This month looking at assessments and feeding back from the DFG Assessment Summit.
Health and Housing
The right home environment is essential to health and wellbeing. It is a wider determinant of health.
The right home environment protects and improves health and wellbeing and supports physical and mental ill health. It also enables people to:
- manage their own health and care needs, including long term conditions
- live independently and safely in their own home for as long as they choose
- complete treatment and recover from substance misuse, respiratory illness or other ill-health
- move on successfully from homelessness or other traumatic life event
- access and sustain education, training and employment
- participate and contribute to society
There are risks to an individual’s physical and mental health associated with living in:
- a cold, damp, or otherwise hazardous home (an unhealthy home)
- a home that poses risks such as being overcrowded or inaccessible to a disabled or older person (an unsuitable home)
- a home that does not provide a sense of safety and security including precarious living circumstances and/or homelessness (an unstable home)
The right home environment is essential to delivering NHS England’s Five Year Forward View, and local authority plans for social care. It can:
- delay and reduce the need for primary care and social care
- prevent hospital admissions
- enable timely discharge from hospital, and prevent re-admissions
- enable rapid recovery from periods of ill health or planned admissions
Removal of hazards in the home not only supports the occupier, but also acts a stimulus to the local economy, promoting employment and supply chains.
The Department of Health and Social Care estimates that in England approximately 676,000 people are living with dementia Prime Minister’s Challenge on Dementia 2020 (2015) (opens a new window), and the numbers are set to double over the next 30 years.
The term dementia covers a range of symptoms and behaviours which are linked to a degeneration of the brain tissue and death of brain cells through disease. The main forms are Alzheimer’s disease, dementia with lewy bodies and vascular dementia. There are many other forms of dementia, however, and some other conditions and diseases may also lead to dementia, for example, Huntingdon’s and Parkinson’s diseases. Frontotemporal dementia (including Pick’s disease) is less well known but can affect people in their 40s and 50s.
Dementia is commonly understood to affect memory, but can also impair behaviour and emotional stability, affect language and understanding, and have a physical impact on other senses such as sight and taste. Some people can become aggressive or overly affectionate, or they can withdraw from friends and family, and regress into the past – perceiving carers or family members as strangers (because they don’t remember meeting them) or mistaking them for other people such as deceased parents or spouses.
Although the condition is currently irreversible, many people can stay at home and undertake everyday tasks for some time after diagnosis. Indeed, for some, attempting to move people from their home environment may increase anxiety. Home Improvement Agencies are well placed to help people stay at home for as long as possible, and adaptations to the home can reduce risk and anxiety for the person affected and their carers and families.
> See our list of possible home modifications for people with dementia.
The Alzheimer’s Society has published a booklet that describes ways to create or adapt the home environment so that it remains a safe and familiar place. Download (opens a new window)) Making your home dementia friendly. They have also produced a fact sheet (opens a new window) that looks at various pieces of equipment and parts of the home that can be adapted for people with dementia.
Dementia Dwelling Grant
A number of local authorities have introduced new grants into their Housing Assistance Policy to support people with a diagnosis of dementia. A great example is the Dementia Dwelling Grant (opens a new window) which was introduced across Worcestershire and externally assessed by the University of Worcester.
Enabling People with Dementia to Remain at Home: A Housing Perspective
Published to coincide with World Alzheimer’s Month , this report has been produced on behalf of the Dementia and Housing Working Group (opens a new window) and Housing LIN (opens a new window), and supported by Homeless Link (opens a new window), Foundations and the Life Story Network (opens a new window).
The full report (opens a new window) and the accompanying executive summary (opens a new window) set out the key role housing providers, and in particular social housing providers, can play in supporting people living with dementia to stay independent in the home of their choice for as long as possible. Its findings are divided into ones directly relevant to those working in the housing sector and those that provide a platform for wider application; for example, to become more dementia-friendly.
Dementia does still have a stigma attached to it, although that is now changing. However, special care should be taken when dealing with people with dementia, and Dementia Friends training (opens a new window) can help Caseworkers, Technical Officers and contractors who come into contact with people with dementia understand some of the challenges that they may face.
