The 100 year life The role of housing, planning and design 5 September 2018

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The 100 year life The role of housing, planning and design 5 September 2018
The 100 year life
The role of housing, planning and design
5 September 2018
The 100 year life The role of housing, planning and design 5 September 2018
Welcome and context
Ewan King
Director of Business Development and Delivery
Social Care Institute of Excellence (SCIE)
ewan.king@scie.org.uk
www.scie.org.uk
The 100 year life The role of housing, planning and design 5 September 2018
Context
1 in 3         children born today can
               expect to live to 100
Baby boomers retiring
More people with disabilities living into old age
By people’s late 80s, more than 1 in 3 people have difficulty
with 5 or more day to day activities

Leads to increased pressure on individuals, communities,
health and care systems
The 100 year life The role of housing, planning and design 5 September 2018
The opportunity
Reason to innovate – not just celebrate
To ensure more people enjoy a good
later life, changes need to be made
Policy context:
• Grand Challenge on Ageing
• Green Paper on Care for Older
    People: role of housing, technology
    and design
• Focus on prevention
SCIE, Design Council and Centre for
Ageing Better workshop: policy
recommendations
The 100 year life The role of housing, planning and design 5 September 2018
Today’s session

1.30   Welcome and context            Ewan King, SCIE

1.40   Role of mainstream housing in Rachael Docking, Centre
       improving later life          for Ageing Better

1.50   Making life better by design   Ellie Runcie, Design
                                      Council

2.00   Family carer perspective       Dame Philippa Russell

2.15   Table discussions

3.15   Wrap up                        Ewan King

3.30   Close
The 100 year life The role of housing, planning and design 5 September 2018
The role of mainstream
housing in improving later life
Rachael Docking
Senior Evidence Manager, Centre for Ageing Better

rachael.docking@ageing-better.org.uk
www.ageing-better.org.uk
The 100 year life The role of housing, planning and design 5 September 2018
Homes headed by someone aged 85 and over are
the fastest growing household*

By 2025 there are projected to be 1.5 million households headed by someone aged 85 or
over – an increase of 54% from 2015*
              *Source: Ageing Better calculations based on: Department for Communities and Local Government (2016), ‘2014-based Household Projections: England, 2014-2039’.   7
The 100 year life The role of housing, planning and design 5 September 2018
More than 90% of older people live in mainstream housing

Only 3.2% of those aged 65 and over live in care homes*
80% of the homes we need by 2050 are already built**                                                           8
                                                          *Source: ONS, 2014; **Source: Boardman et al, 2005
The 100 year life The role of housing, planning and design 5 September 2018
A large proportion of people do not intend to move

                          Source: Ipsos MORI survey of 1,389 people aged 50 and over. Later life in 2015 Centre for Ageing Better   9
The 100 year life The role of housing, planning and design 5 September 2018
The % of people who have difficulty with activities
of daily living increases with age

                            475,000
                      By people’s late 80s, more than
                     1 in 3 people have difficulty with
                      5 or more day to day activities
                                                          10
Current UK housing stock is not suitable, adaptable or
accessible for people in later life

Only 7% of homes meet basic accessibility features*
                                    *Source: DCLG (2016), English housing survey 2014 to 2015: adaptations and accessibility of homes report   11
Home adaptations improve people’s quality of life

                                                                                                                                                                                                     £7000
                                                                                                                                                                                                       V
                                                                                                                                                                                                    £29,000

Home adaptations have been shown to improve the quality of life for 90% of recipients

