of sheltered housing with 24/7 care available on-site. Older people live in their own homes within a facility and have control over their care plans and daily activities which they would lose in a residential care setting.
Research has demonstrated that residents living in properties run by the Extra Care Charitable Trust cost the NHS £1,115 less per person, per year, compared to costs incurred by comparable residents in the surrounding area.
The Department of Health's Extra Care Housing Capital Fund invested in excess of £227 million into 88 extra care schemes between 2004-10, and continues as the 'Care and Support Specialised Housing Fund 2015-18'. However, according to Housing Lin, by 2030 there will be an estimated shortfall of 61,000 units of Extra Care housing in England - so the model needs further investment.
4. Specialist homes for Dementia sufferers
Dementia Care forecast that by 2025 the UK will have 1.14 million dementia sufferers, which will put a growing strain on social care services.
Supported housing providers are increasingly developing solutions to help dementia sufferers remain as independent as possible in their own homes. A variety of approaches have been developed focusing on either integrating dementia sufferers within a wider community, or separating their housing into designated areas where higher care needs are easier to service.
Dementia-friendly design principles are also gaining prominence in the sector and specialist home adaptations are being considered by organisations such as Foundations (the national body for home improvement agencies).
5. Intergenerational living
Intergenerational living schemes are on the rise. The concept is founded on the idea that older people's needs won't be best met if they're housed in 'elderly ghettos'. Instead, older people should be placed at the centre of vibrant mixed communities with inbuilt support structures that combat social isolation and ensure older people are referred for greater support before their needs escalate to an emergency.
One such scheme in the Netherlands called Care Centre Humanitas houses six students alongside 160 older people aged over 55. In return for 30 hours of voluntary support per month, the students get to live rent free. There's a good BBC video about the project here.
How can we help these housing solutions gain greater traction?
Often the challenge for innovative and ambitious housing providers is in developing the right commercial models that will allow a new scheme to operate sustainably, and then to raise the capital required to finance construction. At Baxendale we're helping a range of housing providers to develop their models and to access the right forms of investment to support them in their growth.