Introduction
Most older people wish to live in their own homes as they age and to have choice over their housing and care situation. However, currently many older people’s own homes are not accessible (for example, people cannot move around them or use all the rooms easily or safely) or are in poor condition. This may affect whether, how soon and how quickly social care needs such as difficulties with mobility develop. Older people’s housing may also affect whether they can receive care at home, who they receive this care from, and how long they can live independently in the community.
This study looked at non-specialist (mainstream) housing which is where most older people currently live. It explored the different characteristics of housing in combination, reflecting the ways in which people live in real life, including type of housing (e.g. flat or house), how many rooms and how many people live there, whether the home is rented or owned, and whether the home is in good condition.
Objectives
This study looked at how these housing characteristics are linked to people’s social care needs, use of care services, and care received from family and friends. It focused on people aged 50 and older in England.
Five main questions were explored:
- What are the links between housing characteristics and when and how quickly care needs develop?
- What is the link between housing characteristics and people’s use of adult social care services and care from family and friends?
- If some of these housing characteristics were to be changed, would this change the number of older people who have care needs and how much we need to spend on social care for them?
- How do older people experience the links between housing characteristics and how their social care needs are met? What choices are available and how are these choices made?
- How can improvements in adult social care and housing practice help older people to have more choice over their current and future housing and care situation?
This project was also in receipt of further funding from NIHR SSCR. The main objective of this work is to understand the experiences of older persons with care needs from the Bangladeshi Sylheti community on: 1) the link between housing condition and characteristics and when and how care needs develop, as well as use of formal or informal care; and 2) choices and preferences with respect to housing including how decisions are made, barriers to this and what would help increase choice.
Methods
To answer these questions, the study:
- Held Theory of Change workshops and carried out interviews with stakeholders to develop the theory of change for the study, help set priorities, provide valuable early insights, identify sub-groups who may have different experiences, and foster early engagement with stakeholders;
- Undertook secondary analyses of longitudinal data to investigate onset, level, and trajectories of (a) care needs as measured by functional capabilities (as defined by ability to perform activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs)); (b) care utilisation (formal/unpaid) over time, how trajectories of care needs and utilisation differ and their association with housing conditions; and (c) geographical and/or socio-economic inequalities in these patterns;
- Built a ‘simulation model’ to estimate and project (i) the number of older people with care needs currently living in various specified housing conditions based on existing housing practice and policy (i.e. base case / no policy change scenario); and (ii) the number of older people with care needs if a range of social care and housing practice changes aimed at improving housing for older people (practice change scenarios) were implemented;
- Carried out in-depth qualitative interviews with older people with care needs and unpaid carers about their experiences.
Findings
Key messages include:
- In non-specialist housing occupied by older people, higher number of housing problems is associated with earlier age of onset of care needs, being more likely to have care needs, and a steeper increase in care needs over time.
- Key housing problems associated with developing or worsening care needs are cold, damp and fuel poverty.
- Other problems associated with care needs are disrepair and difficulties keeping the home clean and clutter-free, non-ideal space, access into and around the home, and housing tenure.
- Housing improvement to remedy housing problems could reduce formal care costs by £1.1 billion a year by 2027 and unpaid care costs by £3.5 billion.
- Housing problems increase care use overall mainly via increasing care need but for some people are a barrier to care use leading to unmet need for care.
Resources
Associated LSE blog is at https://www.lse.ac.uk/News/Latest-news-from-LSE/2023/d-April-2023/poor-housing-conditions-may-lead-to-early-onset-of-long-term-care-needs-in-England
Cartagena Farias, J., Brimblecombe, N., & Hu, B. (2023). Early onset of care needs in the older population: The protective role of housing conditions. Health & place, 81, 103007. https://doi.org/10.1016/j.healthplace.2023.103007
Hu, B., Cartagena-Farias, J. & Brimblecombe, N. (2022) Functional disability and utilisation of long-term care in the older population in England: a dual trajectory analysis. Eur J Ageing 19, pp. 1363–1373. https://doi.org/10.1007/s10433-022-00723-0
Related publications
