Prevention of homelessness in older people - the policy drivers

Prevention in relation to older people

Encouraging action on the prevention of homelessness in local authorities and housing providers is a key plank in the government's agenda to achieve a reduction in homelessness. In 2008/09 local housing authorities reported a total of 130,000 cases of homelessness prevention or relief having taken place. Whilst much generic prevention applies to preventing homelessness amongst older people, there are specific issues that need to be taken into account. Below the strategic drivers that can be used to promote homelessness prevention for older people are explored

The CLG have produced Guidance on the Prevention of Homelessness and an Evaluation of homelessness prevention in a number of local authority areas.  There is a package of measures in place to reduce youth homelessness but the homelessness of older people is given less priority and is a much more hidden issue. However many older people are insecurely housed and people do lose their homes in later life. Becoming homeless is always a trauma but for it to happen in old age is hard to recover from.

Partnership for Older People's Projects

In national policy terms prevention in relation to older people is much more likely to refer to prevention of loss of independence necessitating moving into care or prevention of unnecessary hospital stays than homelessness prevention.  In the face of the changing demographics ( by 2026 there will be 2.4 million more older householders in England than there are today)  prevention of the need for higher care options is the key agenda in relation to older people.

There has been a focus on the preventative approach in the last few years through initiatives such as Link Age plus and Partnership for Older People's Projects (POPPs).  A publication from the DH, Improving Care and Saving Money  promotes the findings that have emerged from the Partnerships for Older People's Projects, pilots exploring joint approaches to reducing reliance on long term institutional care and acute hospital admissions. The key message is that promoting the independence of older people through a fundamental change in focus to prevention and early intervention can produce better outcomes and greater efficiency for health and social care systems. The document defines prevention as delaying  older people’s deterioration, reducing the risk of crises, maximising people’s functioning, and arranging for the least institutional or intensive care intervention. Whilst the POPPs' programme had no stated focus to prevent homelessness, many of the lessons are transferable because the same crises; a worsening of health problems; bereavement; increased alcohol use; debt or not being able to manage at home can lead either to moving into needing care or can be a trigger for homelessness.

The overall preventative approach can have an impact on preventing homelessness amongst older people:

• For people with multiple and complex needs, who as a result are intensive users of health and social care services, it involves health and social care agencies developing effective working relationships and offering an integrated service.
• For people with substantial needs, the approach involves case finding and case managing those at risk, offering services such as befriending, counselling, handy person's services, shopping and gardening.
• For those with low needs and as a whole population approach, it involves access to advice and services through a single point of access, locally based community development, being enabled to make positive contributions  through volunteering and inter-generational initiatives.

The DH report concludes 'It is incumbent on local health and social care systems to resolve the misalignment of investment and benefits through joint commissioning and/or risk sharing arrangements. Opting out from joint work on prevention is not an option'.

An awareness of homelessness prevention should also be embedded into this approach.

Lifetime Homes Lifetime Neighbourhoods

The National Strategy for Housing in an Ageing Society, ‘Lifetime Homes, Lifetime Neighbourhoods’ was published in 2008.  It is promoted by the government as representing ‘a major shift that puts housing in the frontline in both supporting older people's aspirations and preventative care, placing the needs of older people at the heart of policy making'.  Gordon Brown states in the introduction to the strategy that he ‘wants to see older people get a better deal on housing right across the board'. 

One of the three key tasks outlined in the strategy is to: ‘Improve prevention, information and choice to enable people to make informed choices and plan ahead properly’ and to ‘support those most in need, enabling people with complex needs and multiple problems to get joined-up housing and related services to enjoy the best possible quality of life’.

As the strategy states ‘to achieve a significant improvement in the effectiveness of preventative services we must get to the right people much earlier’.  The focus of this guidance is how to identify the older people who are insecurely and precariously housed and reach them with housing advice, housing options and housing support in a timely way. 

Older people's Housing Strategies and Homelessness prevention strategies

‘Lifetime Homes, Lifetime Neighbourhoods’ encourages local authorities to review existing older people's housing strategies in the light of the national strategy. Older people who are precariously housed tend to be a group whose needs fall between two stools, and appear in neither, planning for older people nor planning for homeless people.

The introduction of the Common Assessment Framework for adults will gradually encourage the integration of services across housing, health and social care. An awareness of the type of crises that can tip older people over into homelessness and the importance of effective preventative interventions should flow from increased inter -sector working. 

Joint strategic needs Assesments

Local authorities and Primary Care Trusts are required to work together to gather information on health inequalities and unmet health needs across their areas to feed into the Joint Strategic Needs Assessments process (see Homeless Link page on JSNA's for more information). Older people who are at risk of homelessness are an important group to think about in relation to health inequalities and unmet health needs. Gathering robust information on this client group and commissioning good quality services will help to address health inequalities. 

Cost effectiveness

Homelessness has costs to the public purse across housing, health, social care and other budgets. A failure to pick up on support needs or a move to evict someone for arrears or anti social behaviour before really assessing what help they can be given or offering only minimal assistance  can result in much higher costs than high quality support. There can be substantial cost savings of many thousands of pounds a year if older people who could otherwise be homeless receive appropriate interventions to enable them to stay in their home. See the case study as an  illustration of cost effectiveness.

Strategic Action

We would like to see a refresh of local older person's housing strategies that link across housing, homelessness, health and social care agendas that recognise that the prevention agenda, when applied to older people, needs to take into account homelessness. POPPs, and the projects that follow on from them, need to add homelessness prevention into their agenda. Additionally homelessness prevention strategies need to have sections specifically about the routes into homelessness for older people and effective interventions that prevent homelessness occurring.

The next section looks in more detail at the triggers that make older people vulnerable to homelessness.