Read the full case study for 'Home adaptations for older people' here (HTML)

• About 2 million households in England include one or more people with a health condition/disability that require adaptations to their home.
• Home adaptations are permanent alterations which aim to make buildings more suitable for older people and have been identified as one of the 10 most promising prevention interventions for older adults.
• Home adaptations secure better home usability, improve independence and functional ability, and can prevent falls.
• Those who received home adaptations, and their carers, widely appreciated them as they believed they led to improvements in their health and well‐
• Delays in the provision of home adaptations may increase the risk of hospitalisation and associated costs.
• More research funded by NIHR SSCR is underway to explore whether major adaptations to bathing facilities (these adaptations usually involve the removal of a bath or inaccessible shower and replacement with a level or easy access shower) improve or maintain older people’s health, safety, quality of life, and ability to manage their personal care. It will also explore whether delayed installation has a negative effect on physical and mental health and independence, and also leads to more costs.

A Return on Investment Tool for the Assessment of Falls Prevention Programmes for Older People Living in the Community
Public Health England Public Health England, London. 2018

This report presents results of a tool developed by York Health Economics Consortium to assess the potential return on investment (ROI) of falls prevention programmes targeted at older people living in the community. The tool pulls together evidence on the effectiveness and associated costs for four programmes where there was evidence of cost-effectiveness: Otago home exercise, Falls Management Exercise group programme, Tai Chi group exercise, and home assessment and modification. Based on an example analysis, all four interventions were found to be cost-effective, thus producing a positive societal ROI. One out of four interventions was also found to have a positive financial ROI (ie cost savings outweigh the cost of implementation). An accompanying Excel sheet allows for results to be tailored to the local situation based on the knowledge of the user. (Edited publisher abstract)

A scoping review of home modification interventions – Mapping the evidence base
Phillippa Carnemolla, Catherine Bridge A scoping review of home modification interventions – Mapping the evidence base 2020

A survey of Local Authorities and Home Improvement Agencies: identifying the hidden costs of providing a home adaptations service
Curtis, Lesley A., Beecham, Jennifer A survey of Local Authorities and Home Improvement Agencies: identifying the hidden costs of providing a home adaptations service 2018

An Economic Evaluation Framework for Government-Funded Home Adaptation Schemes: A Quantitative Approach
Zhang B, Zhou P. An Economic Evaluation Framework for Government-Funded Home Adaptation Schemes: A Quantitative Approach 2020

Analysis of Outcomes from the Bracknell Forest Homes Major Works Investment Programme
Musson S and Bowlby S University of Reading, Berkshire. 2013

Home improvements can increase wellbeing according to research by the University of Reading for Bracknell Forest Homes into the social value of their £61m home improvement programme. They found that communities not only benefitted from physical improvements to homes but also benefitted from social and psychological wellbeing benefits.

Bathing Adaptations in the Homes of Older Adults – The BATH-OUT Trial
Whitehead P University of Nottingham, Nottingham. 2017

The BATH-OUT study is a feasibility randomised controlled trial with nested qualitative interview study. It involves adults aged 65 or over, and their carers, who have been assessed by a social care occupational therapist and referred for an accessible showering facility. We want to investigate the impact of the accessible showering facility on disabled older adults and their carers.

Our long term aim is to evaluate the effect of these adaptations on quality of life, health and wellbeing and functional ability. We also want to investigate the impact on health and social care costs and whether waiting times lead to increased costs and poor outcomes. The first stage is this feasibility study which is being carried out within Nottingham City. If we show that it is feasible to use this method in our research we aim to plan a further study involving different areas of the UK.

The study is being led by Dr Phillip Whitehead from The University of Nottingham and is collaboration between the University and Nottingham City Council. It is funded by NIHR School for Social Care Research. Favourable ethical opinion has been given by the Social Care Research Ethics Committee (ref. 16/IEC08/0017).

