Age, Home and Community: next phase

Actions

“Strategies integrating housing, health and social care need to consider the three tiers involved in meeting unmet, current and projected needs: new housing supply, built to inclusive and wheelchair design standards in all tenures; balanced with investment in adaptations; and in effective systems and supports for allocating adapted rented housing.”

Julia Fitzpatrick,
Horizon Housing Association

What We Will Do

Delivering the actions to ensure that older people in Scotland enjoy full and positive lives in homes that meet their needs, will require collaboration across many sectors. The Scottish Government will continue to work alongside local authorities, third sector organisations and other stakeholders as well as the monitoring and advisory group.

We will take forward 22 actions under the three principles: Right Advice, Right Home and Right Support, recognising the inter-connection and links to other policies across Government, notably health and social care, equalities, social security and transport. By doing this we will ensure that we meet the appropriate Scottish Government outcomes from the national performance framework.

The actions will form part of a delivery plan which will be developed by the Age, Home and Community monitoring and advisory group. This will set out what we will do to achieve the 22 actions.

Aim – Strategic development: to ensure that the housing system works with other services to support older people to live well and independently.

Actions

1. We will promote greater collaboration between Scotland and the other UK nations to share wider housing information and best practice that benefits an ageing population.

An ageing population is not a phenomenon that is restricted to Scotland. The right house can make a huge impact to the quality of later life. Good physical health, mental health and wellbeing, benefit from improved social connections and have a positive effect on reducing the need for costly interventions. The Scottish Government will take forward plans to engage with housing colleagues from elsewhere in the UK and beyond to share knowledge and best practice during 2018.

2. We will work with local authorities, health and social care partnerships and other stakeholders to ensure the positive connections between health, social care and housing are recognised in Local Housing Strategies, Housing Contribution Statements and local development plans, to support the delivery of suitable housing in the right place for older people in the private and public sectors.

Legislation has ensured that housing is included as an integral part of health and social care integration, and while progress in some areas has been very positive, there is still room to improve. We recognise that to achieve a fully integrated system we must do more to raise awareness and support a cohesive and effective service. Housing is a key part of integration. The physical environment, comprising buildings, streets, public spaces and natural spaces, are equally important as the social environment represented by relationships, social contact and support networks that make up a community. All need to be connected so that the person has the right house in the right place.

3. We will continue to ask older people for their views and opinions to help inform and monitor the next phase of the strategy.

The Scottish Government is working with Age Scotland to survey older people and gather their views on a variety of housing issues from adaptations to fuel poverty. The results of the first survey are due in summer 2018.

Older people are increasingly more likely to have a fall at home that results in hospital admission - 8471 admissions amongst over 75s in 2016/17
Source: ISD 2016/17

Aim – Right Advice: We want to help people understand how their housing choices will impact on their lives as they age, and know when and where to access advice to support their decisions.

Actions

4. We will continue to support the service provided by Care and Repair to older homeowners as a trusted source of advice and handyperson services as well as using the opportunity to further develop beneficial partnerships with the Scottish Fire and Rescue Service and Home Energy Scotland.

We recognise the benefits of preventative services and those organisations that are trusted by older people. With more older people living at home, prevention is the key to keeping people out of hospital and avoiding costly interventions. Although the services vary within each local authority, Care and Repair is recognised as providing handyperson services to older and disabled homeowners and are one of a small number of services openly welcomed into the home. As shown in the case study their preventative intervention can have a positive outcome for those they visit.

Mr & Mrs D, both in their 80’s, have lived in their current home in Arran for more than 25 years. They approached Care & Repair (C & R) after receiving a quote of almost £3,000 to fix a leaking roof. They live on a very tight budget and did not have the money to do the vital repairs needed to keep their home watertight. The C&R officer visited and looked at sources of help.

The officer advised the couple to contact the DWP to get a benefit check as they may be eligible for pension credit. As Mr D had been an agricultural worker before retiring and had served in the forces when he was younger, the officer referred the couple to an agricultural benevolent charity and an armed forces charity. Between them the charities were able to fund the work needed. The couple were also eligible for an annual annuity of £1100 and a heating grant of £300 from the agricultural charity. Mr & Mrs D heard back from the DWP and were also eligible for pension credit.

