Standards Wise International - Blog

A Festival of Ideas - Day 4

Personalising home adaptations – Innovations in Disabled Facilities Grant funding to create safe and accessible, forever homes
Ed Warner, CEO of Motionspot/Fine&Able chaired the morning session. In his opening comments he said that every decision about care is a decision about housing.
Dominic Woodward-Lebihan from the Department of Health and Social Care said that reform of adult social care is a journey which takes time, and that the publication of the White Paper last week is the next significant step in the journey.
The White Paper is slightly different to others as there was a large amount of input from Providers, which began in March. There were advisory groups for each chapter of the White Paper, taken from every region of England.
The feedback was that the sector needed an idea of what the vision would look like. There are three main parts of the White Paper: people can have choice and control, can access outstanding care; and that the care they access is fair and accessible.
Alex Palmer-Wales, Housing Lead at the Department of Health and Social Care then spoke about the housing element of the White Paper. He said that the Government is trying to ensure that, where possible, the care and support can be delivered in people's own homes.
Opportunities for improvement are: too many people are living in unsuitable homes, older people are being digitally excluded, and there is insufficient innovation of new models. One of their main policies is over £300m to support local areas to provide more specialised housing.
A further £573m pa will be committed to help local areas deliver the Disabled Facilities Grant (DFG), a new service which will help make minor repairs and changes to people's homes to help them remain independent and safe.
Ed Warner then spoke about ‘Fine&Able’. He became involved in the sector after his schoolfriend suffered a spinal cord injury and needed to make adaptions to his home. His friend said that every morning he wakes up and is reminded of his condition because of the products around him.
The pandemic was a catalyst, as they realised that there were many disabled people isolating in homes which were often inappropriate. Before the pandemic 1 in 3 over 65s had a fall, at huge cost to the NHS. Funding enabled them to launch 'Find&Able'.
'Find&Able' focuses on the individual rather than the product, it looks at function and form. One of the challenges the adaptation space has is that it is difficult to be clear on price. They offer a consultation and full quote, they also offer an installation service so that users didn't have to find someone to install adaptations, as well as after-care service.
Examples of innovations in adaptations include: slip-resistant flooring, toilets positioned at the right height for wheelchair transfer and with easy flush mechanisms, washbasins with integrated handgrips, and accessible lever taps which don't require real dexterity.
Housing associations are increasingly using flexible adaptations which can be added or removed. We need to be encouraging organisations to think about how they can build the design into buildings from the outset.
Maria Clark, who featured in George Clarke's Old House, New Home shared her personal experience.
She is a GP and her elderly mother lives with her family. Before the adaptations there were no grab rails, her mother could not flush the toilet and had trouble with stairs. They went to Fine&Able, who worked with the family to find an option which her mother was comfortable with and which also could be folded away so that her daughter was also able to use the room. Rounded taps and activator plates to flush the toilet (which lit up at night) are useful adaptations. Her mother feels that the adaptations don't look like the room has been adapted just for her.
Sheila Mackintosh, Research Fellow at the University of the West of England, then spoke about the role of adaptations in housing associations (HA). The Design Guide is for people in the public sector who have limited resources. On average about half of tenants in social housing have disabilities or long term illnesses, and about 1/3 of DFGs go to housing associations.
Uneven use of the DFG has led to uneven funding - some Local Authorities (LA) have surplus funds and some do not means test it; whilst others offer discretionary grants.
There is some very good practice in LAs, but many HAs have an upper limit of £500 for minor adaptations, leading to long waiting times. There used to be more sharing of DFG costs, but now less HAs make contributions. In addition, the application for the DFG is made by the tenant not the landlord, leading to delays.
Communication can be an issue, and there is concern about adaptations being refused in general needs properties. Also adaptations are often removed when the tenancy changes.
HAs have lost their direct funding and have restricted adaptation budgets, with often only one staff member dealing with numerous LAs, and their 'landlord' and 'home adaptation' roles are often in conflict.
There are complex customer pathways with numerous handovers. Landlord consent often happens a long way down the process, they may not even be aware that the tenant requires adaptations.
Report recommendations include: To increase the HA's minor works budget, and that rather than the tenant applying for the DFG the landlord does it, and therefore has more control over the process.
We need to ensure less adaptations are removed, we also need to remove the stigma so that there is earlier intervention rather than waiting until it reaches crisis point. We also need to improve on the recycling scheme for adaptations which are removed.
We should also seek to change the attitude, so that design is seen as a long-term view rather than a cost; and that it is considered earlier in the process rather than at the end when it is more difficult and costly to make changes.