Bathing adaptations in the homes of older adults (BATH-OUT): results of a feasibility randomised controlled trial (RCT)
Whitehead, P.J., Golding-Day, M.R., Belshaw, S. et al. Bathing adaptations in the homes of older adults (BATH-OUT): results of a feasibility randomised controlled trial (RCT) 2018

Better Housing, Better Health in London Lambeth: The Lambeth Housing Standard Health Impact Assessment and Cost Benefit Analysis
Ambrose A, Bashir N, Foden N, et al Centre for Regional Economic and Social Research, Sheffield. 2018

Main message: Our indicative cost-benefit analysis shows that Lambeth’s Housing Standard (LHS) investment programme will have a major impacton the health and quality of life of council tenants, with wider monetised benefits of £227million for individuals, for the National Health Service,social care services, the Criminal Justice System and the local economy

Boiler on Prescription Trial
Burns P and Coxon J GENTOO Group, Sunderland. 2016

The report finds a 60% reduction in the number of GP appointments needed by patients taking part in the boiler on prescription trial in Sunderland between Gentoo and the local Clinical Commissioning Group.

The trial took place after it investigated the impact of domestic thermal efficiency works on the health and wellbeing of NHS patients.

It found:

A&E attendances reduced by 30%
emergency admissions to A&E departments reduced by 25%
It also appears that the patients’ ability to self-manage their condition has increased, which has reduced the number of appointments they have needed at their local GP practice.

Can aging in place be cost effective? A systematic review.
Graybill EM, McMeekin P, Wildman J Public Library of Science One, 9, e102705. 2014

Purpose of the Study
To systematically review cost, cost-minimization and cost-effectiveness studies for assisted living technologies (ALTs) that specifically enable older people to ‘age in place’ and highlight what further research is needed to inform decisions regarding aging in place.

Design
People aged 65+ and their live-in carers (where applicable), using an ALT to age in place at home opposed to a community-dwelling arrangement.

Methods
Studies were identified using a predefined search strategy on two key economic and cost evaluation databases NHS EED, HEED. Studies were assessed using methods recommended by the Campbell and Cochrane Economic Methods Group and presented in a narrative synthesis style.

Results
Eight eligible studies were identified from North America spread over a diverse geographical range. The majority of studies reported the ALT intervention group as having lower resource use costs than the control group; though the low methodological quality and heterogeneity of the individual costs and outcomes reported across studies must be considered.

Implications
The studies suggest that in some cases ALTs may reduce costs, though little data were identified and what there were was of poor quality. Methods to capture quality of life gains were not used, therefore potential effects on health and wellbeing may be missed. Further research is required using newer developments such as the capabilities approach. High quality studies assessing the cost-effectiveness of ALTs for ageing in place are required before robust conclusion on their use can be drawn.

Connecting with Health and Care
Foundations and Housing Learning and Improvement Network, London. 2009

In Autumn 2007 Foundations, the National Body for home improvement agencies, was commissioned by Communities and Local Government to carry out research and produce a report examining the options for the future delivery of home improvement agency (HIA) services. The report draws on examples from within and outside the HIA sector to highlight possible areas for development. It does not present a ‘one-size-fits-all’ model, but a series of options that may be appropriate depending on the identified needs of the local population, taking account of other services already in place.

Costs and outcomes of improving population health through better socialhousing: a cohort study and economic analysis
Bray NJ, Burns P, Jones A, et al International Journal of Public Health, 62, 1039-1050. 2017

Objectives

We sought to determine the impact of warmth-related housing improvements on the health, well-being, and quality of life of families living in social housing.
Methods

An historical cohort study design was used. Households were recruited by Gentoo, a social housing contractor in North East England. Recruited households were asked to complete a quality of life, well-being, and health service use questionnaire before receiving housing improvements (new energy-efficient boiler and double-glazing) and again 12 months afterwards.
Results

Data were collected from 228 households. The average intervention cost was £3725. At 12-month post-intervention, a 16% reduction (−£94.79) in household 6-month health service use was found. Statistically significant positive improvements were observed in main tenant and household health status (p < 0.001; p = 0.009, respectively), main tenant satisfaction with financial situation (p = 0.020), number of rooms left unheated per household (p < 0.001), frequency of household outpatient appointments (p = 0.001), and accident/emergency department attendance (p < 0.012). Conclusions Warmth-related housing improvements may be a cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.

