A vision of housing, care and support for an ageing society

In your lifetime

For information and resources on issues relating to care, support and supported housing.

In your lifetimeA vision of housing, care and support for an ageing society

The National Housing Federation and its members share a vision of housing,support and care that enhances older people’s ability to live independently foras long as possible. We share a vision of support and care services, which areflexible in their delivery and, most importantly, are based on the needs andaspirations of the resident.

This report illustrates the Federation’s vision for housing, care and support forolder people. The focus of this report is on national, regional and localgovernment-led action to allow housing associations to achieve this vision.

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National Housing FederationLion Court, 25 Procter Street, LondonWC1V 6NYTel: 020 7067 1010Email:info@housing.org.ukwww.housing.org.uk www.inbiz.org

Contact: Amy SwanEmail: amys@housing.org.uk Tel: 020 7067 1090

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Thanks are due to:

• Amy Swan, policy officer at the National Housing Federation, who drafted this report

• Federation members who responded to the survey ‘Housing for Older People: the Age ofOpportunity’ which fed into this report.

• Servite Houses, Abbeyfield, MHA Care Group, Pennine Housing 2000, Central & Cecil, WalthamForest Housing Association, Affinity Sutton, Aragon/Macintyre Housing Association, Willow Housingand Care who took part in a roundtable discussion feeding into this report.

• Octavia Housing (for providing photos on pages 13 and the front cover), Hanover (for photos onpages 3, 9, 17, 4, 7, 15 and 23), Affinity Sutton (for the photo on page 6), and Southern HousingGroup (for the photos on pages 2 and 21).

This report illustrates the NationalHousing Federation’s vision forhousing, care and support forcurrent and future generations ofolder people.

• The National Housing Federation andits members share a vision of housing,support and care that provides a rangeof housing options and enhances olderpeople’s ability to live independentlyfor as long as possible.

• We share a vision of support and careservices, which are flexible in theirdelivery and, most importantly, arebased on the needs and aspirations ofthe resident.

• Everyone should have access to a quickand effective adaptations service.

• Older people with dementia andmore intensive care needs must beoffered the opportunity to live inhousing with flexible and responsivecare and support, improved safety and security, whilst maintainingmaximum independence.

The focus of this report is on urgentnational, regional and localgovernment-led action to allowhousing associations to achieve thisvision. We are looking for MPssupport to help the Federation andits members achieve our vision forhousing, care and support for olderpeople. Our priorities are clear – we want:

• Older people’s housing and support tobe prioritised in regional and localhousing strategies

• More certainty that support servicesand models of housing with supportsuch as sheltered housing for olderpeople will be funded over the longer-term

• A consistent approach across localauthorities in terms of timescales,assessment and delivery, and thefunding of aids and adaptations,promoting local partnerships and thesetting up of service level agreementsbetween housing associations and local authorities

• And the ability to continue offering24 hour care and support modelsin an era of personalisation andIndividual Budgets.

CONTENTS PAGEOur vision 4 - 5

Housing options for older people 6 - 9

Support and prevention 10 - 13

Effective adaptations 14 - 17

Promoting independence through flexible care 18 -21

In summary 22 - 25

References 26-27

SUMMARY

older people (11%)in the UKalways or often feel lonely.Just over 4

One in five children born today can expect to live to years old. 3

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OUR VISIONHousing is central to our happinessand well-being. Ensuring that peoplehave access to good housing into laterlife is a vital part of maintaining adecent quality of life.

People want to continue making informedchoices about the forms of housing,support and care that best suit them asthey grow older and as their circumstanceschange. Some older people may need theirhome to become more manageable orsimply want the comfort, security andsocial environment offered by sheltered orcommunal housing. Others may need tomove to housing that meets care needsthat cannot be adequately provided in theirhome, but offers them the independence oftheir own apartment.

In trying to meet the challenges of anageing population, housing associationshave had a key role in shifting the policyagenda from dependence to prevention,from paternalism to choice andindependence. The National HousingFederation and its members share avision of housing, support and care thatenhances older people’s ability to liveindependently for as long as possible. Weshare a vision of support and care services,which are flexible in their delivery and,most importantly, are based on the needsand aspirations of the resident. With anolder population growing not only innumbers, but also in diversity, theseunderlying principles are just as importantas ever before.

Housing associations provide affordablehomes for almost one million1 olderpeople, with 5%2 of all older people living intheir sheltered housing and extra careaccommodation. Set at the heart of thecommunity, housing associations are wellplaced to deliver housing and services thatprevent people from needing moreintensive care and support for longer,providing older people with peace of mindfor their own security and making itpossible for them to live in a place wellconnected to local community networks.