Hoarding is a complex, often long-term mental health disorder and usually consists of excessive clutter, difficulty in getting rid of items when they are no longer useful or needed and/or excessive buying/other acquiring and difficulty organising possessions. Hoarding becomes a concern when people collect and keep things to the point where it encroaches significantly on their living space, which cannot be properly used, and where it presents health and safety risks, as well as causes stress and impacts on day to day living.
Hoarding can make life a misery for individuals and their families, affecting health and lifestyle, and posing a significant risk of fire and other dangers. Research suggests that 25% of accidental domestic fire deaths involve hoarding. Hoarding affects the whole family, making it difficult to receive social visits and in extreme cases, affecting living space and basic freedoms such as space in which to do homework or even sleep.
Other challenges in hoarded homes can include restricted entry and exit, difficulties gaining access to gas and electricity areas, water leaks, mould, and rat and other infestations. Financial implications may include not having access to paperwork, leading to unpaid bills and other complications.
Previously viewed as part of obsessive-compulsive disorder, hoarding disorder was recognised as a mental health disorder in its own right within the Diagnostic and Statistical Manual of Mental Disorders (DSM) in May 2013.” Jo Cooke – Hoarding Disorders UK”
> Search for our previous presentations on hoarding in our Library
Foundations run training courses about hoarding behaviour. These courses are run by an industry expert who talks through what hoarding is, the different stages of hoarding and ways in which we can work with people who may demonstrate hoarding behaviour.
The housing health and safety rating system (HHSRS) is a risk-based evaluation tool to help local authorities identify and protect against potential risks and hazards to health and safety from any deficiencies identified in dwellings. It was introduced under the Housing Act 2004 (opens a new window) and applies to residential properties in England and Wales.
This assessment method focuses on the hazards that are present in housing. Tackling these hazards will make housing healthier and safer to live in.
This guidance is aimed at non-specialists, to help them understand the requirements under the Housing Act 2004 in relation to the HHSRS and help them identify the type of work that is needed to conform with the HHSRS.
HHSRS Guidance (opens a new window)
Foundations run training courses on the HHSRS. These courses are run by an industry expert who talks through how to assess properties against the HHSRS.
Fuel poverty remains a huge challenge. Not only does it lead to vulnerable people struggling to keep their homes warm enough, cold homes also have a range of further harmful and costly impacts: deteriorating health and wellbeing, social isolation and increased hazards such as falls – worry, stress and strain.
BRE/CIEH estimate that the cost of poor housing to the NHS (opens a new window) is over £1.4bn. Nearly 5 million homes in England (21% of all homes) still fail to meet the decent homes standard and 26% of older households live in non-decent housing (English Housing Survey 2013/14) (opens a new window). Age UK estimates that 1.14m older people live in fuel poverty.
Cold homes can affect or exacerbate a range of health problems including respiratory problems, circulatory problems and increased risk of poor mental health.
Children living in cold homes are more than twice as likely to suffer from a variety of respiratory problems than children living in warm homes, significant negative effects are also evident in children’s weight gain, hospital admissions, developmental status and severity and frequency of asthma.
HIAs provide help to people who are elderly, vulnerable or have long-term illnesses and are finding it hard to heat and insulate their homes. They help through small measures such as draught proofing, bleeding radiators, boiler repairs, through to insulation and providing advice on energy efficiency and switching providers if necessary.
The Warm at Home programme
A £637k programme managed by the charity Foundations Independent Living Trust has helped 3,600 people stay in their own home warm, safe and well over a 12 month period. Read the evaluation report (opens a new window) by the Centre for Regional, Economic and Social Research at Sheffield Hallam University.
Warmer Homes, Advice and Money
A collaboration between the Centre for Sustainable Energy, West of England Care & Repair and Talking Money was set up to assist at least 2,750 families in low incomes, unemployed people and lone parents in private sector accommodation struggling to stay affordably warm at home (an estimated 8,250 people). Read the case study. (opens a new window)
If you are a member of the public looking for help with home improvements, please contact your local home improvement agency (opens a new window) .
Speak to our Regional Advisors
Our team of Regional Advisors are at the heart of what we do – providing advice and support to Local Authorities and Home Improvement Agencies. And because we’re funded by the Department of Levelling Up, Housing and Communities our everyday support is free of charge.
Whether it’s a question about the DFG legislation, you need advice on how to commission a HIA or anything in between – we’re here to help.