Complex Adaptations

Data from annual local authority returns show that the number of complex adaptations costing £30,000 or more had significantly decreased over the last decade before bouncing back in 2022/23. 

One of the main issues is deciding how to fund the costs of the DFG upper limit of £30,000, and who is responsible. Unfortunately, there’s not always an easy answer but there is a range of potential options 

Discretionary Housing Funding

Local authorities in England can utilise the Regulatory Reform (Housing Assistance) (England and Wales) Order 2002 to help fund costs that go beyond the £30,000 upper limit for a Disabled Facilities Grant (DFG). 

Regulatory Reform Order

There are two distinct approaches that local authorities can use when providing additional financial assistance in cases where the upper limit of £30,000 is not sufficient: 

1. Policy to Top Up Maximum Grants:

When a local authority has a “policy to top up maximum grants,” it means they have a set of rules in place. These rules decide when they can give more money than the usual limit for certain types of help. They make these decisions based on specific situations and conditions that they’ve already decided on. This helps them be fair and consistent when giving extra money. 

2. Using Discretion to Consider Exceptional Cases:

When a local authority “uses discretion to consider exceptional cases,” it means they look at each situation one by one. They don’t just follow fixed rules. They think about what’s unique in each case, like how serious the problem is and what kind of help is needed. This helps them make decisions that fit each person’s needs better. But because it’s not based on fixed rules, the decisions might be a bit different from one situation to another. 

Even where a local authority has a policy, it still needs to have an agreed approach to using its discretion to consider exceptional cases – otherwise it could be fettering its discretion, which is unlawful. A typical approach is to provide delegated authority to the Head of Service and a Cabinet Member to approve such cases. 

Social Services Funding

The current DFG guidance (March 2022) says:  

Where the social care authority determines that a need has been established it is their duty to assist, even where the housing authority is unable to approve or to fully fund an application. So, for example, where an applicant for DFG has difficulty in meeting their assessed contribution from the DFG means test or the work will cost more than the upper limit, the social care authority can step in to provide financial assistance. Or if a disabled person is assessed as needing an adaptation which is outside the scope of the statutory DFG duty, then the social care authority can provide it. Social care authorities may also consider using their powers under the Care Act 2014 to charge for their services where appropriate. 

The Care Act 2014

The Care Act defines minor adaptations as those costing £1,000 or less, which must be provided free of charge. However, local authorities also have discretion to provide or arrange major adaptations, even if they cost more than £1,000. They may also choose whether to do that as a grant or a loan. 

There are no definitive eligibility criteria, the decision is based on illustrative examples which give general ideas about outcomes and well-being. This allows for flexibility in giving support. 

Section 23 of the Care Act says that social services can’t do things that are covered by the Housing Act 1996. But this rule doesn’t apply to the Housing Grants, Construction, and Regeneration Act 1996 and DFGs. So, social services can still help to fund home adaptations, and they can also work together with housing authorities. 

Chronically Sick and Disabled Persons Act 1970

In certain circumstances, DFG applicants who are required to contribute to all or part of the cost of the works may qualify for financial assistance under the Chronically Sick and Disabled Persons Act 1970 (CSDP).  

Section 2 of the CSDP places a duty on local authorities to “make arrangements” for “the provision of assistance for that person in arranging for the carrying out of any works of adaptation in his home or the provision of any additional facilities designed to secure his greater safety, comfort or convenience”. This duty applies to any disabled person who is ordinarily resident in their area where they are satisfied that this is necessary to meet the needs of that person. 

NHS Funding

Continuing Healthcare  

When it comes to NHS continuing healthcare, the rules and advice are very clear. If someone’s needs show that they really need ongoing healthcare, the NHS is in charge of setting up and paying for their care completely. Social services are not allowed to do things that the NHS should be doing. 

For people who have NHS continuing healthcare and live at home, the changes that social services would normally help with are now the NHS’s job. This includes things like getting advice, support, equipment, and making changes to the home to help with everyday life. 

For bigger changes to the home, like making it more accessible, the advice is to first check if the person is eligible for a DFG. But the people in charge of the NHS should also know that they have the power and responsibility to help with housing-related needs for those with NHS continuing healthcare. They can give extra help when it’s needed. 

Groups that handle the healthcare budget (Clinical Commissioning Groups or CCGs) should make clear plans with other groups to make sure people with NHS continuing healthcare get the changes they need. This includes ways to refer people and decide who pays for what. It’s a good idea for CCGs, HIAs, social housing providers, and local authorities to work together to make sure changes are done well. 

