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
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
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 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
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 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
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
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
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 % 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
10Current 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 11Home 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 navigateWhat 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 homesMaking 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 2018DESIGN 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 2018Shaping 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 definitionReducing 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 PROTOTPYINGOutcome 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
372. 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
CouncilAre 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/remortgageRecommendations (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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