                          *Source: Heywood, F. and Lynn, T. (2007). ‘Better outcomes, lower costs. “Implications for health and social care budgets of investment in housing adaptations, improvements and equipment: review of the      12
                                                                                                                                                     evidence”’. London: Office for Disability Issues/Department of Work and Pensions.
Key findings on the role of home adaptations
     Minor adaptations
     Repairs and home improvements
     Person oriented
     Timeliness (system delays and putting off installation)
     People delay adapting home due to clinical appearance of
     adaptations and their association with vulnerability
     System delays caused by lack of resource
     Process so complex professionals struggle to navigate
What is happening externally?
     Last spending review the DFG was increased
     DHSC commissioned a review of the DFG
     CLG Select Committee report on housing for older people
     Social Care Green Paper due 2018
     Industrial Strategy Grand Challenge: Healthy ageing
     Improving health and care through the home: MoU
    Government commitment to building new homes
Making life better by design
Ellie Runcie
Director, Growth and Innovation, Design Council
ellie.runcie@designcouncil.org.uk
www.designcouncil.org.uk
Practice into policy?
                                                                Economic growth
                                                                Planning as a balance of
                                                                conservation and growth

                                                                Teaching and learning
  Housing numbers                Economic
                                                                Employment

  Green belt versus
  brownfield

  Infrastructure                                                Demographics
  digital and physical                                          People living alone and later
                         Place                   Societal       access to home ownership

                                                                Health and wellbeing
                                                                inactivity in society

                                                                Ageing population
                                                                Impact on the built environment

                         Inclusivity and community engagement

                                                                                                  © Design Council 2018
DESIGN COUNCIL SPARK
                           Inclusively designed products
➢ Getting up & dressing
                           for every day living
➢ Moving around

➢ Keeping active

➢ Easier bathing

➢ Kitchen support          Tru-Unity               Workey              Elba
➢ Managing health needs
                          Door Handle             A key turning       London
                           An ergonomic          tool that eases   A well-fitting bra
                           handle which           grasping and         that is
                            supports a            turning to aid   comfortable and
                          natural grip and          dexterity.      easy to put on
                           twist motion.                             and take off
                                                                                            DRINK
                                                                                         A wheelchair
                                                                                        accessory that
                                                                                           carries a
                                                                                        variety of glass
                                                   Ezi-Plug          TickleFLEX            sizes and
                                                                                          attaches to
                           Handy Fasteners       A mains plug        Place on the            almost
                              An adaptive         and socket       end of an insulin       anything.
                                magnetic         designed for        pen to make
                              alternative to      people with        self-injecting
                           traditional buttons     dexterity        safer and more
                                                    issues.          comfortable.
System design
or
problem redefine?

                    © Design Council 2018
Shaping solutions….

                  Problem Definition
….before we explore the
problem
A framework for innovation
Discover             Define                   Develop          Deliver
Insight into the     The area to              Potential        Solutions
problem              focus upon               solutions        which work

                            Being people centered

                           Communicating visually

                         Collaborating & Co-creating

                            Iterate, iterate, iterate

Problem                      Problem definition             Solution
The design process           This is a clear statement of   The solution is an output
begins with a problem,       the problem to be solved       that meets the requirement
question or hypothesis                                      of the problem definition
Reducing Trips and Fall: Teignbridge?

- East Teignmouth has a higher
  than average ageing
  population, with 7% of
  residents aged over 85-years-
  old

- Trips and falls are the most
  common cause of death in the
  over-65s in the area

- Existing prevention solutions
  not working
1. Being people centred?

Capturing real stories

Improving
understanding

Evidence that a new
approach was
needed focusing on
prevention.
Extreme users

  Range           Core       Range
                (Majority)
2. Communicating (visually)
2. Communicating (visually)
3. Collaborate & Co-create?
4. Iterate, iterate, iterate…?
                                 ADD IMAGEs OF PROTOTPYING
Outcome
1. Three service areas identified for development:
  • Online photo submission
  • Home assessment service
  • Volunteer support pack

2. Relationships between various health agencies
resulted in greater collaborative working
3. Joint funding bid to embed this way of working
The value of the design approach