The Client

There are a range of funding options that the Client might consider accessing to cover costs exceeding the £30,000 limit: 

1. Personal Loans:

Clients might consider obtaining a personal loan from a bank or financial institution to cover the additional costs of home adaptations. Personal loans can provide flexibility in terms of repayment options and loan amounts. However, it’s important to carefully consider the interest rates and terms before committing to a personal loan. 

2. Charitable Organisations and Grants:

Some charitable organisations provide grants or interest-free loans to individuals with disabilities to help with home adaptations. These grants can be used to cover costs that exceed the DFG limit. Research local and national charities that focus on disability support to explore available financial assistance options. 

3. Equity Release:

For homeowners, equity release can be an option to access funds by using the value of their property. This might involve selling a portion of the property or taking out a loan secured against the property’s value. Equity release is a significant financial decision and should be considered carefully, with advice from financial professionals. 

It’s crucial to seek financial advice before deciding on any loan option. Consulting with a financial advisor can help Clients understand the implications of different loan choices, assess their financial capacity, and make informed decisions.

The traditional approach where the occupational therapist (OT) conducts the assessment and then passes the case on to technical officers or architects for design and implementation has been widely practiced in the past. However, this approach has limitations compared to the collaborative approach where the OT and technical officers work together throughout the process. Let’s compare these two approaches: 

Traditional Approach (OT Assessment and Handoff):

1. Limited Integration of Expertise: In the traditional approach, the OT’s expertise in understanding the individual’s functional needs and daily activities is disconnected from the technical expertise of the architects or technical officers. This separation can lead to designs that are functional on paper but lack practicality in real-life usage.

2. Potential Miscommunication: Passing the case from the OT to technical officers might result in miscommunication or incomplete transfer of critical information. The nuances of the individual’s needs and the reasoning behind certain recommendations might not be adequately conveyed, leading to suboptimal modifications.

3. Design Limitations: Technical officers might solely focus on the architectural aspects, disregarding the detailed functional requirements of the individual. This can result in modifications that meet building standards but do not cater to the individual’s specific needs and goals.

4. Delayed Problem Identification: Any issues or discrepancies between the design and the individual’s needs might only become apparent during the implementation phase. This can lead to delays, costly revisions, and frustration for all parties involved.

Collaborative Approach (OT and Technical Officers Working Together):

1. Holistic Understanding: Collaboration ensures that both OTs and technical officers have a comprehensive understanding of the individual’s needs and the built environment. This holistic view enables them to create modifications that are not only functional but also tailored to the person’s requirements.

2. Efficient Problem-Solving: Collaborating throughout the process allows for real-time problem-solving. If design challenges or conflicts arise, the OT and technical officers can work together to find solutions that maintain functionality while meeting structural and regulatory requirements.

3. Innovative Designs: Collaboration encourages creative thinking and the generation of innovative design ideas. Technical officers and OTs can brainstorm together to come up with modifications that are both feasible and inventive in meeting the person’s needs.

4. User-Centric Designs: The collaborative approach ensures that the final modifications are user-centric. By considering the person’s unique abilities and limitations from the outset, the designs are more likely to provide meaningful enhancements to their quality of life.

5. Reduced Revisions and Delays: Collaboration minimizes the chances of major design revisions during the implementation phase. The designs are more likely to be accurate from the beginning, resulting in smoother construction processes and reduced delays.

6. Enhanced Communication: Direct collaboration between OTs and technical officers facilitates clear and ongoing communication. This reduces the likelihood of misinterpretation and ensures that all parties are aligned in their understanding of the modifications.

In comparison, the collaborative approach between OTs and technical officers provides substantial advantages over the traditional handoff approach. The traditional approach may lead to functional and communication gaps, whereas collaboration ensures that adaptations are well-informed, user-centric, and efficient from both a functional and architectural perspective.  

As a result, the collaborative approach is increasingly recognised as a more effective way to create meaningful and comprehensive home adaptations for individuals with disabilities. 

Shared Responsibility

This approach also recognises the shared responsibilities of housing and social care authorities to provide home adaptations. As shown in the previous section, this extends to the provision of funding. 

It is good practice to establish a virtual team of all those involved in supporting the family on a case-by-case basis. This team should agree to meet when required to agree on what adaptations should be funded from public sources and help to unblock any issues that may arise. 

Together, OTs and technical officers play a big role in creating spaces that tell stories. When designing for families with a disabled member, involving them in the design process really matters. This section explains why working together makes designs more meaningful and accessible.  

