Older people at risk of being forced into residential care due to massive delays in making adaptations to homes

Older people at risk of being forced into residential care due to massive delays in making adaptations to homes

Two-thirds of local authorities took longer than the recommended six months to deliver an adaptation through the Disabled Facilities Grant, with the longest taking more than 24 months.

In a new report, Age UK calls for all local authorities to radically improve the way they deliver adaptations. The Charity says an overhaul of the system is required to help older people to live independently for longer and reduce pressure on NHS and care services.

Age UK today publishes a report which highlights the shocking delays many older and disabled people face waiting for councils to install home aids and adaptations, making it more difficult for them to live independently at home.

The report, 'A step change: improving delivery of the Disabled Facilities Grant' says that increasing the amount of age-friendly, accessible housing and providing quicker access to appropriate aids and adaptations should be central to the UK's vision for the future of older people's housing.

Surveys consistently show that older people are keen to remain living independently at home. Accessible housing, aids and adaptations are key to this independence and give people the autonomy and confidence to live a full and active life. They are also important in reducing pressure on the NHS and social care services.  Adaptations such as walk-in showers and stair-lifts help to reduce falls, sustain better health, lessen dependence on others for care and ease hospital discharge.

However, in 2021/22, the most recent year for which figures are obtainable, over two-thirds of local authorities took longer than the six months recommended by the Disabled Facilities Grant guidance, issued by the Government, to install most adaptations through the grant. The longest took more than 24 months. These are average figures and so some individual cases will have taken even longer. Anecdotally, there have been further delays since, due to a backlog of cases post-COVID. Sadly, there is little sign of improvement.

There are a number of reasons for these lengthy delays, according to the Charity, but many seem to come down to poor administration and customer service, and a lack of communication between local authority teams. The case studies included in the report set out a catalogue of unreturned calls, incorrect information and endless delay. Responsibility is often split between multiple busy local authority departments and cases fall between the cracks. Many adaptation teams are working to make their part of the process effective but admit to being severely stretched. Some teams have focused on making their administration of the Grant more efficient and are achieving much better results, proving this is possible, but in too many areas this hasn’t happened.

The report tells the story of two older people having to strip wash in a sink for three years while waiting for a shower to be installed[iii]. Age UK had to keep pushing the case through each stage of a lengthy process; getting an assessment, design and costing the adaptation, applying, getting approval and a date for the works to be carried out. Installing the shower only took two weeks.

In April 2023, the Government announced an additional £102m of funding for the Disabled Facilities Grant, which was a welcome injection of cash. However to get the most from this funding the Charity says it is crucial to get its local delivery right. The fund is run by local authorities and administration therefore varies from area to area. As Age UK has found, outcomes are very mixed. The budget for 2023/2024 is now £623m, almost triple the £220m budget we saw in 2015/2016 and 8.7% up on 2022/2023.

The Government has, rightly, recognised the potential benefits of the DFG and the advantages of enabling older people to live independently at home. However, with an ageing population and significant unmet need, this budget will have to rise further over the coming years. We know that the number of people over 85 is forecast to almost double between 2020 and 2040, and in 2019/20 53% of households that required adaptations did not have all the adaptations that they needed.

In many authorities there have been problems with the administration of the DFG for some time. Age UK says we need to ensure that lasting improvements are made so that the huge potential benefits to older people of these funds are maximised.

Caroline Abrahams, charity director at Age UK said:

“Our report highlights the horrific delays older people often face when trying to get the adaptations they need through this funding. Better off people tend to give up and buy their own kit instead, but if you are on a low income and don’t have many savings this isn’t an option and you are condemned to wait for as long as it takes. Sometimes the delay is so pronounced that by the time an older person finally has the opportunity to explain what they want, the adaptation they requested is no longer relevant, because their health has declined to the point that they can no longer make use of it. In the meantime, while older people endlessly wait, they have to endure discomfort and inconvenience, and they may be at increased risk of falls. This is so frustrating when installing an adaptation could have made all the difference. 

