‘Home is where the heart is’ ‘There’s no place like home’ ‘Home sweet home’
How deeply embedded in our culture this concept of ‘home’ is. Yet across the world as well as here in Scotland there are real concerns about the person living with dementia and what home means for them. While the perception is that a majority of older people and those living with dementia would express a preference to “age in place” in their own homes within their own communities; a number of medical, social and economic factors mitigate against this including being frail, living alone, becoming depressed, not owning your own home and not having the resources to carry out repairs and home modifications (Kendig, Honge Gong, Cannon & Browning, 2017). Consequently, the cost of poor housing to the NHS in the UK in 2011 was estimated at £2.5 billion and equivalent to an effect on health similar to that of smoking or alcohol (Nicol, Royce and Garret, 2015).
In 2017, we published the report ‘Being Home: Housing and Dementia in Scotland’, the first of its kind in Scotland. It was funded by the Life Changes Trust and commissioned by Angus Care and Repair supported by a housing and dementia group and written by a team here at the Alzheimer Scotland Centre for Policy and Practice at the University of the West of Scotland which included researchers and housing experts following consultation with a wide interdisciplinary project team. The key findings of the report can be downloaded from https://www.lifechangestrust.org.uk/sites/default/files/20170613%20Housing%20Dementia%20Key%20Findings%20FINAL.pdf
We found some examples of good practice in housing and dementia, in Scotland and further afield, that could be implemented and developed. Housing associations in particular lead in the development of innovative approaches, but their work in this field could be more effectively disseminated and replicated. For example the work of Viewpoint Housing at Croftspar in Glasgow is shown here.
Of particular interest was concern that much of Scotland’s housing stock has high levels of disrepair and poor energy efficiency making many current homes unsuitable for a lot of the older people living with dementia who live in them. This issue is especially pertinent among owner-occupiers, where owners may need to use private equity release schemes to finance home adaptations. There is also a dearth of suitable accommodation appropriate to the diverse needs of people with dementia, a finding echoing other reports about the UK’s housing stock and its suitability for older people. See https://www.bre.co.uk/filelibrary/Briefing%20papers/86749-BRE_briefing-paper-PHE-England-A4-v3.pdf
Worryingly planning and building regulations currently do not support development of housing and services to meet the needs of the ageing population and in particular people living with dementia. While housing and planning guidance contains some consideration about meeting the needs of an ageing population there is very little guidance given regarding people living with dementia.
Information about good design for housing the person living with dementia is available, but is not sufficiently accessible to the people who want it and need it. One concern is that frontline housing staff in Scotland identify a gap in their knowledge of dementia, highlighting the need for a joined up approach to training within integrated health and social care (Chartered Institute of Housing and Arneil Johnston, 2017). This is increasingly important as estimates are that about 2/3rds of people living with dementia are living in the community in mainstream (private) housing (Alzheimer’s Society, 2017).
So what can be done?
Housing sector organisations:
- Need to Increase new build private housing suitable for older people and people with dementia.
- We need to include design principles for dementia as part of planning for all new buildings and retrofit activities and explore ways to implement housing innovations in both private and public housing developments.
- Provide information about design and dementia that is accessible to the general population and all those affected by dementia.
- Need to take action to enhance the role and education of their staff.
For health and social care partnerships:
- Housing, particularly poor housing has to be seen as an important determinant of health and an important issue to tackle nationally. Recognition needs to be given to the place of housing as an important component in current and future dementia care and that requires healthcare professionals to engage with and become involved in partnerships with social and private housing representatives now!
- Need to consider and integrate housing and the person’s home into advance planning processes about the current and future needs for the person living with dementia.
- Any home adaptations need to be done as early as possible on recognition of the illness and at the earliest assessment where the need for home adaptation is identified
- While technology may have a role to play in ensuring people can remain at home there is a need to increase the available information, training and support to people living with dementia and their families interested in using it. For more about this see https://www.atdementia.org.uk/editorial.asp?page_id=45
If you are interested in learning more about Dementia Friendly housing you could look at the Alzheimer’s Society Dementia Friendly Housing Charter
To find out more about the work of Alzheimer Scotland Centre for Policy and Practice at the University of the West of Scotland see @AlzScotCPP
Chartered Institute of Housing (CIH) and Arneil Johnston (2017) Dementia Pathways- Housing’s role: Key research findings. Edinburgh, CIH. Available at: http://www.cih.org/scotland/housing_dementia_prog
Kendig, H., Honge Gong, C., Cannon,L. & Browning, C. (2017) Preferences and Predictors of Aging in Place: Longitudinal Evidence from Melbourne, Australia, Journal of Housing For the Elderly, 31:3, 259-271, https://doi.org/10.1080/02763893.2017.1280582
Nicol, S., Roys, M., Garrett, H. (2015) The cost of poor housing to the NHS – Briefing Paper. St. Alban’s, BRE. Available at: https://www.bre.co.uk/healthbriefings [26/03/18]
Dr Margaret Brown is Senior Lecturer and Depute Director Alzheimer Scotland Centre for Policy and Practice at the University of Scotland School of Health, Nursing and Midwifery. @owlbroon
Mr F. J. Raymond Duffy is the Programme Leader for the MSc in Gerontology and MSc in Gerontology (with Dementia Care) at the University of West of Scotland @uwsraymondduffy
Dr. Louise Ritchie is a Lecturer in Dementia (Research) working within the Alzheimer Scotland Centre for Policy and Practice at the University of West of Scotland @lourit