Older people deserve better

The word 'deserve' disturbs me and implies that whoever ‘deserves’ has had to have done something to earn whatever is on offer. This actually implies an inequality for some people. Those people might be you, me, your sister, brother, mother or father. I have always been interested in how the use of language to describe people and practices does tend to influence attitude.

So I want to concentrate on the fact that we need to remove that word 'Deserve' and focus on rights for all people, recognising the humanity in us all.

It is amazing and indeed shameful that older people felt the urgent need in Wales to actually produce an explanation of what Human Rights meant to them.

But we must understand why we still have to use the word ‘Deserve’ when we consider older people's care and support. I think this is because there is still evidence out there of failed care, omissions of services and public inquiries into abuse.

My contention is that we are continually being pushed into lobbying for better services for older people, and using terms such as ‘Deserve’ indicates that society and public services still do not understand ageing or adequately recognise the real cost and benefit to supporting older people to maintain their health and wellbeing.

Similarly prejudicial remarks have long been recognised as inappropriate when applied to, for example, gender or ethnicity. So it seems that older people are still the last frontier and we are still having to use this term to get what older people actually need to enable them to experience a higher quality later life.

The attitudes that fester the lobbying for better services I have just mentioned affect assessments of need and packages of support. The customary diagnostic rigour which, for instance, healthcare professionals have been trained to apply as standard, can sometimes be mysteriously replaced for older people as patients by ageist therapeutic emptiness. In other words, nothing substantial to help them maintain their health. Professional values and training still overly prioritise the acute, the rare, the high-tech and the cure, and need to change to reflect the reality of modern health and social care practice which now is beginning to embrace, in partnership, the work undertaken within housing services for older people.

If we are providing a public service based on need and preventing ill health, and also implementing action on health and wellbeing as equally important, then we must give adequate and full assessments to all the people who actually turn up in the system, rather than for those whom we would find more personally engaging, or those ‘consumers’ who shout loudest.

It's great that the housing sector is championing a change in the approach to support for the older person and I am proud to be a part of that. However, there needs to be much more commitment all through the health system and action undertaken now which recognises the work that we, the housing champions for older people, have done to promote the rights of older people to continue to live independently and to experience a good later life.

Lets get to a situation in Wales where we never have to use the term ‘Deserve’ any more.

Lorraine Morgan
Board Member, Care & Repair Cymru

Resilience during Times of Change

We are often asked in Academi Wales…‘why is change so difficult to lead and manage in our organisations?’ When we consider how we drive whole scale change, we need to focus on the behaviors, the system and the symbols. We may start by considering the system (the way we do things) and focus on changing our tasks, actions and outputs to make the change happen. We may focus on the symbols (the non-verbal message) the brand, the meaning and the image our organisation conveys. We should always link this to behaviour (what I do and say) and this can often be the hardest part of any change.

Last year I contributed to the ‘Developing Resilient Organisations’ book by Strycharczyk & Elvin, in building the case studies I was struck again by how important it is to understand our own behaviour and those of others as a base for our leadership development.  

It is our behaviour that that can be the enabler or disabler for ourselves and others as we experience any change. In understanding our own behaviours we can understand how we have impacted our own experience and the experience of others. Our ability to remain resilient can impact our commitment to any change so it’s important to understand, what does being resilient mean to me? I am fascinated by the why, what and the how of resilience, why do some of us bounce back so quickly, what are the qualities that enable some to thrive whilst others may struggle to cope and how can we understand the behaviours that build or erode our resilience.  

It’s great to be part of #CandRconf15 this week, to offer a taster of development in understanding our resilience, a topic I remain continuously curious about.

Zoe Sweet

keysafe.co.uk
@zvsweet
@AcademiWales

Stronger Together – can cross-sector organisations work together to deliver successful solutions?

There are many stereotypes about the voluntary sector and also the commercial sector. The voluntary sector can be perceived to be a bit ‘hippy dippy’, extremely caring, but maybe not overly business-like, driven or innovative in approach; whereas the commercial sector are all pin-striped suit wearing salesmen who are all in it for the money. Obviously, these are extreme viewpoints for the purpose of this article and very few will believe that these are truly reflective, if at all. However, it can still be unusual for the two to work together, let alone work together to develop innovative and workable partnerships that deliver fantastic outcomes for all of those involved. The great news is that these partnerships are happening and are beginning to deliver real solutions to the challenges being faced in this new climate.

The history of Care & Repair in Wales began in the late 1970s. Concern about the circumstances of older people led to the early research about housing for older people. Successive studies and house conditions across the UK pointed to older people occupying disproportionately poor housing. Home Improvement Agencies (Care & Repair) developed in the UK in response to the growing awareness of problems faced by older homeowners living in housing that was statutorily unfit for habitation, lacking basic bathroom and kitchen amenities, damp, in serious disrepair, unhealthy and sometimes dangerous.

Fast forward to today and Care & Repair Cymru is now the ‘Older People’s Housing Champion’, supporting older people through not only housing repairs, but also many other valuable services such as benefits advice, housing adaptations, falls prevention, energy efficiency and affordable warmth. In 2013-14 alone the Care & Repair movement in Wales helped over 40,000 people through various interventions, helping older people to live in homes that enhance their quality of life.

In addition to on-the-ground support and individual help, Care & Repair Cymru also works to influence national policy and thinking; for example, appearing before Welsh Government Committees and UK Government Inquiries and advising on housing’s contribution to social care challenges, championing older people from grass roots to the very highest level.

