Supporting an ageing population to stay in their homes longer

With the outcome of a review into the Disabled Facilities Grant due to be published in autumn this year, we discuss the current funding arrangements and whether a partnership approach to undertaking adaptations to support people to stay in their own home can make a real difference:

The issues around the ageing population are widely known and understood.  The impact on the housing needs of the population are also known and many papers have been published. However, the challenge this presents in terms of making housing accessible and the impact that adapted, accessible housing can make on the long-term health and wellbeing of the elderly and disabled population remains an area of myth and mystery.

It is almost impossible to quantify ‘how much longer’ a person can stay at home if their property is adapted rather than needing residential or nursing care. The ‘savings’ achieved through adapting a person’s home are often seen in the budget of a different organisation to that which spends the money on the adaptation.  However, what is generally accepted is that a person’s health and wellbeing is much better served by them staying in their home or being in an appropriately adapted home than moving to a care setting.

Home adaptations can increase independence, help to prevent falls, reduce the length of a stay in hospital and delay care home admission. Adaptations can range from large scale extensions to fitting a grab rail in someone’s home, the principle behind them being to support independent living. Many adaptations are funded through Disabled Facilities Grants (DFG) however more and more people are arranging their own adaptations or looking to their landlord for help. DFG funding is available to everyone, regardless of tenure, although it is means tested. Experience shows that the best outcomes are achieved through partnership working and by all organisations adopting a flexible approach.

The legislation which governs DFGs is 30 years old this year and earlier this year the Department for Health & Social Care appointed a partnership led by the University of the West of England with Foundations, the Building Research Establishment, Ferret Information Systems and an experienced Housing Occupational Therapist to carry out the first independent review of DFG system since 2005.  This report is currently with Government and the outcomes expected to be published in late Autumn of 2018.

The review focussed on:

  • How the DFG is used currently – who gets what and how it’s delivered
  • How the DFG could change in the future – focussing on the current means test, the £30,000 maximum grant limit, the allocation formula and methods of delivery
  • The link between adaptations and health and social care services, including timely hospital discharge
  • The changing aids and adaptations market
  • The impact of Section 36 of the Equality Act 2010 on adaptations to communal areas.

Housing Association tenants often don’t access DFG funding for adaptation, with associations either wholly or partially funding adaptations from their own budgets.  This can create a two-tier system which can work both for or against tenants, depending on how effective the associations system is.  What we do know is that in many areas there is DFG funding available that is not being spent and that by new and innovative ways of working this funding could be used to keep people at home for longer. In 2002 the government brought in the Regulatory Reform (Housing Assistance) (England and Wales) Order 2002 (RRO) which provides freedom and opportunities for local authorities to address housing issues including DFG funding and adaptations.

This created greater flexibility and allows an authority to address issues on a wider preventative basis. The adoption and publication of a policy for housing assistance is a requirement of the RRO before assistance can be offered. The scope of the order is very wide and allows the Council to decide whether it provides grants, loans, advice etc for the purpose of repairing, improving, extending, converting or adapting housing accommodation of any tenure.

The government has increased the amount given to Local Authorities significantly in recent years with the amount expected to reach £500m in 2019/20. The expectation is that the powers under the RRO will be used to allow authorities to be more flexible in how the money is spent. The DFG monies are now contained within the Better Care Fund (BCF) and health priorities are becoming more important in the way DFG is spent, so that delayed transfers of care and readmission to hospital, which are key health priorities, could be supported using some of the DFG finance. Housing options advice and support with moving is another important issue that could be funded using the RRO.

Examples already in use include:

  • DFG money has been top-sliced to focus on non-means tested minor adaptations facilitating discharge and keeping people independent in their home
  • Additional money was given to an authority to facilitate adaptations on a non-means tested basis for people being discharged from hospital or at risk of being readmitted (often known as ‘frequent fliers’)
  • Funding is used in one area on a county-wide basis to provide Modular Ramps. This offers a quicker, more efficient and better service for residents. Each district contributes from their DFG fund allocation and the equipment can be recycled for future use. The ramps are fitted using the County-Run Community Equipment Service without a means test
  • A local authority has approved use of a Home Adaptation Grant that can be used in place of a DFG allowing for a quicker less bureaucratic use of DFG monies with the grant being available to all tenures. Through a partnership approach with their main stock-holding association the Council has agreed a pre-adaptation protocol with joint visits by housing officers and occupational therapists to ensure the adaptation is the ‘best’ option for the tenant.

We know that through partnership working and an open approach to using the Regulatory Reform Order, authorities and associations can achieve amazing outcomes for their residents. We are very much looking forward to the publication of the DFG review and hope that it will provide the basis for some much-needed reforms for adaptations and provide clear guidelines which will enable comparative evaluation of the impact and outcomes of adaptations to be measured effectively, rather than the outputs focus which many services still focus on.  To know a service has delivered ‘X’ number of adaptations is fantastic – but what really matters is the difference those adaptations made to the life of the person who needed them.