But there are a number of barriersthat prevent housing associationsfrom achieving what they would likefor older people in offering the fullchoice in housing and support theyboth need and deserve.

This report sets out national,regional and local government-ledaction to allow housing associationsto move beyond the barriers todeliver, to achieve this vision ofhousing, care and support for current and future generations.

London alone needsapproximately 800additional units of housingfor older people by 2017.5

Over 2 million older people of state pensionage are living alone with no transport.6

About 3.1 million olderpeople live alone.7

It is estimated that up to42,000 older people areunofficially homeless inEngland and Wales.8

The number of people over 85 in the UK is predicted to havedoubled in the next 25 years and to have trebled in the next 35.9

FACT FILE

Housing associations have a track record of working with residents to maintain thequality of their life through listening to and supporting them to have greater choiceand control over where and how they live. Many housing associations are tailoringtheir provision of housing to offer a wide range of models of specialist supportedhousing, ranging from housing with a low level support package to housing with on-site domiciliary care, catering and extensive facilities. They can offer housing for both rent and affordable ownership that meet the needs of older people. This demonstrates their ability to provide older people with a choice of housing,support and care.

The statistics are very clear about the need for more housing for older people. Thesharp increase in the age of the population and the increase in the amount of peopleliving alone can be starkly contrasted to the distinct lack of housing options for olderpeople as their need for security, support and care increases.

Investment in housing for older people must be driven by evidence of need, yetcurrently there is no requirement to produce either regional or local analysis of olderpeople’s housing needs. Too frequently, local housing strategies do not address theneed for specialist housing for older and vulnerable people.

Older people’s housing will only be a priority for investment if the need for it isidentified in local and regional strategies; but commissioners have found it challengingto integrate the evidence base for health, housing, care and support at both local andregional levels.

HOUSING OPTIONS FOR OLDER PEOPLE

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without central heating.

7.8 million older people are living in accommodation

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To address the lack of housing optionsfor older people, the National HousingFederation is calling for:

• The Homes and Communities Agency(HCA) to ensure that the singleconversation on local investment needsincludes a dialogue on the need forinvestment in specialist housing for olderpeople to ensure older people areproperly represented in investment plans.

• Older people’s housing and support tobe prioritised in regional and localhousing strategies. Every region andlocal area should analyse the need forolder people’s housing11 to inform theirspatial strategies, as well as local plansand to inform the local housing strategy.

• The Homes and Communities Agency(HCA) to develop a national picture of theneed for older people’s housing andsupport drawing on local and regionaldata to inform its investment levels inolder people’s housing. The HCA shouldinclude a set of older people’s housingtargets as part of their development ofan integrated set of performancemeasures. This will ensure they target,measure and report on performance inolder people’s housing.

• Every joint strategic needs assessmentcarried out by the local authority (whichidentifies the health and wellbeing needsof a local population) to include a specificspecialist housing and housing relatedsupport assessment. This will facilitate a more joined up assessment andplanning of health, social care andhousing support.

• The HCA to work with housingassociations to see what more can bedone to encourage growth in mixedtenure and shared ownership throughlow cost home ownership options forolder people.

• The HCA to provide clear guidance onhow to access grants for remodellingexisting sheltered housing, where acomprehensive option appraisal has beencarried out. A proportion of shelteredhousing is in older housing stock, whichbecause of its design and configuration isno longer fit for its purpose.

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CASE STUDY

Moving to retirement housingWhen Jackie Cooper was diagnosedwith cancer in her fifties, she and herhusband, Dennis, started thinkingabout moving for their retirementyears. They owned their propertynear Manchester, but when Jackiebecame more ill and realised thatshe may become less mobile, theydecided they needed a moreaccessible property that was easierto manage. Jackie and Dennis wantedto move south to be closer to theirgrandchildren. They decided to rentbecause they liked the idea of nothaving to maintain the propertythemselves as they grew older andmaybe became frail.

They came to the decision thatretirement housing, with anemergency alarm facility and thesupport of an estate manager, wasthe best option because of thesecurity and peace of mind it offeredthem. They accepted an offer byHanover, a nationwide housingprovider for older people, of a flat inHemel Hemstead. They liked theproperty, but after nearly two years atGreat Palmers, they realised thatJackie’s mobility was getting worse.She was finding the stairs too difficultand needed more support. The estatemanager was able to offer them theflexibility of moving to another estatein the same area, Hanover Green,which had lift access to the first floor.