Care & Repair Cymru has long recognised that to truly meet the needs of the older people they support, they need to look outside of traditional funding solutions and cannot rely on public sector funding alone. As with many third sector organisations, this has become particularly relevant in recent years following the credit crunch as budgets have been contracted with numbers of individuals needing vital services ever growing.

What has been particularly important to Care & Repair Cymru is that their Caseworkers are empowered to be able to help those that they look after in as many ways as possible. The last thing that a Caseworker or Care & Repair Cymru would ever want would be to be approached by an older person in need and not be able to help in any way. As part of increasing the number of options that Caseworkers have available to them, Care & Repair Cymru has made innovative partnerships with a number of organisations that can help them offer more options to those that they look after. One of these partnerships has been with social enterprise advant~age.

advant~age is a national organisation that enables charities to help vulnerable people, their families and carers, and supporters obtain access to safe and reputable products and services, whilst at the same time generating valuable unrestricted income for the charity and minimising reputational risk. One of the services that advant~age offers through its partner Bower Retirement Services is equity release advice. The role of advant~age includes performing rigorous due diligence and quality control on the providers of the services that it offers. This then ensures that customers can then be confident they will receive a high quality service at a fair price and charities can feel confident in signposting to providers, knowing that their reputations are protected. This was of particular importance to Care & Repair Cymru. With grants for repairs and adaptations shrinking, equity release advice can be an option that older people may want to consider as a way of funding works on their homes. As a member of the Equity Release Council and registered with the Financial Conduct Authority, Bower Retirement Services can offer safe and reputable, independent whole of market advice to individuals that may want to find out more about the options that are available to them.

Equity release isn’t the answer to everything, but by being able to signpost to reputable advice Care & Repair Cymru can increase the number of options that are available to those that they look after. For individuals that can mean access to funding to repair their homes and enable them to live more independently for longer, for Caseworkers it means that they can offer more solutions to more people more of the time. In addition to increasing the services available for any equity release services that are completed, a donation is made to the Care & Repair Cymru hardship fund, at no extra cost to the individual, enabling Care & Repair Cymru to deliver even more vital services in the communities it supports.

Care & Repair Cymru, advant~age and Bower Retirement Services believe that this type of cross-sector partnership will have a key role in the future provision of services to older people where traditional options are reducing or even disappearing. It is fantastic to see such a variety of organisations working together to develop and build services in partnership to provide solutions to the challenges that are being faced by individuals, third and public sectors alike.

For further information, please click here. 

Heather Dungey, Care & Repair Cymru
Jenni Buckland, advant-age
Ian Howarth, Bower

Who takes care of the carer?

A few years ago, my Dad was suffering with heartburn and was having difficulties with swallowing. He was diagnosed with oesophageal cancer. Due to his age (69) he was not able to have an operation to remove the tumour and therefore started aggressive chemotherapy.

My mum, already retired, became a full-time carer. Both of their worlds completely changed. Mum was fit and healthy and very independent, attending her gym and tai chi and visiting me and my brother who now live far away. As time went on, she lost everything due to Dad’s illness.

After a few months, Dad stopped being able to eat entirely and was fed through a tube. He suffered terribly with the chemotherapy and, despite three rounds, it did not shrink the tumour. Dad lived another 18 months, deteriorating during this time.

My Mum received excellent support from local health services and Dad’s Macmillan nurse. Dad tried attending the local hospice for a few afternoons but didn’t like it so Mum had no respite from him. He was both physically and psychologically demanding, as you can imagine. Marie Curie nurses were also an outstanding support to us in his last few weeks, as they took over the night shift. Because of their support, Dad was able to die at home.

Mum and Dad were typical Care & Repair clients. They had both worked all their lives and owned their own home. Dad was a mechanic and was able to maintain their large three bedroomed house until their crisis occurred. They had never received any statutory services or benefits and were therefore unaware of how to access support.

Due to where they lived in England, they did not have access to Care & Repair services like the Care & Repair services we manage here in Wales. Upon leaving hospital after falling and breaking his leg, Dad would have been eligible for our Rapid Response Adaptations Programme for adaptations to help him and Mum move him safely around the home. Care & Repair would have helped to move the bed downstairs when necessary and would have supported Mum to access Attendance Allowance to fund the extra costs of caring for Dad. They could also have provided advice about the other services which Mum could access to support her needs as a carer. All of these things, of course, were implemented for Mum and Dad, but nowhere near as quickly and as smoothly as they would have been if they had one Agency like Care & Repair to manage this practical support.

Three years on; Mum lives alone. Her health suffered during the first few years but now she is back to her independent self. She not only lost Dad but lost all of her networks due to caring for Dad, so she has had to work hard at developing her own life again. What does she find most difficult? The answer is managing a three bedroom house and a garden, alone, without a Care & Repair handyperson to trust to do small jobs around the house and without a Care & Repair service to support her through larger works.

I wrote this blog to highlight the amazing work of carers and the agencies which supported Mum to care for Dad and allow him to die at home. I also wrote it to highlight the work of Care & Repair in Wales and why it is imperative that our services are protected in order to support the ever increasing numbers of older people in Wales to live their independent lives.

Rachel Gingell
Policy Officer, Care & Repair Cymru 

Care & Repair doctoral research project

The Care & Repair Swansea University Doctoral Research project is now live! Given many of the headline messages from social policy and Welsh Government strategy relating to housing, health, social services and primary care, around a community-based social model of healthcare and public service integration, this is an exciting opportunity. Detailed work around our main activity as a frontline, home-visiting casework service will undoubtedly trace a bigger community footprint, which should be useful for policy development at a crucial stage in the debate around future-proofing public services.

