Older People and Physical Health

It has long been recognised that the housing sector can – and should – play a unique role in the health and wellbeing of residents. A 2015 report by the Smith Institute noted that housing associations should “develop service offers which emphasise the promotion of personal, social and economic wellbeing, and are based on strong partnership with the world of healthcare and local councils. The sector is well placed to be a strong part of better, more effective local service provision for older people.”

This short briefing will focus on examples of how housing associations are creating service offers which respond to this agenda; working in partnership with public and charitable bodies and ultimately delivering more effective (and cost-effective) local service provision for tenants.

Amid signs that the Department for Health are beginning to look at the effects of poor housing and poor health in more detail, it is becoming increasingly clear that organisations seeking to enhance their role in delivering affordable and holistic health services may benefit from change in Government thought.

Shelter notes that England has an ageing population with people living longer and low birth rates. In 2005, there were almost 9.4 million people over retirement age (18.5 per cent of the total population). It is projected that the proportion of people in this age group will continue to rise. By 2021, 10.6 million (or 19.4 per cent) will be in this age group – an increase of 13 per cent. Subsections of this data show that the North has a disproportionately large share of this ageing population. A demographic change on this scale will have to result in new ways of working between housing associations, local authorities and health bodies if the NHS is not to be over-loaded.

Delayed discharge, or “bed blocking”, the long-term occupation of hospital beds, chiefly by elderly people, due to a shortage of suitable care elsewhere, has risen up the agenda of late with a recent independent report by Lord Carter noting that delayed discharge costs the NHS an estimated £900m a year. Other issues related to older people and physical health – including the suitability of general needs stock to house them and how it can be adapted – are rapidly rising up the list of issues faced by registered providers across the North.

This briefing will explore the links that can be made by housing associations and local authorities and bodies such as Clinical Commissioning Groups and other charitable groups to deliver better care solutions for older people.  It looks at traditional models of housing support for older people and how they have been expanded and augmented by arrangements with other groups to provide a better standard of care to older people. It also highlights the new approaches being taken by housing associations to address historic problems such as providing for older people at the end of their life.

It will also highlight independent living and how – by integrating the NHS, tele-care, care and housing, major savings can be achieved for the health sector as well as highlighting the positive role that housing can play in reducing costs to the NHS.

Case Study: Peaks and Plains Housing

TrustLink, a part of Peaks and Plains Housing – a Cheshire-based social landlord with around 4,880 homes – have provided a 24/7 control centre for tele-care services since 1988 but more recently have used their decades of experience to pursue new collaborative models of working and new opportunities for outreach work.

The TrustLink team consists of 3 interlinking groups of professionals led by a Senior Manager and 3 Team Leaders.  The current management team have been involved since the inception of these services, years before the current technology was available. As a result of this, TrustLink incorporates the very best elements of services from nearly 3 decades of delivery and combines them to deliver market-leading services to a vastly diverse client group.

TrustLink themselves deal with an average of around 130 falls per month through their tele-care services which, on the face of it, represents 130 fewer responses needed from the North West Ambulance Service and fewer hospital admissions. Each TrustLink Officer attending a fall is trained to analyse each fall for signs that a customer should be hospitalised (for instance, where their breathing is laboured or where they are bleeding) or whether it is simply a case of immediate help and support to get the faller back on their feet.

Working Collaboratively

TrustLink work closely with the North West Ambulance Service to help older people avoid falls in the home and, over the past 18 months, they have reached an agreement whereby any falls attended by the local Ambulance Service that do not result in hospitalisation are automatically raised with TrustLink via an email so that a risk assessment can take place.

The assessment ensures a trained member of staff meets with the person who has fallen within 72 hours to offer them advice and guidance on how to avoid falls, keeping hydrated (dehydration being a common cause of falls) as well as the benefits of TrustLink’s tele-care services which are available to private sector customers as well as Peaks and Plains Housing Trust’s customers.