Demonstrating the Health and Social Cost-benefits of Lifestyle Housing for Older People
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2017

This report, commissioned by Keepmoat Regeneration/ENGIE, sets out the evidence for the benefits of developing specialist retirement housing for people aged over 55, including cost savings. It focuses on the benefits of age restricted retirement housing or sheltered accommodation, care villages and specialist extra care housing with services and care on-site. Part one lists key facts and figures on the health and social care cost-benefits of lifestyle housing for older people. Part two provides more detailed findings of the potential benefits including the areas of: social connectedness and reducing loneliness; life expectancy, keeping couples together and supporting informal carers, financial savings in adult social care and the NHS, and preventing the need for institutional care. References and links are listed at the end of the document.

Developing your Local Housing Offer for Health and Care
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2016

Updated in 2016, this tool acknowledges the significance of housing as a partner and contributor to achieving the aims of health and social care services. With references to latest policy and practice, it is aimed at helping housing and support articulate and demonstrate the value of their services in terms of their partners’ targets and outcomes.

Do home adaptation interventions help to reduce emergency fall admissions? A national longitudinal data-linkage study of 657,536 older adults living in Wales (UK) between 2010 and 2017.
Hollinghurst J, Daniels H, Fry R, et al. Do home adaptation interventions help to reduce emergency fall admissions? A national longitudinal data-linkage study of 657,536 older adults living in Wales (UK) between 2010 and 2017. 2022

Evidence review of home adaptations in the UK and other OECD countries
Yang Wang, Kenneth Gibb, Dr Vikki McCall Evidence review of home adaptations in the UK and other OECD countries 2022

Falls Prevention: Cost-effective Commissioning
Public Health England Public Health England, London. 2018

A resource to help commissioners and communities provide cost-effective falls prevention activities.

Framing the evidence for health smart homes and home-based consumer health technologies as a public health intervention for independent aging: A systematic review
Reeder B, Meyer E, Lazar A, et al International Journal of Medical Informatics, 82, 565–579. 2013

Introduction
There is a critical need for public health interventions to support the independence of older adults as the world’s population ages. Health smart homes (HSH) and home-based consumer health (HCH) technologies may play a role in these interventions.

Methods
We conducted a systematic review of HSH and HCH literature from indexed repositories for health care and technology disciplines (e.g., MEDLINE, CINAHL, and IEEE Xplore) and classified included studies according to an evidence-based public health (EBPH) typology.

Results
One thousand, six hundred and thirty nine candidate articles were identified. Thirty-one studies from the years 1998–2011 were included. Twenty-one included studies were classified as emerging, 10 as promising and 3 as effective (first tier).

Conclusion
The majority of included studies were published in the period beginning in the year 2005. All 3 effective (first tier) studies and 9 of 10 of promising studies were published during this period. Almost all studies included an activity sensing component and most of these used passive infrared motion sensors. The three effective (first tier) studies all used a multicomponent technology approach that included activity sensing, reminders and other technologies tailored to individual preferences. Future research should explore the use of technology for self-management of health by older adults, social support and self-reported health measures incorporated into personal health records, electronic medical records, and community health registries.

Get Well Soon
Studdert J, Stopforth S, Parker S, et al New Local Government Network, London. 2016

This report from New Local Government Network (and supported by Midland Heart) argues that the health service in its current form is not sustainable, and sets out a new plan for shifting the system to focus on preventing illness, shorten stays in hospitals and help people live independently for longer.

