A vision for the green paper

The launch in April of the 20/20 Project’s paper on the future of older people’s housing and care services was the largest consultation outside government this year. The launch coincided with that of the government’s adult social care green paper, both aiming to set out a 10-15-year programme in the context of a changing and ageing population.

Housing is as important as care in ensuring someone’s dignity, yet the green paper is light on housing. The 20/20 partners have an ambition “to create a society where people are empowered to choose the appropriate home environment that meets their needs and aspirations as they age”.

Nearly 40 recommendations targeted at service commissioners, housing and care providers and national government underpin this vision for housing and care services in a report, 20/20: Creating a Vision for Housing and Care, launched at this week’s annual conference of the Local Government Association and the Association of Directors of Social Services.

Older people are stereotyped and perceived as powerless. This has led to services being developed for a “client” group, resulting in insufficient housing and care choices, whatever people’s affluence. Older people are not a homogeneous group; they go through several transitional stages from 60 to 90-plus. A new approach that considers desired lifestyles and maintaining them as people age is needed.

Providers and commissioners should explore partnering with private developers and older people themselves to develop purchase and flexible tenure options for older home buyers. More age-friendly properties with built-in telecare facilities and on-site concierge would be a start.

Supporting People is already changing the shape of housing provision, rightly aiming to support people wherever they live. Establishing a set of core national standards for Supporting People services as well as strategies, alongside analyses of the housing and care needs of the “very old” locally and regionally, would help to avoid the emergence of a postcode lottery.

Extra care housing is now the favoured option for housing and caring for frailer, older people. The green paper calls for “development of new responsive care models, such as extra care housing”. Yet, estimates of the future demography create a worrying scenario: by 2021, the 680,000 people aged 85-plus could result in demand for a further 200,000 care or residential care settings.

This likely shortfall will place unsustainable demands on home care services. More people using telecare in their own home would lessen the demand. Yet, despite telecare’s promotion as the way forward, there is no overriding strategy for national buy-in and funding streams are ad hoc. The many informative pilots can be imitated but wide scale, in-depth knowledge of its true potential should be increased among the housing, health and care sectors.

This summer’s Office of Fair Trading report highlighted the fact that people are unsure where to look for information about housing and care and have no idea of the services or assessments they have a right to receive.(1)

Market research has shown that silver surfers – those aged 65-plus – are the fastest growing group online, while the second fastest is the 55-64 range. Given this increasing web literacy, a one-stop website is a feasible solution providing information on housing, health and care options, supplemented by a national 0800 number and a network of information kiosks at supermarkets. Local information centres would provide the human contact, which is in line with the Department for Work and Pensions’ proposals: a “Sure Start for older people” to be piloted in 2006, like those already established for children.

Housing boards will determine the future funding of social housing, but so far a strategy focusing on older people’s aspirations appears unlikely. Older people are seldom seen as contributing to a local or regional economy and are subsequently out of the housing loop. A national housing and care strategy for older people is needed to ensure that basic standards are available nationally; this should then fit into regional housing, health and care plans.

The green paper reinforces the government’s agenda to extend direct payments to older people. The 20/20 respondents appeared ambivalent on this, acknowledging that it would empower older people but administering it may be difficult without a care broker as facilitator. The role of informal carers will increase, with those in middle age supporting ageing parents on one hand and adolescent children on the other. This needs to be recognised in flexible working policies and financial assistance.

Recognising the increasing numbers of old and very old people, and the demands they will put on care and health services, the green paper’s cost-neutral stance is likely to be unachievable as we work towards 2020.

If there is a widescale move towards direct payments or individual budgets, this will also need more bureaucracy to handle the administration from one social services pot to several hundred thousand individual pots. The appointment of an intermediary as a care enabler would create another support role that would need funding.

An increase in extra care housing is noted in the green paper, but perhaps the government’s actuaries hope health will improve even more rapidly in older age, so that 80 becomes the new 60, as 60 now is the new 40, thereby reducing the number requiring this form of housing and care.

The workforce providing services to older people will also need to increase. A widening of roles would avoid duplicate visits from health and social care professionals, but the expectation that more services are delivered to individuals in their own homes is likely to increase costs.

Younger people today realise the state will not be the guardian angel overseeing their future financial viability, and society will also begin to acknowledge that their housing and care needs will not be met by the public purse. If there is continued polarisation of society into the rich and very poor, however, the number of very old people on low incomes will need significant state support.
For further information about the 20/20 Project and to download a copy of the report, visit www.shelteredhousing.org

Also, visit www.communitycare.co.uk and go to Article Search. Type “adult care green paper” or go to The Bigger Picture on the adult green paper.

Michele Hollywood is 20/20 project manager and corporate marketing director of Hanover Housing Association. She has worked for Hanover, a specialist housing and care provider for older people, for more than 10 years. Previously she worked in marketing in the private sector. One of her aims is to challenge stereotypes of older people.

Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.

Abstract
The 20/20 Project was launched in March, a collaborative initiative involving nine housing and care organisations and charities seeking to help shape future housing and care policy through consultation with stakeholders. This article discusses the findings of the project’s consultation on future housing and care services for older people, compared with the recommendations made in the government adult social care green paper.

References
(1) Office of Fair Trading, Care Homes for Older People in the UK – A Market Study, 2005

Contact the author
Telephone 01784 664 001 or e-mail michele.hollywood@hanover.orguk