Housing an ageing population: housing options and the value of information and advice to older people HSA Conference 2012 Dr Gemma Burgess

A worldwide concern Worldwide, the proportion of people age 60 and over is growing faster than any other age group. Between 1970 and 2025, a growth in older persons of some 694 million or 223 percent is expected. In 2025, there will be a total of about 1.2 billion people over the age of 60. By 2050 there will be 2 billion with 80 percent of them living in developing countries.

The UK’s ageing population Over the last 25 years the percentage of the population aged 65 and over increased from 15 per cent in 1983 to 17 per cent in 2010, an increase of 1.7 million people. Trend projected to continue. By 2035 it is projected that those aged 65 and over will account for 23 per cent of the total population compared to 18 per cent aged 16 or younger. By 2083, one in three people in the UK will be over 60. The fastest population increase has been in the number of those aged 85 and over, the ’oldest old‘. In 1983, there were just over 600,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in By 2035 the number of people aged 85 and over is projected to more than double again to reach 3.5 million, and to account for five per cent of the total population. From the 1950s onwards, the number of centenarians (people aged 100 and over) in England and Wales has increased at a faster rate than any other group to reach 12,640 in 2010.

Emerging policy landscape Ageing has economic impacts – health, social care, housing, pensions etc. Systems will have to change. Funding care is a big issue – how to meet the costs, who should pay and how? Dilnot. Cost constraints lead to shrinking role of local & central state. Local Councils given more discretion over cut budgets. Support services to people not in critical need reduced. Pressure to allocate housing & resources most effectively. Resources increasingly allocated direct to service users. Focus on Active Citizens within communities and thus core role of information & advice. Issue of access to information & advice. Need for better links between health, housing & social care.

Older people facing more uncertainties Help with home repairs. Contribution to social care costs. Retirement age. Inheritance for children. Lifetime tenancies. Final salary pension. Care homes. Individual budgets, direct payments, personalisation. Help to maintain independent living. Telecare and telehealth. Choice of health and care providers. Home based rehabilitation.

The housing pressures of ageing Good housing is imperative for wellbeing in later life and will be critical in managing the mounting pressures of health, care and support expenditure. Over two thirds (68 per cent) of householders aged over 65 in the UK own their homes outright without a mortgage. More than one in five pensioners in Britain lives below the poverty line. Many older people live in the worst housing conditions with a third of older people in the UK (2.1 million households) living in non-decent or hazardous housing.

The housing pressures of ageing Older households (60+) are more likely than average to live in non-decent and energy inefficient homes with those aged 75+, receiving means-tested or disability-related benefits, living in private sector housing, or being resident in their current home for a long time, most at risk of poor living conditions. For the increasing number of older low-income homeowners, this is due to declining income and capacity to deal with the repairs and improvements required to maintain a property to a decent standard. For older people living in unsuitable homes that are in need of repair, heating and insulation, it can contribute to illness and social exclusion. As people age, ordinary tasks within the home can become more difficult.

Health, housing, care and independence

Poor housing results in poor health and care home admissions Falls alone cost the NHS £1.7bn a year. 25,400 “excess winter deaths” winter % go into care home after hospitalisation because a return to home is not practical. Number of older disabled people to double from 2.3 m to 4.6 m by Approximately half of all the accidental dwelling fire deaths in England and Wales occur among the over 60s. Older people are twice as likely to be in fuel poverty. Long-term care expenditure would need to rise by 325% in real terms between 2002 and 2041 if we do nothing.

Ageing in place Underoccupation…. Ageing in place is an important issue in that it is related to how people think of housing. They live in “homes” that have been invested in, both in a financial as well as psychological, or very personal, way so people often have a sense of “place” that is associated with one’s home and this will affect future housing patterns. Older people predominantly choose to stay in their own home. For many, this decision will be straightforward, but for some, as their support needs change, it may mean: adapting the property (e.g., facilitating wheelchair access), providing services in the home (e.g., cleaning, meals on wheels), help in the repair and maintenance of the property, improving energy efficiency to lower heating costs, involving the local authority to assess need and provide or commission services accordingly, etc., and many of these have cost implications.

Financial savings from enabling independence Evidence demonstrating that an accessible, adapted home can make a significant contribution to improving older people’s quality of life. Where home adaptations are an alternative to residential care, prevent hip fractures or speed hospital discharge; where they relieve the burden of carers or improve the mental health of a whole household, they will save money, sometimes on a massive scale. The average cost to the state of a fractured hip is £30,000. This is almost five times the average cost of a major housing adaptation (£6,000) and 100 times the cost of fitting hand and grabs rails to prevent falls (Heywood and Turner, 2007). The National Strategy for Housing in an Ageing Society included the expansion of the Handyperson schemes, new rapid repairs and adaptations services for older people, development of the home improvement agency sector, and improved access to the Disabled Facilities Grant.

Housing options Housing options – stay put or move. Downsizing (and releasing family sized properties) requires attractive options. Moving can require specialist accommodation. Staying put can require changes to enable continued independence. Equity release in situ – to support staying put, pay for care and adaptations? Information and advice provision – to make good decisions.