It makes a number of references to housing interventions and the care efficiencies that can be achieved and recommends that any new resources for health announced by government should be designated to support a transition to place-based health and a renewed focus on people’s wellbeing to drive a reduction in health inequalities.

In addition, with devolution in mind, it calls for metro mayors and council leaders to be in charge of pooled budgets and other financial models that ensures places rather than institutions are held to account for health.

Health Begins at Home
Family Mosaic Family Mosaic, London. 2013

This new pamphlet provides interim results at 6 months from a fascinating Family Mosaic research project being undertaken by the London School of Economics. It seeks to measure and test out the impact of their services, both as a social landlord and as a provider of housing-related care and support services, and ways in which they can improve the health and wellbeing of older residents whilst at the same time help reduce NHS costs in the areas they operate in. Initial findings suggest an annual saving of £860,000 to local health economies for the 597 participants alone. With a range of useful information and examples of prevention and reablement at work, read below.

Home Solutions to our Care Crisis
Papworth Trust Papworth Trust, Basildon. 2012

Research findings by the Papworth Trust that unsuitable housing costs the public purse and that too many disabled and older people suffer stress, accidents or health problems because their homes are not suited to their needs. They recommend a radical shake up of the adaptations system to enable people to live healthy and independent lives.

Homes and Ageing in England. Briefing Paper
Garrett H and Burris S Building Research Establishment (BRE) on behalf of Public Health England, London. 2015

The BRE paper outlines how simple changes made to the homes of older people could save the NHS more than £600 million a year. Using data collected by the English Housing Survey, and the methodology from the earlier report, ‘The Cost of Poor Housing to the NHS’ (opens new window). the findings show that there are over a million homes occupied by those over 55 where there is a significant risk to health (for example, excess cold or of injury from falling on poorly designed steps, both inside and outside the home). It estimates that treating these avoidable illnesses and injuries costs the NHS over £600 million a year and offers a selection of case studies.

Housing Associations and Home Adaptations: Finding ways to say yes
SHEILA MACKINTOSH & RACHEL FRONDIGOUN Housing Associations and Home Adaptations: Finding ways to say yes 2022

Housing, Prevention and Early Intervention at Work: A Summary of the Evidence Base
Porteus J Housing Learning and Improvement Network, London. 2011

This Viewpoint provides an overview of the evidence base and personal account of the key housing and housing with care and support issues relating to prevention and early intervention. It was written to help inform priority area 4 of the Department of Health’s Caring for our Future: Shared ambitions for care and support consultation and the work of the NHS Future Forum

How can Local Authorities with Less Money Support Better Outcomes for Older People?
Centre for Policy on Ageing Joseph Rowntree Foundation, York. 2011

Research shows that older people want and value low-level support – ‘that bit of help’ – but the benefits of investing in this are realised over many years, making it harder to prove impact and protect funding in the face of severe pressure on spending.

This ‘Solutions’ published by Joseph Rowntree Foundation provides examples of imaginative, affordable and effective ways of supporting older people’s health, well-being, social engagement and independence. It highlights projects with some local authority involvement whether as lead commissioner, subsidiary partner, or through small grants or seed-funding.

The projects demonstrate the importance of:

involving people who use support and services in shaping them;
investing in collective solutions, small grants or seed-funding for self-help groups, and developing local markets to provide the support people want and value;
greater emphasis on the assistance that older people need and choose, and their experiences rather than on conventional social care and/or services;
developing place-based approaches that reflect the whole of people’s lives, and delivering value for money, for example by including transport

Impact and economic assessment of assistive technology in care homes in Norfolk, UK
Al-Oraibi S, Fordham Ric, Lambert R Journal of Assistive Technologies, 6, 192-201. 2012