Care & Repair agencies provide a unique and standard approach to the housing, environmental and living circumstances of older people. It is a blended approach, combining social care and technical housing fabric to provide a person-centred and problem-led approach. The older person receives an individually tailored, bespoke service. This has always appeared to work well. However, in a world of integrated approaches, shrinking public investment and competitive approaches, does it still work? ‘Bespoke’ is an old-fashioned and possibly hackneyed term, so are we becoming an old-fashioned service? In a fast-moving world, where the old artisan and craft skills are disappearing, will our approach end up as ‘time consuming’ and ‘over promising and under delivering’? Living under the big community tent and marshalled by statutory partners, are we a pivotal hub and close to the tent pole, or are we a cheap resource, disappearing at the edge of the camp like a flapping guy-rope?

My take on our ‘big offer’ is that we are the most modern of public sector organisations, anticipating important strategic trends and in the vanguard of change. We are defined by our partnerships and our collaborative efforts - in the best sense, ‘co-production’ in action. Seeking to build service capacity, we were a ‘social enterprise’ brand before the social entrepreneurs moved in. If you are looking to define prevention, we are responding to the real challenges older people face before they escalate into crises. If we deconstruct the pseudo-sociological concepts of ‘social model’-speak, we are a plain-talking, honest and accessible community delivery model. For the 12,000 older people we visit in their homes each year, we are a future-proofing service, keeping them ‘ahead of the curve’ rather than ‘stuck in the past’. I would say that, wouldn’t I? What do you think? This is an opportunity to say what you want as research student Joanna Wolton begins her investigations.

Neil Williams
Head of Agency Performance and Funding, Care & Repair Cymru

At this early stage, please leave a comment on the blog if you'd like any further information. 

Launch of Care & Repair Cymru’s Equality and Diversity Handbook

Tai Pawb has been working with Care & Repair Cymru to develop a practical handbook and guide to help Care & Repair Agency staff respond to the diverse needs of older people in Wales. The guide was launched at the Care & Repair Chief Officers Network meeting on 22 April.

At times, it is easy for the diversity of older people to become hidden or not recognised with older people being viewed as one homogeneous group. There is a particular risk of this happening in areas which are falsely perceived as having no or limited diversity, such as rural areas. Viewing older people as one homogeneous group or through stereotyped lenses can lead to actions which undermine services' attempts to treat individuals with dignity and respect. However, recognising the diversity of older people can help organisations to develop more holistic approaches that are sensitive to the needs of all potential service users. Having a service that recognises and removes barriers is vitally important for people who may have faced discrimination in the past.

It is the small things that can often make a big difference. For example:

• An isolated and grieving service user being able to open up to their case worker about the death of their same sex partner. 
• A service user having their communication needs met when engaging with an agency, enabling them to feel informed, empowered and listened to. 
• Using inclusive language so that people can relate to and not feel excluded from the service. 
• A home maintenance officer treating someone’s home with respect, such as wearing shoe coverings or thinking about the implications of moving items within someone’s home.

The aim was to make the guide as practical as possible. That is why, alongside the main handbook, quick reference sheets have been developed for the different job functions within agencies. Each sheet has been tailored to reflect practical tips and information most relevant for the different roles and engagement with service users which staff members will have.

The main guide and quick reference sheets provide tips in relation to age, disability, gender, gender identity, race and ethnicity, religion and belief, sexual orientation and carers on areas such as:

• Communication
• Making appointments
• Treating individuals with respect 
• Visiting or carrying out work in a person’s home
• Office visits
• Raising awareness of services

It also highlights issues that have safeguarding implications in terms of situations where staff members come across cases of domestic abuse, hate crime and elder abuse. The main guide also notes what staff should do if they face discrimination or harassment.

It is recognised that the handbook only provides general guidance and staff are advised that they will need to respond to each person’s individual needs. Each situation and each service user is very different.

Although some of the information in the guide may seem like common sense, implementing these small actions can have a huge impact on the quality of service a person receives.

A copy of the guide can be found online here.

Mair Thomas
Equality and Diversity Officer
Tai Pawb
mair@taipawb.org / 029 2053 7635

The scandal of pensioner winter deaths

Why is society in Wales so prepared to put up with more older people dying in the winter compared to other months of the year?

In 2012/13, the Chief Medical Officer for Wales confirmed that this is the case with 1,900 more deaths in the winter months, with 70% of these attributed to our over 75 year olds. This pattern is repeated year on year.

Why? Because as we age, we become frailer, our bodies are less able to cope with low temperatures and we become more susceptible to respiratory and circulatory illness.

This is backed up by accepted figures in Wales that 140,000 pensioners are in fuel poverty, meaning they need to spend more than 10% of their income on fuel costs.

“Just turn the heating on”, I hear you say. It’s not as simple as that. With rising energy costs and many older people on a fixed income, many cannot afford to pay their fuel bills... so they don’t turn on the heating. Many older people face many difficult decisions, like choosing between eating or heating their home.

Many thousands of older people can’t survive on their state pension or are not claiming the benefits they are entitled to. They have boilers which are old, inefficient and use more fuel. They live in properties which aren’t insulated. They are on an expensive fuel tariff and don’t know how to change provider. They don’t know about the latest government grant scheme that just might be able to help them.

This isn’t good enough. It is clear that the system isn’t working because we still have older people dying in the winter who wouldn’t be dying in other months of the year.