“The Disabled Facilities Grant is one of the few sources of Government funding directed at supporting older people to live in their own homes which has actually significantly increased in recent years, and with public money so tight it’s crucial that we make best use of it. Speedy installation of the right aids and adaptations is not only good for older people, it can also pay back in terms of the savings to the NHS and social care from enabling them to stay fit and well.”

“We know that falls cost the NHS more than £2.3 billion per year, with 30% of people aged 65+ and 50% of people aged 80+ falling at least once each year, so you can see how important home adaptations can be. Something as simple as a grab rail or a walk-in shower can make the difference between someone being able to remain at home, living independently, and having to move into a care home, at substantial cost to the taxpayer or to themselves if they have to pay their own fees.”

“We also need to improve the accessibility of our new and existing housing stock so there is less need for expensive adaptations in the first place. There is a massive shortage of accessible housing and we should be making better use of new build and renovation work to provide more homes that can easily flex to meet our changing needs as we age.”

“Where adaptations are required however, many people will need to continue to rely on the Disabled Facilities Grant. It’s delivery would be transformed if each local authority made a conscious effort to speed up the process, learning from the practice of the best. Better communication within local authorities and between them and older applicants is also essential. The frustration some older people experience when applying for this funding adds insult to injury. At Age UK we fully recognise that local authorities are underfunded and under enormous pressure, but that makes it all the more important that they make the best use of the money they do have.”

Note to editors

Although data for 2020 to 2022 is distorted by COVID, when installation was often difficult and some cases never came forward, pre-COVID the time taken to install an adaptation through the Disabled Facilities Grant is similar. In 2018/2019, 71% of local authorities averaged longer than the 6 months guidance. The worst local authority took an average of 39.4 months. In 2019/2020, it was also 71%, and the worst performance was 25.2 months.

Six months is the time recommended by the Disabled Facilities Grant guidance for all but the most complex and not urgent adaptations to be completed. This covers all four stages of the process. 

People sometimes quote figures for the last two stages only & compare them to statutory time limits. Much of the delay is in the first two stages and the statutory timescales are significantly longer than the recommended times in the guidance. So these figures flatter performance and do not give a real picture of the delay users of the grant actually experience.

The average cost of two hours daily help per year is £13,200, and of residential care £39,520. Therefore, essential home adaptations to keep people living independently at home is vital. [i]

[i] i] https://ukcareguide.co.uk/home-care-costs/ https://www.carehome.co.uk/advice/fees - P4

[iii] STORY 1

Three years for the installation of a shower

Two older housing association tenants were living in a property with a bath. Both were unable to use the bath anymore and wanted to have a shower installed so that they could wash independently and safely. Both had been strip-washing in a basin since early 2020. It was possible to install a shower in their property and the work was estimated to take 10 days.

April 2020: Age UK first spoke to the client. They were looking for a new flat because their housing association had told them it was not possible to install a shower.

April 2020 to July 2020: Age UK tried repeatedly to contact the relevant housing officer so that the two older people could be referred for a Bathing Assessment.

October 2020: The Bathing Assessment was completed and confirmed that a shower could be installed.

November 2020 to November 2021: Over the course of the year, Age UK repeatedly chased up the case.

After a year the project was put out to tender.

February 2022 to May 2022: The tender was sent to the housing association and approved.

June 2022: The contractor was commissioned to undertake the work.

August 2022: It was discovered that an asbestos report for the wrong property had been sent to the contractor, so they were unable to proceed with the works.

October 2022: The clients were told that the works would be done in November/December and would take 10 days.

January 2023: The work had still not been completed and Age UK continued to push the case.

Mid-February 2023: Age UK sent a formal complaint to the housing association.

March 2023: The housing association said that they had found the original asbestos report and the works were now with the local authority contractors.

April 2023: Works were completed.

In the course of our conversations, Age UK case workers caught up in some of the cases expressed their concerns:

“I have always known there were issues but when you see it yourself, you cannot believe how bad it is”.

“You have no idea of the impact of this on the person until you see it first-hand.”

And for those trying to administer the grant within local authorities, the process can be "disheartening".