Housing adaptations for ageing in the UK : policy, legislation and practice
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Demographic change has imposed financial strains on the healthcare system in the UK. In face of such a challenge, the concept of “ageing in place” was introduced as national policies to support older people living independently in their own homes. Housing adaptation was characterised as a very foundation for successful independent living and has been given a greater political priority. However, so far there is no legislation or guidance that identifies one primary organisation responsible for the delivery of adaptations. Instead, different local authorities are allowed to decide their own guidelines, procedures and eligibility criteria. Consequently, housing adaptation practice varied significantly across the country and sometimes confusing. This study is aimed at reviewing the current status of housing adaptation in different parts of the UK, assessing the effectiveness of the existing practice and making relevant suggestions for its improvement. A mix-methods sequential explanatory research strategy was employed for this study. In the first quantitative phase, a questionnaire survey was carried out, involving all 378 local authorities in England, Scotland and Wales. It focused on finding out how local authorities plan, organise and monitor their adaptation services. The second qualitative phase included twelve interviews and a focus group meeting with stakeholders, including social worker, occupational therapists, housing officers, staff from care and repair and older service users; the aim was to explore the statistical results in more depth from different perspectives. The results from the survey indicate some good practices, such as partnership guidance, the key caseworker, regular progress reports and agreement on the specification. However, the current implementation of adaptation policies is limited in most local areas. There is a relatively small number of adaptations with low levels of spending, compared with the potential needs from an aging population. There are noticeable differences between the different nations in the UK. Overall, Welsh government gave more attention to adaptation services and made them a higher political priority than England and Scotland; and provided a higher level of funding. In Scotland, local authorities focus primarily on middle- and small-scale adaptations with a cost up to £3,000. In England, the adaptation service is complex with the involvement of two tier government – district and county councils. Some common deficiencies have caused inefficiencies and ineffectiveness of the service, presenting important implications for policies related to healthy aging and community care. First, the way of setting adaptation budget based on the previous year’s spending is problematic; it does not reflect the changing needs. As the general population aging, demands for housing adaptation are set to increase. Local authorities should adopt ways of assessing the real need before setting adaptation budget. Currently, multiple organisations are involved in the adaptation delivery process. Poor cooperation between partnering organisations is a major barrier to timely and effective service delivery. Practical guidance should be provided to improve joint working in partnership particularly across different local authorities. Besides, there are many inconsistencies and inequities in the adaptation process between local authorities, including initial referral, assessment arrangements and eligibility criteria. To ensure equal access to adaptation services across the whole country, it is important to introduce a unified national approach for housing adaptations with a minimum eligibility threshold applied in all local areas. Furthermore, delays are often found in the delivery of adaptations. Some priority systems lead to faster processing of urgent cases. However, a reasonable maximum waiting time should be set even for non-urgent applicants. Finally, although performance management is widely adopted, different monitoring methods and a variety of performance indicators are used in different local authorities. A standard framework in this regard will be useful in driving up overall performance of adaptation service delivery.