While there are undoubtedly plenty of schemes that could help, there is confusion for older people about where to go and what help they can get, and we are not doing enough to find and help the people who need that help the most.

There have been numerous grant schemes, over many years, such as Home Energy Efficiency Scheme (HEES), Carbon Emissions Reduction Target (CERT), Community Energy Saving Programme (CESP), and now, the NEST and Energy Company Obligation (ECO). There is lots of evidence to suggest that these schemes have helped improve many properties, helped many people on low incomes and reduced carbon emissions, particularly in the social housing sector. Housing associations and local authorities have undoubtedly carried out some great work with energy companies for the benefit of their properties and their tenants.

We now need to focus on the people we haven’t reached. One particularly affected group is low income, older owner occupiers dispersed in urban, suburban and rural areas across all of Wales. Finding these people requires more up front effort and is not as attractive to energy companies who have legal targets on the quantity of carbon emissions they need to reduce, so instead have targeted geographic energy efficiency schemes at scale.

So, to combat older people dying of cold this winter, Care & Repair Cymru is running their Fighting Fuel Poverty campaign this week (October 20-24) to find older people who are most at risk and to provide them with practical advice.

We aim to help them access benefits and available grants to keep them warm, as well as assisting them directly with our “Health through Warmth” grants, delivered in partnership with Npower.

We’re also asking people who receive the winter fuel payment, but don’t need it, to donate it to a hardship fund at Care & Repair by calling 0300 111 3333 so that we can redirect this to older people in fuel poverty who need more help.

As we head into the winter months and look ahead to the UK elections next year, we believe that the UK and Welsh Governments need a rebalancing of policy focus so that tackling fuel poverty and stopping winter deaths amongst our older people receives as much attention as reducing CO2 emissions.

We need co-ordinated action by government and energy companies to target advice and energy efficiency grants based on specific need of individuals as well as wider need to reduce the carbon footprint.

As the Older People’s Housing Champion for Wales, our “Fighting Fuel Poverty” campaign aims to highlight the scandal of pensioner winter deaths and find solutions to help those in need. We’re only a phone call away, so if you’re an older person or have a relative, neighbour or friend in need of help, please call one of our local agencies on 0300 111 3333. Care & Repair can reach out and spread a bit of human kindness and warmth this winter to those feeling left out in the cold.


Chris Jones
Chief Executive
Care & Repair Cymru

Working in partnership for warmer homes

With Autumn now firmly taking hold, people across the country are starting to turn the heating on. However, it’s easy to forget that not everyone has the luxury of keeping their home warm.

A warm home has a significant impact on our health and wellbeing. As research has shown, cold temperatures can have a detrimental effect on people with long-term health conditions such as heart, circulatory and respiratory disorders, as well as the elderly community.

Indeed, this subject has become a real focus for the Government in recent months, with calls for a collaborative approach across the health sector to ensure that those who need it most are able to heat their homes. Recent guidance from the National Institute for Health and Care Excellence (NICE) has also added to the debate, calling for the wider community, from gas engineers to health workers, to work together to identify vulnerable people who are at risk.

This partnership approach is one that npower Health Through Warmth has championed since the scheme began in 2000, by working with organisations such as Care & Repair Cymru. Together, we help vulnerable people to stay warm at home, whether it’s by replacing broken boilers or installing heating systems or loft and cavity wall insulation.

That’s why npower Health Through Warmth is supporting Care & Repair Cymru's Fighting Fuel Poverty campaign, to remind people that help may be available for vulnerable home owners who have a long term illness, a low income with little or no savings and who are unable to fully fund the work required.

For more information, or to find out if you or someone you know could be eligible for help, visit www.healththroughwarmth.com or contact your local Care & Repair Agency on 0300 111 3333.


Elaine Midwinter
Scheme Manager
npower Health Through Warmth

Fighting fuel poverty - let Care & Repair help you

According to latest figures, there are almost 2,000 excess winter deaths a year in Wales. We hear the term ‘excess winter deaths’ quite frequently, but it’s hard to imagine how and why this can happen.

As an Affordable Warmth Caseworker for Care & Repair Cardiff, visiting older people on a daily basis in their homes, unfortunately I can see how this happens. When reporting on this issue, the press might conjure up images of older people with blankets around their knees, shivering in front of a gas fire. This is not the case for the majority of older people, but for some this is actually their reality.

I saw a lady recently in Riverside who was wearing a dressing gown over her clothes to keep warm every time I visited her. I saw a gentleman in Canton who wore a woolly hat and refused to put the heating on unless it snowed because he was scared of high gas bills. I saw a lady in Grangetown who had no form of heating whatsoever in the house, had never had any, and cried every time I visited as she couldn’t face another winter living that way. Unfortunately, this is how some older people live, and it is easy to see how their health and wellbeing can be affected.

Many older people live on low incomes, have little or no savings and live in homes that don’t suit their needs. Quite often, they live in the family home that they have lived in for decades which they now find that they can’t afford to maintain or heat adequately. There are often problems with the heating system, windows and damp, along with stairs and bathrooms that can’t be managed. Many people are just used to managing and used to be being cold; they’re not aware of the damage it could be doing to their health or where to go for help. Poor physical health and mental health problems can also complicate the issue and make it difficult for people to find and access help, or even to face having anything done to their home.

There is help out there. We can help people to find grants to improve their home and heating and support them through the process of having any work done. We can help people to take control of their bills by looking at changing supplier or making sure they are on the best tariff. We also make sure that people are claiming all the benefits they are entitled to which can vastly increase their income and make life a little easier. We’ve also helped people to clear gas and electricity debts.

