Home adaptations: Costs? or Savings?

A man kneels on the floor, he is laying floor tiles.Lesley Curtis and Jennifer Beecham argue that the expertise of occupational therapists can help save money in health budgets as well as improve the lives of people needing assistance at home. Their article is about home modifications and identifying the hidden savings in providing home adaptations. They explain their methods and argue that significant savings can be made if you tally all aspects into the calculations. The article is available from Sage Publications. You will need institutional access for a free read. The title is, A survey of local authorities and Home Improvement Agencies: Identifying the hidden costs of providing a home adaptations service.

Abstract: The Royal College of Occupational Therapists has launched a campaign to demonstrate that occupational therapists improve lives and save money for health and social care services. Occupational therapists play a major part in supporting older and disabled people to remain in their own homes through the provision of home adaptations. Among other benefits, studies have shown that home adaptations can reduce falls in the home and could therefore help reduce hospital admissions. However, to evidence savings, information on the full costs of supplying and fitting home adaptations are needed.

Method: Local authorities and Home Improvement Agencies were surveyed in 2014–2015 to obtain the information required to estimate these costs. Time inputs for staff involved in their provision have been collected and staff costs and total costs calculated for 18 commonly fitted adaptations. The process of obtaining publicly funded home adaptations is also discussed.

Findings: For major adaptations, the total mean cost was £16,647, ranging from £2474 to £36,681. Staffing costs absorbed up to 24% of the total mean cost. The total mean cost for minor adaptations was £451, with average staffing costs forming 76%.

Conclusion: Staff costs are an important consideration when estimating the costs of providing home adaptations.

Ageing better at home

Bathroom in an old house has been stripped and bare walls and old tiles remainBecause the majority of our homes are designed as if we are never going to grow old, most of us will need to modify our home as we age. That’s if you want to stay put, which is what most older people say is their preference. An easy to read and nicely presented report from Centre for Ageing Better in the UK gives an excellent overview of how home modification improves quality of life, mental health and overall independence. All good reasons for universally designing our homes from the start for the whole of our lives so modifications aren’t needed or are at least easier to do. Dwellings might be a “product” to property developers but for the rest of us a “home” is the pivot point for living our lives.

A great quote from a study participant to reflect upon, “You don’t get taught, at any point in your life, how to become an older person. It just sort of happens, you know…”. So waiting for consumers to ask for universal design isn’t going to work.

For a more academic take on a related issue of housing quality and health see a longitudinal study from UK.  

UD for a social and sustainable life

A long ladder is resting against the gutter of a two storey houseThe word “sustainability” mostly conjures up notions of clean and green, but social sustainability – an aspect just as important – has been left out of mainstream discussions. This point is made in Universal Design as a Significant Component for Sustainable Life and Social Development. The authors argue that both home and neighbourhood need to be considered for a socially sustainable environment. An evolving criteria for social sustainability is access to facilities and amenities that are vital for people to run errands and do all the everyday things. Going to the shops, a medical appointment, or the cinema should be available to all no matter their age or circumstances. There are useful explanatory graphs in this in-depth paper that emphasises well-being, safety and accessibility. The authors sum up in the conclusion, “The social aspect of sustainability should be emphasized in the mainstream discussion on sustainability because it influences human behaviour and quality of life in many ways”. They also point out that it is environmentally unsustainable to build homes that need major modifications, “which causes pollution, hazardous construction equipment and material and inappropriate methods of wastage removal”. The article can also be found in Asian Journal of Environment-Behaviour Studies.

Abstract: Universally designed environment provides comfort, adaptability and flexibility that can help to reduce human life cycle impact and encourage residents’ participation in the community. With that, the purpose of this conceptual study is to explore the concept of Universal Design (UD) as a significant aspect of social sustainability, based on professional practitioners’ and scholarly views. UD implementation in built environment may cater the needs of diverse users over the changing abilities throughout lifespan. This study concludes that UD has evolved as a significant component for sustainable life and social development within the individual’s own dwelling and the community as well.

Housing quality improves health

A man in a bright yellow T shirt is painting and archway in a wall inside a home. The wall is grey and there are tools on the floor.Ever wondered what the long term effects of a home modification are? A longitudinal study from the UK shows that household improvements in social housing can reduce risk of hospital stays, particularly in older people. While the study picks up major improvements in chest and heart health, it also found that falls and burns were reduced too. Over the ten years of the study, they found that homes that were modified and upgraded correlated with reduced hospital events. That means savings in the health budget or beds freed up for other patients. Obviously it is better for occupants too. It is not clear how poor the condition of the housing was prior to the upgrade or modification relative to Australian housing. This is an academic paper outlining the methods and comparing to other studies, but the discussion and conclusions give you the take-home message – health and  the quality and design of housing quality are related and should be integrated in policy-making and planning. 

One key finding was: “Using up to a decade of household improvements linked to individual level data, we found that social housing quality improvements were associated with substantial reductions in emergency hospital admissions for cardiovascular conditions, respiratory conditions, and fall and burn injuries.”

The title of the study is, “Emergency hospital admissions associated with a non-randomised housing intervention meeting national housing quality standards: a longitudinal data linkage study”. Sarah Rodgers et al. Journal of Epidemiology and Community Health.

