Paul Smith, the Director of Foundations, the national body for home adaptations (and a member of the ADASS Housing Policy Network) has written this piece in relation to DFG's and reducing care home admissions. As budgets get ever tighter Directors are faced with the dilemma of needing to spend money on services that meet immediate and pressing need whilst wanting to invest in those things that will deliver better outcomes for people and save money in the longer term. Housing solutions have a fundamental part to play in the prevention agenda and the increase in DFG funding as part of the BCF gives us an opportunity to take that longer view - but are Director's and their CCG partners convinced that the returns will follow the investment? Paul provides a thoughtful contribution to help Directors and encourages a wider view of how DFG's should be used.
Neil Revely, ADASS Housing Co-Lead
By Paul Smith, Director of Foundation
When the extra funding for Disabled Facilities Grants (DFGs) was announced in last year’s comprehensive spending review there was a caveat that the investment ‘is expected to prevent 8,500 people from needing to go into a care home in 2019-20’.
To put this in perspective there are around 386,000 people already living in care homes in England with an average stay of just 15 months.
Foundations’ research in late 2015 highlighted how home adaptations do delay entry into care homes, but keeping people out of care homes is a long standing health service objective. Back in 2014, NHS England chief executive Simon Stevens said he would be disappointed if care homes ‘still existed by 2060’.
So what is it about home adaptations that does seem to prevent people needing to go into care homes, and what else do we need to consider if we’re going to meet the Chancellor’s target? Perhaps we should start by looking at the reasons why people are admitted into care homes.
From the many studies into the subject there appear to be five main reasons why older people go into residential care:
- following a fall/fracture
- following an acute illness
- because of a general deterioration in their health and their ability to look after themselves
- as a result of increasing pressure on their carer
- because of loneliness.
Of course, people are much more complicated than that and in many cases there is a combination of these events with around half of all admissions also preceded by a hospital stay. So how could DFG funding be used to address these issues, in theory at least?
For falls, there have been many studies on what works well to prevent them – and there’s no single answer. However, home safety programmes that identify and eliminate hazards are known to be effective in reducing the number of falls, but only among older individuals most at risk of falling and not in the general older population. Could falls prevention targeted at frail older people become a standard part of the work of handyperson services?
For acute illnesses, where a hospital stay is likely to be involved, then the issue is likely to be the swift provision of adaptations to aid discharge. It’s relatively easy to fit a grab rail quickly, but do we have systems in place that could adapt a bathroom or build a ramp? And if the person doesn’t have a permanent and substantial disability, is there a case for relaxing existing DFG criteria to enable a swift return home?
With a slower deterioration in health, particularly where dementia is involved, then there is potential to make proactive changes to the home environment. The Social Care Institute for Excellence (SCIE) has a range of resources on dementia friendly environments from clear front cupboards to circular garden paths. It could be argued there’s a case for funding these to allow someone to remain living safely in their own home for much longer.
Recent research from Australia shows that carers can benefit significantly from the provision of home adaptations – reducing their care giving hours by up to 60%. However, DFG is typically provided to meet the needs of the disabled person. Should, as Foundations suggests in our evidence to government, we be using DFG to support carers too?
It could be argued that as home adaptations increase a person’s independence, they reduce reliance upon carers and this could lead to increased isolation. With studies showing that loneliness is as bad for your health as smoking 15 cigarettes a day, the intervention of a home improvement agency to put people in contact with clubs, groups or befriending services could be part of a more holistic DFG process. Assistive technology could also play a role.
Whichever options we choose, it will be important for all interventions to include reference to the NHS number of the disabled person. This will allow the link to care home admissions to be monitored and prove that 8,500 people have been prevented from needing to go into a care home.
Paul Smith is director of Foundations, the DCLG funded national body for home improvement agencies and DFGs.