• Putting people at heart of this   Key challenge:
  process                           1. Scale up
• Collaboratively exploring the     2. Embed capabilities
  problem with multiple
  stakeholders
• Supports new ways of effective
  engagement
• Testing alternative approaches
  early and often to manage risk
• Breaking down complexity
Scale up
Six innovation briefs
1.   Steps to a positive future

2.   Mobility & Transport

3.   Life Transitions

4.   Caring about carers

5.   Right information, right time

6.   Making connections

                                     37
2. Embedding capabilities
Epping Forest    To reduce the volume of unnecessary A&E attendances
District         by the frail elderly ie. over 75s
Council
Islington        To understand the needs of frail individuals and identify/
Council          test new solutions to support their independence                                13 teams
Bexley Council To create a co-production model to design and fund
               Better Care Fund prevention and early intervention
               projects
Southwark        To tackle undiagnosed heart disease, which drives
Council          premature death, health inequalities and healthcare
                 costs
Doncaster        To redesign services to support self-management
                                                                                    30
                                                                               organisations           Public
Council          across an integrated health and social care system
                                                                                                       Health
North Tyneside To utilise design principles that will facilitate the
                                                                                                       focus
Council        engagement of inactive adults into physical activity at
               scale
Stockport        To find a new way of collaborating with VCSE partners
Council          to coproduce social connection, reduce isolation and
                 build resilient communities
City of          Creating a healthy, strong district harnessing the built
Bradford         environment to support wellbeing across our                  New call for applications open –
Metropolitan     communities for the future                                   deadline midday 21 September!
District
Council
Are we ready for the 100 year life?
Partnership, Participation or Purdah?
A family carer perspective
Dame Philippa Russell DBE
Vice-President, Carers UK
philipparussell118@gmail.com
l118@gmail.com
The 100 Year Life: Transitions from institutional solutions to
     family life: Simon’s story and a personal journey
‘The ‘big conundrum’ – Why family carers matter:                 ‘We
need mature conversations’ about ‘co-producing’ 2lst century care and
                             support’.

    •   1 in 10 of the population will become a family carer - 4 million
        carers (840,000 dementia carers) – but anxiety amongst many
        families about sustaining care with personal and economic well-
        being and their own developing care needs. LSE/University of
        Newcastle (The Lancet Public Health, August 2018) notes that
        increasing long-term disability and care needs could ‘be
        unsustainable for family carers’.
    •   Increasingly complex and long-term nature of care – Major
        developments in past three decades around deinstitutionalisation
        and community participation – how can we sustain the progress
        and think ‘out of the box’ , learning from the families about what
        good care and support looks like.
The ‘Age-Old Question’ – a 2lst century perspective on the
         challenges ahead and a reflection on solutions

• The challenges for Simon and his family – we need to change our
  negative expectations of longer lives! [Royal Society for Public Health/Calouste
   Gulbenkian Foundation survey, 2018]

    –   24% thought ‘all older people will get dementia sometime’.
    –   25% thought ‘it’s normal for older people to be depressed and sad’.
    –   24% thought that ‘’older people can never be really attractive’.
    –   64% of respondents did not have any friend with a 30 year age gap
        from their own [general feeling that older people ‘not really part of
        society]

    – ‘It’s a young world now, no place for older people. Social media has
      changed all that, I don’t know we can bridge the gap.’ [quote from
      respondent]
We need a ‘New Narrative on Ageing’ – a new narrative for ALL
generations moving older people from ‘problems’ to ‘citizens’

• The ‘l00 Year life needs a new narrative on ageing – and
  one which can only be developed in partnership with
  older people themselves. In effect we need all our citizens
  to be ‘activists’ in reshaping the agenda – and reflecting
  on their own futures decades into the future.
   – Ageing is an inter-generational issue ‘ ‘We need to plan it like a
     space mission not see older people and their families as ‘a
     demographic time bomb’!
   – We need a personalised approach to ageing, not the ‘collective
     lumping’ of older people into negativity and problems
   – Older people are active citizens AND a vital part of our ‘care
     and support system’ with assets to share – IF we ‘co-produce’ a
     different future.
‘Why we need to talk about caring - One in ten of us can expect to
 become a carer during out life-time – will we be able to carry on
                   caring in a 100 Year Life’?