This collaborative working by TrustLink and the North West Ambulance Service ensures that those at risk of falls are offered support services to put them at less risk and to avoid hospitalisation, where possible, when falls do occur through TrustLink’s service. It is difficult to quantify the direct savings to the NHS but given that the NHS spends around £2 billion a year on hip fractures (which are one of the most common injuries from a fall in old age) it is clear there is a substantial cost saving that could be made through more collaboration of the kind between TrustLink and North West Ambulance Trust.

The collaboration was aided by a successful bid to the Eastern Cheshire Clinical Commissioning Group (CCG) and represents a clear signal that CCGs are willing to engage with the housing sector to deliver better services to older people as well as allowing housing associations to use their expertise in a wider setting.

LifeLinks

The LifeLinks service is an outreach service delivered by Peaks and Plains Housing Trust and Cheshire East Age UK that provides a range of outreach and signposting services for customers across East Cheshire. It links with and compliments the work of TrustLink by providing more relaxed, outreach-based approach to promoting independent living. Fundamentally, it is service that promotes health and wellbeing among older people in the Peaks and Plains Housing Trust area.

One of LifeLinks’s recent innovations is the LifeLinks bus, an outreach service that visits areas of high footfall (such as supermarket car parks) to do outreach work within the community promoting simple measures such as blood pressure checks and BMI checks and other low level health awareness initiatives. Further support is offered through the development and support in implementing health improvement plans.

Throughout the whole project, there is a strong focus on inter-agency working between Peaks and Plains Housing Trust, East Cheshire Age UK and Cheshire East Council. This can involve simple signposting to groups and clubs offering everything from low impact exercise to companionship clubs built around shared interests hosted in the local area. The ethos running through the LifeLinks service is one of information and education as part of a wider drive to create better environments for older people through partnership working and through self-care. It is hoped that this will pay dividends to the organisation and the wider NHS by encouraging a better lifestyle and fewer instances of hospital treatment.

Case Study: Home Group

Improving End of Life Care: ‘A Good Death’

Home Group is one of the UK’s largest providers of high quality housing and supported housing services and products. They house over 120,000 people a year, managing 55,000 homes in over 200 local authority areas in England, Scotland and Wales which, each year, includes working with almost 30,000 vulnerable people through more than 500 supported housing, justice and health services.

With an ageing population, it is more important than ever to ensure that end of life care appropriately supports an individual and delivers a person-centred approach. Part of this will involve increasing the support available to people who would prefer to die at home.

It is anticipated that two-thirds of people would prefer to die at home, yet fewer than 20 per cent do. In addition, research shows that up to 40 per cent of people who die in hospital had no medical reason to be there at all owing to delayed discharge.

Failure to tackle this issue is leaving many people with terminal illness feeling out of control and is also contributing to rising NHS costs. For example, spending by health trusts on end-of-life care can be as much as £6,000 per patient, with total costs at around £245m on specialist palliative care services. These costs are likely to escalate in the future, with forecasts anticipating 90,000 more people dying in an institution and a 17% increase in the annual number of deaths by 2030.

Home Group have realised that their customers are over-represented among people who die in hospital and people who die of terminal illnesses. It is clear that housing association’s role as providers of social care should be encouraged. For example, of the two-thirds of deaths each year are among people aged 75 and over, 20 per cent live in social households.

This proximity landlords have to their tenants means that housing associations have the capabilities, personal relationships and knowledge needed to help identify people approaching end of their life and co-ordinate the support they need. Home Group piloted a project supporting 63 people over nine months who wanted to die at home, yet the conditions within their homes were not appropriate and required adjustments. As part of this, Home Group support clients to make practical arrangements and choices which will enable them to remain in their own homes for as long as possible.

Home Group’s scheme noted significant positive outcomes. Most importantly, there was a significant increase amongst tenant’s feeling of being in control over the course of the service and a improvement in their quality of life.

These outcomes run alongside the evidence that community based end of life care delivers savings for the NHS. For example, studies have shown that a reduction of a third in the average length of stay of cancer patients in the last year of their life would deliver cost savings of around £151m a year.  Additionally, there is a potential £958 saving per person who dies in the community rather than an inpatient care.