Unfortunately, not long after, Mr D became ill suffering from breathlessness and mobility problems. With help from C & R the couple obtained help to install a wet floor shower. As they now receive pension credit they received 100% grant funding towards the cost of the shower.

Having identified boiler problems C & R also referred the couple to Home Energy Scotland. Mr & Mrs D were delighted to be told that they were eligible for a new boiler and possibly insulation too.

Once these works are complete, the couple should be able to continue living in their much loved home within their close knit community. [Source-Care and Repair Scotland]

Hospital emergency admission rates increased from 52,044 to 54,080 per 100,000 of the over 85 population
Source: ISD 2015/16 and 2016/17

5. The Scottish Government’s Fairer Scotland Action Plan sets out a range of measures to ensure older people have a thriving third age.

Our ambition, as set out in the original Fairer Scotland Action Plan, is ‘to build a better country - one with low levels of poverty and inequality, genuine equality of opportunity, stronger life chances and support for all those who need it.’

Through the Fairer Scotland Action Plan, published on 5 October 2016, the Scottish Government has committed to:

• help those older people who want to keep working after they have reached state pension age
• fund a Financial Health Check service for older people to help them claim the benefits they are entitled to
• develop a social isolation and loneliness strategy
• improve the current system of Funeral Payments, to help more people, make it simpler to apply and provide help more quickly

The first annual progress report, setting out the Scottish Government’s progress against each of the 50 fairness actions was published on 23 November 2017.

6. The Scottish Government will develop an older people’s framework making sure we continue to tackle barriers to independent living for older people and promote older people’s rights and equality.

Older people make up a significant and growing proportion of the population of Scotland making an important contribution to their communities and to broader society. We will develop a supporting structure for our work with older people, with equality at its heart. The aim is to ensure all of our collective efforts have the maximum impact and effect, so that everyone in Scotland can have a thriving third age.

Housing Options Scotland is a housing advice charity that offers support to disabled people, military veterans, and older people across Scotland.

Martin and Ann - Dumfries and Galloway

Martin (64) and Ann got in touch with HOS as Martin had complex needs which required him to use a wheelchair. Martin and Ann owned their own property, but the nature of the road and pavement outside of their home meant that Martin was unable to get in and out of his home safely.

HOS sent a housing options report detailing all of their available options, from renting to ownership. With the support of HOS, Martin and Ann contacted an Independent Financial Advisor who helped them obtain a mortgage to buy a property in the same area. The couple are very happy with their new property as it is suitable for Martin’s needs and its location means their granddaughter whom they look after, can still attend the same school. [source –Housing Options Scotland]

7. We will continue to tackle inequalities by helping older people get online and develop basic digital skills to improve their home environment.

The Scottish Government published the Digital Strategy for Scotland in 2017 and will continue to improve participation amongst older people, disabled people and those on lower incomes. We want to enable everybody to benefit from the digital world by using the internet to search, buy goods and services online, keep in touch with family and friends, use social networks and have an understanding of how to remain safe and secure. It is essential that the technology and knowledge are shared widely, making an effort to reach out to those who traditionally do not interact with services.

8. We will initiate a “planning for the future” campaign so that older people are prompted to make informed choices about how their housing meets their needs both now and in the future.

Difficult decisions about housing are often put off by the older person or their families until there is a crisis. We want to encourage people to consider what choices they have well in advance. Considering options before decisions become critical, removes the need to have difficult conversations at a stressful time and can allow changes to happen well in advance, preventing a crisis situation. This also helps older people to be in control of the situation and have more of a say in their housing choices.

Developed for Falkirk Council, the “Do you want to move or stay?” leaflet, is a set of hints and tips for people who are beginning to think about whether their current house is still right for them. It includes a checklist to help find out if you are in the right house and where to get advice.

The council talked to older people who live in the Falkirk area and who have moved house. They also produced a Directory that provides information about the services and community groups in the area. They stress that the most important advice is: “This is about what is right for you”.

Aim – Right Home: We want to ensure there is sufficient supply and choice of housing for older people, so that everyone can find a home that works well for them.

The vast majority of older people live in ordinary homes (98%) not specialist housing or care homes. 72% of older people are home owners, 22% live in the social rented sector and 4% live in the private rented sector and 2% in specialist housing or care homes (source: SHS2016). In most cases housing that is suitable for older people will generally work well for everyone.

