Older People s Housing Plan 2013-2018. Enabling Independence

Older People s Housing Plan 2013-2018 Enabling Independence

Index 1. Introduction 2. National Context 3. Local Context 4. Consultation 5. Housing and Support Options for Older People Universal Solutions 5.1. Floating Support 5.2. Dorset Home Service Home Improvement Agency 6. Housing and Support Options for Older People Extra Care Housing 7. Housing and Support Options for Older People Sheltered Housing 8. Diversity 9. Action Plan Page 1

1. Introduction 1.1. Plan Development The Dorset County Council Housing & Support Services: Commissioning Strategy 2013-2018 sets out an overarching vision for supported housing services in Dorset. This plan focuses on the delivery of services for older people. The development of this plan is taking place during a period of unprecedented reduction in public expenditure. However, the majority of savings needed in expenditure on older people s housing services have been made and this plan focuses on the development of services taking account of best practice and aims to result in the continued provision of cost effective and high quality services for service users. 1.2. Definition of Older People The Department of Health website states:... old age... according to different interpretations, includes people as young as 50, or from the official retirement ages of 60 for women and 65 for men. [Many of] these people are active and independent and many remain so into late old age. The goals of health and social care policy are to promote and extend healthy active life and to compress morbidity (the period of life before death spent in frailty and dependency). The services considered in this plan are generally available to people aged over 50 years on the basis of need. Some accommodation based services are governed by planning restrictions which limit occupation to people aged over a certain age. 1.3. Abbreviations The following abbreviations have been used throughout this document. ADASS: Association of Directors of Adult Social Services BME: Black and Minority Ethnic (an ethnic group forming part of the population) CIL: Centre for Independent Living DCC: Dorset County Council; DCLG: Department for Communities and Local Government DFG: Disabled Facilities Grant DILS: Dorset Independent Living Service (proposed service) DH: Department of Health DWP: Department for Work and Pensions EAC: Elderly Accommodation Council HIA: Home Improvement Agency HMA: Housing Market Assessment ILC-UK: International Longevity Centre United Kingdom Page 2

LIN: Learning and Improvement Network LSVT: Large Scale Voluntary Transfer (the transfer of housing stock from a Council to a housing association) MW: Migrant Worker ONS: Office for National Statistics PCT: Primary Care Trust POPP: Partnership for Older People s Project SAIL: Safe and Independent Living SHMA: Strategic Housing Market Assessment SP: Supporting People 1.4. The aim of the plan To ensure older people have access to a range of housing options and housing related services that enable them to remain independent and to lead a full and active life. To help to achieve this the following priorities have been identified: The need to provide high quality information and advice services for older people The provision of decent, accessible, warm and safe homes for older people Promoting independence Increasing housing choice Services are generally available to all older people however provision is based on need. For instance, housing association sheltered housing is generally not available to owner occupiers who have the option of purchasing private sector sheltered housing. 1.5. Key commissioning principles The Housing and Support Strategy for Dorset, 2012 to 2015, which was published in autumn 2011 set out a number of key commissioning principles for accommodation based services: Services should not be commissioned in isolation, but should form part of a whole system approach. Service models and contract arrangements should be designed in such a way as to increase service users choice and control. Service models should be sufficiently flexible and dynamic, offering genuine pathways to greater independence Service users must be involved in decisions about their services A positive relationship with the provider sector is of the highest importance Where both care services and housing related support services form part of a service, they should be commissioned together Services must achieve good outcomes for service users Page 3

Services should make maximum use of opportunities to engage with the voluntary and community sector. Procurement methods should be flexible enough to ensure the best possible outcome is achieved at best possible value The approach to savings should be strategic not based on across the board cuts Dialogue should be maintained with neighbouring authorities These principles have informed this plan. 2. National Context 2.1. The Coalition Government recognises the impact of an ageing population and appears to want a coherent and integrated approach to: Engaging older people as partners and putting decision-making directly in the hands of older people, for example through personalisation. Ensuring that preventative interventions are available that relate to all aspects of older people s lives. This involves developing a strategic approach to older people s services that goes beyond health and social care. Recognising the contribution that older people can make to society, and the need for a focus on quality of life and well-being. Ensuring that all older people are able to contribute to and be part of society by addressing issues of social exclusion amongst older people. 2.2. The Government s, October 2010, Comprehensive Spending Review (CSR) set out significant changes to the way services will be planned and delivered: Funding for Local Government has been reduced with year on year reductions estimated to total approximately 26% by the end of the 4 year period. Most of the Local Government funding no longer has a ring fenced element. A significant amount of regulation of the public sector has been removed. This includes planning targets, performance indicators and the role of the Audit Commission. The CSR identified an additional 2 billion via DCLG and DH to support an integrated approach to the planning and delivery of preventative services with specific mention of re-enablement services and assistive technology. The Supporting People budget was set at over 6 billion which represented a stand still position. However, it was confirmed that Support People grant would now form part of the Formula Grant and would not be ring fenced. 2.3. The Localism Act 2011 Has made a number of changes: There will be a significant shift in decision making with Local Authorities taking greater control of planning and housing development. Local communities will also have a greater right to challenge decisions and to bid for control of local amenities and services There are significant changes to the way new housing is developed in the future. The Government aims to increase housing supply by reforming the planning system. In Page 4