This study looked at whether new assistive technology (AT) systems in care homes for elderly residents, reduced the number of falls and demands for formal health services. The project collected retrospective data about the incidence of falls before and after AT systems were installed in two care homes in Norfolk, UK. These homes were selected purposefully because a recent assessment identified the need for upgrading their call system. They had different resident profiles regarding the prevalence of dementia. Standard incident report forms were examined for a period starting ten months before the upgrades to ten months after in Care Home 1 and from six months before to six months afterwards in Care Home 2. Overall there were 314 falls reported during the course of the study; the number reduced from 202 to 112 after the introduction of AT. The mean health care costs associated with falls in Care Home 1 were significantly reduced (more than 50%). In Care Home 2 there was no significant difference in the mean cost. The results suggest that installing an AT system in residential care homes can reduce the number of falls and health care cost in homes with a lower proportion of residents with advanced dementia compared to those with more residents with advanced dementia

Meeting the home adaptation needs of older people Is your council actively addressing residents’ need for help with home adaptations?
e Local Government Association (LGA), the Association of Directors of Adult Social Services (ADASS), Age UK and Care & Repair England Meeting the home adaptation needs of older people Is your council actively addressing residents’ need for help with home adaptations? 2020

Money Matters: Reviews of Cost-effective Initiatives
Institute of Public Care The Institute for Research and Innovation in Social Services, Glasgow. 2011

This set of eight case studies, produced by the Institute of Public Care on behalf of IRISS (the Institute for Research and Innovation in Social Services), provides detailed analysis of the cost-effectiveness of a series of recent social care initiatives, ranging from nationwide and relatively high-profile schemes such as individual budgets to those thus far unique to one country, city or local authority area in the UK.

In each case, the report provides an overview of the initiative – its origins, including previous variants of the scheme, who it is intended to help, and how it works in practice – before justifying claims of cost-effectiveness by reference to detailed comparative costings, using one illustrative implementation of the scheme where the initiative is nationwide. Based on the analysis, the report sets out the initiative’s applicability to other settings as well as potential impediments to broader implementation.

The eight initiatives scrutinised are:

A study of Shared Lives schemes in south east England for providing care in the carer’s own home for individuals placed there by the local authority.
An extra-care housing scheme completed in Bradford.
Health in mind – social inclusion support for people with mental health needs in Bradford based round a series of mental health “well-being cafes”.
LinkAge Plus – analysis of nationwide DWP-funded pilot schemes for an holistic approach to provision of services for older people.
The Rapid Response Adaptations Programme – a Welsh initiative for providing adaptations such as ramps to let people return to their own homes.
A project in north west England to guide older people with low-level needs through a self-assessment process.
Analysis of various pilot sites taking different approaches to individual budgets, based on a broader evaluation conducted in 2008.
A project in two acute trusts in London to reconfigure hospital discharge procedures to emphasise rehabilitation.

Putting Home Adaptations on the Policy Agenda in England
Sheila Mackintosh Putting Home Adaptations on the Policy Agenda in England 2020

Reducing Delayed Transfer of Care through Housing Interventions: Evidence of Impact. Case Study
Adams S Care and Repair England, London. 2016

A case study and independent evaluation of a housing intervention designed to help older patients to return home from hospital more rapidly and safety. The initiative is delivered by West of England Care & Repair (WE C&R), who organise clutter clearance/deep cleaning; urgent home repairs, emergency heating repairs and essential housing adaptations for older people in hospital. The evaluation examined all case records, interviewed 15 hospital staff and undertook an in depth analysis of a sample of 4 cases. Analysis of the case records estimated a saving in hospital bed days of £13,526. The cost of housing interventions was £948, resulting in a cost benefit ratio of 14:1. Additional savings in hospital staff time amounted to a further £897. A short case study illustrates how the service was able to help one woman return home from hospital. It concludes that the small scale evaluation is indicative of the potential savings that a practical and effective home from hospital housing intervention service can generate for the health service

Releasing Somerset's Capacity to Care: Community Micro-providers in Somerset
Community Catalysts Community Catalysts, Harrogate. 2017

