Why is every decision about care a decision about housing?
The role of housing in realising the full ambition of the Care Act 2014
Housing is fundamental to the health and wellbeing of its residents. For those who need it, good quality, suitable and affordable housing with support improves health and reduces pressure on health and social care. In the Care Act 2014, housing is acknowledged as a health-related provision.
This article looks at the role of supported and specialist housing, including homes for older people, in achieving the aims of the Care Act 2014. It explores how housing is integrated with health and social care, leads to prevention and promotes wellbeing and choice. It looks at what has been achieved and what needs to happen for the Act’s ambitions to be fully realised.
What is the role of housing in integration?
Every decision about care should be a decision about housing. The Care Act requires social services to integrate care and support with health and health-related provision where this promotes wellbeing. Under the Act, housing is seen as a health-related provision.
Integration between health, social care and housing means residents in specialist housing can receive treatment in good time. Early intervention helps prevent care needs and illnesses from getting worse and reduces the need for more serious interventions later on.
By helping people access the right services and support at the right time, specialist housing reduces GP and hospital visits, stops people staying in hospital for longer than needed and prevents or slows people needing care."
How does housing help prevention?
Under the Care Act, councils must make sure people receive services that prevent their care needs from becoming more serious and help people regain skills after time in hospital.
Commissioning housing with integrated care and support is a cost-effective way of reducing the likelihood that residents will go into hospital or residential care and reducing re-admission by helping them recover wellbeing and independence.
If people are discharged from hospital into safe accommodation with the right support and adaptations, their outcomes are improved. Staying longer than needed in hospital or being placed in residential care too soon can negatively affect someone who could live independently with the right support.
The benefits of living in sheltered housing are averting falls, reducing loneliness and reducing pressure on hospitals. Research also shows extra care schemes can help to combat the onset of dementia.
Without supported housing, 41,000 more people would be homeless, 30,000 people would be at risk of homelessness and we would need 14,000 more inpatient psychiatric places, 2,500 additional places in residential care and 2,000 more prison places.
How does the right housing improve wellbeing?
Good-quality specialist housing is vital to wellbeing. It helps residents build healthy relationships, improve self-esteem and independence, retain social connections and combat loneliness. It also helps people access primary care, treatment and diagnosis.
Support services reduce homelessness and help people settle into their new home, maintain their tenancies, stay safe, access work, education or training, learn skills and work with services.
How does housing help build choice and control?
A big part of wellbeing is having control over your life and being able to choose how your care and support needs are met.
Specialist housing allows residents to retain choice and control. It allows residents who need assistance with some elements of daily life to be as independent as possible. It offers a holistic, person-centred experience where residents have their own tenancy and can decide who comes into their home.
For many people with support or care needs, the only alternatives to specialist housing are residential care, hospital or another secure institution, which are not a home environment.
Why is partnership working so important?
It is crucial that councils work with partners to help plan future services.
Housing associations are community anchors and understand the needs of their area. They provide vital services to support health and wellbeing for their residents. They benefit the wider local economy through specialised support and community investment.
Where they are involved in local planning for housing, care, support and wellbeing services, their expertise can help local areas provide much needed services in the most cost-effective way, with the best outcomes for people.
There are many examples of where supported and older people’s housing providers have worked with councils and health partners to meet local needs in a strategic way.
What is the picture today?
Specialist housing delivers significant savings to public funds. Specialist housing for older people saves £3,000 per person annually. For people with a learning disability or mental health needs, the saving reaches £12,500-£15,500. More investment in supported and older people’s housing will save even more money for health and social care.
The People at the Heart of Care White Paper predicts that demand for supported homes in England will increase by 125,000 by 2030. The APPG on Ageing and Older People estimates that 38,000 new homes for older people are required each year.
With increasing need and a cost-of-living crisis, supported and older people’s housing is more important than ever. However, funding has reduced significantly and inflation is increasing managing costs. It is very difficult for not-for-profit providers to sustain services where revenue does not meet costs. We need stable and ringfenced funding for councils to continue to commission specialist housing.
There are also barriers to developing new housing schemes. Low capital grant rates, planning, land availability and revenue funding are major barriers. With improved revenue and grant funding, housing associations can address the national shortage of specialist housing.
A lack of affordable and suitable housing means people often have nowhere to move on to. We need a long-term plan for housing so everyone can live in a safe home they can afford. We also need more flexible and adaptable homes to meet future needs.
Too often, care and support services are commissioned based on short-term considerations of costs. The Health and (then) HCLG committees’ 2018 report found that restricting reform to funding mechanisms for care risks failing to consider the value of preventative services, quality of life and services to help people live independently. Choice and control for residents should be at the heart of the services we commission.
What needs to happen?
So councils can retain and commission new supported and older people’s housing, the government should ring-fence housing-related support funding to at least match the £1.6 billion per year councils in England received in 2010. This would help unlock development and meet the growing need for housing, whilst reducing spending on residential care.
To ensure supported and older people’s housing is part of a strategic vision, the government should recommit to the £300 million Housing Transformation Fund, to support the development of specialist housing and the integration of housing into local health and social care systems.
There must be improved revenue and grant funding so we can meet the target for 10 per cent of the Affordable Homes Programme to deliver supported housing and develop more housing for older people.
We need a long-term plan for housing to ensure everyone can live as independently as possible, for as long as possible, in a home that meets their needs.
Ultimately, every decision about care should be a decision about housing.