addition, it introduced a New Homes Bonus that directly rewards and incentivises local authorities and local communities to be supportive of housing growth. New intermediate rental contracts have been introduced for social housing that are more flexible, at rent levels between current market and social rents (80% of market rents). They are known as Affordable Rents. The increased rental income is intended to stimulate investment from housing providers who will be expected to commit more of their own resources to development. This is likely to be the main vehicle for future development of rented accommodation There is a new community right to build giving communities the right to build homes and amenities, without planning permission in some circumstances Local Authorities are able to adjust their waiting list criteria to make best use of the stock There is a Plain English Guide to the Localism Act 2011 at: http://www.communities.gov.uk/publications/localgovernment/localismplainenglishupdate 2.4. Housing Benefit Policy Welfare Reform The government is looking to reduce the overall cost to the exchequer of welfare benefits. The Welfare Reform Act 2012 will replace a range of benefits with Universal Credit. The stated aim of simplifying things is laudable; however, many older people will be looking to support providers to help navigate an unfamiliar system at a time when providers are facing significant cuts in funding. The main elements of the Welfare Reforms are: The introduction of Universal Credit to provide a single streamlined payment replacing income-based jobseekers allowance, income-based employment and support allowance, income support, child tax credits, working tax credits and housing benefit Housing benefit payments for claimants of working age being related to the size of the property, with payment reduced for those under-occupying. The bedroom tax. Limiting the level of Local Housing Allowance payable for different sizes of property, making least expensive 30% of properties for rent in any area now affordable for people making a new claim Reforms to the Discretionary Social Fund (DSF) scheme. In Dorset it has been replaced by the Emergency Local Assistance. Information at: http://www.dorsetforyou.com/emergencygrants Introduction of a cap on the total amount of benefit that working age people can receive Introduction of a new benefit called Personal Independence Payment (PIP) to replace Disability Living Allowance (DLA) for eligible working age people aged 16 to 64 Council tax benefit will be abolished and replaced by a system of localised support called the Local Council Tax Support scheme. However, the changes also mean that help paying for an extra bedroom is available for people needing a carer providing overnight care Whilst changes generally exclude people of over state retirement age some younger people living in sheltered or extra care housing will be affected. Page 5

2.5. Health and Social Care Act 2012 The Act sets out the government s vision for the National Health Service: A new structure for delivering health through groups of GP practices - Clinical Commissioning Groups (CCGs). In Dorset this is Dorset CCG. Primary Care Trusts have been abolished Strategic planning responsibility for public health to transferred Local Authorities through the creation of Health and Well-being Boards and transfer of the Public health function The further development of personalisation Greater integrated planning and service delivery between Adult Social Services and Health Prevention is seen as a key theme 2.6. Putting People First The Putting People First compact had a cross government goal of delivering choice and a personalised approach to promoting independence, enabling and supporting for both active and vulnerable older people in the community. This was the main driver of personalisation. The coalition government explicitly supports this approach and in November 2010 the DH published further details in: Vision for Adult Social Care Capable Communities and Active Citizens. In January 2011, 21 organisations including the Department of Health, the Association of Directors of Adult Social Services and the National Housing Federation signed up to a new sector agreement called Think Local, Act Personal that is intended to move the delivery of personalisation forward 2.7. Living well with Dementia: National Dementia Strategy The Strategy, published by the Department of Health in 2009, sets out an approach to one of the consequences of an ageing population and considers a range of options. Subsequently two implementation plans have been published. The most recent, Quality Outcomes for People with Dementia; builds on the work of the National Dementia Strategy and was published by the Department of Health in September 2010. 2.8. Housing Green Paper: Homes for the future: more affordable, more sustainable Published in July 2007. This has a specific section on housing for an ageing population which states that older people will make up 48% of all new growth in households to 2024, and a substantial majority of new households in many regions will be over 65. It makes it clear that new housing and infrastructure should reflect this demographic change, and that planning authorities should consider the housing requirements of older people. Page 6