Over the years, Jackie and Dennishave thrown themselves into life atHanover Green. They love living thereand feel they are part of a community.They are involved in organising coffeemornings, quiz nights, as well as aregular fish and chip supper night.They are also involved in the residentscommittee. Jackie says they arebusier now than they ever were. InManchester, they would sometimesgo to the pub with friends, butwouldn’t really do any other activities.

Jackie knows that if anythinghappens she can use the emergencyalarm system and get a servicestraight away. She has used thealarm several times. For them, livingin retirement housing seems lessstressful across the board. Jackie andDennis use the estate manager astheir first port of call for any issuesfrom benefit claims to reporting theirrepairs to him. They find it verycomforting to know that there issomeone they can turn to for supportand advice. In the future, if eitherDennis or Jackie becomes ill or frail,the estate manager can liaise withadult social services to carry out acare assessment and bring in morecare or support services if needed.

When Jackie looks back at their moveinto retirement housing, she is gladthat they moved when they did andwould not want to complete the samemove now she is that little bit older.

Names in all of the case studies have been changed to protect privacy and anonymity

The UK average annual fee for a single room in a nursing home is

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SUPPORT AND PREVENTIONWith over 2.7 million older people currently needing care, it’s easy tounderstand the concerns about the burden of increasing care costs.However, this only strengthens the case for investment in prevention andre-enablement. We need more services to support people before theyrequire intensive and expensive care and health services.

Supporting People (SP), a Governmentprogramme run by local authorities,helps vulnerable people liveindependently and keep their socialhousing tenancies. SP Services such assheltered housing, flexible telecare andtailored packages of support provideessential preventative services to olderpeople that should be valued andprotected. The evidence of cashablesavings that can be made from healthand adult social service budgets by theprovision of housing based support areplain to see, with the estimated netfinancial benefit from providing SPservices to older people at around £1.4billion. These services can prevent longstays in hospital and readmission tohospital, and can delay or prevent theneed for care services or a move to acare home.

Such preventative support services arenot only important in delivering savingsto the tax payer, but also boost thehealth, quality of life and well-being ofolder people, allowing many tomaintain the independence they want.

Yet, despite the fact that SP has beenshown to provide considerable value formoney to the public purse, housingassociations have real concerns aboutolder people’s support losing out toother local priorities. This is likely to beexacerbated with the removal of thering fence from SP funding. There is avery real risk that there will be a drift offunding away from preventative supportservices to meet the statutoryobligations of other services.

Local Strategic Partnerships (LSPs),which bring public, private and thirdsector bodies together to improve thelocal area and decide on localpriorities, are crucial when it comes todeciding these local priorities. Yet manyhave no representation from orlinkages to older people’s housing orsupport providers. Too frequently,decisions about expenditure prioritiescan be taken without the relevantinformation and without theimplications being fully understood.

Local commissioners are often unaware ofthe preventative benefits of housing relatedsupport for older people. In some casesthey are also shifting funding from supportin sheltered housing to models of floatingsupport which they perceive as better value for money. These models can beeffective, but this shift does not alwaysconsider the value of sheltered housing and the wider role it can play as a base forproviding support to older people living inthe wider community.

In tight expenditure conditions, localauthorities have to make difficult decisionsabout which support services to fund, butany changes that are made to a supportservice must involve the residents and thehousing provider in designing the overallpackage of housing, care and support.When SP was introduced, it split thefunding for housing and support, yet thesefunctions remain fundamentally connected.Procurement processes need to recognisethat support is not a simple service thatexists in isolation from others: it is part ofthe overall housing offer to residents. Thereis an inherent interdependence betweensupport and other functions such ashousing management, asset managementand care provision.

The number of emergency readmissions for peopleaged 75+ in English hospitals in 2006/7 was

a rise of 69% since 1998/99

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In 2025, there will be 485,720older people in residentialcare. Currently there are306,278 older people inresidential care.14

In 2009 3.4 million olderpeople were unable tomanage at least one domestictask on their own, and 2.8million older people wereunable to manage at least oneself-care activity. Thesefigures will almost double in2025.15

Supporting People funding forolder people’s services has fallen by £7.5 million since2006.16

FACT FILE

CLG research by Cap Gemini found that

an investment of £1.6bnin housing related support services

generates savings of £3.41bnthe public purse.12

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The National Housing Federationsees several solutions to thesechallenges:

• Good practice guidance for LocalStrategic Partnerships (LSPs) shouldbe amended by Communities andLocal Government (CLG) torecommend that both housingorganisations and support providersbe included in LSPs.