Health conditions or frailty are often limiting factors to the right home, but homes with the right design can help older people remain in their homes. The Scottish Government will consider the recommendations of the Equalities and Human Rights Commission ( EHRC) report on housing and disabled people published in May 2018 as we take forward the actions within Age, Home and Community – The Next Phase.

9. The Scottish Government has committed to delivering at least 50,000 affordable homes over the lifetime of the current Parliament and will ensure that this includes flexibility to deliver homes which can be adapted for older people and people with physical disabilities.

We want everyone to have a home that is able to meet their needs and to ensure people are able to live independently. Accessibility of course means different things depending on the level of mobility.

The vast majority of the new homes delivered as part of the 50,000 affordable homes target will meet varying needs standards, which means they will either be accessible or will be easily adapted to be accessible. Based on current health trends, and even improving health trends, the impact of the ageing population means that the number of wheelchairs users is likely to increase.

Taking account of local needs and priorities is important when planning new housing supply and this is particularly so in rural areas. The Rural and Islands Housing Funds will provide £30 million from 2016-17 to 2021 to increase the supply of affordable housing of all tenures in rural Scotland and contribute to the affordable homes target.

10. Scottish Government will work with stakeholders at both national and local level to improve the strategic planning, funding and delivery arrangements for adaptations.

The role of housing adaptations in supporting independent living is well recognised. However, the delivery of those adaptations is seen to be complex and driven by tenure, as much as the needs of the people who require these. We will review and strengthen where necessary the existing guidance for health and social care partnerships on the role of housing in supporting prevention and in delivering successful health and wellbeing outcomes for individuals.

11. The Scottish Government will continue to support improvement of housing quality by implementing fuel poverty measures to ensure older people have a warm and comfortable home.

The Scottish Government has always prioritised tackling fuel poverty and is committed to ensuring that everyone in Scotland lives in a warm home that is affordable to heat. We are on track to deliver our commitment to make half a billion pounds available over 4 years and, by the end of 2021, we will have allocated over £1 billion pounds since 2009 on tackling fuel poverty and improving energy efficiency.

We have also consulted on a new long term fuel poverty strategy, including proposals on new targets and putting in place a revised definition of fuel poverty. As part of our Strategy, we will introduce a Fuel Poverty (Target, Definition and Strategy) (Scotland) Bill to set a new statutory fuel poverty target to drive forward the provision of support to those who are most in need of help to heat their homes.

Mrs M and her husband had experienced constant problems and breakdowns with their boiler. She contacted Home Energy Scotland for free advice and discovered she was eligible to have a new gas boiler and seven new radiators at no cost. “ Our new boiler is much more efficient. We have a large flat with high ceilings, but it now takes less time to heat up and is warmer than before, which is great.” http://www.greenerscotland.org/home-energy/case-studies

12. The Scottish Government has increased access for older people to our shared equity home ownership schemes and will work with other organisations to address the financial barriers to older people moving to a suitable home.

Since October 2017 older people have had priority access to a range of shared equity home ownership schemes including Help to Buy (Scotland), Open Market Shared Equity ( OMSE) and New Supply Shared Equity ( NSSE). For many, selling their current home will not provide enough finance to purchase a new home that is suitable for their needs. Shared equity can help them move to a property more suited to their needs, for example one without stairs and a level access shower instead of a bath, or help people move to a new home which will allow them to be closer to family and care support.

The Link Group Ltd spent £4.3 million constructing 38 ‘independent living’ homes, aimed at retirement living, for social rent and new supply shared equity. Abbey Place, Paisley included £2.3 million funding from the Scottish Government. Built by Westpoint Construction, there are 13 one and two bedroom properties for social rent with three designed to meet the needs of a wheelchair user. There are also 25 homes to buy through the New Supply Shared Equity scheme. Each property has gas central heating and hot water systems, high thermal insulation and double glazing to create warm, comfortable and energy efficient homes that will be easy and economical to run. It also has a fully furnished day lounge and en-suite guest bedroom as well as an area for storing and charging mobility scooters.