2.9. Lifetime Homes, Lifetime Neighbourhoods: A National Strategy for Housing for an Ageing Society (CLG, DH and DWP, 2008) Sets out the government s vision for meeting the growing housing demands of an ageing population and ways to meet the changing lifestyle needs and aspirations of current and future generations of older people. It focuses on giving older people greater choice and addressing the challenges of an ageing population. It makes a number of recommendations for a more explicit housing offer for older people built around: Better information about housing options, and advice about staying at home services or moving to specialist accommodation such as extra care Further development of preventative services including property services such as handyperson services and home improvement agencies Equity release products More robust market information and a stronger role for planning Improved strategic analysis on accommodation with care solutions for older people across all tenures A new future for specialist housing, through a wider range of both housing, service and tenure choices, beyond residential and nursing home care 2.10. A Housing Strategy for England (DCLG, 2011) Addresses the challenge of an ageing population in relation to housing policy. The strategy sets out a new deal for older people s housing, with a better offer to support older people to live independently for longer. Key messages from the strategy are that: Some 60% of projected growth in households to 2033 will be aged 65+. Good housing for older people can reduce caring pressures on working families. It can also prevent costs to the National Health Service and social care providers. Attractive choices to move to smaller, more suitable homes can free up much-needed local family housing. The main elements of the new deal are: Enabling older people to make an informed choice about their housing and care in later life, through a 1.5m investment in the FirstStop information and advice service Protecting funding for DFGs, with the national allocation due to increase from 169m in 2010/11 to 185m in 2014/5. This funding is not ring fenced. Help for small repairs through 51m funding for handyperson schemes between 2011-15. This funding is not ring fenced. Work to help extend the reach of HIA services and to ensure that the Green Deal works for older people Stimulating the development of attractive equity release products Page 7

Encouraging local authorities to make provision for a wide range of housing types across all tenures, including accessible and adaptable general-needs retirement housing, and specialised housing options including sheltered and ExtraCare housing for older people with support and care needs Continued promotion of Lifetime Homes standards Promotion of innovative solutions such as Homeshare (matching someone who needs some companionship or a little help to carry on living in their own home, with someone who is willing to give a little help and needs accommodation) Promoting Lifetime Neighbourhoods 2.11. Improving housing with care choices for older people: an evaluation of extra care housing Published by Personal Social Services Research Unit (PSSRU) and Housing Learning and Improvement Network (LIN), November 2011. This report sets out findings of a Department of Health (DH) funded evaluation by PSSRU of 19 extra care schemes that received capital funding from the DH Extra Care Housing Fund and opened between April 2006 and November 2008. The key findings were: Delivering person centred outcomes: o o o o Outcomes were generally very positive, with most people reporting a good quality of life Of those who were still alive at the end of the study over 90% remained living in their extra care scheme For most people physical functional ability appeared to improve or remain stable for the first 18 months after they moved in, and more than half had either improved or remained stable by 30 months Cognitive functioning remained stable for the majority, but at 30 months a larger proportion had improved rather than had deteriorated Costs and cost-effectiveness: o Costs varied according to the level of physical and cognitive impairment o Combining care and housing management arrangements were associated with lower costs o When matched with a group of equivalent people moving into residential care, costs were the same or lower in extra care housing o Better outcomes and similar or lower costs indicate that extra care housing appears to be a cost effective alternative for people who have the same characteristics who currently move into residential care Improving choice: o People had generally made a positive choice to move into extra care housing o Alternative forms of housing such as extra care are seen as providing a means of encouraging downsizing Page 8

o Levels of supply of extra care as an alternative to residential care are low thereby limiting choice for older people o Funding of extra care housing is complex and particularly in the current financial climate it is important that incentives that deliver a cost effective return on investment in local care economies are in place if this is to be a viable option for older people in the future More capital investment and further development of marketing strategies was needed if extra care housing was to be made more available and more appealing to more able residents. 2.12. SHOP: Strategic Housing for Older People Published by ADASS and Housing LIN, December 2011 and refined in April 2013. This strategic housing for Older People Toolkit provides a framework for addressing the housing demand and supply challenges for an increasingly ageing population. Key messages are: The way we have thought about, designed and funded housing for older people has to change Housing and care solutions need to be much more positive and attractive than those that have been seen as appropriate in the past Predicting demand is complex, but we know that whilst there is a clear preference by older people to remain in their family home, many older people contemplate a move to alternative accommodation, although few people wish that to be residential care The wish to move and preference for where to move to is heavily influenced by what is available and suitable. Show attractive and affordable alternatives that match peoples desires and they are much more likely to opt for change. For example, in the Netherlands where there is a wider choice of specialist accommodation, the numbers wishing to move to alternative accommodation is greater than the UK. The numbers of people wishing to remain in their family home may be heavily influenced by limited choice rather than by a real preference SHOP identifies two main approaches to projecting future demand: Care home demand. The SHOP report suggests that at least one third of residents could have been diverted to other more appropriate forms of housing with care, such as extra care, and possibly up to two thirds if appropriate information and advice had been available Population data. There is a range of other recent information and guidance available on the Housing LIN website (www.housinglin.org.uk). 2.13. Supporting People service - Value For Money studies It is now well-established that investment in specialist housing and housing-related support services delivers significant savings in public sector spending. Both capital investment for specialist housing and revenue funding for housing-related support services contribute to efficiencies across public sector services, particularly in health and social care and the criminal justice system. A number of recent reports have demonstrated the value of this investment. Page 9