• Any guidance should promote thesetting up of local specialist housingforums which can inform LSPsconcerning specialist housinginvestment. Government Officesshould encourage and support LSPsto apply such amended guidance.

• CLG should encourage localauthorities to include housing relatedsupport targets in Local AreaAgreements (LAAs), which set out thepriorities for a local area. LAAs that donot include these targets should bechallenged by Government offices togive evidence that there is no need.

• CLG should be responsible for makingpublicly clear how much moneyisallocated to local authorities forSupporting People (SP) services, andlocal authorities must monitor andmake public how much money hasactually been spent on these services.

• The Audit Commission and CareQuality Commission should ensurethat the Comprehensive AreaAssessment (CAA) highlights the need for a strong vision and robustcommissioning of older people’sspecialist housing services.

• CLG, HCA and local authorities should work together to develop amore stable contracting environmentfor support services, with longer termrevenue contracts. Local authoritycommissioners should recognise theimportance of working in partnershipwith the housing provider and theirresidents in procurement andtendering initiatives.

CASE STUDY

After a car accident, Ted Willis was left permanently disabled. His disability resulted in a severedecline in his mobility and acontinuous increase in pain, whichcaused him to feel depressed, neglecthimself, and to disengage with his GPand other support contacts.

A few months ago, Ted was foundcollapsed at home, requiringemergency admission to hospital due to extensive circulatory damage. He has now lost the use of both legsand has to use a wheelchair to getaround. The hospital referred Ted for the hospital discharge supportservice with NS Housing.

Ted’s private rented home was in a verypoor condition, having been poorlymanaged for many months leading upto the hospitalisation. Essentialmaintenance had not taken place, hisbenefits had been suspended, and therewere many unpaid bills. Hospital staffwere concerned that Ted’s dischargefrom hospital would be delayed due tothe inaccessibility of his home.

The hospital discharge support serviceat NS Housing, a housing association in the South West, worked with Ted’s landlord to facilitate urgentmaintenance to his home. Theycontacted utility suppliers to informthem that Ted was in hospital, andarranged future payment plans. They organised for the replacement of the front door, which had beendamaged when the emergency services forced entry.

After providing written information andevidence to benefits departments, Ted’s claims and rent payments werereinstated and a review of Ted’sDisability Living Allowance rate wasinitiated. The home was deep cleanedenabling hospital staff to carry outhome visits in order to assess hisimmediate equipment needs. NS Housing also liaised with bothlandlord and occupational therapists to ensure Ted got the adaptations heneeded to live independently.

Ted arrived home to a safe environmentwith clear pathways in, out and aroundthe home for his wheelchair. Kitchenadaptations were undertaken to enableTed to cook independently. He receiveddaily visits from support workers atfirst, when he needed it most. Withoutthis service, a probable alternative forTed would have been a residential carehome, as it is often a struggle to findwheelchair accessible housing or asuitable sheltered housing scheme.

Ted has since re-established regularcontact with his GP and is aware ofother services that may be of benefit to him in the future. Thanks to NSHousing putting him in touch withdisability friendly transport, he can nowget out and socialise, and attend anyappointments independently. Ted ismuch more active and independentthan he had been for many monthsprior to his admission into hospital.

Prevention and regaining independence

Falls represent over half ofhospital admissions for accidentalinjury. Half of those with hipfracture never regain their formerlevel of function and one in fivedies within three months.20

Over 2 thirds of people over 85 inthe UK have a disability or limitinglong-standing illness. Currentlyaround 3.9 million older peoplehave a limiting long-term illness,rising to 5.5 million in 2025.21

It is predicted that the amount ofolder people admitted to A&E as aresult of a fall will rise from 2.2million to 2.5 million in 2015.22

42% of households in socialhousing have a resident who wasdisabled or had a limiting long-term illness compared with anational rate of 17%.23

FACT FILE

Men in the UK canexpect to live their last

years with a disability. For women, the average is 9.1 years.19

of demands for adaptations come from olderpeople28, and the numbers of disabled older peopleare set to double over the next 30 years.24

accommodation because of a medical condition or disability.18

Over three quarters of a million people

and over need specially adapted

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EFFECTIVE ADAPTATIONS

Adaptation demand continues to disproportionately affect social housingproviders. Housing associations recognise the need to work with localauthorities to meet the demands for aids and adaptations and to provide aneffective and good quality adaptations service.