Co-production isn’t just teamwork; it’s a way of thinking. It means working side by side with the families. They share their needs and ideas, and you turn those into real designs. This approach makes projects better and brings OTs, technical officers and families closer. 

Talking with families is crucial. It helps you understand their daily life, problems, and dreams. This helps make designs that really fit them. 

Co-production gives families power. They’re not just clients or customers – they’re part of creating the design. Their ideas become real designs that show who they are and what they want. 

Working together also brings new ideas. Families point out things you might not have thought about. This leads to designs that work better and look good too. 

Being open and honest is key. Sharing how designs are coming along builds trust. It shows that you care about what families want. 

Designs should be flexible. With co-production, designs can change as families’ needs change. This means the design stays useful for a long time. 

Families learn too. They find out how designs work and why they’re made a certain way. This helps them understand and appreciate the design even more. 

When everyone is happy, it’s great. Co-produced designs are even better than expected. This makes families happy, and they engage more with the process. This significantly reduces the potential for conflict and complaints. 

Co-production isn’t just a trick. It’s about teamwork and understanding families’ stories. For OTs and technical officers, it’s about making designs that life better.  

Effective communication with the family is crucial for understanding their needs and creating a successful design. Here are some practical tips: 

Active Listening: Take the time to actively listen to the family’s concerns, preferences, and goals. Encourage open dialogue and make them feel heard.

Initial Meeting: Begin with an initial meeting to discuss their requirements, expectations, and any specific challenges they’re facing due to the disabled family member’s needs.

Questionnaires or Surveys: Provide questionnaires or surveys that allow the family to express their needs and wishes in a structured format.

Site Visits: Visit the current living space to observe the family’s daily routines, challenges, and how they use the space.

Visual Aids: Use visual aids like sketches, diagrams, and digital renderings to help the family visualise the proposed design.

Explain Design Concepts: Clearly explain how design concepts address their needs and concerns. Use plain language and avoid jargon.

Share Success Stories: If you have worked on similar projects before, share success stories to provide reassurance and build trust.

Collaborative Design Workshops: Hold collaborative workshops where family members can actively participate in brainstorming and design discussions.

Regular Updates: Keep the family informed about the design progress through regular updates. This keeps them engaged and allows them to provide feedback at various stages.

Flexibility and Adaptability: Be open to making changes based on their feedback and evolving needs. Flexibility shows that you value their input.

Digital Tools: Utilize technology to share design concepts and updates virtually, making it easier for them to review and provide feedback.

Cultural Sensitivity: Respect cultural and personal preferences that may influence their design choices.

Empathy and Patience: Understand that they might be going through a challenging time. Show empathy, patience, and a willingness to accommodate their emotions and concerns.

Set Clear Expectations: Clearly outline the project timeline, milestones, and what the family can expect at each stage. Be realistic rather than optimistic.

Regular Check-Ins: Schedule regular check-in meetings to discuss progress, address concerns, and answer any questions they may have.

Feedback Loop: Establish a feedback loop so they can provide input throughout the design process.

Remember, effective communication is a two-way street. Create an environment where the family feels comfortable sharing their thoughts, and actively involve them in shaping the design. This collaborative approach will help ensure that the final design meets their needs and expectations. 

We have created a questionnaire that you can tailor to meet your local situation and preferences and be open to additional input a family might want to provide beyond the structured questions. This information will help you create a design that truly meets their unique requirements. 

Apart from DFG-funded adaptations, it is almost unheard of to start designing a building project without knowing an indicative budget. Yet, the traditional approach to large-scale adaptations is to carry out an assessment, identify the needs, design the scheme, obtain quotations, and then try to work out how it will be funded.  

In many cases, this can lead to significant delays while departments try to figure out who should fund what. Having an agreed approach is important, but setting an indicative budget early in the process for a large-scale adaptation is crucial for several reasons: 

1. Realistic Planning: An indicative budget sets the financial parameters for the project, guiding decisions about design, materials, and scope. It helps you plan realistically and avoid overambitious or unfeasible designs that could lead to cost overruns.

2. Design Alignment: With a budget in mind, you can ensure that your design choices align with what is affordable. It helps in prioritising features and materials that fit within the budget constraints.

3. Scope Definition: A clear budget aids in defining the scope of the project. It helps identify what can be included within the available funds and what might need to be scaled back or postponed.

4. Risk Mitigation: An indicative budget helps identify potential financial risks early in the process. This allows you to plan for contingencies and make adjustments before issues arise. For example, how would you handle poor ground conditions that require deeper and more costly foundations?