An evaluation of the Community Catalysts project in Somerset. Community Catalysts is a social enterprise working across the UK to make sure that people who need care and support to live their lives can get help in ways, times and places that suit them, with real choice of attractive local options. In Somerset, the project aimed to increase the number of flexible, responsive, high quality local services and supports that can give people real choice and control over their care. As part of the project Community Catalysts has worked with partners to develop the Community Somerset Community Micro-enterprise Directory. The directory features 275 community-enterprises all of whom offer services linked to health, care or wellbeing. 223 offer help to older people to enable them to stay at home. 58% of these providers offer personal care services, including for people with more complex care needs. This care is often provided alongside home help, domestic and social support. 42% offer home help type services including support, companionship, domestic help, gardening, cleaning, trips out, transport. 3,500 hours of care a week are delivered by Community micro-enterprises in Somerset. Community Catalysts also undertook a survey of 45 families who have used both a micro-provider and a traditional domiciliary agency. The results showed that community micro-providers are able to deliver strong and valued outcomes for the people they support, and significantly outperform traditional domiciliary care delivery. The evaluation indicates that 32 community micro-enterprises in rural West Somerset are delivering £134,712 in annual savings. Projected across the 223 micro-enterprises supported by Community Catalysts in Somerset, the project delivers: £938,607 in annual savings; 56% of people supported use direct payments, showing £525,619 of direct and ongoing annual savings to the council.

Room to Improve: The Role of Home Adaptations in Improving Later Life
Centre for Ageing Better Centre for Ageing Better, London. 2017

This report summarises the findings from an evidence review on how home adaptations can improve later lives and provides recommendations to improve access to, and delivery of, home adaptation and repair services. It shows that both minor and major home adaptations are an effective intervention to improve outcomes for people in later life, including improved performance of everyday activities, improved mental health and preventing falls and injuries. It also identifies good evidence that greatest outcomes are achieved when individuals and families are involved in the decision-making process, and when adaptations focus on individual goals. Based on the findings, the report makes recommendations for commissioners and service provides. These include for Local Sustainability and Transformation partnerships to put in place preventative strategies to support people at risk in their home environment; for local authorities to make use of the Disabled Facilities Grant to fund both major and minor adaptations; and for local authorities to ensure people have access to information and advice on how home adaptations could benefit them, in line with the Care Act 2014.

Safe at Home: A Preventive Handyperson Service in Devon
Evans S Housing Learning and Improvement Network, London. 2011

This case study showcases a successful handyperson scheme in Devon. It describes how the scheme was established and its subsequent evolution in the face of changes in the organisational and financial landscape. A range of Evaluation data are included to demonstrate the value of the scheme in promoting independence and reducing risks at home for older people and children and families across the community. Publication of this case study follows the launch of the national evaluation of the government funded handyperson programme by York Health Economics Consortium and the Centre for Housing Policy at the University of York.

Service planning and delivery outcomes of home adaptations for ageing in the UK.
Zhou, W., Oyegoke, A.S. & Sun, M. Service planning and delivery outcomes of home adaptations for ageing in the UK. 2019

Small But Significant: The Impact and Cost Benefits of Handyperson Services
Adams S Care and Repair England, London. 2018

An evaluation of the impacts and cost benefits of handyperson services carrying out small repairs and minor adaptations in the home for older people. It looks at how handyperson service fit into the current policy landscape summarises current evidence on their impact and cost effectiveness. It then provides an in depth evaluation of the of Preston Care and Repair handyperson service, with analysis of outputs, outcomes and examines the cost benefits in relation to falls prevention. The evaluation involved data analysis of jobs completed, a survey of users of the service and interviews with staff and service users. It reports that during the 9 month evaluation period 1,399 jobs were carried out in the homes of 697 older people, which exceeded outcome targets. Of people using the service, 46 percent were over 80 years and 72 percent were older people living alone. Older people also valued the service. Ninety-six percent of those surveyed said that the Preston Care and Repair handyperson service made them less worried about their home and 100 percent said that they would recommend the service to others. Analysis of the falls prevention impact on a small number of higher risk cases, found that for every £1 spent on the handyperson service the saving to health and care was £4.28. Other health and social care related outcomes included a risk reduction for hospital admission risk reduction and faster discharge to home, improved wellbeing, safer independent living, and reduced isolation. The report illustrates the impacts of handyperson services cover health, housing and social care aims and objectives. They also offer a cost effective solution with significant cost benefits and a high rate of return on investment, both financial and social