13. We will examine options to meet the demand for reasonably priced homes that suit the needs of older people.

We recognise that the majority of older people live in ordinary homes in their local communities. Local authorities have a key role in planning for the housing needs of everyone within their local community including housing for older people and wheelchair housing. The Scottish Government is developing guidance for local authorities and other stakeholders on the need to set a realistic target for the delivery of wheelchair accessible housing across all tenures and to monitor delivery. This will be incorporated into revised Local Housing Strategy guidance.

The Scottish Government will explore options for further research to identify numbers of new private sector completions that achieve accessibility standards similar to those of Housing for Varying Needs. We will continue to work with house builders, local authorities and planners to ensure that all future building takes account of the needs of a broader range of purchasers including alternative models such as co-housing and self-build.

Housing Options for Older People ( HOOP) Glasgow

HOOP explores the individual housing circumstances and support needs of older people, aiming to help them make informed choices at a time of significant change in their lives. It aims to help prevent delayed hospital discharge by assisting health & social work colleagues navigate what can be a complex housing system. Housing staff are deployed in health and social work locations liaising with hospitals, social work and intermediate care units.

An 84 year old lady was recently discharged from hospital following 28 admissions in the last year. She had lived in the same home for 47 years and had lost her only friend 4 years ago. Housing Options team interviewed her in her home and noted she was anxious and isolated which contributed to the number of hospital visits. She is partially sighted and has multiple health conditions and was struggling to keep her home clean. As part of the overall intervention the team arranged a visit to a sheltered housing complex near her home. She enjoyed meeting other residents and said she had a great day. The Project Officer helped complete applications for sheltered housing. Since the initial Housing Options interview there have been no further admissions to hospital. [provided by SFHA]

14. The Scottish Government will take action through the National Dementia Strategy to ensure those diagnosed with dementia have access to the right housing and support to enable them to live in their home independently for as long as possible.

Scotland’s National Dementia Strategy 2017-2020 sets out a shared vision of a Scotland where people with dementia and those who care for them have access to timely, skilled and well-coordinated support from diagnosis to end of life which helps achieve the outcomes that matter to them. For people with dementia, a familiar home environment is particularly important, especially as their symptoms develop. Early consideration of the role of aids and adaptations is an essential part of enabling people to live safely at home. The Scottish Government will work with stakeholders to promote and develop the role of housing professionals to recognise and improve practice when providing housing solutions for those with dementia.

CIH Scotland dementia research

The research focused on improving the links between housing organisations and partners in health, social care and the third sector, with a specific emphasis on the role of the housing professional in meeting the needs of those living with dementia. The research mapped out the role of housing staff and services across four key interactions, which form important stages of the dementia journey.

Dementia Pathways – Housing’s Role Key Research Findings

Dementia Pathways – Housing’s Role Practice Guide

It is estimated 90,000 people are living with dementia in Scotland
In 2014 there were approx. 17,000 new dementia diagnoses - expected to rise to 20,000 by 2020
Source: Dementia Estimated Diagnosed Incidence in Scotland 2014

15. The Scottish Government will investigate the possibility of extending an equity loan scheme for house repairs and adaptations.

We know that most older people who own their own homes and live on fixed incomes often worry about paying for house repairs and keeping their home safe to live in. Lenders can be reluctant to provide loans to those who are no longer working so at present the options are limited to commercial equity release or savings to pay for the work needed. The Scottish Government piloted the Help to Adapt equity loan scheme which enabled older people to access the equity in their home to pay for preventative adaptations that they need now or in the near future. We will use the learning from this alongside the experience from the Home Energy Efficiency Programmes for Scotland ( HEEPS) equity loan scheme, to look at future products to help older people fund house repairs and adaptations using the equity in their homes, to provide greater control and choice over their current and future housing needs.

16. We will work with housing stakeholders and organisations working with older and disabled people, to increase awareness of the Home2Fit accessible housing register.

While many older and disabled people live in ordinary homes, it is sometimes necessary to install adaptations to ensure they can live independently. When they move it makes sense to reallocate the adapted properties to those in most need. The ideal situation would be to reuse the home with its adaptations making full use of the equipment. At present, however, homes are often re-let and adaptations removed because of a lack of awareness that these homes are available to people that may benefit from them. Improving the posting and sharing of information between housing providers will result in better use of adaptations and reduce duplication of resources that already exist.

Aim – Right Support: We want to ensure that all older people in Scotland have the support they need to enjoy full and positive lives at home or in a homely setting.

