Introduction

1. Housing an ageing population – the value of information and adviceDr Gemma BurgessHousing Studies Association Conference 2010

2. Introduction • An ageing population • Pressures on housing and care • Early intervention and prevention • Need for information and advice • Evaluation of FirstStop • Proving cost savings and value for money

3. An ageing population Population by age, UK, 1983, 2008 and 2033 http://www.statistics.gov.uk/cci/nugget.asp?ID=949

4. An ageing population • Last 25 years the percentage of the population aged 65 and over increased from 15% in 1983 to 16% in 2008, an increase of 1.5 million people in this age group (ONS, 2009). • By 2083, 1 in 3 people in the UK will be over 60. • Fastest population increase been in the number of those aged 85 and over. • From the 1950s, the number of people aged 100 and over in England and Wales increased at a faster rate than any other group to reach 9,600 in 2008.

5. Housing and ageing • Number of households with heads or even all members over 65 is increasing rapidly. • Many are well established in the housing market. • Houses are large, owner occupied and with substantial equity value. • 68% of householders aged over 65 own their homes outright without a mortgage. • Lower mobility rates than households in general. • Under-occupation. • Encourage downsizing. • Social sector.

6. The pressures of ageing • Ageing is polarised. • More than 1 in 5 pensioners live below the poverty line. • Many older people live in the worst housing conditions with a third of older people (2.1 million households) living in non-decent or hazardous housing. • As people age, ordinary tasks within the home can become more difficult. • Over three quarters of a million people aged 65 and over need specially adapted accommodation because of a medical condition or disability • 145,000 people aged 65 and over report living in homes that do not meet their needs.

7. Housing becomes unsuitable • “Most of our homes and communities are not designed to meet people’s changing needs as they grow older and older people’s housing options are too often limited to care homes or sheltered housing” (CLG, 2008). • What we need from our housing changes as we age. • Lack of choice. • Limited options. • Policy goal - a home for life. • Policy goal - reducing under-occupation, equity release, using housing wealth to fund own care.

8. Burden on public finances • The National Strategy for Housing in an Ageing Society - good housing is imperative for wellbeing in later life and will be critical in managing the mounting pressures of health, care and support expenditure. • Without intervention, social care expenditure would need to increase more than threefold (325%) by 2041 to meet demographic pressures.

9. Coping with housing and care crises • Some people plan ahead e.g. move to sheltered housing, downsize, buy insurance. • But many people do not plan ahead. • Often slow increase in difficulty managing e.g. the garden is too big, problems with the stairs, brought to crisis point. • Falls, hospital admissions, illness, sudden increase in physical frailty or mental health - inability to manage becomes a crisis. • Nursing and residential homes. • Traumatic.

10. Selling the family home • Mr H said that his family did not know how to find a care home place or how to fund it and were worried about having to sell his grandmother’s house: • “My grandmother has savings and owned her own home so we really wanted to know if we could save selling the house. She and my grandfather worked hard all their lives and they had savings and the house which she would like to have left to the family. I really didn’t know where we stood on this. At the moment we are having to pay for her care, we haven’t tried selling the house yet, but know the time will come when we do. It is so unfair, my grandparents saved all their lives and are now being penalised. It would have been better if they had frittered their money away while they could.”

11. Emotive issue • Betrayal of a Spitfire hero: NHS withdraws care home funding for war veteran struck down by dementia. • The 88-year-old grandfather, who requires round-the-clock nursing at a home because of dementia and diabetes, had the funding for his care withdrawn despite the advice of his GP. • His family now fear they will have to sell the house where his 94-year-old wife lives to cover the care home costs. • His daughter said: ‘My father made great sacrifices for his country, he is a war hero and deserves better than this. I feel totally let down and hurt that he has been treated in this way. It is a complete nightmare, a disgrace and an insult. He was, and still is, a very dignified man.’