Survey on accessible housing

Front cover of the reportIf you want to know what people think about accessible housing, the findings from a recent survey will give you a good idea. With the prospect of a Regulatory Impact Assessment of accessible housing on the horizon this is a timely report. There are four narratives that frame the report: the housing industry view; the government view; prospective buyers’ view; and the perspective of people who need mainstream accessible housing. The survey was initiated by Australian Network on Universal Housing Design and the data were collated, analysed and discussed by Courtney Wright and Jacinta Colley from Griffith University. It is a lengthy but detailed report. Essential reading for anyone interested in this topic and/or who wants to know the history behind the universal design in housing campaign that goes back nearly 20 years. Dr Courtney Wright will be presenting the findings at the 3rd Australian Universal Design Conference in Brisbane 4-5 September.

Is there a market for accessible homes?

Front cover of Habinteg report showing coins and Monopoly housesA UK blog site has an article that discusses the market appeal of Lifetime Homes in the UK context. Dominic Aitken cites some interesting research and reports by the London School of Economics, Ipsos MORI, and Habinteg Housing and Papworth Trust. UK homes are traditionally two storey with the bathroom and toilet upstairs. They are generally smaller than Australian homes too, which makes it more difficult in terms of circulation spaces. It was thought that Part M of the building code would create greater accessibility in homes, but it hasn’t helped much at all. The best part is that it requires a downstairs toilet, which is handy for everyone. Aitken explains his own research project on this topic looking at homebuyers and estate agents. The blog site has attracted several good comments and are worth reading too. By the way, it seems stair lifts are not that popular with purchasers. 

Housing: what theory and what research?

facade of an apartment building showing long balconiesThree academic articles come together for an intellectual tussle on housing theory and policy. David Clapham claims that there is a divide between researchers who focus on policy and those who focus on theory, and he asks where theory for housing research should come from and what it would look like. Hannu Ruonavaara, poses four positions about housing related theory: Is it possible to have one theory for all housing related research?; is it desirable to have one?; should we scrutinise housing as a special activity and experience?; and can we construct a theory about the relationships between the housing system and features of society?  Manuel Aalbers, who in his article, asks What kind of theory for what kind of housing research? responds to both academics. He discusses the pros and cons of their arguments. The point about housing research being largely for the audience of other housing researchers is well made. He believes it is more important to demonstrate the relevance of housing research to other social scientists. More importantly it needs to influence policy. Not light reading, but fascinating if you are a housing researcher or interested in housing policy. 

Do it yourself housing design

A webpage showing the navigation toolMy Home Space is an interactive online tool that takes you through the design details of all parts of the home including spatial requirements. The website has a video explaining how to use the guide. The tool is enhanced by references to assistive technology. The information in the tool takes the form of “things to consider” and is provided in the context of the NDIS. However, some of the design tips are useful for most homes. There is a companion paper, Government perspectives on housing, technology and support design within Australia’s National Disability Strategy that explains the background and the methodology for developing this tool. This is the work of Libby Callaway and Kate Tregloan from Monash University who will be speaking at the upcoming Australian Universal Design Conference 4-5 September 2018. 

Housing Challenges Past and Future

House half built showing timber frameworkFrom the US another article that supports universal design in housing. To give context to the current challenges, it covers the history of housing from the Great Depression through to the current day. It poses the same arguments for (non) cost of universal design, and the imperatives for it. An interesting point is that there are now more Millennials than Boomers in the US and they will be the future drivers of the housing market. The article concludes that with declining home ownership rates, “Two solutions on the supply side are Universal Design and Accessory Dwelling Units, neither of which are currently supported by public policies. To increase wealth building and economic mobility in the short, middle, and distant future, local, regional, state, and national policy makers may want to focus on these and other innovative strategies.” Graphs help with explanations of statistics.

The article is on page 24 of the Realtor University publication, The Journal of The Center for Real Estate Studies. The article is titled, Past, Current and Future Housing Challenges in the United States. There are four other articles that might be of interest, rent growth, millennial home ownership, manufactured homes, and real estate investment. The text is not easy to read and is in two column format. 

Co-designing bathrooms with older people

Public toilet in Kawakawa New Zealand. It has large mosaic tiles all at different angles. The toilet seat is timberHow do you know what older people want in their bathroom design? Simple. Ask them. And have lots of Post It Notes handy. That’s the basis of co-design. Having a more flexible and safer bathroom at home is one of the keys to ageing in place. Knowing “what’s best” is not necessarily in the hands of design experts or health professionals. The Livable Bathrooms for Older People Project investigated and evaluated all aspects of bathroom design, fixtures and fittings. The report spells out in great detail how the project was conducted, including the role of participants in the process, and the outcomes of the research. There are many explanatory pictures demonstrating the process.The report is available on ResearchGate or can be purchased from Google Books.

The Co-Design research was carried out by Associate Professor Oya Demirbilek, the Co-Design Sessions Lead Investigator with assistance from PhD Students Alicia Mintzes, Steve Davey and Peter Sweatman. University of New South Wales. 2015.

Note: The picture is of the renowned public toilet in Kawakawa New Zealand. It would be very confusing for someone with perception issues.  Editor’s photo.