The rapid growth in demand for adaptations exists in a context of uncertaintyamong housing providers about how to fund adaptations to meet the needs of their tenants. Many housing associations feel the current system forfunding and fitting adaptations has led to patchy access to the DisabledFacilities Grant (DFG) among tenants and extensive delays to delivery due tothe priorities of the local authority and the availability of funds.

Of the 355 housing authorities in England, nearly all have different policiesregarding the funding of adaptations in housing association properties, whichare mainly based on the level of resources they have allocated to adaptationsand how adequate those resources are to meeting demand. Some havedeveloped agreements with housing associations to fund adaptations.

Now that the requirement for local authorities to match DFG funding foradaptations has been removed, and the ring fence around DFG has beenrelaxed, with proposals to remove the ring fence completely pending the outcome of the pilots, these funding difficulties are set to continue and intensify.

In order to deliver an effective adaptations service, it is important that thelocal allocations process works with a register of adapted properties,particularly through choice-based lettings – a system which allowscustomers to 'bid' for a particular property, which is openly advertised.Otherwise adapted properties can remain empty or expensive adaptationshave to be removed, even though three quarters of a million people aged 65and over need specially adapted accommodation because of a medicalcondition or disability17.

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• Communities and Local Government(CLG) should ensure the DisabledFacilities Grant (DFG) does not lose its identity if the ring fence is removed. It should encourage local authorities to recognise the value of fundingadaptations.

• CLG should be responsible for makingclear how much money is allocated tolocal authorities through the DFG, andlocal authorities must monitor and makepublic how much money has actuallybeen spent on these services.

• CLG should stress the importance oflocal authorities’ match-fundingadaptations through the DFG.

• CLG should encourage a consistent goodpractice approach across localauthorities in terms of timescales,assessment and delivery, and thefunding of aids and adaptations,promoting local partnerships and thesetting up of service level agreementsbetween housing associations and local authorities.

• Lettings systems must signal whatadaptations are already in place in eachproperty and who the property would bemost suitable for. Local authoritiesshould also monitor and supportdisabled people to engage with choice-based lettings, working with otheragencies to publicise the propertiesmore widely.

• There are very clear links between thedemand for adaptations and theprovision of housing built to LifetimeHomes Standards. The standards shouldbe included in the building regulations toensure all housing, whether publicallyfunded or not, is accessible and easy to adapt.

CASE STUDY

From bath to shower in weeks Mrs Edna Lawton had lived in a homeowned by South StaffordshireHousing Association for many years.At 94, she had become frail and gaveup using the bath to wash becauseshe felt unsafe. She was then forcedto strip-wash at the sink, which tookher over half an hour every day.

Soon after an assessment with theoccupational therapist, a walk-inshower was fitted for Edna makingher life so much easier. Throughoutthe process, Edna had clearinformation about who wasresponsible for the work and howthey could be contacted to minimisethe stress and disruption to hereveryday life.

South Staffordshire HousingAssociation’s Project IndependentLiving means that the waiting list forminor adaptations has been cut fromtwelve months to seven days. Thisservice has become possible becauseof the partnership created betweenthe housing association, its tenants,South Staffordshire District Counciland Staffordshire County Council.

After assessing their service, SouthStaffordshire Housing Associationfound that delays occurred when, forboth funding and medical reasons,applicants needed to be assessed by

an occupational therapist before workcould start. To add to the frustration,applications, assessments,commissioning work and fittingequipment were each being doneby different agencies. Applicantsdidn’t know where they were in thesystem or who they should be chasingfor information.

South Staffordshire HousingAssociation approached the localauthority with the solution that theybecame the first and only point of callfor applicants. They commissioned an occupational therapist who, as well as doing assessments for majoradaptations, trains their staff inassessing for minor aids. This has cutwaiting times and the partnershipwith the local authority has reducedcosts for major adaptations from£7000 to £4,200, a 40% reduction.

South Staffordshire HousingAssociation is also building a pool ofhousing stock with adaptations. Theyhave produced an integrated registerof people with disabilities and homeswith adaptations. This means thatwhere a property does not lend itselfto adaptation, they can adviseresidents of where there is a vacancywhich may suit their needs.