Housing in later life: improving choice by building a better offer

The afternoon session began with chair Louise Drew saying that it is estimated that £1.4bn per year is paid by the NHS because people are living in accommodation which is unsuitable for them.
Is there a perception issue around retirement living, or does the general public not understand what is available to them? The steering group wanted to tackle the lack of understanding, improve the perception of retirement living, redefine and reenergise interest in later living.
Five key points of the research into retirement living: tackling perceptions, understand the benefits, who to target, how to target, consistency of language.
The research showed that 1 in 5 thought that 'retirement housing' meant 'care homes'; they also thought that the people who moved into these properties were single and already had health issues.
There is a disconnect between what the people living in retirement living thought should be offered by providers; and what the providers themselves thought they should do. There is a lot of uncertainty around tenure (affordable/social housing etc).
Consistency of language: respondents were asked what they thought was classed as old. Respondents all added 20 years to their own age to say what they thought was old – this suggests that we are all in denial about growing old. There are many different terms for later living, which is confusing.
Michael Voges from ARCO then explained that there are lots of different forms of retirement housing, and there are lots of different terms - the Government alone uses 12 different terms.
Their research showed that only 22% of people were confident about what a 'retirement community' was; and half of the people surveyed said that they were afraid to speak to their families about moving, as they thought they would be seen as old and weak.
2/3 of the integrated retirement community sits within affordable housing, but the largest growth is in the private market. The focus of policymakers is shifting towards the mid-market, where there is little provision. The Government White Paper which came out last week was very clear that we need to expand the options available to older people.
Nursing and care homes are focused on acute care, and there is a gap in the middle. If it is positioned just as an alternative to the family home it is not an attractive proposition, if it is positioned as an alternative to needing to go into a care home it is much better. Of the top 15 homebuilders in New Zealand, 5 are retirement living developers. In the past few years only 2 care homes have been built there which were not part of a wider retirement community.
They know from research that one of the biggest issues consumers have is cost escalation. There is a risk curve - compared with other classes, integrated retirement communities are seen as risky because of the lack of regulation.
Michael Spellman from the ExtraCare Charitable Trust then outlined the strands of the new development brief they have: build homes which older people want, offer a lifestyle they can enjoy, provide care when they need it, and offer something which is financially, environmentally and socially sustainable.
In terms of design, they look at passageways for ambulances to leave the scheme with minimal disruption, flexible apartments where people can use the space in different ways, and develop the entire scheme to be somewhere where people want to live by looking stylish and being easy to navigate.
Inclusive design standards are introduced one at a time, gradually embedding dementia friendly design principles. Some things aren't about the built environment, you must consider the social environment too.
Dr Vikki McCall from the University of Stirling then spoke about her research on Planning for Later Life. We know that the population is ageing, and that we are woefully underprepared for it. A project called 'A good life in later years' used community peer researchers.
One of the key principles is co-production: equalizing the relationships in the planning process. It encourages people to think that we are all stakeholders, as we are all ageing.
Lots of things are involved in a good life in later years: Housing, services, health, travel, wellbeing, money, independent choice, communities, environment, and technology.
'If you plan for the most excluded, you include everyone'.
The housing and ageing programme was a game which made people play until the year 2030. They had different roles - policymakers, developers, etc. Their aim was to improve the lives of the people living in the fictional 'Hope Town'. No group reached the end of the game without someone living in inappropriate housing, homeless, etc. It made people think about the effects of the decisions they had made earlier in the game.
The first finding from the game was that it was difficult to plan ahead, as you were dealing with the immediate chaos. The second finding was that when all the different roles in the game worked together, outcomes were improved. This shows the importance of co-production.
Inclusive living - a vision for the housing sector: They want to reset the way we think about adaptations so that they are not just an 'add on'. Thinking about inclusive living supports housing decisions and development, rather than thinking in silos. This will tackle the stigma.
A systematic evidence base and toolkit was developed as a result.
The final speaker was John Nordon, who helped establish Pegasus Life. The hypothesis at the time was that it was a needs-based offer and there was less choice.
The question Pegasus Life asked was: how could they attract retirees to right-size? The target market was already living in the best properties in the areas, so developments would need to be attractive to them and remove stigma.
Marketing of all kinds of products airbrushed out anyone over 65. How can we make places more attractive? Corridors can become winter gardens, care visits become social visits, properties designed in cloisters around small courtyards (Tetbury).
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