Most older people do not move Choice to stay put – but also lack of choice constrains opportunities to move. Shortage of public and private older persons’ accommodation - now and worsening in future. Planning issues create constraints. Use class issues C2 or C3 – S106 contributions. Lack of clear definitions – who is an older person; what do sheltered, extra care etc mean? Specialist older persons’ accommodation (e.g. extra care) cannot compete with general needs housing in the residential land market.

London supply and demand Current occupancy of specialist accommodation 54,000 units. Potential demand 10-17% of older households. If 15% of over 75s and 2.5% of 65-74s live in specialist accommodation London needs 55,000 units now and 80,000 by Care home beds – shortfall of 3,500 bedspaces – rises to over 6,000 by Existing shortfall of older persons’ housing units will worsen unless action is taken to increase newbuild supply. Apparent surplus of affordable rented units - BUT – most of it outdated and some unsuitable. Significant shortfall of owner occupied and shared ownership/shared equity accommodation and care beds.

Equity release Huge problems for self funders with limited means. Pressures on DFG’s and Improvement Loans will grow. Develop suitable, cost effective equity release products to fund works to home, a move, and/or care. Change perceptions to overcome distrust of equity release, and market widely. How best to provide impartial advice? Promote models which enable “trapped middle” to buy property of higher value than existing home. Longer term may be less demand – increase in PRS, declining home ownership.

Housing options – information and advice Previous and current government recent investment. FirstStop Advice is an independent, free service offering advice and information for older people, their families and carers about housing and care options in later life, funded by DCLG. Led by the charity Elderly Accommodation Counsel (EAC) working in partnership with other national and local organisations. National telephone helpline and website. FirstStop has also seed-funded a number of local information and advice services. These local projects aim to raise the profile of housing options for older people in their area and to provide a face to face case work service to older people. The case work is a mixture of information and advice provision and more intense case work to assist older people in resolving their housing and care problems.

Evaluation The evaluation has involved: a literature and policy review; interviews with national stakeholders; interviews with FirstStop staff; analysis of FirstStop’s client data; two postal surveys of FirstStop customers; follow up interviews with customers who responded to the surveys; an evaluation of the training programme; interviews with local exemplar project managers; five local exemplar project case studies which included interviews with case workers; analysis of detailed client information from the local exemplar project case studies and a value for money analysis of the local and national services. Ongoing.

Positive response “Every aspect I asked I got a clear answer. It was very impressive to get all the advice from one person; it took away being passed from pillar to post and was very reassuring. The tone of the person on the phone was business like but very sympathetic. She fully understood the minefield I was in and took me through every aspect. She also gave me her name so if I needed to call back I could ask for her. It was nice to be reassured I was doing the right thing. On the money side she worked through everything with me, benefits, pension, house, she did a calculation and told me I didn’t have to worry. I needed someone cold blooded to work it out and she gave me the courage to stick up for myself with social services. I needed proper advice rather than advice from well intentioned people. I came off the phone feeling stronger”.

Local housing options case work There is lots of evidence of positive client outcomes, whether the older person was supported to move or supported to stay in their current home. The research identified a number of benefits to the individuals who used the services: feeling more confident in making decisions, feeling more informed and more able to choose between different options; supported to stay in or move to the accommodation of their choice, empowering them to live in the housing that they felt suited them best and giving them wider choices; prevention of housing related health problems e.g. falls and unplanned and unwanted moves into care homes; some clients were financially better off through receiving financial advice and/or benefits checks; reduced anxiety; improved well being and quality of life.

Value for money? In terms of value for money the research identified a number of benefits and potential savings to the public purse. May be realised over a number of years, for example, where someone is assisted to remain living independently in their own home rather than making a premature move to a residential home. Many of the vulnerable older people using the case work services had a history of recurrent falls as a result of living in inappropriate accommodation. The cost of a serious fall with necessary follow up care is around £ Preventing falls by adapting homes or assisting people to move to more suitable accommodation has potentially very significant savings. Analysis of the case study local projects showed that there have been savings generated to the public purse. Analysis of one local project suggested that once the costs of providing the service were taken into account it generated additional savings to the public purse of more than £ over a one year period.

Somerset West case study Outcomes which can be given a monetary value = Main outcomes were moved to sheltered housing – in some cases preventing falls, hospital admissions, saved OT/SW time, reducing care at home needs. Based on the case studies provided, the actual outcomes were identified for each client and based on the in depth case notes, an informed assumption about the likely alternative outcomes was made for each client. The actual outcomes for each client were then costed to assess what cost they will have to the public purse over one year. The cost to the public purse of the identified alternative outcomes for each client if there had been no case work intervention were then costed to estimate what they would have cost the public purse over one year. The saving to the public purse can be found by deducting the cost of the actual outcomes from the cost of the likely outcomes if there had been no case work intervention. The cost of providing this part of the service must then be deducted.

The future Housing options – most will stay put. Need attractive options to move. Shortage of public and private specialist accommodation. Staying put often requires support e.g. adaptations. Equity release. Support to decide between the options. Can not only empower older people, but save public money.

HSA Conference 2012