The National Housing Federation sees several solutions to these challenges:

Nearly 700,000 people areestimated to be suffering fromdementia in the UK in 2007 and, by2025, the number is expected torise to one million. By 2051, it isprojected to exceed 1.7 million.27

According to the formerCommission for Social CareInspection (CSCI), 1.5 millionpeople in England have care andsupport needs that the state doesnot meet. It is estimated thataround 6,000 older people withhigh support needs and 275,000with less intensive needs receiveno care at all, from state orinformal sources.28

FACT FILE

older people in England have care needs. This figure will increase to in 2025.29

It is expected by 2009all local authorities will only be able

to support older peoplewith high level needs.26

aged 65 or over have dementia.

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PROMOTING INDEPENDENCETHROUGH FLEXIBLE CARE

Housing associations provide housingand related services, which cansupport people with dementia andother health conditions to liveindependently. Sheltered housing hasthe potential to prolong the time thatresidents with dementia can remainliving there independently withsupport. Extra care housing can offersome people with dementia analternative to residential care, offeringa combination of flexible, responsivehome care and support, and improvedsafety and security. Extra care housingprovides well-designed housing thatenables people to self-care for longerand gives them access to care andother services, which help them toretain their independence.

As the population ages, new social carechallenges are developing. The numberof people with dementia is growing at analarming rate, whilst funding for socialcare is in jeopardy. The inability of thestate to directly fund the care of all olderpeople who need it is becomingapparent, while a new era ofpersonalising care is underway with theadditional challenges that come with anunknown transformation.

The personalisation agenda means thatevery person who receives care andsupport services will have choice andcontrol over the shape of that service in all care settings. It brings newopportunities to older people andproviders of housing and supportservices, particularly those who provide sheltered or extra care housing.However, there is a risk that the funding regimes of certain models ofolder people’s housing may beundermined by the implementation of Individual Budgets (IBs), even though, ideologically, the two fittogether perfectly.

For extra care housing, its key definingfeature is the availability of twenty fourhour care and support. Night time careis very rarely available in communitysettings. Without some degree offunding commitment from the localauthority, housing providers will not beable to establish an on-site care andsupport team to provide a core serviceto help with personal tasks like bathingand washing, getting up and going tobed. Where core services already exist,they will not be sustainable if manyindividual residents opt out because thefunding will follow them.

There may not be alternativedomiciliary care available which will provide night cover, leaving older residents without the care they need. For many residents in extra care housing, the withdrawal of services in these circumstances will be incomprehensible andpotentially devastating.

Personalisation should not betranslated into micro-commissioningof services, especially if this erodes ordestroys successful models such asextra care housing. Too much focus onindividual purchasing may obscureother ways in which services can bepersonalised through greater say overhow a service is run, or through theprovision of a core service for nightcare cover with a flexible menu ofservices to choose from on top, suchas flexible support worker hours or acash fund to purchase alternativesupport services or goods.

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Dementia services are just one aspect of the role of housingassociations in meeting care and support needs in innovative andindividualised ways. Clearly this work should continue and itshould not be undermined by individual budgets (IBs). It isimportant commissioners continue to support such vital services.

• Local authority commissioners should ensure that there is a portfolio ofservice provision available which has an overall emphasis onpersonalisation and choice, including commissioned services inspecialist housing.

• Local authorities should recognise the role for commissioned servicesto operate in conjunction with IBs, with individuals receiving a budget foradditional services on top of a commissioned core service (foremergency, overnight and responsive work).

• The Department of Health should ensure that commissioning guidanceon the implementation of personalisation recognises the circumstancesand key contribution of sheltered and extra care housing to ensure thatthese services are not overlooked by social care commissioners.

CASE STUDY

Emily Gregg was diagnosed withAlzheimer’s in the late 1990s, andspent the next couple of yearstravelling to London for tests andscans. In 2002 her husband diedvery suddenly and her son movedin to care for her. However, despitesetting up community meals andcarers to prompt her to take herpills, it didn’t work as Emily neededa lot more care and support thanher son initially realised.

After a couple of years Emily agreedto move near to her daughter. Over the next year, Emily began tostruggle to do her own cooking orwashing. Being on her own also lefther vulnerable to other people whodid not really understand why shedidn’t remember them from the daybefore. Emily didn’t have muchconfidence and often couldn’tremember how to get back to her flat if she went too far.

Her daughter got in touch with thelocal mental health team, and it wassuggested that Emily would be agood candidate for Rowan Court, a specialist extra care dementiascheme in Hampshire owned byFirst Wessex, a group of housingassociations operating in the South East.

