"Unacceptable bureaucracy and delay in getting adaptations approved and installed"

The profile of home adaptations for older and disabled people was raised when the Care Act 2014 placed new obligations on Local Authorities to adapt the houses of those eligible. Recent research published by the House of Commons Library into Disabled Facilities Grants (DFGs) however has highlighted

“unacceptable bureaucracy and delay in getting adaptations approved and installed.”

Among other measures, the Government has now committed to increasing funding for DFGs in England from £468 million in 2018-19 to £505 million in 2019-20.

With a renewed emphasis on the home adaptations service, we decided that it was time to bring the costs of supplying and fitting home adaptations up to date. Underestimating these costs could potentially lead to a shortfall in DFG allocations and result in longer waiting times for people needing their homes adapted. This in turn could lead to falls and high-cost hospital admissions.

We searched for published studies so we could present updated costs in our annual publication, the Unit Costs of Health and Social Care, which contains the unit costs for many health and social care services. We found none that reported full costs, that is, costs including both materials and all staff time involved in providing a home adaptations service. In 2015 therefore, with the help of the Department of Health and Social Care, a collaboration with Foundations was organised with a view to establishing how much it costs to supply and fit several major and minor home adaptations. Using the information provided by Local Authorities and Home Improvement Agencies and drawing on the PSSRU’s well-established approach we estimated the costs for several types of adaptations.

Although we found that the average cost of providing major home adaptations was £16,647, well within the DFG threshold of £30,000, the most expensive category of adaptation, for building a downstairs extension for bedroom and en suite facilities, had a mean cost of £33,639 (2013/14) which exceeded the threshold.

The costs of providing major and minor adaptations

For these adaptations, commonly funded by DFGs, including local authority and home improvement agency staff added between 9% and 32% onto the cost of the item or materials.

For minor adaptations, which don’t require a DFG funding application, staffing costs formed on average 76% of the total. We also found that the cost of some minor adaptations, such as fitting showers over baths and creating steps, exceeded the commonly applied DFG threshold (£1,800 v £1,000).

Planning costs

Our research participants reported that sometimes approval for DFGs had been delayed for up to six months because annual budgets were exhausted. This led us to conclude that there may be a need to revisit the current DFG cost thresholds, which would mean fewer adaptation applications would have to go through the sometimes lengthy process of applying for DFG funding.

For details of the costs of providing major and minor adaptations and information on how organisations participating in our study are trying to reduce their costs, download the published article in the Kent Academic Repository or alternatively, search on the British Journal of Occupational Therapy website.

This report is independent research funded by the National Institute for Health Research (Policy Research Programme, Unit Costs of Health and Social Care, 035/0093). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.