The Cost-benefit to the NHS Arising from Preventative Housing Interventions
Garrett H, Roys M, Burris S, et al IHS BRE Press, Bracknell. 2016

BRE (Building Research Establishment) is an independent, research-based consultancy, testing and training organisation, operating in the built environment and associated industries.

In 2014 a ‘Bletchley Day’ workshop was organised by Care & Repair England. BRE was tasked with considering ways to demonstrate the investment value of home adaptations and modifications.

BRE researched some of the cost-benefits to the NHS of undertaking preventative home interventions for households with a long-term sickness or disability, where the risks of accidents in their home are worse than the national average. This identified the need for preventative work in around 3 million households who have a long-term sickness and disability. This work would make their homes safer and warmer and so would reduce the likelihood of NHS treatment and the need for a Disabled Facilities Grant (DFG) adaptation required as a result of injury.

On 29 April 2016, BRE published The cost-benefit to the NHS arising from preventative housing interventions (FB82) by Helen Garrett, Mike Roys, Selina Burris and Simon Nicol.

The Costs and Benefits of Preventative Support Services for Older People
Pleace N Centre of Housing Policy, York. 2011

This paper is a brief overviewc ommissioned by Scottish Government Communities Analytical Services. This paper reviews the evidence on the cost effectiveness of preventative support services that assist older people with care and support needs to remain in their own homes. The costs of these preventative support services are contrasted with the costs of specialisthousing options, such as sheltered and extra care housing and also with the costs of health services, as part of reviewing the value for money of preventative support services

The economics of housing and health: The role of housing associations
Buck D, Simpson M, Ross S King's Fund, London. 2016

This report, based on work commissioned by the National Housing Federation from The King’s Fund and the New NHS Alliance, looks at the economic case for closer working between the housing and health sectors. The authors demonstrate how housing associations provide a wide range of services that produce health benefits, which can both reduce demand on the NHS and create social value.

The report concludes that there is no one piece of economic analysis that will persuade health providers or commissioners to work with or commission housing associations. However, the case studies in the report illustrate the economic benefits that housing association can provide through:

providing safe, decent homes that enhance wellbeing. This has health impacts that are valued, and can save the NHS money
alleviating the overall cost burden of illness and treatment
helping to offset and reduce costs of delivering health care to individuals
demonstrating cost-effectiveness in helping to meet the objectives of the NHS and of improving health more broadly
demonstrating the cost–benefits of their interventions in terms of the value of improvements to people’s health and savings to the NHS.
The report is one of a set of three commissioned by the National Housing Federation; the second report focuses on how housing associations can develop a business case that will be better understood by the health sector and the third explores how the health and housing sectors differ in their approach, language and terminology, roles, and use of evidence.

The Lightbulb project: switched on to integration in Leicestershire
Moran A Housing Learning and Improvement Network, London. 2017

A case study of the Lightbulb project, which brings together County and District Councils and other partners in Leicestershire to help people stay in their homes for as long as possible. The approach includes GPs and other health and care professionals and relies on early at home assessment process at key points of entry. This is delivered through a ‘hub and spoke’ model with an integrated Locality Lightbulb Team in each District Council area and covers: minor adaptations and equipment; DFGs; wider housing support needs (warmth, energy, home security); housing related health and wellbeing (AT, falls prevention); planning for the future (housing options); and housing related advice, information, and signposting. The Lightbulb service also includes a cost effective specialist Hospital Housing Enabler Team based in acute and mental health hospital settings across Leicestershire. The team work directly with patients and hospital staff to identify and resolve housing issues that are a potential barrier to hospital discharge and also provide low level support to assist with the move home from hospital to help prevent readmissions.