12. Political issue • “Councils 'will struggle with ageing population’.” Audit Commission said the £9bn a year social care bill will double by 2026 if current practices continue. 18 Feb. • Eight pensioners every day are still forced to sell their homes to pay for care they had every right to expect from the state, after lifetimes of paying taxes and National Insurance. Meanwhile, the feckless and spendthrift have been given the same care for nothing. 31 March. • “Government drops 'death tax' as social care funding plans confirmed” 30 March. conservativehome.blogs.com

13. Shift to prevention • An agenda has been developing around preventing older people from moving into high housing need, particularly at times of crisis, which is often very costly to both individuals and public finances. • A recognised need for the provision of information and advice to assist older people in planning ahead and coping with changing housing and care needs. • Older people face problems that cut across housing, health, finance, care and their general rights.

14. Should I stay or should I go? • The main areas in which older people want information and advice are: • Advice on moving - often round a crisis, e.g. bereavement or a fall. • Advice on staying at home - and being able to deal with disrepair, adaptations, benefits and finances. • To know their options - should I move or should I stay at home, what are the implications? • General housing issues - housing rights, housing benefit and income issues.

15. Problems with provision of I&A • Most advice services have been fragmented across a range of voluntary and statutory agencies. • Relied on short-term funding, leading to patchy provision. • Need for a single, simple and accessible route to obtaining independent, impartial information and advice on housing and related issues, including finance and care options. • Communities and Local Government is funding FirstStop to provide a web and telephone service at a national level and to develop links with local services.

16. FirstStop • FirstStop is an innovative initiative that provides holistic information and advice about housing, care, finance and rights. It is testing the hypothesis that the approach of providing information and advice can encourage prevention of housing crises for older people and can generate financial savings. • Planning ahead and coping with crises.

17. The research • Independent evaluation of FirstStop. • Started in November 2009, included: • a literature and policy review • interviews with participating organisations and other stakeholders • interviews with front line staff • postal survey sent to a random sample of 300 customers • telephone interviews with customers • interviews with local partner pilot projects • analysis of the training programme • analysis of the data, actions and costs of the service.

18. What has FirstStop achieved? • Minister Lord McKenzie, whose Communities and Local Government department is backing FirstStop along with the Big Lottery Fund, said he was delighted at the early findings contained in the report: • "Older people have made clear for many years that they would value a good quality, personal service to help them ensure that their living environment works well for them as they age, and to organise any help or support they need. I am very encouraged that this research shows that FirstStop Advice is shaping up to provide that service effectively."

19. Success?

20. Case study FirstStop customer • Contacted FirstStop on behalf of her mother and her aunt who shared a house. • Concerned about her mother’s mobility and wished to move her to the ground floor of the house. • Her mother died before this could take place and her aunt collapsed on the same day. • Her aunt has since fallen and broken her hip and is currently in hospital. • Interviewee is now trying to find a care home for her aunt.

21. Case study FirstStop customer • She contacted FirstStop for assistance and found the service invaluable: • “I knew nothing about what to do. FirstStop sent me leaflets which also have useful phone numbers on the back. I got information about care homes and about financial assessments. The financial side of things is a nightmare, the FirstStop leaflet lays out all the costings. I’ve called them twice and both times the information came really quickly. They made me aware of what roads were open to me. They really have time for you and didn’t rush me and they listened and answered any point that needed to be expanded upon. They were just brilliant and I can’t think of anything better.”

22. Savings? • Is it good value for money? • How much does it save and for who? • What are the costs, the benefits and the savings to the public purse?

23. What cost savings can be generated by providing information and advice? • Preventing people in moderate housing need from progressing into high housing need. • Reduce care home expenditure by supporting a person to stay in their own home for longer or enabling alternative housing moves. • Health sector savings e.g. when better health is achieved through housing improvements and when falls are prevented through home adaptations and other risk reduction measures. • A 1% cut in the numbers of older people going into institutions could save the country as much as £3.8 billion. • Financial advice can make funds for care last longer.

