Take the public health approach for housing an ageing population

In recent times we have started to define the issues that challenge the health, care and housing economy as one in which people, and particularly older people, get stuck.

Flow through NHS services is hampered by the 4,500 acute beds and 2,200 non-acute beds occupied by patients experiencing delayed discharges of care – aka ‘bedblocking’ – every day. That is the equivalent of more than ten 650-bed hospitals.

Our broken housing market could be fixed if only the 3.3 million older people under-occupying family homes downsized and released some of the £820bn in equity they hold. ‘Generation Stuck’ could be freed by increasing the supply of specialist housing with care and better information and advice.

There is an imperative to reframe these arguments in the context of an ageing society where people over 65 will form nearly a quarter of the population by 2039, outnumbering people under 16 by over five million and where older people account for 155,000 household growth per annum.

Older people are the new normal and the demographic challenge will have to be reframed in the largely positive view older people themselves express when talking about the NHS or living in their own home. People over 75 report consistently high satisfaction rates with the NHS and at rates higher than their younger counterparts.

And recent research commissioned by DCLG from the English Housing survey on Housing for Older People records very high levels of satisfaction (94%) with the accommodation occupied by older people. This rises to 97% high satisfaction rates among older people who are deemed to under-occupy their home. These extremely high satisfaction rates contradict the perceptions of policymakers in the capacity of our existing housing stock or NHS in meeting the demands of an ageing society.

This is not to suggest that there is not a serious problem of demand for health services and specialist housing with care provision outstripping supply. Neither funding for the NHS and care system or the pace at which developers are building specialist housing, currently at about 7,500 homes per annum, are keeping pace with the projected growth in older households. This means we have to make better or different use of existing stock and services and capitalise on people’s long-term happiness and aspirations to live well in their own home. That also means dealing with people where they currently live; in their own homes and communities.

As well as ensuring that people stay in hospital not a day longer than they strictly need to and are able to access a range of  specialist housing with care options, we should change our own mind and behaviour about what good in later life looks like. As professionals and policymakers that means we have to create opportunities for people approaching and in later life to exercise positive and informed choices about what they need to do to ensure extended wellbeing. 

Currently these options are rendered in terms of growing care and support needs and the management of long-term conditions. This is inadequate incentive for people who have aspirations to pursue personal interests, a great social life and own a desirable home.

Plenty of people make positive choices whether these are about diet, exercise and leisure or the place they live. Across Nuffield Healthcare’s national network of gyms the most frequent user is 72 years of age and exercises eight times a month. Some 50,000 people a year move to pursue lifestyle choices, move closer to friends and family and indeed ensure that possible care and support needs may be addressed. The evidence suggests that people exercising these ‘lifestyle choices’ do so on the basis of relative prosperity.

If the health and care system is serious about prevention we need to make opportunities for positive choices about how, where and in what circumstances we grow old to greater numbers of people across the wealth spectrum and before these choices are forced by sudden changes in health or personal crises.

Where and how people live is not just a matter of personal responsibility. Public, primary and acute health services accept their roles in influencing the lifestyle of their patients and they have a similar role in raising the awareness of their patients about making some informed decisions about where they live and how they use that home.

Taking a behaviour change approach to the issue of successful ageing in place, health services need to start taking their functions in terms of raising awareness – persuading, motivating and educating older people about the need to think about their home and facilitating action in adapting and changing that home much more seriously. 

At a national level, that understanding is expressed by an existing memorandum of understanding between national health, care and housing policymakers. At a local level, this understanding needs to be more widely adopted into planning for and delivery of substantive services.

We need to take a public health approach to the challenge of housing an ageing society and adopt forms of social prescribing that will nudge people into adapting or changing their home. It’s more likely to ensure much greater numbers take informed decisions about how they will live in their own home in later years than a grants system addressing greatest need at a point of crisis.

This article was originally published on the HSJ website.