Why senior housing is the key to better health

COMMENT The case for integrating health and social care has never been clearer. The pandemic starkly highlighted the systemic failure of our health service to work with the elderly care system. In response, the government has finally grasped the social care nettle. There remain questions over its approach and there is one big omission in its policy. Housing. We don’t have enough homes suitable for our large elderly population. With over 12m people aged 65 or more, senior citizens represent one in five of households. Yet many of them are living in homes that are unsuitable for them – some are too large, some are in a poor condition and many of them simply aren’t designed for older people with mobility and other health problems. The impact on the NHS is considerable. For example, many ambulance services report that at least one third of call-outs are old people falling over at home. The knock-on impact in A&E departments and on scarce hospital beds is considerable, not least in what has become an annual event – the ‘NHS winter crisis’. Caught between two systems Equally, the care system is confusing and inadequate for the elderly. People aren’t clear what is available and their options are limited. When geriatric hospital beds were phased out, those with higher clinical needs were pushed into nursing and residential homes often without the resources needed to manage these patients. Worse still, the funding for health care and for personal care is separated, leaving families caught between two systems, each rationing provision from scarce resources. If our health and social care system is to work, we need an effective strategy to improve both the quality and quantity of housing for the elderly, and the availability of care in those homes. A recent excellent report by ARCO (Associated Retirement Community Operators), ‘Putting the care in housing-with-care’ has highlighted both the problem and some of the answers to this issue. The report highlights the confusion over terminology and provision and provides sensible ideas to clarify what is available to increase provision of suitable homes and to knit together our health and social care systems. More land for later living For me there are several changes in housing policy which could help this reform. First, the existing housing stock needs retrofitting to enable more elderly people to remain independent for longer. Homeowners need guidance and the regulations need speeding up. Existing mechanisms that work, such as the Disabled Facilities Grant or Home Improvement Agencies, should be expanded. Government should also work with business to enable the greater adoption of technology in our homes, such as wearable alarms and monitors. Our local plans should allocate more land for senior living, based on need. This will vary across the country, and planners must take care not to push such allocations onto the edge of towns and cities. Good planning can help reduce isolation and loneliness. Just as important is the promotion of a variety of home types and tenures. Bungalows have their place, but so do purpose-built apartments, well-designed care homes and integrated retirement communities. Lastly, all future homes should meet the lifetime housing standard, making them usable for many older people in the years to come. The Housing Select Committee looked at this a few years ago and the net additional cost per home is small but the benefit would be considerable. These reforms would complement any integration of health and social care and would, like all preventative measures, pay real dividends for the elderly and for the taxpayer alike. Mark Prisk is a former housing minister. He is a strategic adviser to Handley House and chairs Saltaire Housing