These comprise: The CapGemini Study Commissioned by DCLG. It concluded that every one pound spent on the Supporting People programme across England saved 2.11. The Frontier Economics Study Commissioned by the Homes and Communities Agency. The report concluded that investment in specialist housing results in a net financial benefit for all client groups except those relating to young people ( however, a known limitation of the modelling is that it does not capture the longer-term (ongoing) benefits that young people receive after they leave specialist housing, but which could be attributed to the specialist housing intervention). The largest single benefit is estimated for the older people client group. Promoting Independence: The Value of Housing-Related Support. This Department of Health published paper opens by stating that Unsuitable housing or a lack of suitable housing related support can lead to an escalation in care needs and can contribute to trigger events that can result in admission to hospital or reduce the individual s confidence that they can live safely in the community. Further information is contained the Dorset County Council Housing & Support Services: Commissioning Strategy 2013-2018. 2.14. Social Care White Paper Caring for our future The white paper was published on 11 th July 2012. It included the announcement of a new Care and Support Housing Fund to provide 200m of capital funding over five years from 2013-14 to encourage providers to develop new accommodation options for older people and disabled adults. According the Department of Health, the draft Care and Support Bill will: Modernise care and support law so that the system is built around people s needs and what they want to achieve in their lives; Clarify entitlements to care and support to give people a better understanding of what is on offer, help them plan for the future and ensure they know where to go for help when they need it; Support the broader needs of local communities as a whole, by giving them access to information and advice, and promoting prevention and earlier intervention to reduce dependency, rather than just meeting existing needs; Simplify the care and support system and processes to provide the freedom and flexibility needed by local authorities and care professionals to innovate and achieve better results for people; and Consolidate existing legislation, replacing law in a dozen Acts which still date back to the 1940s with a single, clear statute, supported by new regulations and a single bank of statutory guidance The draft Bill will therefore include the following key provisions: New statutory principles which embed the promotion of individual wellbeing as the Page 10

driving force underpinning the provision of care and support; Population-level duties on local authorities to provide information and advice, prevention services, and shape the market for care and support services. These will be supported by duties to promote co-operation and integration to improve the way organisations work together; Clear legal entitlements to care and support, including giving carers a right to support for the first time to put them on the same footing as the people for whom they care; Set out in law that everyone, including carers, should have a personal budget as part of their care and support plan, and give people the right to ask for this to be made as a direct payment; New duties to ensure that no-one s care and support is interrupted when they move home from one local authority area to another; and A new statutory framework for adult safeguarding, setting out the responsibilities of local authorities and 3. Local Context 3.1. Dorset County Council (DCC) s Corporate Plan 2011-2014 Includes the objective to provide housing accommodation with support and advice, to maintain or develop independence for vulnerable households. 3.2. Finance DCC s Cabinet has reviewed all County Council budgets in order to make the savings necessary to meet the requirements of the Government for public sector spending reductions. The Supporting People budget was cut, with expenditure in 2013/14 reduced by 1.9m pa. It was agreed by Supporting People Commissioning Group in February 2011 that funding for Older People s services would be cut by 23% compared to the 2008/9 funding. However, as a result of funding received from other sources including District and Borough Councils the net reduction in expenditure is 19.2%. In 2010/11 expenditure on older people s services was budgeted at 2,586,000. The 2013/14 budget is 2,089,263. Savings have been mainly been achieved by the remodelling sheltered housing and extra care services. This work commenced in 2011 and should be completed by September 2013. 3.3. Dorset Housing and Support Commissioning Strategy 2013-2018 The strategy is designed to support those national drivers outlined in section 2, whilst meeting DCC s and partners specific local needs. The Strategy sets out the aims and objectives of DCC and the Dorset Supporting People Partnership. A key task of the Partnership is to achieve the best possible value from the earmarked budget, made available mainly by Dorset County Council, for the purpose of purchasing housing-related support services. It also seeks to respond to the rapidly changing environment in which public sector health, housing, support and care services are provided and commissioned. It is an overarching strategy, setting the framework for a number of existing or emerging Page 11

client group based housing and support strategies, including this one. As an overarching strategy it focuses on issues common to all client-groups. The strategy seeks to address the short-term goal of delivering the necessary efficiency savings but also to take a longer term view on transforming the delivery of housing and support services. The strategy is aligned with other county-wide strategies such as the Move-On Strategy, Domestic Violence Strategy and Homelessness Strategy as well as district and boroughs own housing strategies. A number of Housing Plans, including this one, flow from this strategy. 3.4. Ageing Well in Dorset. Published by Dorset County Council, 2009 Dorset County Council is working with partners including NHS Dorset and voluntary organisations to support people to stay healthy and independent for as long as possible and lead full and active lives. During 2009 over 4000 older people took part in an consultation exercise which asked them what they thought they needed to help them to achieve a healthy and active older age and what currently prevented them from doing this. The consultation found that older citizens in Dorset want to: Feel secure and safe Feel free from discrimination Be socially integrated and not isolated Make a positive contribution and experience fulfilment as a result Have dignity, choice and control throughout their life Be in good health in mind and body Have housing suitable for individual needs Feel financially secure Representatives from the county council, NHS, district councils, the third sector and older people are working collectively to using the information collected to support older people to live healthy independent lives and to promote positive attitudes towards ageing. This work is called Ageing Well in Dorset. 3.5. Dorset Strategic Housing Market Assessment In 2011 the Bournemouth, Dorset and Poole Strategic Housing Group appointed Justin Gardner Consulting to undertake a refresh of the 2008 Strategic Housing Market Assessment (SHMA) for the Bournemouth/Poole and Dorchester/Weymouth Housing Market Areas (HMAs). The review involved detailed analysis of secondary data, including updating the 2007 Housing Needs Survey. The consultants also undertook new research including interviews with Estate and Lettings Agents and other housing stakeholders across the County to get a picture of the current housing market. Population and household projections that fed into the analysis were prepared by the Local Authorities. Bournemouth/Poole HMA It was estimated that in 2011 there were 587,019 people resident in the HMA. The age profile of the population is heavily focussed towards older age groups with an estimated 11.5% of the population of the HMA being aged 75 and over (compared with 8% nationally) Page 12

