Does housing wealth really have untapped potential to fund care and support options for older people? Recently Age UK held a policy seminar on housing inequality among older people to consider this and a number of other related questions, with the help of some leading experts. The conclusions they drew seem to challenge a number of faulty assumptions about housing wealth – assumptions that are shaping the thinking of policy makers. Dr Beverly Searleof St. Andrew’s University offered an alternative and more complex picture of the distribution of housing prosperity in England and the implications for policy.
Dr Searle described dramatic geographical variations in the location of housing wealth – linked to house prices – which determine the equity available to older people and the choices they can make. Dr Searle found that 42% of housing wealth is concentrated in London and the South East, while 20% is located in the North East, Yorkshire and Humberside and the North West combined. Only 3% of housing wealth is found in North East. These inequalities mean that some housing and care options will only be available in affluent places, while choices for older people in poorer areas decline.
It was with tentative optimism that I read the short paragraph in the Government’s recently published social care white paper that proposed that everyone with a care plan should be allocated a named professional to take responsibility for care coordination. The importance of on-going support to help people access and coordinate services, for example from a dedicated case manager, was a key finding of the research we recently carried out at the Social Policy Research Unit (SPRU, University of York) into good practice in social care for people with severe and complex needs.
For this study we consulted people with complex needs (including older people with dementia), family carers and members of specialist voluntary and user organisations, about what they consider to be good practice when someone’s needs are severe and complex. In addition to a person centred approach to everyday care and support (for example from a known and trusted helper ), participants valued person-centred support to arrange and coordinate care, over time, from a case manager or other individual who knew them well and had expert knowledge of their needs and the services available to them.
When we carried out a literature review to scope the evidence on good practice for people with complex needs, we were disappointed to find little robust evidence about what works. However, there was some evidence in support of intensive case management for older people with severe dementia. In a study by Challis and colleagues (2002), older people using a community mental health service who received case management had reduced needs compared to older people using a similar service with no case management, and their carers experienced less stress. What’s more, after two years 51% of the case management group were still living in their own homes, compared to only 33% of the comparison group.