17. Scottish Government will continue to develop Scotland’s new social security system ensuring that it treats people with dignity and respect and supports people while applying for, being assessed for, and receiving benefits with a Scottish agency delivering devolved benefits.

Older people can continue to live independently in their own homes for longer if their incomes are maximised. This includes claiming the benefits and financial support they are entitled to. The Scottish Government set up ‘Experience Panels’ involving over 2,400 people who have recent experience of receiving benefits to help design and test the new system to ensure it works for them. Older people are well represented on the panels. With the help of panel members, the process from application to award will be redesigned to take a different approach to providing social security.

The Scottish Government is committed to protecting disability benefits, including Attendance Allowance, ensuring that they continue to be non-means tested. Through the new powers Scottish Government is increasing Carer’s Allowance to the same level as Jobseeker’s Allowance from summer 2018. Improving financial support for carers will build on wider support being introduced in 2018 through the Carers (Scotland) Act 2016. The Act extends and enhances the rights of unpaid carers. The new legislation will help ensure better and more consistent support for both adult carers and young carers.

18. Scottish Government will develop a social isolation strategy to address loneliness.

In January 2018 the Scottish Government launched its draft strategy to tackle social isolation and loneliness for consultation. This can impact on anyone regardless of age, status, circumstances or identity. Older people are particularly vulnerable to social isolation and loneliness resulting from loss of friends and family, reduced mobility or income. Studies have shown that being lonely or isolated can have a detrimental effect on health and wellbeing. Consultation events were organised throughout the country to gather views from individuals and stakeholders about what is needed in the community to reduce social isolation and loneliness and increase social connection. Over 400 responses were submitted to the consultation, which closed on April 27th. Following the end of the consultation, all responses are being analysed and considered along with other available evidence to inform the development of the final strategy.

Loneliness or social isolation is just one issue that can impact on overall mental health. The Mental Health Strategy 2017 -2027 makes it clear that older people should have the same support regardless of age. Mental and physical health are equally important issues that can impact on underlying conditions that affect health.

“Our tenants have been benefitting from the facilities within the Care Home at Ostlers Way in Kirkcaldy, including using the café facilities rather than Meals on Wheels, accessing social activities and the hairdresser.”

Lynn Leitch,
Housing Manager, Fife Council

100,000 people aged 65 or over ‘always’ or ‘often’ feel lonely…

… one in six people aged 65 or over feel ‘cut off’ from society

For 300,000 older people, TV is their main form of company…
…equivalent to two in five
Source: TNS Loneliness Omnibus Surveys for Age UK (April 2014 and November 2016)

Community Connectors has been developed by Glasgow Council for the Voluntary Sector ( GCVS) and Glasgow & West of Scotland Forum of Housing Associations ( GWSF). It is funded by Glasgow’s Integrated Care Fund. They provide support to people over 60, and/or their carers, to help take positive steps to improve health and wellbeing, increase the level of social interaction and help individuals enjoy a more vibrant, independent life within the community.

What clients say:

“If only it had been around earlier, I think it would have kept me out of hospital.”

“The new club has allowed me to meet new company and have people to talk to, I’m heading towards my goal of getting involved in the community again.”

“I wouldn’t be here without Community Connectors. I just sat in the house for two years after my wife died but Community Connectors changed all that. I have something to do every day to pass the time now.”

https://www.communityconnectors.org/

19. We will work with key stakeholders to develop training to support frontline housing and other staff to provide them with the skills to conduct housing options conversations with clients.

People’s housing needs change over time and it is important that tenants keep their landlords informed of any changes. Many Registered Social Landlords already offer housing health checks for their tenants which allow them to make best use of their stock. The Scottish Social Housing Charter will continue to support this work. We will also support workforce training to provide housing and other staff with the skills to have conversations with older people and those with dementia, to consider their housing options. This includes supporting third sector organisations that provide advice services to older people and their families.

20. We will increase understanding and use of Technology Enabled Care ( TEC) in all tenures.

Technology Enabled Care ( TEC) is defined as “where outcomes for individuals in home or community settings are improved through the application of technology as an integral part of quality, cost-effective care and support”. This includes telecare, telehealth, remote access and consultations, and can extend to citizens use of apps and digital information to support health and wellbeing.