and 17.7% aged between 60 and 74 (compared with 14.6% nationally. Since the 2007 SHMA was carried out there has been a significant downturn in the national and local property market with a decline in both house prices and the number of sales made. Although prices have decreased the increases in private sector rent levels are likely to mean that affordability pressures have not eased to any degree due to the market downturn. It is estimated that around 26% of households across the HMA cannot afford housing at current market prices/rents without the need for some form of subsidy. Across the HMA it is estimated that there is an annual need to provide 8,350 additional units of affordable housing per annum if all needs are to be met (in the five year period from 2011 to 2016). West and Weymouth HMA It is estimated that in 2011 there were 166,177 people resident in the HMA (100,313 in West Dorset and 65,864 in Weymouth and Portland). The data suggests that the population profile in the HMA varies markedly from the national profile with a relatively small population aged 15 to 29 (and also 30-44) and large proportions in older age bands. In particular it is estimated that 12.3% of the population of the HMA is aged 75 and over (compared with 8% nationally) whilst 20.8% are aged between 60 and 74 (compared with 14.6% nationally). The data for the Dorchester/Weymouth HMA closely mirrors the experience found nationally. Prices showed strong growth up until the third quarter of 2007 and then levelled off to the second quarter of 2008. Prices then showed a sharp drop before recovering in late 2009 and through 2010. By the first quarter of 2011 the average price in the HMA was recorded at 209,000 still 7% below the highest quarter 1 figure (in 2008). In the private rented sector the information available suggested that rental cost difference did not vary as much as prices. The figure indicates that entry-level rents in the HMA range from 450 per month for a one bedroom home in Weymouth and Portland up to 950 per month for a four bedroom property in West Dorset. Rents in Weymouth and Portland are notably lower than in West Dorset for all sizes of accommodation. Overall the data suggests that 25.4% of households in the HMA would not be able to afford market housing (without some form of subsidy) if they were to move home now. The Future Housing Market Macro-economic factors are expected to influence effective market demand for housing in the short-term. These include mortgage finance, market confidence, short-term employment growth, and pressures on household incomes. Market demand is expected to be subdued and can be expected to impact on housing completions. While this can be expected to increase need and demand within the rented tenures, supply is unlikely to respond to the demand drivers in the short-term given the investment-led model for the private rented sector and the funding model and constraints in the affordable housing sector. As a result the housing market is expected to be dysfunctional. 3.6. Diversity The County Council serves a diverse population. This plan recognises that the County Council and service providers must ensure that: Everyone should have access to the resources and facilities which the County Council commissions Full account is taken of people s views and expectations when designing and delivering services Page 13

Resources are distributed in such a way as to ensure that equality of access and opportunity is maintained as a priority and a right The County Council will, when necessary, will target delivery of services to individuals and groups. See also Section 9 of this plan. 3.7. Previous Older People s Strategies This plan builds on and replaced the following strategies: Sheltered Housing Strategy for Dorset, 2006-9 Extra Care Strategy for Dorset, 2007-10 Home Improvement Agency Strategy for Dorset, Older People s Housing - Service Development Strategy, 2011 3.8. Demographics Numbers of older people are projected to increase significantly. In the UK, the number of people aged over 65 is projected to rise from 10.1 million to 16.7 million over the next 25 years. In 2008, there were 1.3 million people in the UK aged 85 and over. This number is projected to more than double to 3.3 million by 2033. People aged 85 and over are more likely to have care and support needs, reflecting the greater frailty and higher prevalence of dementia in this age group. At the same time as numbers increase, older people s social and housing expectations are changing. For example, there are far higher levels of owner occupation now amongst older people than was the case when much of our sheltered housing was first built. In addition, older people, as with the rest of the population, have higher expectations of independence, choice and control over their lives. Housing will need to accommodate older people with these aspirations, but also be able to offer care and support as people age and become frailer. (Source: Making Best Use of our Sheltered Housing Asset, Housing LIN Briefing Paper 3, 2012) Dorset is an average sized County at 2,542 square km, but is among the smallest counties in England in terms of population, 412,900. It has a relatively sparse population, 162.5 persons per sq km. As a result it is important to ensure that services are rural proofed and available the people no matter where they live. (Source: dorsetforyou/census-2011) Dorset s Population The population of England and Wales increased by 7.8% between 2001 and 2011. The increase in Dorset was 5.6%. However, this masks changes in individual parts of Dorset ranging from 1.4% in Purbeck to 10.8% in North Dorset. The figures from the 2011 census are given below: Page 14

