Making housing and dementia a national priority: fourth update from the National Housing and Dementia Forum

In our fourth and final evidence session of the National Housing and Dementia Forum, organised by the Scottish Government, Co-Chairs Ashley Campbell and Lesley Palmer summarise below the discussion from the session. If you would like to find out more about the National Housing and Dementia Forum click here.

In this session our group of expert advisors were asked to discuss:

1. What are the main reasons for moving from one type of accommodation to another in later life?
2. Are people able to make appropriate moves?

The Chairs acknowledge that the general nature of the questions was likely to invite discussion which reached beyond the remit of housing and dementia. Indeed, the conversation amongst the group captured broader themes of housing in later life, housing pathways, planning for retirement living and attitudes to ageing.

What are the main reasons for moving from one type of accommodation to another in later life?

The group discussed the many personal reasons that someone may move in later life (for example, the loss of a spouse or partner, or moving closer to a family member), but in general the reasons for moving were attributed as falling within one of three groupings:

• Suitability of the home in respect of access (to services, support, family), maintenance and upkeep, the individuals’ financial situation and their perceptions of (a lack of) security/safety.
• Compatibility of the home with the individuals’ needs (physical, cognitive, social, care etc.) acknowledging the likelihood of increased frailty, long term conditions and co-morbidities with age.
• A move in crisis. For example, to a care home because the person has been identified as being at increased risk, or to hospital due to an accident at home such as a fall. The group noted that admittance to hospital presents multiple challenges to people living with dementia and often results in greater deterioration with subsequent discharge to care. It was acknowledged that a move in crisis is rarely a positive choice and often considered the last resort.

A desire to move to be part of a community was also noted and the social housing providers within the group acknowledged that some people enlist to housing waiting lists for supported living accommodation several years in advance. Despite the incorrect assumption that the longer the person is on the list the more likely they will receive an appropriate home, the group considered this to be a positive indication of a pre-emptive approach by the individual to find suitable accommodation and plan for their future.

All agreed that further research was needed to ensure the above anecdotal evidence is accurate and based on current data.

Barriers to moving in later life were attributed to:

• Perceptions of ageing; the individuals’ disinclination to see themselves as ageing, the stigma which still surrounds getting older and specialist older persons’ housing (albeit it was noted that negative preconceptions of supported living dissipate once the individual has moved in).
• Lack of suitable or desirable housing options available within people’s existing communities and the supposition that older people want to live in smaller (1-1 ½ bedroom dwellings).
• Lack of awareness of housing options and a reduction in funding for housing support charities to provide information advice.
• The logistics of moving home and the need for project management/removal services which support people to move (e.g., organising utilities, removals etc.)

The Co-Chairs welcomed a broader discussion on housing options, preferences, and availability. The group raised issues of maintenance, poor environmental performance, and poor adaptability of Scotland’s existing (and perhaps dated) housing stock.

Additionally, the group noted there is a will to build new housing for older people within the private and social housing sectors but specialist housing for older people requires both a commitment to build and to provide care. This, it was acknowledged creates a point of discord because the housing provider is required to enter into a long-term capital commitment (of +25 years) but their care partners are only able/willing to commit to contracts of 2-3 years, thus imposing additional risk to the housing provider.

Housing models which provide care and offer 2 bedroom properties, preferably bungalows with mixed and flexible tenures in rural locations were noted as the most attractive. The group were also complimentary of intergenerational housing models as well as care village approaches which offer flexible housing and care options across tenures.

Are people able to make appropriate moves?

The ability to make an appropriate move was recognised as being contingent upon the individual having access to housing advice, them being financially able to move and there being suitable housing within their desired location. This it was felt was a challenge.

A ‘postcode and/or advice lottery’ exists across Scotland with many struggling to access the right support to help them plan or make housing decisions in their later life. The group agreed that social housing tenants are more likely to access and have access to information and advice on their future housing options than those who own their own home or are renting from the private rented sector. The individual’s financial position inevitably influences their housing options and poor financial planning for later life and/or a disconnect between the individuals’ aspirations and their bank balance means that for many, they are not able to make appropriate moves.

Additionally, and in relation to the provision of post diagnostic support (PDS) for people living with dementia, it was acknowledged that improvements in PDS housing advice are needed at a national level to ensure people living with dementia are offered meaningful, timely advice to enable them to plan for their future needs.

In summary, there was a general sense within the group that moving in later life is still considered a regressive step. The public image of ageing as a hopeless, forlorn chapter in one’s life was impacting on the nation’s willingness or ability to view positively plan housing options for their future selves.

There was also feeling of unease amongst the group in respect of the lack of financial planning for later life, incentives to save and advice available.

So, how do we address this challenge?  The panel were of the view that to reduce the stigma of ageing a national campaign to encourage people to plan, consider their housing options and seek advice (financial, legal, removals etc.) will offer a much needed and practical approach to raise awareness and encourage discussion on housing in later life.