TEC is a key delivery programme for the emerging Digital Health and Care Strategy - creating the conditions at national and local levels for scale up and adoption. While Telecare has been around for some time there are new opportunities with the planned shift to digital telecare over the next few years and more citizen centred approaches which can support both health and care needs using familiar technology. For many, TEC is a new area where outcomes for individuals in home or community settings can be improved through the application of technology as an integral part of quality cost-effective care and support. Raising awareness and sharing good practice in health, social care and housing is important to expand the use of and understanding of TEC. The Scottish Government published its Digital Health & Care Strategy in April 2018 and builds on the strong partnership with the housing sector to support people to stay at home in their community for longer and minimising the need for hospital admission.

“Technology is transforming all our lives – whatever age we are. It has massive potential to help deliver these actions and to support older people to live longer, healthier lives at home or in community settings.”

TEC Funding has helped Angus Council develop a seated activity programme in 3 local sports centres and 4 care homes. Weekly activity classes from 2 of the sports centres are operational, with the 3rd being launched. A short YouTube video “Pull up a Chair” has been developed for promotional purposes, and will be played on screens at local sports centres. Most care homes across Angus have now expressed an interest in taking part in the programme. Testing Video Active in sheltered housing is also being considered. “They (Residents) don’t usually all join in the activity but they’ve all joined in with this”.

Amanda Britain,
Advisor, Technology Enabled Care Programme

21. We will work with partners to fully embed Self-directed Support ( SDS) as our mainstream approach to social care.

Through the Social Care (Self-directed Support) (Scotland) Act 2013, adults, children and carers who require social care are supported to decide what matters to them (their personal outcomes), how their support is delivered, by whom and within the available budget. This makes sure individuals are empowered to be equal partners in their care, support decisions and participate in social and economic life. There are many examples of positive progress in implementing SDS and we will continue to work with stakeholders and local authorities to support the development of new, alternative and preventative types of support within local communities. However, more needs to be done to raise awareness and encourage uptake.

MECOPP, Scotland’s only dedicated Minority Ethnic Carers Organisation, received funding from the Scottish Government Self-directed Support fund to develop a Community Brokerage Project for South Asian and Chinese Communities with long term health conditions and disabilities and their carers.

A 72 year old Pakistani man (Mr A) was referred to the project from a local dementia service. Mr A and his wife had moved in with their daughter and her family to allow him to have additional family support. Despite being fluent in English and Urdu, he had become isolated in his new home due to his dementia diagnosis, and because he was now living in a new area. His wife was becoming irritable with him as she didn’t understand the effects of his dementia, and his daughter was working full-time, trying to raise a young family and support her parents. MECOPP worked with Mr A to identify his interests and were able to link him up with a number of social and gardening projects that suited his needs. They were also able to identify Edinburgh based peer support services for people caring for someone with dementia. The additional support arranged through the brokerage project means Mr A and his family are now coping much better with the dementia diagnosis. [ MECOPP]

22. Accessible transport is vital to communities so that people can stay socially active, particularly for those in rural areas or later in life. The Scottish Government will take forward a collaborative review of our National Transport Strategy, with accessibility identified early on as an important theme, as well as bring forward a new Transport Bill to lock in improvements to the system. The Scottish Government is investing £53.5 million in bus services to keep fares affordable, and is continuing to support the National Concessionary Travel Scheme to allow older and disabled people improved access to services, facilities and social networks by free scheduled bus services.

“If I didn’t have coping strategies to remain independent and mobile I’d be very lonely and soon sink into depression. Travel brings normality to an often abnormal life”

Upstream

Upstream ( www.upstream.scot) is a project funded by Life Changes Trust and ESP Group, a company that provides mobility services. In the Western Isles they are working with the Dementia Friendly Community project at An Lanntair along with Alzheimer Scotland, regularly visiting various groups in Stornoway and more remote locations to learn about the challenges of island transport, with a particular focus on sea and air links. In East Lothian they have strong links with Dementia Friendly East Lothian. Workshops are held with memory skills groups and carers groups to gather insights about travel in an area which, though close to Edinburgh, has many rural areas and related transport challenges. In Aberdeen, supported by the Aberdeen Council of Voluntary Organisations (ACVO) and Alzheimer Scotland they are working with people living with dementia exploring links with local transport operators and planners.