I think it will be difficult to find a long term solution to fuel poverty. Grants for new boilers are excellent in the short term, but what happens in 10 years time when that boiler is inefficient again? It’s not a long term solution to the problem. We hear that insulating our homes is the best solution, but most people have had cavity wall and loft insulation fitted and accessing more complicated specialist measures is difficult and very expensive.

One thing I have come to learn in this job is the importance of planning for your old age. Older people should be able to live out their later years in comfort without worrying about living in cold homes which don’t suit their needs. It’s of benefit to everyone of any age to think about maintaining their homes, having appliances regularly serviced and using energy as efficiently as possible. These are all things that Care & Repair can assist with, so I would advise anyone who needs advice to contact us on 0300 111 3333.


Beatrice Roberts
Caseworker, Care & Repair in Cardiff

Fighting Fuel Poverty

The impact of fuel poverty goes beyond financial consequences. Living in fuel poverty can affect people’s health, increasing the risk of common ailments such as colds, flu and respiratory infections including bronchitis. This has resulted in worryingly high excess winter death levels in Wales, with older people particularly susceptible.

There are indirect effects: stress in children and adults, long-term depression and anxiety, social exclusion, damaged health and life chances for families and individuals and reduced educational attainment.

Moreover, there are broader budget implications for education, employment and health services in Wales.

You are in fuel poverty if 10% or more of your household income is spent on energy.

The causes of fuel poverty are equally complex, requiring a person centred approach alongside energy efficiency measures.

In 2012, 30% of households in Wales were living in fuel poverty, equating to 386,000 homes. Nearly 85% of these are vulnerable households, containing a child, older person or someone with a disability or chronic illness.

Energy efficiency is not the only way of helping fuel poor households and further opportunities exist, including helping people to find the best energy deal and to maximise their income.

True partnership working is key to finding those who are hardest to reach, ensuring that they receive all the help they are entitled to and developing solutions to meet their needs and situation.

No one agency can provide all the solutions to a complex problem affecting people with diverse circumstances. However, a central movement such as Care & Repair Cymru can guide people in the right direction to obtain the help they need.

Last year, Care & Repair agencies gave energy advice to 1,800 older people and 1,000 older people who had damp in their home. Amongst other things, they can advise on whether you are eligible for a £140 Warm Home Discount on your electricity bill and how, as a pensioner, you can join your energy supplier’s Priority Services Register.

If you require help or are unsure about the help you can receive, then contact Care & Repair for free advice on 0300 111 3333.

Mark Isherwood AM 

Chair of the Cross Party Group on Fuel Poverty sponsored by NEA Cymru and Citizens Advice Cymru 

Positive ageing - bucking the trend?

This week is Positive Ageing Week, which also includes Older People’s Day today, (1 October). The narrative around ageing and particularly around the substantial increase in the number of older people in the coming decades is often focused on the challenges of increasing demand for services and the fact that, across public services, we aren’t ready to accommodate this need.

At Care & Repair’s recent Annual Conference, a consultant from Powys Teaching Health Board (Prof. Bim Bhowmick) spoke about caring for older people with more acute needs in the community. One of his main points, which really resonated with me, was in saying that an increase in the older population doesn’t have to mean greater demand… more need… pressure on hospital services. He’d been leading on a consultant led “virtual ward” service aimed at keeping older people out of hospital. Through this he demonstrated a few things, namely:

• Consultant-led community services for older people will reduce attendance at A&E and instances of delayed transfer of care.
• Services configured to intervene at the time, before someone is admitted to hospital for further checks etc., is by far the most important time to intervene. 
• Ensuring that there's an understanding of what can be provided in the community by NHS staff and other stakeholders is key for General Practitioners. 
• The home is often an appropriate place to provide interventions for people with acute needs. 
• If we make these changes on an all-Wales level, we can realise a future where even though there’s a large population of older people, better service focus along with changes in lifestyle and behaviour can combine to offset the type of demand being predicted at present. 

The way we understand housing in the context of positive ageing is also very important. All too often this is a bit one dimensional – along the lines of poor housing leads to poor health. Clearly this is a really important part of understanding the impact housing can have, and the implications of poor housing. But an over-focus on the physical environment may lead us to overlook much of what it means to age positively. Housing certainly underpins this, but (for example) opportunities to socialise, learn new skills, inform and participate in local and national debate, spend more time with family, work or volunteer and travel the world can all have a huge bearing on how 'positively' we age. 

For the housing sector, it’s about understanding how we can best support this shift in emphasis and if there’s capacity to provide staff, share expertise or facilitate patient, carer or family engagement in building a shared understanding of how we support people in truly holistic way. 

Matthew Kennedy
Policy Officer: Care, Support and Health

Cardiff's Healthy @ Home Service - doing the right thing at the right time

Housing and health are closely linked and health related work has become a key part of what we in Care & Repair do, both to improve people’s overall health and to make them safer in their home by preventing accidents and potential hospital admission. Because we visit older people in their own homes, we have the ideal opportunity to discuss a range of healthy issues as well as their housing needs.

The Healthy @ Home Casework service is a partnership project, funded by the Welsh Government’s Intermediate Care Fund, which works with GP surgeries across Cardiff to offer the Care & Repair service to their patients on their 75th birthday. During the home visit to the client, we can offer a range of services that may be of interest to them now or in the future. Our aim is to support the client to stay safely living at home for longer, thus having a long term positive impact on their health and wellbeing.

