Innovative Housing Options

Jeremy Porteus – 25 January 2011

Why make the case between health and housing?

• A fall at home that leads to a hip fracture costs the state £28,665 on average – over 100 times the cost of installing hand and grab rails

• Where it is appropriate, postponing entry into residential care for one year saves an average of £28,080 per person

• A hospital discharge service that enables older people to return to a safe and suitable home environment saves over £100 per day – the amount charged to local authorities when patients ‘block beds’

(source: Fit for Living Network Position Statement, hact 2010)

• What is your future vision for care – residential, home care, intermediate care, respite care, extra care? • Is housing development or management a key component of your delivery/growth plans? • Sustainability of markets in present climate? Uncertainty of funders, external relationships?• What can you offer that is different? Can you fosterinnovation, diversification and development?• How to realise and evidence benefits eg dementia• Motivate staff/create a learning and knowledge sharingenvironment for workforce – sector care academy?• Regulation and inspection – lighter touches, self-assessment but balance against safequarding.

What are the perceived challenges for you as an organisation?

• over 15 million people in England with a long term condition, includes heart disease, diabetes, asthma, respiratory problems and dementia• proportionally far higher users of NHS and PCTs• Account for 55% of GP appointments, 68% of outpatient appointments and 77% of inpatient bed stays• more likely to be older and have other complex needs leading to disabilities which require care and/or support• they live in poor housing, which could exacerbate their condition and make them more likely to be admitted to a care home (recent Sir Michael Marmot Review, Fair Society, Healthy Lives)

What are the health drivers for good quality housing with care?

• Significant age shift, especially older old

• Changing users’ housing/careaspirations eg lifestylechoices and needs

• Diversification housing and care markets eg fromspecialist to adaptable, fromsingle tenure andinstitutional to mixed tenure and community based

• But, rapidly changing economic and financial climate

• And, what impact on both mainstream and specialist markets and consumer confidence?

10%

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25%

30%

2004 2014 2024

An Ageing Population

Some General Facts & Figures...• 90% of older people live in ordinary housing, rented or owned

• 67% of older people are owner-occupiers (2005)

• Disabled people are twice as likely as non- disabled people to live in social housing

• 1.5m individuals report having a medical condition or disability that requires specially adapted accommodation (2006)

• The most common reason for older people considering a move is that their home is inappropriately adapted for their mobility health needs (Scottish Government ‘Time to Move?’ 2006, CLG New Horizons Research 2008)

Role of Housing• Every citizen should be able to

live in an environment where they feel safe, they can afford and in which their care and support needs are increased– Wheelchair accessible– Equipment to support daily

living– Community Alarms and

Telecare/Telehealth– Daily support or floating

support– Accessible for staff/service

delivery

Retirement housing new-build

The Policy landscape• We will establish a commission on long-term

care.• We will break down barriers between health

and social care funding to incentivise preventative action.

• We will extend the greater roll-out of personal budgets to give people and their carers more control and purchasing power.

• We will use direct payments to carers and better community-based provision to improve access to respite care.

• We will help elderly people live at home for longer through solutions such as home adaptations and community support programmes.

• We will prioritise dementia research.• We are committed to an NHS that is free at the

point of use and available to everyone based on need, not the ability to pay

Developing policy & funding• NHS White Paper – extend personal

budgets• Comprehensive Spending Review• Revision of the NHS operating framework• Response to the Law Commission• Establishment of a Care Commission• New social care Partnership Agreement• Dementia Declaration and Pledge• Review Carers Strategy• Public Health White Paper • Social Care White Paper (forthcoming)• Welfare benefit reform (DWP)• Localism Bill (CLG)• Reform of planning (CLG)

DH if not otherwise indicated

Types of outcomes sought• Less dependency on high cost care• Developing intermediate care and re-ablement services• Make best use of telecare and smart technology (grey

and green)• End of Life Care – avoid hospital admission• Preventing costly health interventions eg, as a result of a

fall• Providing meaningful choices and lifestyle aspirations to

meet personalisation objectives• Building effective social capital to enable greater

community engagement/informal care/volunteering• Appropriate housing, including supported and assisted

living (not dependent on social grants)

Role of Housing• Every citizen should be able to

live in an environment where they feel safe, they can afford and in which their care and support needs are increased– Wheelchair accessible– Equipment to support daily

living– Community Alarms and

Telecare/Telehealth– Daily support or floating

support– Accessible for staff/service

delivery

SUPPORTED LIVING OR UNIVERSAL HOUSING

• Two models of housing both called extra-care housing– Care Village – Universal offer– Alternative to Residential Care

• Models of cost effective housing solutions– Apartments with communal

space for on-site care– Flats close together

• Role of Technology to support re-ablement, eg telecare and assistive technologies – virtual extra care and supported living choices

• The Beacon Centre, winner 2010 UK Housing Awards

Capital Funding• Councils Capital programmes• Homes and Communities

Agency • Section 106 – Local

Development Framework• Government capital grants –

DH extra-care housing• Housing Associations – ability

to borrow. • Prudential Borrowing• Private Finance Initiatives• LIFT in DH• Private Investment• Need to consider longer term

financing – awaiting CSR

Revenue Funding• Block care contracts • Personal social care

budgets• Personal Health Budgets• Supporting People• Means tested/non means

tested benefits/HB• Self funders• Equity release/insurance• Continuing Care (NHS)• Other incentives and

rewards?• Volunteers?

Going forward• Post CSR – All parties need to

be more creative on capital & revenue (Supporting People) funding

• Alignment of investment - local authorities, HCA, health sector and third sector within Local Investment Plans

• Joint strategies and commissioning partnerships

• Local (public) Land Initiative opportunities – land swaps

• HCA’s Delivery Partner Panel• Local frameworks

Going Forward• Affordable rent packages with registered providers to

include Extra Care• If care homes continue to close, reinvestment of land

sale receipts in new projects• Place making, regeneration and development to meet

the needs of the whole community • Extra Care is not the only solution for older people – is

a different housing/care offer more appropriate?• Local authorities – commissioning providers and

development partners, supported by HCA• Make sense of personal budgets and self funders’

markets

Future arrangements• Market presence: what is your offer to Housing, the NHS and social

care? Have they heard you/know you are there re: extra care?• Protecting the bricks and mortar: Is your stock ‘fit for the future?

Adaptable, remodel, decommission, ‘care ready’? Convert to extra care?

• The extent of personalisation: what will this mean under a new govt. Will it extend choice and control even further?

• Health and care outcomes: can you evidence tackling health inequality, preventing homelessness, sustaining tenancies, avoiding a move to residential care

• Operating in a tighter financial envelope: Public sector spend looking for efficiency savings in all areas, access to capital/revenue streams, including HB and wider welfare benefit reform

• Workforce arrangements: recruitment/retention, training and learning improvement

• Leadership: Do you have the vision and capability (skills, knowledge etc) to change? Do you want to change?

Thank You info@housinglin.org.uk