The idea of Rowan Court is that theresidents are assisted to live asindependently as possible but areencouraged to join in with thevarious activities, which aredesigned to keep residentsmentally active for as long aspossible. They are safe from callersand protected from wandering toofar from home.

Emily is much happier at RowansCourt, and joins in with so muchmore than she did even before shehad Alzheimer’s. Her daughter iscertain that this has contributed tothe length of time her mother has lived independently withAlzheimer’s, with a little help from her daughter and increasinglymore help from the carers at Rowan Court.

Since Emily moved into RowanCourt, the unit has continued toevolve, and First Wessex isconstantly looking out for newmethods of caring for people with dementia, as well as newthings to keep residents entertained and active.

Living longer with dementia

Dementia affects 1 person in 5 over 80, 1 in 4 overthe age of 85 and 1 in 3 people over 90.30

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We are asking regional government to:

• Ensure every region and localarea analyses the need for olderpeople’s housing to inform theirspatial strategies, as well as localplans and to inform the localhousing strategy. Older people’shousing and support must beprioritised in regional and localhousing strategies.

• Encourage and support LocalStrategic Partnership (LSPs) toapply amended guidance for LSPs,recommending that both housingorganisations and support providersbe included on LSPs.

• Challenge any LSPs in the regionthat do not include housing relatedsupport targets in Local AreaAgreements (LAAs) to evidence thatthere is no need.

We are asking the Homes andCommunities Agency to:

• Develop a national picture of theneed for older people’s housing and support needs to inform itsinvestment levels in older people’shousing. The HCA should include a set of older people’s housing targets and measure and report on performance in older people’shousing.

• Ensure that the single conversationon local investment needs includesa dialogue on the need forinvestment in specialist housing forolder people, to ensure older peopleare properly represented ininvestment plans.

• Work with housing associations tosee what more can be done toencourage growth in mixed tenureand shared ownership through lowcost home ownership options for theolder people.

• Provide clear guidance on how toaccess grants for remodellingexisting sheltered housing, where acomprehensive option appraisal hasbeen carried out.

• Work together with Communitiesand Local Government (CLG) andlocal authorities to develop a morestable contracting environment forsupport services, with longer termrevenue contracts.

We are looking for MPs support to help the Federation and its membersachieve our vision for housing, care and support for older people.

IN SUMMARY

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We are asking Communities and Local Government to:

• Amend good practice guidancefor LSPs to recommend that bothhousing organisations andsupport providers be includedon LSPs. Any guidance shouldpromote the setting up of localspecialist housing forums which caninform LSPs concerning specialisthousing investment.

• Encourage local authorities toinclude housing related supporttargets in Local Area Agreements(LAAs), which set out the prioritiesfor a local area.

• Be responsible for making clearpublically how much money isallocated to local authorities for SP services.

• Work together with HCA and localauthorities to develop a morestable contracting environment forsupport services, with longer termrevenue contracts.

• Ensure the Disabled FacilitiesGrant (DFG) does not lose itsidentity after the ring fence isremoved and local authoritiescontinue to recognise the valueof funding adaptations. CLGshould be responsible for makingclear how much money is allocatedto local authorities through theDFG, and local authorities mustmonitor and make public how muchmoney has actually been spent onthese services.

• Stress the importance of localauthorities’ match-fundingadaptations through the DFG.

• Encourage a consistent goodpractice approach across localauthorities in terms of timescales,assessment and delivery, and thefunding of aids and adaptations,promoting local partnerships andthe setting up of service levelagreements between housingassociations and local authorities.

We are asking the Audit Commission to:

• Ensure that the ComprehensiveArea Agreement (CAA) highlightsthe need for a strong vision androbust commissioning of specialisthousing services.

We are asking the Department of Health to:

• Produce commissioning guidanceon the implementation ofpersonalisation to recognise thecircumstances and key contributionof supported housing to ensure thatthese services are not overlooked bysocial care commissioners.

We are asking the Care Quality Commission to:

• Ensure that the CAA highlightsthe need for a strong vision androbust commissioning of specialisthousing services.

We are asking local authorities to:

• Ensure every Joint Strategic NeedsAssessment includes a specificspecialist housing and housingrelated support assessment. This will facilitate a more joined upassessment and planning of health,social care and housing support.

• Work together with CLG and the HCAto develop a more stable contractingenvironment for support services,with longer term revenue contracts.

• Ensure local authoritycommissioners recognise theimportance of working in partnershipwith the housing provider and theirresidents in procurement andtendering initiatives.