We all know the saying: prevention is better than cure. Our service gives us access to older people who may benefit from our services and those of other organisations at an early stage to support them living independently and to prevent them from reaching a crisis situation in their home.

As well as discussing home repairs, maintenance and adaptations, we provide assistance with welfare benefits, home safety and fire safety checks and information on health and well being. If relevant, people are assessed for falls and referred back to their GP for a follow up appointment. Our project is unique in Cardiff and of real benefit and help to older people.

During our home visit, the Healthy @ Home Caseworker will listen to what the client wants and needs, will make suggestions and offer solutions to address these issues. By addressing the needs of clients, we undertake and organise a variety of direct interventions or make referrals to existing voluntary and statutory agencies to draw in and co-ordinate with other services as appropriate. Through partnership working with other voluntary and statutory agencies, we can provide the right assistance at the right time.

There is so much information available, much of which is, or seen by our clients as, complex. Many clients are not accessing schemes due to a misunderstanding of the referral process.

It is our experience that our clients still prefer a home visit where someone speaks to them face to face, someone who is willing to understand and discuss their needs. That someone is a Care & Repair Healthy @ Home caseworker.

Julie Swain
Senior Caseworker, Care & Repair Cardiff

Who says health, housing and social care can't work together?

I heard about The King's Fund ‘Innovations in the delivery of care for older people’ conference through Twitter. The King's Fund wanted to showcase different innovative projects at the event and were inviting submissions. I immediately thought of the Rapid Response Adaptations Programme (RRAP). While it's not a traditional ‘care’ project, it is an excellent example of a successful partnership between housing, health and social care sectors, which are usually more 'fragmented'.

The majority of referrals to the RRAP programme are received through social care and health practitioners such as occupational therapists, social workers, physiotherapists and discharge nurses, who are happy to place their trust in our voluntary sector organisation to support their work. It is a real achievement that each Care & Repair agency, across all of the 22 local authority areas in Wales, has been able to develop such positive relationships with their health and social care teams.

The Rapid Response Adaptations Programme is funded by the Welsh Government and allows Care & Repair agencies to carry out minor adaptations, such as ramps and handrails, to enable people to return safely to their own homes following hospital discharge. These adaptations can also prevent the need for admission to hospital or residential care. The programme requires these adaptations to be completed within 15 working days, although jobs can be carried out immediately in response to a crisis.

For health professionals, not only are ‘hospital beds unblocked’, allowing clinical scheduling and prioritisation to improve, there are clear indications of cost savings through the programme. It has been estimated that £7.50 is saved in Health and Social Care costs for every £1 of public funding invested in RRAP.

A recent report found that, by 2017, demand for unpaid care will begin to exceed supply, and the ‘care gap’ will grow sharply from then onwards. In turn, pressures on A&E departments and hospitals are likely to increase, as fewer older people receive the care they need and more are likely to slip into crisis (IPPR 2014).

Care & Repair Cymru carried out a survey of stakeholders in 2011. One hundred per cent of respondents felt that RRAP had helped to delay or prevent the need for social care services.


Stakeholders told us:

• RRAP promotes independence in the home and therefore reduces long term dependency on care. 'People are able to remain in their own homes for longer and it reduces the demand for more costly support from social services.'

• 'There is benefit (from RRAP) to the quality of service users’ lives which is greatly overlooked but of great significance.'


It is recognised that most people, as they grow older, would like to remain living in their own homes (Wanless, 2006). The demand for services such as RRAP which contribute to enabling older people to remain living independently in their own homes is likely to increase as the ageing demographic increases. The programme has proved to be extremely cost effective and yet the service remains unique to Wales.

The benefits of the RRAP programme were recognised by The King's Fund panel and were presented to the audience at the conference on 18 June.

Whilst attending the conference, it was clear that most of the innovations showcased, all immensely exciting and inspiring, were mostly carried out within the confines of one local health area. Care & Repair, however, supported by Welsh Government funding, work across the whole of Wales, ensuring equity of service for older homeowners and not confined by boundaries. Hopefully, by sharing good practice through such events, older people across the UK will gain greater access to excellent services such as those showcased at the conference.

NB. In the previous year, Care & Repair agencies carried out almost 15,500 works through the Rapid Response Adaptations Programme.


Rachel Gingell, Policy and Research Officer
Care & Repair Cymru 

Stepping stones to falls prevention

Older people have a right to expect the highest possible quality of life. Sadly a lot of older people have slips, trips or falls and falling can badly damage a person’s quality of life and level of independence.

Falls are not necessarily a natural consequence of ageing and many can be prevented through simple lifestyle changes.

A fall is often the trigger to make people look at their life and take the opportunity to improve their health and fitness and hopefully prevent themselves falling again.

In Bridgend, as part of a falls prevention project, a folder of information has been developed. The aim of the information is to enable people to get the help they need in the Bridgend County Borough Council area as well as good advice e.g. how to adapt their home environment, how to get up if they fall, strength and balance exercises for healthy ageing.