Total Population 2001 2011 Change from 2001-2011 % growth 2001-2011 England and Wales South West Region Bournemouth UA 52,041,900 56,075,900 4,034,000 7.8 4,928,500 5,288,900 360,500 7.3 163,400 183,500 20,100 12.3 Poole UA 138,300 147,600 9,300 6.7 DCC Dorset 391,000 412,900 21,900 5.6 Christchurch 44,900 47,700 2,800 6.2 East Dorset 83,800 87,200 3,400 4.1 North Dorset 61,900 68,600 6,700 10.8 Purbeck 44,400 45,000 600 1.4 West Dorset 92,400 99,300 6,900 7.5 Weymouth & Portland 63,700 65,200 1,600 2.4 Over 65s represent a significant sector of the Dorset population. Population Over 65 population (rounded) Percentage aged over 65 Dorset County 412,900 104,100 25.2% Christchurch Borough 47,700 14,100 29.5% East Dorset District 87,200 24,300 27.8% North Dorset District 68,600 14,800 21.5% Purbeck District 45,000 10,800 24.0% West Dorset 99,300 26,300 26.4% Weymouth and Portland Borough 65,200 13,600 20.8% Page 15

Of people aged over 65 living in Dorset 13.6% live in Christchurch Borough, 23.5% in East Dorset District, 14.3% in North Dorset District, 10.3% in Purbeck District, 25.3% in West Dorset District and 13.1% in Weymouth and Portland Borough. There is an over representation of all 50+ age groups in Dorset, whilst the age groups 20-39 years are significantly under-represented. Dorset has, for several decades, had a relatively high proportion of older people. However, the low proportion of younger adults is a more recent change. This is partly due to the lack of a higher education establishment in the County and partly due a decline in birth rates, seen across the country. Dorset has a particularly high proportion of older people. Over 29% are over the retirement age (65+ males/60+ females) compared with just 19.5% across England & Wales. The population pyramids below shows the age structure of Dorset s population compared with that of England & Wales. The wavy black line indicates the situation in England and Wales as a whole, demonstrating, for instance, that Dorset has far more 60-64 years olds than the national average. In summary: Dorset CC has the highest percentage of older people of the 16 South West counties and unitaries, and the lowest percentage of working age people. Christchurch has the highest percentage (29.5%) of people aged over 65 of any district in England. The number of older people living in Dorset is expected to increase, but particularly critical will be the growing number of people living to an advanced old age, largely due to continuing gains in life expectancy. The table below is based upon projections provided by the Office for National Statistics and shows that all three of the age bands of older people are expected to increase over the next Page 16

more than doubled since 2008. This will have a major impact on the future provision of services in the County due to the increased vulnerability associated with this older age group. Projected number of older people in Dorset, 2008-2033 (Source: ONS 2008 based projections) Life Expectancy varies across the county and tends to be lower in relatively deprived areas: Male life expectancy in the area ranges from 78.1 in Bournemouth to 81.2 in East Dorset; all above the England figure (77.9, SW 79). East Dorset, North Dorset and Purbeck have, respectively, the 1 st, 2 nd, and 3 rd highest male life expectancies in the region. Female life expectancy in the area ranges from 82.2 in Bournemouth to 85.1 in East Dorset; also all above the England figure (82, SW 83.1). East Dorset, Christchurch and North Dorset have, respectively, the 1 st, 2 nd, and 3 rd highest female life expectancies in the region. (Source: Office for National Statistics - Life Expectancy at Birth 3-year rolling average 2006-08) Dorset is expecting to see a higher than average increases in older people over the next twenty years with the number of people over 85 doubling. West Dorset is expected to have the highest proportion of older people (almost 41%) and even the area with the lowest proportion of older people (Weymouth & Portland, 33%) still has significantly higher proportion than the England average (23%). Other drivers of demand for supported housing such as deprivation and the number of older people living alone will also affect parts of Dorset. Weymouth & Portland falls in the top quintile for both these indicators. Local survey data from 2008 has been used to quantify the self reported housing need of older people and this have been mapped compared to the proportion of the older people in Page 17

each area. The highest current needs are dispersed across Dorset and include urban and rural areas. The need for aids and adaptations is most acute in parts of North Dorset and Purbeck, although as this is self reported data, respondents knowledge of this type of support will affect their responses. A look at current activity has highlighted that the majority of older people live in mainstream housing and own their homes outright. Page 18