The Role of Home Adaptations in Improving Later Life
Powell J, et al Centre for Ageing Better, London. 2017

A systematic review of evidence on the effectiveness and cost effectiveness on how home adaptations can contribute in helping older people to maintain their independence for as long as possible and what works best to improve the health and wellbeing. Conducted by a team from the University of the West of England, the review covered peer-reviewed literature and professional and practitioner-led grey literature published between 2000 and 2016. It found evidence that both minor and major home adaptations can improve outcomes for people in later life, including improved performance of everyday activities, improved mental health and preventing falls and injuries. It also identified good evidence that greatest outcomes are achieved when individuals and families are involved in the decision-making process, and when adaptations focus on individual goals. It also found strong evidence that minor home adaptations are an effective and cost-effective intervention. The report also includes analysis from the Building Research Establishment which shows that home interventions to prevent falls on stairs, can lead to savings of £1.62p for every £1 spent. Based on the findings, the report makes recommendations for commissioners and service provides. These include for Local Sustainability and Transformation partnerships to put in place preventative strategies to support people at risk in their home environment; for local authorities to make use of the Disabled Facilities Grant to fund both major and minor adaptations; and for local authorities to ensure people have access to information and advice on how home adaptations could benefit them, in line with the Care Act 2014

Total Transformation of Care and Support: Creating the Five Year Forward View for Social Care
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2017

Adult social care has repeatedly demonstrated its capacity for transformation: pioneering de-institutionalisation, personal budgets and more recently, asset-based approaches.Health and care systems will not provide good services that meet rising demand without realigning around people and communities.There are five areas where transformation needs to take place: 1Helping all people and families to stay well, connected to others and resilient when facing health or care needs.2Supporting people and families who need help to carry on living well at home.3Enabling people with support needs to do enjoyable and meaningful things during the day, or look for work.4Developing new models of care for adults and older people who need support and a home in their community.5Equipping people to regain independence following hospital or other forms of health care. If the sector scales up promising practice, economic modelling shows that outcomes can be improved and costs reduced.The sector needs to have difficult, challenging and creative local conversations involving people who use services and others, which create space to move forward together. Further research and economic modelling is needed on the promising practices to build a business case for proper and effective investment in truly integrated care and health.

Warm Homes for Health: Exploring the Costs and Outcomes of Improving Population Health through Better Housing
Tudor Edwards R, Nathan Bray N, Burns P, et al Centre for Health Econmics and Medicine Evaluation, Bangor. 2016

This briefing by the University of Bangor reports on a research project undertaken with Gentoo in Sunderland to understand the impact that warmth-related housing improvements have on the health, well-being and quality of life of families living in social housing.

In addition, it sought to find out the costs and outcomes associated with new warmth-related housing improvements, compared to existing, unmodified social housing.

Of note, it found that after installation of housing improvements:

across the cohort the number of GP visits in six months reduced by 10%
hospital visits reduced by 67%
accident and emergency department attendance reduced by 45%
inpatient stays reduced by 4%
More than £50,000 worth of NHS cost savings were observed due to reduced health service use

The researchers estimate, ‘if the 4.8million ‘unhealthy’ UK homes were to receive similar housing improvements the NHS could potentially save £1billion a year in health service use costs.’

What is the cost-effectiveness of home adaptations for older people?
Dr Silviya Nikolova, Professor Andrew Clegg Ashley Akbari Dr David Meads Dr Joe Hollinghurst Professor Sarah Rodgers Professor Alan Watkins Dr Sarah Hillcoat-Nalletamby Dr Richard Fry What is the cost-effectiveness of home adaptations for older people? 2019