Here are some top tips on preventing slips, trips and falls:

• Remove or tape down loose rugs to avoid slips and trips
• Wipe up floor spills straight away 
• Minimise bending/climbing  
• If you must climb, use proper steps 
• Get up from chairs/bed slowly 
• Have a regular eye test/wear your spectacles and make sure they are clean 
• Avoid trailing clothes which may trip you up 
• Don’t wear sloppy slippers, buy a new pair that fit well 
• Keep stairs free from clutter 
• Keep stairways and halls well lit 
• If prescribed medication is making you feel dizzy, keep taking it, but consult your GP 
• Be aware of pets. Dogs and cats can cause trips and fall if they are around your feet

If you do have a fall:

• Don’t panic – you will probably feel a little shocked and shaken but try and stay calm
• If unhurt look for something to look onto 
• Hold onto a firm object for support, place one foot flat on the floor with the knee bent in front of the body 
• Lean forward putting weight on hands and foot until it is possible to place other foot beside the one on the floor and stand up slowly 
• Sit down and rest for a short time

In Bridgend the Bridgelink Telecare service is a home and personal alarm service which, in the event of an emergency/fall, can automatically contact a 24hour control centre to call assistance. A mobile response team is also available to assist. This service has prevented many hospital admissions and ambulance call outs as the mobile response team, following an assessment, have equipment that enables them to pick a client up from the floor, if they have fallen, to a bed or chair. This service is administered, installed and maintained by Bridgend County Care and Repair.

Health, social care and voluntary agencies are now all actively involved in falls prevention campaigns across Bridgend County Borough Council, the aim being to develop a robust Integrated Falls Pathway for the people of Bridgend.


Anita Williams
Agency Occupational Therapist/Falls Coordinator
Bridgend County Care and Repair

1 in 8 adults in Wales are carers... did you know?

Carers Week is a celebration of the contribution the 370,000 unpaid family carers in Wales make to society on a daily basis. They provide hours of personal care, physical and emotional support, help with finances, checking on medication and a whole range of other practical support, which saves the state millions of pounds every year. 100s of local events are being held across Wales throughout the week.

Wales is a caring nation but there are big challenges ahead. A Carers Week/You Gov poll this week found that the majority of adults in Wales vastly underestimate the number of carers there are in Wales (most said 1 in 25 when in fact 1 in 8 of us are carers). The same poll showed that most adults in Wales do not think that they will ever become a carer, when in reality over 60% of us will at some point.

The IPPR Generation Strain report 2014 highlighted recently that many more adult children caring for elderly parents will have to provide more care for longer, carers of working age will increasingly struggle to balance care and more older people themselves will be carers.

All of which highlights the need for carers to be 'Prepared to Care' so that we can all make decisions in a planned and considered way rather than in a crisis.

Caring has always been a mixture of caring 'for' and 'about' someone but carers need to be prepared for the emotional, practical and financial implications caring can have. Unfortunately the Carers Week/You Gov poll also found that over half of current carers in Wales say that they do not receive enough support to do the role well. Carers’ biggest worries were money matters, the emotional strain of caring and not having the right skills for their role. They also said that the most important thing for them would be to know exactly what help is available right from the start.

Health and Local Authorities have a huge role to play, of course, but the third sector also plays a big part in supporting carers across Wales. Organisations such as Carers Wales, Carers Trust, MS Society, Macmillan, Marie Curie, Parkinsons UK, Stroke Association, Age Cymru, Alzheimer’s Society, Care & Repair Cymru and others all provide vital services to carers.

We all have two years to plan for the implementation of the Social Services and Wellbeing (Wales) Act 2014, which will bring major changes to social care in Wales, and the third sector will be keen to contribute fully. Although fundamental questions still remain about how, as a society, we invest in social care to meet the needs of carers and those they care for.

Keith Bowen

Director

Carers Wales

Warmer homes, better health

We may not want to admit it, but as we get older we face an increased risk of health problems. But how many of us recognise how important a warm home is to our health and wellbeing?

Indeed, research has shown that cold temperatures can increase your heart rate, blood pressure and risk of chest infections. Keeping the most used rooms in your home warm could help to prevent your health being adversely affected by the cold. The recommended temperatures are 21°C for the living room and 18°C for the bedroom, but can be higher depending on personal preference, your age and level of mobility.

At npower Health Through Warmth, we work closely with Care & Repair Cymru to help vulnerable older people stay warm at home by, for example, replacing broken boilers or installing heating systems and loft and cavity wall insulation.

That’s why we’re supporting Care and Repair Week and reminding people, both clients and caseworkers, that help from npower Health Through Warmth may be available to vulnerable homeowners who have a long term cold-related illness, a low income with little or no savings and who are unable to fully fund the work required. You do not have to be, or become, an npower customer to benefit from the scheme.

To date, through our work with Care & Repair Cymru, more than 200 older people in Wales have been referred to us for help with heating and insulation. As a result we have levered more than £150,000 to help fund the work required, which includes £130,000 from the unique npower Health Through Warmth Crisis Fund.

For more information, or to find out if you or someone you know could be eligible for help, contact your local Care & Repair Agency on 0300 111 3333.


Elaine Midwinter
Scheme Manager
npower Health Through Warmth
www.healththroughwarmth.com

Helping clients to surf the information superhighway

The aim of Care & Repair is to enable clients to remain safely and independently in their own homes. Part of the service we offer is for caseworkers to visit clients at home - many of whom are socially isolated, live in rural areas or where there is limited public transport. Some find it difficult to get out and about and rely on family and friends for support, and other clients’ families and friends live too far away to be able to offer the support needed. However, many of the things our clients find harder to do can all be done online - shopping, chatting to family and friends, sending and receiving photos.

Not everyone wants to be online! However, often people are unaware of the benefits or just need extra support to get online. Sometimes the cost of getting online can also be a major barrier.

