Published on 6th July 2018
Published on 6th July 2018
People needing housing adaptations to enable them to live more independently often delay the process because of the clinical appearance of the adaptations and negative associations with vulnerability and loss of independence, a report has found.
The study by Centre for Ageing Better revealed that people needing adaptations and practitioners noted how people would delay the process as the design of equipment offered is often practical rather than attractive and ‘echo hospitals’ or ‘spoil the décor’.
“People delay installing adaptations until they reach crisis point, so as not to ‘medicalise’ their home, and instead adapt behaviour rather than adapting their home,” said the report.
Despite facing many challenges within their home environment, the majority of participants in the study highlighted their desire to stay in their own homes and rejected opportunities to move to a more suitable property. Therefore, it was largely a trigger within the home that drove participants to recognise a change was needed.
For some individuals, this resulted from a specific event, for example a fall, whereas for others it was from a gradual acceptance and eventual tipping point that current coping strategies were no longer working.
There were significant assumed associations that adaptations signalled vulnerability and incapacity, reminding participants of mobility lost rather than movement and freedom gained.
In order to ensure more people make changes to their homes earlier, there is an urgent need for positive messaging about home adaptations and a wider understanding of the adaptations and their benefits, said the report.
While some people do self-refer themselves, practitioners largely felt that there is a general lack of awareness of how to access home adaptations.
Sources of information and advice on the role of home adaptations mostly came from friends, family and, to a lesser extent, signposting agencies, such as age-related or disease-specific charities and home improvement agencies. There was some consensus amongst older people and practitioners that formal services, including healthcare and housing, largely became involved at a point of deterioration in health or mobility.
The report found that word of mouth was a key influence to people accessing adaptations, particularly having friends or family members who had previous experience of adaptations. Being able to discuss, informally, the benefits of adaptations and what to expect from the process, supported participants in making their final decision.
Those without friends or family around them with knowledge and experience were unsure of what adaptations were available, where they could access them and how much adaptations cost. They often felt they were navigating the system alone, which resulted in a delayed decision.
Practitioners and participants reported that navigating the route to getting the right adaptations in place for the right person can be a challenge.
Practitioners expressed frustration with assessment and installation ‘bottlenecks’ and there was strong agreement that these were due to lack of resources, such as not having enough staff to process referrals and grants, or contractors to carry out adaptations, rather than insufficient DFG funding.
There were instances where the decision to access a housing adaptation was taken during
times of personal stress, for example following a recent bereavement. This often led to inappropriate decisions being made and participants regretting changes made to the home.
However, once installation is underway, largely there are few reported problems. This suggests that if the earlier part of the participant journey is done right, then positive outcomes can be achieved more often. Installation was particularly successful when professionals worked together to ensure an individualised approach and the client was well-informed. However, when problems did occur there were often long-term impacts on the individual and a negative impact on how the adaptation was valued.
Participants who had good experiences with contractors and traders valued those who provided information, were personable and kept them informed about the work.
The study reiterated previous findings from The Centre for Ageing Better that both minor and major home adaptations can improve a range of outcomes for people in later life, including improved performance of everyday activities, improved mental health and preventing falls and injuries.
Some participants found they had to learn to trust their new adaptations, adopt new routines (charging the stair lift), and change some pre-adaptation behaviours. For a minority of participants, home adaptations did not achieve their intended outcomes, or led to negative outcomes.
There were very positive expressions of ‘getting back to normal’ and reclaiming home spaces such as the first floor or garage. The restoration of small, subtle, routines was appreciated as life affirming, ‘a boon’ and ‘a life-saver’.
While most participants reported that adaptations reduced their likelihood of falling, there were some examples of poorly fitted equipment that led to trips or falls. Other outcomes that were mentioned by the participants included home adaptations preventing unwanted relocation; exit and entry adaptations enabling more social contact; reducing worry and carer strain for family and formal carers; and in some cases, no longer needing, or reducing, care services.
The report makes a number of recommendations and calls on the government to take advantage of the opportunity of the Industrial Strategy Challenge Fund and provide funding for products and services that are inclusively designed. It should also encourage positive messaging, for example offering a ‘Facilitating Independence Grant’, as opposed to a ‘Disabled Facilities Grant’.
The government should increase the DFG budget to cover simultaneous funding to the required resources in the adaptation process, including administration and contractors. Successful and timely distribution of this funding is dependent upon other resources.
Furthermore, it should provide better guidance on home adaptation outcome measures. Such metrics need to be based on robust evidence of what services can achieve as well as policy goals, said the report. Local services should have the flexibility to achieve such outcomes according to local need and local context. Guidance should include when, how and why to present evidence around the impact of home adaptation services.
The report also urges the private sector to sell inclusively designed products as standard. Retailers, buyers, designers and manufacturers need to work together to ensure inclusive products are available and visible in the mainstream market, it adds.
Local services should ensure adaptation services should work with signposting agencies and health services to simplify and speed up the home adaptation processes and to ‘lay it out honestly’. They should also learn from areas that are using their funding in a smarter and more innovative way.
Local services should also reassess their processes to ensure they are not only focused on meeting the functional need of leaving the home, and instead take into consideration use of the wider home environment. They should also ensure contractors, when installing adaptations, adopt a personalised approach to the individuals’ wants and needs
“From our previous review on the role of home adaptations in later life published in 2017 we know there is strong evidence that home adaptations, particularly small changes, can improve outcomes and quality of life for those in later life. They are an effective and cost-effective intervention for preventing falls and injuries, particularly when combined with necessary repairs and home improvements, delivered in a timely manner, and in line with people’s personal goals,” said the report.
“There has been a noticeable shift and increase in interest at local and national policy level on the benefits of adapting the home. This includes plans to reform social care, a review of the Disabled Facilities Grant and the Communities and Local Government Committee’s call for a national strategy on housing for our ageing population,” it added.
“Government is starting to listen and generate change, but there is much more to do to continue to make the case for the role of home adaptations and their positive, often life-changing, impact,” the report concluded.
Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board said: Councils are working hard to provide housing adaptations and mobility aids which are vital to help keep people safe and independent in their homes and prevent avoidable admissions to hospital and care homes.
“To help address requests for home adaptations the Disabled Facilities Grant needs to be fully funded to keep pace with demand. Government also needs to plug the £3.5 billion funding gap facing adult social care by 2025 and reverse the £600 million in reductions to councils’ public health grants between 2015/16 and 2019/20.
“There is a shortage of homes suitable for older and disabled people and people in vulnerable circumstances. To help address this councils need to be given greater planning powers and resources to hold developers to account, ensuring that they build the right homes in the right places needed by different groups within the local community.
“Government needs to work with councils and housing associations to provide a sustainable funding framework through which to offer the certainty and clarity to invest in the future development of housing for people with a range of needs.
“The housing borrowing cap should be also lifted so all councils can be allowed to borrow to build as this will help address the growing number of people, including those with disabilities, living longer with increasingly complex needs,” she concluded.
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