24. Cost savings of home adaptations • Average cost to the state of fractured hip £28,665. • 5 times average cost of major housing adaptation (£6,000) and 100 times the cost of fitting hand and grab rails to prevent falls. • Home modifications to prevent or defer entry into residential care. • One year’s delay will save £26,000 per person, less the cost of a major adaptation at an average of £6000. • Investment in a suitably adapted and equipped home where this makes independent living possible, usually pays for itself in 12 months or less and produces savings to social care budgets thereafter ranging from £25,000 to £80,000 per year (Davis and Ritters, 2009).

25. General acceptance of benefits • David Orr, chief executive of the National Housing Federation, said: "The current system emphasises the role of specialist care and support for vulnerable people only when they reach crisis point and end up in hospital or can no longer cope on their own.“But the proposals outlined today should mean preventative services offered to people in their home will also be a key part of the equation."This makes more sense both at a human level and on a purely financial basis. An investment of £1.6bn in housing-related support generates savings worth £3.41bn to the taxpayer through reduced hospital visits and emergency admissions. 30th March.

26. But difficult to ‘prove’ value for money • Third sector organisations providing I&A services often find it difficult to obtain secure funding. • It is difficult to demonstrate the value of these services when competing for scarce resources . • Requirement to prove to funders that a service can deliver ‘value for money’ - quantitative cost benefit analysis. • Methodologically challenging. • Evidence-based policy – has to prove it delivers. • Politically driven – need for immediate results.

27. Benefits • There are a range of valuable but uncosted benefits: • Reduced risk of social exclusion • Improved health and quality of life • Increased participation in the community • Reduced burden for carers • Greater access to appropriate services • Improved sense of well-being and empowerment • Improved decisions

28. Methodological challenges • Difficult to quantify benefits such as empowerment, continued independence, improved quality of life or feelings of greater well-being. • Benefits can be identified qualitatively, eg. by interviewing people who have received information and advice, but it is far more challenging to place a monetary value on them.

29. Methodological challenges • Difficult to show cause and effect. • Hard to prove the what ifs. • To measure these benefits in more quantitative ways might involve tracking people as they age over relatively long time periods to assess the impacts of receiving information and advice at different times, the decisions and changes they go on the make, and their consequences. • But this type of research will not meet the short term need to demonstrate the benefits of services already in operation. • FirstStop evaluation Phases 2 and 3.

30. Sense of urgency • Unless there is a shift to earlier preparation for the challenges of old age, the cost of ageing is likely to be an unsustainable financial burden, as well as limiting the well-being and independence of older people. • Everyone who will need housing and who might need care in old age in 2050 is alive today. • What they do themselves and what action is taken collectively will have a very large bearing on both the timing and the severity of any future needs. • It is imperative that advice and information initiatives are supported to aid decision-making as we age.

31. Need for change • More joined-up government working across different issues and departments in I&A provision. Many older people face interrelated issues of housing, care, finance and health. • More links between national and local agencies providing I&A/services. Strengthen provision at both scales. • Sustained and stable funding for I&A initiatives over a longer period of time, to allow them to become known to the public and to develop national-local links, also to enable benefits to be evaluated in more depth.

32. Recruitment: Director of Research The Department of Land Economy is seeking to appoint a Director of Research to lead the Cambridge Centre for Housing and Planning Research, following the impending retirement of Professor Christine Whitehead OBE. The new Director will be responsible for maintaining and developing the Centre, its contribution to policy formation and evaluation, its academic output, and its range of funded research. The post is offered on a full time basis but a part time appointment would be considered for a suitable candidate. The appointment will commence 01 January 2011 and will be for a period of three years in the first instance, renewable on the successful attraction of funding. Further information and an application form can be obtained from http://www.cchpr.landecon.cam.ac.uk/recruitment.asp