Case Study: One Housing

Roseberry Mansions Reablement Service is a ten unit service which provides intensive short term support and therapies to enable people who have been hospitalised to return home or to other appropriate long-term accommodation.

The service is based within a purpose built extra care scheme in the heart of the Kings Cross regeneration area in London. An onsite multi-disciplinary team (MDT) works collaboratively to provide a comprehensive reablement service to people for up to six weeks. The main aims of the service are to:

  • improve the quality of people’s lives by enabling and re-skilling them to be able to return home or to other appropriate accommodation in a sustainable way
  • facilitate earlier hospital discharge and avoid unnecessary or repetitive hospital admissions
  • prevent or delay the need for long term residential or nursing care placements
  • deliver significant NHS and adult social care savings.

The Roseberry Mansions Reablement Service is run by One Housing, a not-for-profit organisation providing high quality homes and care to over 5,000 people in London and the surrounding counties. The Reablement Service has been designed with the ethos of choice, dignity and outcomes for older people.

Roseberry Mansions is a purpose-built environment, with self-contained rooms which are equipped with relevant aids, adaptations, and telecare systems. The intention of the development is to safeguard people and give them the confidence to re-establish their skills, as well as enabling then to become familiar with equipment that they may continue to use once they return home. Tenants can also re-learn life skills, such as cooking and shopping, that they may have lost during a prolonged period in hospital.

Referrals to the service are made by hospital discharge teams to a social worker, and must meet the following criteria:

  • Be over 55 years old
  • Have less than 20 hours care needs a week
  • Need insulin no more than twice a day
  • Currently have their own tenancy or home
  • Be assessed as benefitting from the reablement service

More than half (57%) of the referrals received by Roseberry Mansions Reablement Service have met these criteria and been accepted to the service. Personal care plans are then developed, and each patient is allocated a key worker who will welcome them to the service upon their arrival and provide consistent support throughout their stay.

The dedicated onsite multi-disciplinary healthcare team (MDT) is commissioned by Camden Adult Social Care and delivered by Central and North West London NHS Foundation Trust. Working together with One Housing’s care and support workers, the MDT consists of social services, occupational therapists, physiotherapist, speech therapists and district nurse inputs.

The benefits of this collaborative multi-agency working are manifold. Patients receive a responsive, focused service which delivers the most effective and enabling support interventions, improving their skills and building confidence. NHS, adult social care and social service staff are allocated to Roseberry Mansions meaning the team is stable and the support experience is more consistent for customers.

One Housing and Camden Adult Social Care collaborated to gather quantitative and qualitative data throughout the first ten months of the service provision. It found that the average length of stay was 41 days, just under the six week allocation and, as a result of the service:

  • 72% of people returned home, or to other appropriate accommodation such as sheltered or extra care services
  • 28% of those who returned home did so with a reduced care package

The service contributes to relieving the NHS’s issues with delayed discharge by enabling patients to be discharged to an appropriate and constructive programme earlier than would have been otherwise possible. As well as the clear advantages for the NHS, the reablement service gives real quality back to customers’ lives by relieving negative anxieties and rebuilding skills and abilities for independent living.

Where Next?

These case studies show that building new partnerships; taking initiative on long term problems and innovating new ways of caring can deliver real benefits for registered providers and local NHS services.

These case studies illuminate simple solutions to simple problems: that it is easier to treat people in their homes than it is in hospital; it’s also more comfortable (for tenants) and more cost effective (for the NHS). They show that new ways of providing post-hospital care – a half step between hospital and home – deliver real savings for public purse and reduces the risk of further hospital admissions. They also show that CCGs are proving to be invaluable supporters for innovative ventures by housing associations, not just in the case of East Cheshire, but also in other areas such as Oldham with the Warm Homes Oldham scheme.

Is your organisation trailing new ways of working? Are you working with traditional and non-traditional partners to tackle problems associated with health and housing? If so, we’d love to hear from you. Please email Callum Smith at callum.smith@northern-consortium.org.uk to arrange a phone call or a visit.