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Investing in tomorrow: Our future homes

On 26 November the Ministry of Housing, Communities and Local Government and DHSC published their joint report

When they launched the Taskforce the two Departments set them the task of “Understanding the market in England for older people’s housing today and into the future; the enablers for older people when seeking to move into appropriate or specialist housing; opportunities and benefits of broadening provision and choice for older people, including continuing to live in their own home if they wish to do so; and to develop a viable and implementable approach for enhancing choice for older people in the housing market.”

The report is all about how we can support people to live well and longer in an age friendly, dementia inclusive, faith and culture sensitive home and neighbourhood of their choice.

It discusses Older People’s Housing (OPH) or Later Living Homes (LLH). 

Whilst clearly a publication more aimed at the Retirement Living market there are lots of interesting health and care sector points contained within it which we thought worthy of note and which readers might like to consider.

One point that is made several times throughout the report is that improving lives can also save money for the NHS e.g. by avoiding unnecessary hospital admissions from slips, trips and falls and readmissions. It also highlights that to ease the pressure on the NHS and social services the government needs to construct OPH/LLH at the rate of 50,000 new units a year compared with the current 5-7,000 being built.

They want to build upon the positive energy and insights generated by the Taskforce across housing, health and social care to develop a long-term collaborative action plan.

Facts and figures

There are interesting statistics such as:

  • Over 11 million people are aged 65 years or older, 18.6% of the total population (compared to 16.4% in 2011).
  • By 2066 there will be a further 8.3m (26%).
  • The number of people aged 80 and over is the fastest growing segment of the population.
  • Whilst one in three people will develop dementia in their lifetime, one in two will be affected by it through caring for someone with the condition.
  • Poor quality housing costs the NHS £1.4 billion a year.
  • Low-cost modifications could lead to a 26 % reduction in falls that need medical treatment saving £500 million a year to the NHS and social care.
  • Evidence indicates that one older person residing in assisted living generates health and social care cost benefits of £2,441 per annum.
  • We need an estimated 30-50,000 new later living homes per annum to meet growth but only build around 7,000 a year.
  • Current private leasehold OPH options are unaffordable for the majority of English households aged 75 years and over.
  • Around 0.6% live in Housing with Care in the UK - a tenth of the proportion in more mature markets such as the USA, Australia and New Zealand.
  • The vast majority of over 65s - more than nine out of ten - currently live in mainstream housing.
  • Only 12% of older people had level access at the entrance of their building; less than half have a bathroom on the entry level of their home.
  • At present OPH/LLH represents only 2% of investment in the wider healthcare real estate market.

Recommendations

They make nine core recommendations and a tenth overarching one. These include:

Recommendation 2: Incentivise a wide range of OPH/LLH options

Central government should drive progress by DHSC reviewing support for the Care and Support Specialist Housing Fund.

Recommendation 3: Ensure more housing is designed for later life

We have a growing ageing population and housing stock that does not meet their needs. We need to optimise all forms of OPH/LLH including mainstream housing, community-led housing, service-led housing (supported living and assisted living) and though not the focus of this report, care homes.

Recommendation 4: Create age-friendly, dementia-inclusive, faith and culture-sensitive communities

Mandating and funding local authorities and NHS England to publish spatial data on age-friendly and inclusive areas, including accessibility of health services.  Also, requiring the NHS estate to publish data on the accessibility to building-based health assets (e.g. hospitals, GPs, dentists) at local authority levels. Placing a duty on the health service, local government and combined authorities to cooperate in place-making.

Recommendation 10: Create collective leadership to drive change

To achieve a step change, we need to inspire and empower ambitious action, from the top of government and outwards to communities and families. We need to fully integrate housing health and care at all levels of the system. 

Updating the Health and Housing National Memorandum of Understanding (MoU) to support the Integrated Care Systems (ICS) and local stakeholders to work jointly by setting a very clear expectation that the national partnership across housing, health and care is mirrored locally and action plans are agreed through a concordat approach to create strong accountability.

Key points

In the report they quote the Chief Medical Officer from his annual report:

“Older age is becoming increasingly geographically concentrated in England and services to prevent disease, treat disease and provide infrastructure need to plan on that basis. This should be seen as a national problem and resources should be directed towards areas of greatest need, which include peripheral, rural and coastal regions of the country. The NHS, social care, central and local government must start planning more systematically based on where the population will age in the future, rather than where demand was 10 years ago. This includes building or adapting housing and transport to be appropriate for an older population.”

The report highlights four key messages:

  • ‘think housing’
  • ‘address ageing’
  • ‘promote wellbeing’
  • ‘create inclusive communities’

They highlight the plethora of confusing terms used to describe different housing options and suggest these:

  • Mainstream homes/housing
  • Community-led homes/housing
  • Service-led homes/housing with support Supported living
  • Service-led homes/housing with care Assisted living
  • Care homes

Technological readiness features in the report. It includes a focus on information and communication (e.g. electronic health records) and support and assistance (e.g. telehealth, sensors and wearables).

They have noted concerns at ICS levels as some feel that new OPH/LLH would lead to an influx of senior citizens, putting stress on local health and care provision, leading to a potential bias of underestimated need. However, they state that ,as is well evidenced in previous cases, they know that most occupiers of new OPH/LLH tend to be local and already registered with a local GP and go on to say that it is important to plan for the right mix of OPH/LLH development to meet local needs and reduce the care burden in the public sector. They also suggest there should be research on how different models of OPH / LLH impact public services e.g. reducing hospitalisation and social care costs alongside linked agendas such as sustainability.

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