5. Client Expectations: A budget ensures that the client’s expectations are aligned with the project’s financial reality. It helps manage their expectations and minimizes disappointment down the line.

6. Project Financing: If the client needs to seek additional financing for the project, a budget is essential for lenders to assess the viability of the project and determine loan terms.

7. Time Management: Budget constraints can influence the timeline of a project. An accurate budget helps in planning a realistic schedule based on available funds.

If you don’t have an indicative budget: 

1. Cost Overruns: Without a budget, costs can spiral out of control during the project. This might lead to delays, compromises in quality, or even project abandonment.

2. Scope Creep: Without clear financial boundaries, additional features get added in or changes made that aren’t financially feasible, causing delays and misunderstandings.

3. Client Dissatisfaction: If the project ends up costing more than the client anticipated, they may be dissatisfied with the final result, even if it meets their original requirements.

4. Project Delays: Budget-related issues can lead to disputes, renegotiations, and delays in project completion.

5. Strained Relationships: A lack of budget clarity can strain relationships between the OT, technical officer, client, and other stakeholders, leading to misunderstandings and disputes.

6. Legal and Financial Issues: A project without a budget might run into legal and financial challenges if contractual agreements are not well-defined.

Extending a house in England involves several technical and regulatory considerations to ensure compliance with local building regulations and planning laws. Here are some of the key issues you might encounter: 

1. Planning Permission: Depending on the size and type of extension, you might need planning permission from your local authority. Permitted Development rights allow certain types of extensions without planning permission, but these have limitations. Always check with your local planning team to determine whether planning permission is required.

 2. Building Regulations: All building work, including extensions, must comply with the Building Regulations. These regulations cover aspects such as structural stability, fire safety, insulation, ventilation, drainage, and more. You’ll need to submit detailed plans and specifications to the building control department or use an approved inspector to ensure compliance.

3. Neighborhood and Design Considerations: Extensions should respect the character of the neighbourhood and the existing architecture of your home. Local authorities may consider the impact of your extension on neighbouring properties, the streetscape, and overall aesthetics.

4. Conservation Areas and Listed Buildings: If your property is located within a conservation area or is a listed building, there might be additional restrictions and requirements regarding the design and materials used for your extension. You might need conservation area consent or listed building consent.

5. Party Wall Agreement: If your extension involves work on a party wall (shared with neighbouring property), you might need to serve a Party Wall Notice. This notice informs your neighbours of your plans and can trigger the need for a Party Wall Agreement, outlining the rights and responsibilities of both parties.

6. Sustainable Design and Energy Efficiency: Building regulations often require a certain level of energy efficiency in new and extended buildings. You’ll need to ensure your extension meets minimum standards for insulation, heating, and energy performance. 

7. Ground Conditions: Depending on your location, your property might be in an area with poor ground conditions. You’ll need to address any structural concerns in your extension design and consider factors like drainage and foundation design.

8. Utilities and Services: Extending a home might require adjustments or extensions to existing utility services such as water, gas, electricity, and sewage. These changes need to comply with regulations and safety standards.

9. Health and Safety: The Construction Design and Management Regulations and other health and safety regulations need to be followed to ensure the safety of workers and anyone on the property.

10. Insurance: The client might need to update their home insurance to cover the new extension during and after construction.

These are just some of the technical and regulatory issues you might encounter when extending a house in England. It’s recommended to work with professionals such as architects, structural engineers, and building control inspectors to navigate these issues effectively and ensure a successful project. Always consult with your local planning team to understand the specific requirements for your area. 

Here are the key points to consider when engaging contractors for complex home adaptations: 

1. Experience and Expertise: Select contractors with a track record of handling complex home adaptations. Prioritise those who have successfully completed similar projects and can provide reference projects.

2. Health and Safety Compliance: Contractors should adhere to UK health and safety regulations and have a comprehensive plan to ensure the safety of the disabled family member and other occupants during construction.

3. Effective Communication: Establish clear lines of communication with contractors. Regular updates, meetings, and discussions help ensure that everyone is informed about progress, potential changes, and any challenges.

4. Budget and Payment Schedule: Set a transparent payment and agree on who needs to approve any variations.

5. Contract and Scope: Have a written contract that outlines the project scope, timelines, payment terms, warranties, and dispute resolution mechanisms. A legal contract offers protection for both parties.

6. Project Timeline: Discuss a realistic project timeline, considering specific factors like weather and seasonal limitations that might impact the construction schedule.

7. Project Management: Determine how the project will be managed and coordinated.