•   PSSRU (2017) A reminder that carers are a
    scarce resource! Demand for family carers
    for people over 65 expected to increase by
    over 1m in next three years.

•   1.3million carers are over 65 (often for
    more than one person). The number of
    carers over 65 is increasing more rapidly
    than in the wider population (the
    percentage of older carers has risen by
    35% since 2011 as compared to 11% in
    general population).

•   45% of disabled people in the UK are over
    65 – major implications for complex
    health needs.
Managing complexity in an ordinary life – understanding
             what makes a difference!

• Family carers people face increasingly challenging
  roles – number of people with 3 or more long-term
  conditions predicted to rise from 1.9 million to 2.9
  million by 2018. Increase in dementia and ‘new
  survivors’ of younger people with very complex
  disabilities.

• ‘But WE did it!’ – Barbara and Malcolm’s story:
  Managing the ‘web of care’ and meeting the
  challenges of the 2lst century ‘100 Year Life’ and
  ‘making home work’.
Managing
   the Web of
      Care                 Out-of-
                                       Consultant
                                                                     Continence
                           Hours                                       Adviser
  (Last 7 yrs)            Doctors/
                         Paramedics                                            Speech &
                                                       District
                                                       Nurses               Language Adviser
                                      GP
    Care team
2 live-in carers
(alternating weekly)     Dementia                                              Dietician
Replacement carer        Advisory
[Some night nursing
                          Nurse?
– Health]                                                                   Community
Emergency carers                                                              Dentist
 & Barbara                              Malcolm &
                                         Barbara
                                                                            Occupational
                       Social                                                Therapist
                       Worker

                                                                             Equipment
                                      Oxygen                                   Service
                                                    Wheelchair
          Direct                      service
                                                     Service
         Payments
          Team;         Alzheimer’s
                                                                  Physiotherapist
          Rowan        Soc outreach
                                         Alternating
           Org.           worker
                                      Mattress technician
‘We need to rebrand social and residential care and recognise housing as the
‘third pillar’ alongside health and social care; We need a range of options for
 housing with care – for ALL generations. [Professor Paul Burstow, Commission on
                            Housing with Care, 2017]

                                         •   THINKING OUTSIDE THE BOX – WE NEED
                                             TO PERSONALISE CARE’ ‘Most of the
                                             residents in my mother’s nursing home
                                             are really frail and ill – I worried, would
                                             they get the healthcare they really
                                             needed, would their medication, their
                                             dressings be sorted properly. But with
                                             telehealth AND telecare, we all ‘sing from
                                             the same song-sheet’. Best of all, our
                                             mother says that she hasn’t gone into care
                                             (horrid phrase’, she has just changed her
                                             address for a place with a better garden!)
                                             The most important thing is that we talk
                                             about a HOME LIFE and where we an best
                                             enjoy it (and that can mean staying put
                                             with support or going away!)’
And looking into the crystal ball! Bridging the Inter-
    generational gap and creating more inclusive communities.

•    ‘We need some myth-busting about
     ageing and caring’; Creating all-age
     partnerships (eg volunteering, mentoring,
     buddying)

•    ‘ASK THE PEOPLE TOO! It’s going to be us
     one day!’ – Encouraging debates,
     discussions in across the age range about
     what creates inclusive communities.

•    ‘It’s lonely out there sometimes but young
     people get lonely too!’ (eg Jo Cox
     Foundation initiatives to create peer
     support and improve community access
     for young and older people in today’s very
     mobile and often hurried communities)
Location, Location, Location – Recognising the
importance of older people/carers as partners in change

• Creating accessible communities together!
  Older people and carers as a priority group in local/district plans – and involved as
  active citizens NOT demographic burdens!