It is important that we as caseworkers help clients to understand how the internet can be relevant in their everyday lives. One way we do this is by explaining how convenient the internet is. Like all my colleagues across Wales, I use an iPad for work as part of the Care & Repair myPad project. This means I can show clients the benefits of using digital technology and explain the importance of being ‘digitally included’. Once clients see how easy the tablets are to use, it breaks down one of the biggest barriers – the fear of using IT.

I explain how money can be saved by shopping online, as many items are cheaper and price comparison websites can help find the best deals. Some of my clients now order their prescriptions online, have shopping delivered, and speak with family and friends. Some have contact with their social and church groups (through Skype and face time), and use social networking sites to keep in touch and to learn new skills. One client is doing a degree course online, others download reading and audio books, some do their banking online and many enjoy games and puzzles.

The majority of these new skills also improve the client’s self-esteem, confidence and wellbeing, and ultimately help to reduce a feeling of social isolation.


Beverley Evans
Caseworker, Blaenau Gwent Care & Repair 


Watch our video for Care & Repair Week here. Helping nannies and grampies all over Wales!

Only the lonely...

On a wild windy day, only 50m from the crashing waves of Cardigan Bay, Sarah Rochira (Older People’s Commissioner) and her colleague Kelly came to visit Mrs Jones in Aberystwyth, whose terraced house nestles snugly against the castle walls.

We have been helping Mrs Jones to reduce her eye-watering £318 per month Direct Debit from Scottish Power. Mrs Jones had reached the end of her tether in trying to contact Scottish Power since August, when her payments went up to this incredible figure. We hit the same impenetrable brick wall, and only found a way through by using the Welsh language service. Having given the helpful Scottish Power officer the updated meter readings, we have reduced her Direct Debit to a still painful £192 per month. We are working with the client to tackle her inefficient heating scheme.

The Commissioner’s conversation with Mrs Jones, however, uncovered a wider and far more personal issue, common to far too many older people, even in close knit urban areas. Loneliness and isolation was her real heartache. 'I've always been such a sociable person, I loved going out... I've only been out of the house once in the past year, and that was only up the road to St Michael's Church for a funeral.'

The house is accessed via numerous steep, uneven, and varying height steps and, whilst a handrail has been fitted, Mrs Jones still sees the climb back up as an Everest too daunting to face.

Why doesn't she find a more suitable property? A flat or a sheltered scheme?

Herein lies the problem. This is not Mrs Jones's house, it is her home! Her home, which was bought nearly 50 years ago when she was newly married. 'We put in an offer on it and were worried sick all night, but it was the best thing we ever did.... We’ve raised our children and grandchildren here and my grandson still lives with me. I do not want to leave my home.'

The third sector, including us at Care & Repair, must continue to work together to help older people in all aspects that affect their ability to remain independent. That means far more than repairs and adaptations alone, it's all about the 'Care'.

Lesson relearned!


Dafydd Pugh-Jones
Rheolwr Gofal a Thrwsio / Care & Repair Manager

Why the Care & Repair Service is essential to Occupational Therapy intervention

Being discharged home from hospital can be an anxious and worrying time for some individuals. At times people are concerned that they may be unable to get around their home and care for themselves as they did previously, and individuals are often concerned about how they are going to meet the financial burden of not only maintaining their home but also for funding essential care services. The Care & Repair service has played an integral role in enabling occupational therapists to discharge people home from hospital efficiently and safely and in alleviating some of these concerns.

Care & Repair is a reliable and efficient service that, through the installation of small adaptations such as handrails and stair rails or through major building work such as adapted bathrooms, allows people to live in their own homes independently. The comprehensive service that Care & Repair provides enables smooth transition from hospital to home, reducing their length of stay in hospital and preventing readmissions.

Work is consistently completed to a high standard and in a timely manner by qualified technicians who understand the needs of the patient.

As well as providing practical assistance with repairs and adaptations, Care & Repair also provides advice and information regarding benefits, home safety and security.

Without the Care & Repair service, occupational therapists would be unable to address many of the concerns and needs of their client group.


Rachael Gdesis
Advanced Practitioner Occupational Therapist
Princess of Wales Hospital

We can help you

During Care & Repair Week, we want to get a simple message out to the many thousands of older homeowners in Wales who live in poor housing. That message is: 'We can help you'.

If you are having difficulty getting up the stairs, if you can’t get in and out of the bath, if you are cold but afraid to turn on your heating because it costs so much, if your roof leaks, if your walls are damp, if your house is in disrepair, if you’re scared of falling on the steep steps to your house… whatever your housing problem, we can help you.

Last year, we helped 30,000 older people with their housing problems, 12,000 of whom lived alone. Most of the people we help are aged over 60 and their average age is 75. 10% of the people we help are over 90. Last year, 20 of our 22 Agencies helped people aged 100 years old or more.

We provide our services across the whole of Wales so wherever you live, we can get out to you, assess your housing problem, make sure you are claiming everything you are entitled to, talk to you about what you want, find out what grants or other funding is available to help you, find you a reliable builder, supervise the work, or do the work ourselves with one of our in-house handy-persons.

Our services are important. Not only do they help improve older people’s quality of life by keeping them safe, warm and independent in their own home, but they also keep them out of places they don’t want to be - ambulances, hospitals, GP surgeries and residential care homes. And we work with others to get it right, such as important partners like Welsh Government, occupational therapists, local authority housing staff, housing associations and health professionals.

But for older people, our biggest message for Care & Repair week is… We can help you! If you would like to contact us, you can call 0300 111 3333 anywhere in Wales and be connected to your local Care & Repair Agency.


Chris Jones
Chief Executive, Care & Repair Cymru 


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