There are parts of Dorset where residential and nursing care falls below both local and national average and Purbeck currently has the lowest level of provision. Across Dorset there is a lack of specialist dementia care when compared with national rates. The relatively low level of residential care beds in much of the area demonstrates a relative lack of provision but is positive in as much as it suggests a lack of demand for this form of provision and a reliance on other less institutional forms of provision. Christchurch has the highest current level of sheltered housing possibly due to the high number of older people already resident here. There are lower numbers in Purbeck and East Dorset and this may be due to the level of affluence in these areas. However, there is a general feeling that this type of housing can sometimes be hard to let to older people and this may be due to the age of these properties. Level of Sheltered Housing Provision by Population 100 Ratio per 1,000 of people aged 65+ 90 80 70 60 50 40 30 20 60 60 81 85 85 88 10 0 East Dorset Purbeck North Dorset Weymouth and Portland West Dorset Christchurch District / Borough More data is needed to understand the level of provision in terms of cost and usage for lower level support services such as housing improvement agencies, aids and adaptations, Page 19

and assistive technology. Currently there are gaps in our knowledge of who is receiving what services, at what cost and where, and these services all aim to reduce the demand for more intensive support. Models have been used to project forward the potential needs for some services and although there are limitations with this approach and the definitions are not clear, it gives a basis for a discussion as to what provision will be needed in the future. Comparing Estimates of Future Provision 9,000 8,000 Charteris SHMA 8,271 7,000 6,000 5,000 Count 4,000 3,000 2,000 1,326 1,265 1,853 1,000 0 337 356 107-1,000-369 Residential and Nursing Domiciliary Care Sheltered Housing Extra Care Housing Ordinary Accommodation Type The new analysis tool produced by the Housing Learning and Improvement Network (LIN) is a more recent example modelling for future provision and can be found at: http://www.housinglin.org.uk/topics/browse/housingextracare/extracarestrategy/shop/s HOPv2/ Its use is proposed in section 7. 3.9. Dementia There are 800,000 people with dementia in the UK at present and this is expected to rise to 1 million by 2021. The Alzheimer s Society estimates that dementia costs the UK 23bn per annum, with 8bn of that cost hidden by the work done by family carers supporting people at home. [Source: Alzheimers Society Factsheet, 2013] In recent years there has been an improved our understanding of what it means to live with dementia and the ways in which people can be supported to continue living independently with the condition. Dementia is now firmly established as a priority for action in the UK. In 2009, the Department of Health published Living Well with Dementia, the national dementia strategy, which set out proposals for raising awareness of dementia, improving dementia care and encouraging early diagnosis. In March 2012, the Prime Minister set out the challenge on dementia, which aims to push progress on all the areas identified in the strategy by 2015. However, our awareness needs to move beyond the scale of the challenge to understanding different ways to meet these growing needs. People with dementia are currently occupying 40% of general hospital beds. [Source: Department of Health (2010), Quality outcomes for people with dementia: building Page 20

on the work of the National Dementia Strategy] Good housing and related services can impact positively on the lives of people with dementia: reduce or delay demand for health and social care services for people with dementia preventing admission and readmission to hospital improve the rate of diagnosis of dementia delivering improved health and social care outcomes at a lower cost. It is proposed that: Local authorities, housing providers, home improvement agencies, public health and NHS Trusts work in partnership to develop support services for people with dementia. These agencies can build on existing resources such as specialist housing and frontline support services to maximise opportunities for diagnosis and early intervention. [This section is based on the report, Dementia, Finding Housing Solutions, published by the National Housing Federation, 2013] 4. Consultation 4.1. The development of this plan was coordinated by the Older People s Housing Strategy Group. This plan has been developed in consultation with: Older People Service Users Dorset Partnership for Older People's Project (POPP) Dorset Age Partnership Area Groups Magna Housing association Independent Living Tenants Group Providers Housing Authorities Older Peoples Housing Provider Engagement Group 4.2. The first draft of the plan was produced in August 2012. The first phase of consultation took place in Autumn 2102 and involved the Older Peoples Housing Strategy Group. 4.3. A second draft was produced which was subject to a four month consultation period between 1 st January and 30 th April 2013. During this time the draft plan was considered by the 6 area groups of the Dorset Age Partnership. The draft plan was also uploaded to the Dorset Consultation Tracker. Page 21

Sixteen substantive responses were received during the consultation meeting. A summary of the responses is available on the Dorset for You website by searching for Dorset Supporting People and clicking through. The draft plan was then approved with amendments by Older Peoples Housing Strategy Group on 4 th June 2013. The Action Plan was approved by the Group on 10 th September 2013. 5. Housing and Support Options for Older People Universal Solutions Solutions available to all older people. 5.1. This plan focuses on services funded by the County Council. A number of private sector companies specialize in providing accommodation for older people. McCarthy and Stone is one of the larger providers of such accommodation. They offer Later Life accommodation roughly equivalent to sheltered housing and Assisted Living schemes roughly equivalent to extra care accommodation. A number of other providers provide similar services. Details of services in each area can be found on the Housing Care website: http://www.housingcare.org/ It is planned to: Map private sector provision Develop working relationships with private sector providers 5.2. Floating Support 5.2.1. Floating Support is provided to the individual and is not tied to the property they occupy. A stakeholder meeting in November 2011 considered universal services available to all older people. The meeting noted that: The generic floating support service is limited to people aged under 65 unless they have dual diagnosis, for instance they are over 65 and have a learning disability There had been a lack of take up of the floating support available, at that time, as part of the LSVT Sheltered Housing Contract with only around 60 service users across the county, with 40 of these in North Dorset. Promotion of the service has been hampered by the fact that only excess hours (after the needs of sheltered housing residents have been met) are available and providers have had concerns that these hours are hard to predict. A older people s floating support service had operated for some time in Poole, by East Boro Housing Trust. The service had a caseload of c100 service users and cost almost 250,000 per annum. It has been closed by Borough of Poole as part of recent cuts. It is anticipated that a similar sized service in Dorset would cost significantly more due to increased travelling. However, it was noted that there were a number of complementary services providing floating support to older people in Dorset: Careline Services it is estimated that 10,000 households in Dorset have lifeline telephones with a further 5000 households living in sheltered housing. Generic Housing Floating Support Service available to older people with an additional Page 22

