Housing and health: working together
Home improvement agencies are a recognised part of the preventative jigsaw, enabling older homeowners to remain living at home safely and independently. Vicki Jellings explains about the Healthy Homes, Healthier Lives programme that promotes the connection between good housing and good health, to health and social care professionals.
The innovators of the Victorian era knew very well how much environment affected health. Just consider the impact of the introduction of sewage systems and clean water supplies, the slum clearance programmes and rebuilding of housing so that people could live in healthier environments.
So, is it all sorted? Do we not need to consider housing and health any more? Ask anyone who visits vulnerable people in their own homes and almost certainly the answer would be ‘no’. Whilst most people are now relatively well housed, there are still many who are not.
There are currently 6.3 million (DCLG, 2006) ‘non-decent’ homes in England – the technical term used by government to describe whether a property meets a minimum standard. Homeowners aged 75 or over who have lived in the same home for more than 30 years, are more likely to be in non-decent homes.
With a growing emphasis on providing health and social care at or close to home and enabling more older people to live independently in their own homes (DH, 2006) making sure that those homes are decent places to live becomes even more important.
How can those of us working in health, social care and housing work together to make sure that this happens?
A joint initiative in Blackpool, involving the primary care trust, housing authority, social services and newly established Blackpool Care and Repair, is showing how living conditions for older people can be improved.
The aim of SEASHORE (Seeking to Ensure a Safer, Healthier Older Residents Environment) is to provide older homeowners with free environmental inspections, following through with practical measures to rectify any health hazards that are detected. Blackpool Care and Repair carry out these checks and work.
The case of 78-year-old Mr Watson illustrates the point. He was a frequent visitor to his GP with respiratory problems, so the health visitor referred him to Blackpool Care and Repair. They discovered that he was living in one room on the ground floor of his terraced house because he had difficulty climbing the stairs (hence unable to reach the bathroom and bedroom, although there was a downstairs toilet). His only heating was a defective electric bar fire, which had old wiring, making it dangerous to use.
Using their team of ‘handy people’, Care and Repair immediately provided safe temporary heating, moved his bed downstairs (he had been sleeping on the sofa) and then set about organising permanent improvements, which included rewiring, installation of central heating funded by a Warm Front grant and a grant aided stairlift.
The agency also offers a home safety / falls prevention check and undertakes remedial work, for example, installing grab rails, removing trip hazards, electric blanket exchange, smoke alarm installation, and chip pan or safe fryer swap.
‘The people of Blackpool have higher levels of ill health and early death than the average for England. It is now well recognised that improving health is beyond the scope of the NHS and that there are many factors that determine our health. When we examined the causes of the health inequalities in Blackpool, we found that cold homes and accidents in the home made a significant contribution to the town’s poor health. As such, an approach to housing and health is central to our strategy to reduce health inequalities and SEASHORE is delivering this for us.’
Dr Andy Howe, Director of Public Health, Blackpool Primary Care Trust
Blackpool Care and Repair aims to carry out 800 environmental inspections per year. In the first year, they are well on target. Key to this success is the frontline health and social care workers, such as occupational therapists, community matrons, health visitors and social workers, who act as the eyes and ears of the programme, referring eligible householders to get the help they need.
To build and maintain this network, Blackpool Care and Repair hold regular training events and briefing sessions. To date, around 200 frontline health and social care workers have attended sessions where they explore the links between poor housing and poor health and meet representatives from the SEASHORE programme to discuss the role they can play in helping householders to benefit from it.
Healthy homes, healthier lives
To run these sessions Blackpool Care and Repair uses the Healthy Homes, Healthier Lives training kit, which has been designed by Care and Repair England, to encourage and support initiatives like SEASHORE.
The training kit is just one of the resources produced by Care and Repair England as part of its Healthy Homes, Healthier Lives programme.
The charity has a long history of developing practical initiatives to raise awareness of the housing needs of older and vulnerable people and encourage positive action to see those needs met. Funded by the Department of Health and the Rayne Foundation, the programme aims to:
* raise awareness of the negative effects that poor or unsuitable housing can have upon people’s health and well-being
* inform key frontline health and social care staff about the services and resources that may be available to help householders improve their housing conditions
* encourage partnerships between housing, health, social care and voluntary organisations based around referral networks to housing improvement agencies.
The project builds upon the innovative Healthy Homes assessment training, developed by Bristol Care and Repair. Indeed, a range of training and briefing kits has been produced for use in a variety of practice settings:
* the Healthy Homes, Healthier Lives training kit provides all the materials necessary to set up and run a half-day training session
* the Healthy Homes, Healthier Lives presentation kit is for shorter, informal briefing sessions
* a self-training toolkit is for flexible study and development of skills, and explains and illustrates the new Housing Health and Safety Rating System, which was introduced in April 2006.
There is also a presentation pack for older people, designed for use at meetings and events involving older people. Through an interactive approach, it encourages participants to consider the impact that their own housing might have upon their health. This relatively new resource includes a self-assessment questionnaire, ‘Is My Home Good for My Health?’
The kits include a PowerPoint presentation, case studies and real-life scenarios to explore the links between poor housing and poor health. This helps participants to relate the information to their own experience as they consider the implications of poor heating, damp homes, badly sited or inadequate services and poor security, as well as general disrepair and homes in need of adaptation.
The kits provide information about possible actions and services that a local home improvement agency might provide. These include help and advice with home repairs and adaptations, a handyperson service for small repairs and minor adaptations, sometimes linked to a fast tracking Home from Hospital service, plus housing options advice to help older people who are considering moving home.
Because the national provision of services varies, the kits are designed to be locally adapted. Furthermore, to encourage and support similar initiatives, Care and Repair England provides free and minimal cost training and demonstration sessions, including Healthy Homes awareness training for frontline health, social services, housing and voluntary sector staff, and working with Healthy Homes materials ‘train the trainer’ sessions to introduce the resources and to enable people to deliver Healthy Homes sessions.
These provide an opportunity to create links between key staff from health, social care, housing and the voluntary sector organisations. Representatives from the local home improvement and handyperson scheme are invited to take part, and those essential connections are made.
As the Healthy Homes, Healthier Lives programme progresses, Care and Repair England aims to help more local partnerships target their activities around health and safety in the home. It also hopes that briefing and training sessions will encourage health and social care professionals to include a basic appraisal of housing conditions in the Single Assessment Process.
As more health and social care staff become aware of how housing conditions can be improved, often by home improvement agencies, such joint work can make a positive contribution to the prevention of illness and accidents, improved hospital discharge, increased independent living in the community, and the redress of health inequalities.
Department for Communities and Local Government (2006) English House Condition Survey 2004 – Headline Report. London: DCLG Publications.
Department of Health (2006) Our Health, Our Care, Our Say: A new direction for community services. London: TSO. Available at www.dh.gov.uk/assetRoot/04/12/74/59/04127459.pdf.
Department for Communities and Local Government (2006) Housing Health and Safety Rating System. More information at www.communities.gov.uk.
Care and Repair England
To find out more about Healthy Homes, Healthier Lives contact Vicki Jellings of Care and Repair England on 0117 924 9046 and Vicki.email@example.com or www.careandrepair-england.org.uk.
Copyright Pavilion Publishing (Brighton) Ltd. Sep 2006
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