Residential property: homes and health
Ready for ageing?
25 April 2014
Sue Adams considers how homes and the wider built environment need to adapt to an ageing population, not only with regard to newbuild but also through changes to existing stock
First the good news: people are living significantly longer and gains in life expectancy are one of the major achievements of post-war Britain.
Now the bad: the recent House of Lords Ready for Ageing? report describes UK government and society at large as "woefully underprepared" for demographic change. With an expected 51% more people aged 65 in 2030 compared with 2010, including 101% more people aged 85 or over, it is time to act to ensure that the UK has the homes and neighbourhoods suited to this new demographic.
Some 90% of older people live in mainstream housing and most continue to do so until the end of life. Urgent action is needed to design more accessible, flexible new homes and to adapt the existing general housing stock to enable this growing older population to live independently and healthily at home.
Homes for health
Few would contest that improvements in housing and the built environment have played a significant role in extending life expectancy. The quality and suitability of homes and neighbourhoods are major determinants of the quality of life at all ages, but become even more important as we grow older. There is a causal link between housing and the main long-term conditions of later life (for example, heart disease, stroke, respiratory conditions, arthritis) while risk of falls, a major cause of injury and hospital admission among older people (cost of hip fractures alone is over £2bn a year), is significantly affected by housing characteristics and the wider built environment.
The quality and suitability of homes and neighbourhoods are major determinants of the quality of life at all ages, but become even more important as we grow older
The BRE estimated that the cost of poor housing to the NHS is at least £600m a year, with older people accounting for much of this. Excess winter deaths hit the headlines, but cold homes exacerbate many health conditions and result in extra GP visits and hospital admissions. Ensuring energy efficiency in a property becomes critical to being able to afford to keep warm, reducing such risks.
Good for all
The aspiration of the vast majority of people is to maintain independence for as long as possible. We may be living longer, but those extra years see an increase in health problems and incapacity, with 52% of older households including a person with a long-term health condition or disability that is limiting their activities.
The design and standards of homes make a major difference to the capacity to live independently with such problems, but already one in three older people live in homes that do not meet their needs in terms of accessibility or adaptations.
One of the most common difficulties is bathing. More than half of all home adaptations carried through disabled facilities grants are for bathing-related problems. Steps and stairs are the next main difficulty, hence the inclusion of installation of a downstairs toilet in Part M of Building Regulations. Good lighting also plays a key role in safe living because eyesight declines with age.
The simple expedient of incorporating accessibility features such as wet rooms, level showers and lever taps when upgrading a bathroom, putting in a ground-floor toilet, a second banister and bright, even lighting can all help to 'future-proof' a home, as well as making it more usable for visitors, such as ageing or disabled relatives and friends. There is good information available about home adaptations but few people know about it. A useful starting point is to find an independent living centre. The Disabled Living Foundation (DLF) runs a major centre in London, West of England Care & Repair and the Knowsley Centre for Independent Living are at the forefront of new self-help initiatives. In addition, Care & Repair England produces a series of practical guides aimed at making a home a better place to live for sufferers of a variety of illnesses and diseases.
A perfect storm
Looking after the home in later life can also become a challenge. There has been a dramatic increase in the level of home ownership since the 1970s. Although all-age owner/occupation levels have since declined, for the retired population home ownership remains at an all-time high at 75% and over 80% in rural areas and among the 'younger old'.
Lower-income groups were the main beneficiaries of the tenure shift arising from Right to Buy policies and unprecedented access to mortgages during the 1980s and 1990s. Consequently, two-thirds of low-income older households are now homeowners, with major implications for housing maintenance. One in six low-income homeowners lives in a home that is assessed as 'non-decent', and many struggle to afford essential repairs.
Equity release is seen by policymakers as a potential solution to paying for home repairs as well as meeting later life social care costs. However, housing equity is spread very unevenly both geographically and socially. Analysis by St Andrews University (Mind the wealth gap) revealed that 42% of the housing wealth in England is located in London and the South East, falling to 3% in the North East. People in the top-income quintile own 34% of all housing wealth while those on low income are more likely to live in low-equity housing in disrepair.
Home-improvement agencies remain the main source of assistance for private householders on low incomes who need help with organising repairs and adaptations. Many offer affordable 'handyperson services' to undertake the essential small works that can prevent property deterioration, although the pressure on local authority finance is affecting availability. The DLF website lists local provision.
New homes for all
Around seven million properties in England have a head of household aged over 65. Older people are a significant and growing force in the housing market, with 60% of the projected increase in the number of households from 2008 to 2033 headed by a person aged 65+ according to data from the Office for National Statistics/Survey of English Housing.
The high profile of housing shortages and low building rates tend to stimulate short-term policy focusing on the number of units with little in-depth analysis about the long-term social and fiscal costs of building low-quality, inflexible homes.
Around 7 million properties in England have a head of household aged over 65
Building all new homes to Lifetime Homes Standards (LTH) would not only help to address the major shortage of adaptable, accessible housing that we will inevitably face, given the numbers above, but also contribute to aspirations to reduce loneliness among older people. For example, a person with mobility problems may not be able to visit friends and relatives because of the steps and stairs in their homes. Simple measures such as a downstairs toilet and level threshold, as set out in Part M of the Building Regulations, as well as LTH features can make all the difference to being able to look after an ill or disabled relative.
Ironically, there is growing evidence that fewer adaptable homes have been built since the 1980s, with many properties no longer having the necessary internal structures to allow installation of a simple grab rail, let alone a stair lift or tracking hoist.
The current Building Regulations review provides an ideal opportunity to future-proof homes, but the concern is that there will be a rolling back of the gains made to build adaptable, accessible and inclusive places for older and disabled people, with the associated future costs including more accidents, falls and social isolation.
Currently, around 5% of older households live in specialist housing, i.e. built specifically for older people. It is estimated that there are around 500,000 units (100,000 in the private and 400,000 in the public sectors) in England of which around 75% is social rented and 25% private leasehold. Much of the sheltered housing built during the 1970s and 1980s is low-cost, high-density stock with limited scope for adaptation.
Private sector retirement housing for purchase is a more recent phenomenon. It is a highly targeted and differentiated market, with lifestyle and aspirational choice at the heart of the concept. Significant growth is underway, especially at the higher value end. The specialist retirement housing market expects to expand and will no doubt continue to provide useful alternative models for a minority of older people able to afford the purchase and ongoing costs of this option. Models to estimate potential local demand include the Housing LIN/EAC SHOP tool.
The Lords’ report concluded that there has been "a collective failure to address the implications [of ageing] and without urgent action this great boon could turn into a series of miserable crises". It recommends that all concerned need urgently to plan how to ensure that the housing for an older population is better addressed.
Sue Adams OBE is Chief Executive Officer at Care & Repair England