• Thinking outside the box!                        Japanese town with oldest
  population in country reversed the trend after local consultation by putting
  housing for older people in the town centre and moving younger people to more
  expensive suburbs!

• Developing the market!                       Remembering the ‘grey pound’ – why
  must aids and equipment look so clinical and drab (and can we think social
  inclusion – seats in shops and please more accessible buses and toilets!).
And creating Digital Inclusion, the
         gateway to participation
•   Care Act assessment and support for people needing support and for carers: we
    need to ensure that carers know about the possibilities of full range of assistive
    technology and who can give advice and offer ‘whole system support’ to local
    authorities and others (eg Carers UK).

•   Using Personal Budgets and Personal Health Budgets more creatively (and not
    forgetting self funders).

•   Work proactively with community and other groups to improve digital
    connectivity. We need to end the assumption that older people (and some
    disabled people) will never embrace technology. They can and do!
And some reminders….a new generation of adults like Simon with
    learning and other disabilities who for the first time are outliving
                their parents and surviving into later life.

• ‘New survivors’ – ADASS
  (2018) identifies improved
  survival rate of people with
  learning disabilities as
  major pressure point for
  the future.

•   But is the new longevity a problem if we
    adopt a ‘whole community’ approach to
    future planning, co-production and inter-
    dependence?
And a reminder about well-being, relationships and the
experiences that enable us to find creative solutions and
  develop new shared approaches to the 100 Year Life!
Table discussions
2.15 - 3.15pm
Recommendations (1)
1. Align housing, health and social care plans:

•   Green Paper should highlight a common goal to align health, housing
    and care systems around a shared objective of helping people to live
    independently at home that is suited to their needs as they age.
    Include inter-generational solutions to enable family members to
    support each other (as full-time or part-time residents)

•   Local leaders should work together to have a shared objectives and
    single plan and budget for housing, health and social care.
Recommendations (2)
2. Increase finance options

•   Make it easier for older people to access funding to support themselves,
    and encourage innovation in the marketplace.
•   Led flexibly to people in later life: Increase age limit for lending
•   Extend personal health care budgets to allow for cost of adaptations
•   Use Disability Facilities Grant innovatively to drive new ideas to
    market: e.g. remove means test for low-cost adaptations, repairs and
    improvements
•   Use Regulatory Reform Order that allows use of DFG for wider
    purposes
•   Extend terms of equity release: increase age limit for
    mortgage/remortgage
Recommendations (3)
3. Make communities age friendly and inclusive

•   Set space standards e.g 90% of new homes to be built to accessibility
    standards (accessible and adaptable dwelling) and 10% to be ‘wheelchair
    user dwellings’ (eg London)
•   Include design principles that create age-friendly environments (e.g.
    planning authorities could make this a requirements in new
    developments)
•   Invest in skills and learn from age-friendly community approaches:
    Government could invest in training on co-designing
•   Apply evidence: housing developers should apply evidence of what
    works to make homes adaptable and accessible as people age.
Recommendations (4)
3. Use inclusive design and co-production

• Government should use the Industrial Society Challenge Fund to ensure
  everyday products and services are designed to inclusive design
  principles in areas such as independent living, home adaptations,
  transport and mobility.
• Embed the principles and practice of co-production in the design of
  products, services and places.
• Develop the knowledge and skills of policy-makers, commissioners,
  planners, designers and housing professionals in the practice of co-
  production
Table discussions
Discuss each of the 4 key recommendations:
1. Align housing, health and social care plans
2. Increase finance options
3. Make communities age-friendly and inclusive
4. Use inclusive design and co-production

Agree on:
• One positive that recommendation (Rose)
• One negative – or it could be a barrier to the recommendation (Thorn)
• One area of opportunity that could be explored/accelerate progress
   (Bud)

Present back your Rose/Thorn/Buds for one of the four recommendations.
Respond to each table’s feedback.
Report available at
www.scie.org.uk
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