• Monitor how disabled people engagewith lettings systems, working withother agencies to publicise theproperties more widely.

• Local authority commissionersshould ensure that there is aportfolio of service provisionavailable which has an overallemphasis on personalisation andchoice, including commissionedservices in specialist housing.

• Recognise the role for commissionedservices to operate in conjunctionwith Individual Budgets (IBs),with individuals receiving a budgetfor additional services on top of acommissioned core service (foremergency, overnight andresponsive work).

• Monitor and make public howmuch money has actually been spenton SP services.

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1 956,773, Number of homes forolder people (From RSR31/03/2009 & Survey of Tenants2004/05

2 CLG, Lifetime Homes, LifetimeNeighbourhoods, 2008

3 Lifetime Homes, LifetimeNeighbourhoods: A NationalStrategy for Housing in an AgeingSociety, Communities and LocalGovernment, 2008

4 One Voice: Shaping our ageingsociety, Age Concern and Help theAged, 2009

5 National Housing Federation,Building for all, 2007

6 Office for National Statistics (ONS)2001 Census, Standard Tables,Table S062 Household compositionby number of cars or vansavailable.

7 General Household Survey 2007,ONS 2009 (table 3.3); and Office forNational Statistics mid-2007Population Estimates (2008).‘Older people’ refers to age 65 andover.

8 Crane, M. 1999. UnderstandingOlder Homeless People. OpenUniversity Press

9 National Population Projections2006-based, Office for NationalStatistics, 2008

10 Office for National Statistics (ONS)2001 Census, Standard Tables,Table SO54 Shared / unshareddwelling and central heating andoccupancy rating by age.

11 Laing and Buisson Care of ElderlyPeople UK Market Survey 2008

12 CLG, Research into the financialbenefits of the Supporting Peopleprogramme (July 2009)www.communities.gov.uk/publications/housing/financialbenefitsresearch

13 Information Centre NHShttp://www.nchod.nhs.uk/

14 POPPI data based on Office forNational Statistics (ONS) 2001Census, Standard Tables, TableS126 Type of communalestablishment and sex by residenttype and age.

15 Bridgwood, A. (1998) People Aged65 and Over: Results of anIndependent Study Carried Out onBehalf of the Department ofHealth as Part of the 1998 GeneralHousehold Survey, page 46.

16 Figure calculated using SP data onnumber of households receivingsupport.

17 Housing in England 2006/07,Communities and LocalGovernment, 2008

18 Housing in England 2006/07,Communities and LocalGovernment, 2008

19 Life expectancy (LE), healthy lifeexpectancy (HLE) and disability-free life expectancy (DFLE) inyears at birth and age 65: bycountry and sex, 2004-06, ONS,2008

20 “Don’t Mention the F-Word”, Helpthe Aged 2005

21 POPPI data, taken Figures aretaken from Office for NationalStatistics (ONS) 2001 Census,Standard Tables, Table S016 Sexand age by general health andlimiting long-term illness.

22 POPPI, These figures are based ona study of 647,721 A&Eattendances and 204,424admissions to hospital in 1999, forfall related injuries in people aged60 years and over. Scuffham, P. etal, Incidence and costs ofunintentional falls in older peoplein the United Kingdom, Journal ofEpidemiology and CommunityHealth, Vol. 57, No.9, Sept. 2003,pp.740-744. The prevalence rateshave been applied to ONSpopulation projections of the 65and over population to giveestimated numbers predicted toattend hospital A&E departmentsas a result of falls to 2025.

23 MORI/Housing Corporation 2001cited in Habinteg (2007) ‘Housing association guide todisability equality schemes andaction plans’.

24 PSSRU Research Summary 35march 2006; Thirty-Five Years On:Future Demand for Long-TermCare in England.https://www.pssru.ac.uk/pdf/rs035.pdf

25 Alzheimer Society News release19 January 2009

26 NHS confederation, Fundingtomorrow today; social care forolder people and vulnerableadults, 2008.

27 Dementia UK, The Alzheimer’sSociety, 2007

28 The state of social care 2006-07,Commission for Social CareInspection (CSCI), 2008

29 POPPI data based on Bridgwood,A. (1998) People Aged 65 and Over:Results of an Independent StudyCarried Out on Behalf of theDepartment of Health as Part ofthe 1998 General HouseholdSurvey.

30 Research into Ageing fact sheetsupdated from Dementia UK, LSE,King’s College and Alzheimer’sSociety, 2007

REFERENCES