need for, instance, learning disability or mental health issues. Home Improvement Agency. Handled over 3850 enquiries in 2011/12 which resulted in one or more visits to over 1500 homes. Partnership for Older Peoples Projects (POPPS). Have 54 paid part time Wayfinders providing signposting and support. An estimated 60,000 contacts per year. Housing Authority housing advice services Housing Association housing management services Independent Living Centres and the future Centres for Independent Living (CILs) Citizens Advice Bureaux Safe and Independent Living (SAIL) Age UK Other Big Society services included Parish Responders and Church Groups It was considered that these services provide a safety net for older people. 5.2.2. FirstStop Advice is an independent, free service offering advice and information for older people, their families and carers about housing and care options in later life. It is led by the charity Elderly Accommodation Counsel (EAC) working in partnership with other national and local organisations. The service spans housing, care, finance and rights and is delivered through a website, a telephone Advice Line and a network of local and specialist partner organisations. FirstStop aims: to provide clear and independent information and advice on care and housing for older people; to be a sustainable service for the long term, supported equally by charitable funders, Government and commercial organisations; to grow in partnership with local services to provide an accessible service to all older people, their families and carers. 5.3. The Dorset Home Service Home Improvement Agency 5.3.1. Foundations, the national body supporting HIAs, has carried out research into the value of HIA services. This concludes that it is much less expensive for people to be supported by HIAs and other support providers to live at home than to be looked after in an institutional care setting. Research carried out for the Department of Communities and Local Government on the financial benefits of the housing support services found that expenditure of 97.3m on housing support services (including, but not wholly, HIA services) saved 725.3m (the cost of residential or hospital care avoided by providing housing support services to people in their own homes). (Source: Cap Gemini (2009), Research into the financial benefits of the Supporting People Page 23

programme.) Dorset s investment of around 450,000 in HIA services results in a net benefit of 3m. This is based on the assumption that a significant number of people would need residential packages if they were unable to access this service which enables them to remain at home. (Source: Papers prepared for Dorset SP Commissioning Group using the Cap Gemini benefit realisation tool, November 2009.) Providing HIA services is cost effective. For instance: Postponing entry into residential care by just one year through adapting people s homes saves 28,080 per person The average cost of a major housing adaptation is 6,396 and has an average life of at least five years A fall at home that leads to a hip fracture costs the state 28,665 on average ( 726 million a year in total). This is 4.5 times the average cost of a major housing adaptation and over 100 times the cost of fitting hand and grabs rails to prevent falls Housing adaptations reduce the need for daily visits and reduce or remove costs of home care (savings range from 1,200 to 29,000 a year) A hospital discharge service speeds up a patient s release from hospital by installing items such as a key safe, grab rail and securing loose carpets to prevent falls. This creates savings of 120 a day the amount charged to a local authority when patients block beds in hospital. (Source: Handypersons Evaluation, Published by the Department of Communities and Local Government, February 2011.) The value of HIA services is also demonstrated by the anecdotal evidence provided by service users: Mrs V, 81. Mrs V is a regular user of her local HIA handyperson service. She has lived on her own since her husband died, who she nursed through Alzheimer's disease. Mrs V s house had fallen into disrepair. Her husband carried out repair work, but after he became ill was unable to do this and couldn t cope with strangers in their home. Jobs the handyperson carried out included fitting a new toilet seat, fitting a bathroom mirror, repairing a drawer, and mending a chair. Mrs V says: "It's the little things that get on top of you. Finding out about the HIA has given me independence and a lack of worry. It's like having a friend come. It's not just about the handyperson being able to carry out the physical work but also being able to relate to people as well. Lots of people are prisoners in their own homes and care packages mean strangers coming into the house. This sort of care is more important. For example, my chair had wobbly legs and I could have fallen but now it's all fixed." (Source of anecdote: Home Improvement Agencies The key to independent living. Published by Foundations) Research into the operation of HIAs was carried out by Suzanne Bain, NHS Dorset as part of her MBA studies. Part of this research involved asking health professionals their views on HIA processes. Comments received demonstrated that in most cases the service was valued: practical, pragmatic, time focused. quite slick really, not overly bureaucratic Page 24