Domini Gunn, Director of Health and Wellbeing at CIH Consultancy outlines the potential for the right kind of housing and support to reduce the burden and improve the quality of life of older people
I’ve often heard it said that we are facing ‘a tsunami of ageing’ – and you only need to take a cursory glance at the latest statistics to see that’s no exaggeration.
We’re not building enough homes to keep up with our growing population in general – in England 135,050 new homes were built in the year to September 1, compared to the 240,000 experts estimate are needed. But we are particularly underprepared for future changes in demographics 2 – between 2015 and 2020 the UK population is expected to increase by 3%, while the number of over 65s, over 85s and centenarians are expected to grow by 12%, 18% and 40% respectively. Where is the housing that will help these people live independently and well, with access to the care and support they need?
Long-term conditions already account for 70% of health and social care spend 3. Housing ‘hazards’ such as excess cold and damp cost the NHS more than £600m a year according to a recent BRE study 4. There is clearly huge potential for the right kind of housing and support to reduce this burden and improve the quality of life of older people.
A scheme piloted by North Tyneside Homes, focusing on preventing ill health and promoting wellbeing, saved the local NHS Trust £11,000 in 3 months, for example. Housing association Gentoo has launched a pilot with the NHS in Sunderland to ‘prescribe’ new boilers and insulation for tenants suffering from respiratory problems likely to be exacerbated by cold and damp. In the first 6 months alone 5 GP appointments had been reduced by 28% among the pilot group and outpatient appointments by 33%. Research commissioned by the ExtraCare Charitable Trust 6 found that costs are slashed by more than a third and health benefits soar in its housing with care and support developments.
What we really need, however, is a significant increase in housing options, including specialised housing, tailored to meet older people’s very different needs and aspirations. But it looks like recent policy developments are going to make that very hard to achieve. The Care Act 2014 is a laudable piece of legislation – its stated aim is to promote independence, control and choice. But this vision is not reflected in recent housing policy announcements.
The new Housing and Planning Bill, for example, does focus on delivering more homes – but mostly for younger people who cannot afford to buy. Most elderly people already own their homes so are potentially seen as ‘lower priority’, with an assumption that high levels of housing equity are available to all. The bill is largely silent on older people’s housing issues. Some of the measures it includes, however – alongside those in the summer budget, spending review and autumn statement – are likely to have a significant impact on older people, on our existing supply of specialised homes and our ability to build new specialised housing.
Pay to stay, for example – which will see social housing tenants with a household income of £30,000 (or £40,000 in London) paying higher rents – is likely to affect some older people, and we are still waiting to hear whether the policy will include supported housing, which generally commands higher rents and service charges because it is more expensive to build and maintain. If older households are suddenly expected to pay closer to market rents, will they be able to afford it?
In the spending review, the chancellor announced that housing benefit for social housing tenants will be capped at the same rate as Local Housing Allowance (LHA) – the amount that claimants living in the private rented sector are entitled to. Again we are waiting to hear whether this will apply to supported, sheltered and extra care housing for vulnerable, homeless, disabled and older people – but Inside Housing has reported 7 that government officials have privately said that it will. Our concern is that current models will become unaffordable for new tenants and developers will see specialist housing schemes as unviable as a result.
Mick Sweeney, chief executive of One Housing Group, told Inside Housing 8 that a number of schemes under development, including 300 extra care properties, were now under threat due to the change. Extending right to buy to housing associations could also affect older people. We know that housing associations will be able to protect certain homes by offering tenants who want to take up their right a discount on an alternative home. But it is by no means certain that all specialised homes will be exempt. If they are sold, will the homes that replace them be suitable for older people or adaptable?
Housing that is designed for older people, or that can be adapted at a far lower cost than acute care interventions, can not only support us to live well as we age and cut health and social care costs, it can also help younger generations struggling to get a foot on the housing ladder. By giving older people the opportunity to move to a more suitable home, it can ‘free up’ housing for younger people to move into. Housing associations, local authorities and private developers are all keen to play their part in improving and adapting existing homes, and building the new homes we need to support our ageing population – of the right quality and in the right places. But I fear that the current policy environment means we could miss a huge opportunity to get things right now and for the future.
Director of Health and Wellbeing