It's no secret that our already disjointed health and social care system is under serious and growing pressure, due to longer life expectancy and an ageing population. But could housing be the unlikely key to transformation?
Integration has emerged as a theme that politicians, health professionals and those of us in the care and housing sectors agree is the answer to many of the challenges now facing us. Getting this right is vital if we are to improve the situation of older people across the country, but at the moment integration is more rhetoric than reality.
When we talk about our aspirations to join up care for older people, we need to remember that health and social care are only part of the picture. Housing is an essential cornerstone to improve quality of life for older people, improve wellbeing, avoid sub-standard care, and reduce demand on the NHS.
The Commission on Residential Care was created to bring together experts and practitioners across housing, care and health. Former Care Minister Paul Burstow MP has worked with housing and care providers, including Anchor, to tackle this issue, and recommend practical solutions to overcome the challenges around joining up services.
A key issue that must be addressed in order to begin the process of change is to challenge the perceptions of residential care. As a 'brand' residential care is unloved, feared, and certainly not seen as a positive choice. Linked in the public mind to a loss of independence, residential care is seen as a place of last resort.
Personal independence is wrongly associated with remaining in your own home; in reality this may not be the option that enables an active, fulfilling life. Residential care should be seen as part of the continuum of 'housing with care' options on offer.
In fact, CORC is recommending the terms 'residential care' and 'care home' should be banned from use in all government policy and guidance. Instead, they should be replaced with the sector-wide term 'housing with care' to better represent all forms of care delivered in specialised housing settings.
This 'rebrand' is a prerequisite to delivering the kind of 21st century care system that is so needed. It will mean the focus is on the needs of each individual, removing the distraction of the 'where' of care. Each person would have their care needs assessed distinct from any presupposition as to where this might be delivered. To make this possible, housing with care options need to be diverse enough to cater for a range of different housing and lifestyle preferences, as well as care needs, so that when a person has an assessment of their support needs, they have a real and valid spectrum of choice about where they might live to have these needs met.
This is the second key issue that must be addressed - the lack of options when it comes to making choices about housing with care.
The chronic shortage of appropriate homes across the housing chain is sharply felt by older people. As highlighted in Anchor's Grey Pride manifesto 50% of over-60s who want to move into a more suitable property aren't able to due to a lack of supply. The impact of this runs deep, affecting old and young. Ill-suited or poorly-adapted homes are hazardous for older people with limited mobility which in turn increases demand on the healthcare system. Equally, enabling older people to move into retirement housing frees up homes for families and helps first-time buyers get on the property ladder.
Last month, a report was published by independent think tank, Localis, in partnership with Anchor revealing that 77% of local government leaders across England believe there is not enough appropriate later life housing in their area. This is hardly surprising; just 2% of English housing stock is retirement housing, and homes being built specifically for older people have decreased from 30,000 per year in the 1980s to 8,000 per year today. A 2010 study by the National Housing Federation found that only 45% of local authorities had a housing strategy for older people, which perhaps goes some way to explaining why two-thirds of planning applications for retirement housing are refused first time around.
It's time to address the issue of appropriate housing for older people, and this has to mean more choice. From retirement villages to assisted living schemes, housing with care should be better prioritised in local planning systems.
Decision-makers at local and national level need to understand that housing has a crucial role to play when it comes to fixing the health and social care system. A good first step would be to appoint a Minister for Older People, who can lead a cross-departmental approach to ensuring that older people today and in the future receive the high levels of housing and care that they deserve.