CHAPTER 6: PREVENTATIVE SUPPORT SERVICES
6.1 Local authorities and housing associations have a long tradition of providing low level, preventative support services (such as housing support, handyperson, Care and Repair and community support), either as part of housing management services, provided under tenancy agreements, or through separately funded housing support services, such as the former Supporting People programme. Social landlords also play a key role in supporting wider activities in local communities, and services are also provided by Care and Repair and private and voluntary sector organisations. These services are particularly useful for people who just need a small amount of help to live independently and need to be available across all housing tenures. If they can be provided at an early stage, their effectiveness can be enhanced. For some older people, these services are delivered alongside home care services provided by local authority social work departments.
6.2 There is a growing body of evidence that investment in services, which support older people to remain independent and avoid accidents in the home and social isolation, make an enormous difference to quality of life and are cost-effective. In particular, the Christie Commission report  advocated a focus on prevention. Such services bring peace of mind to older people and their families and also contribute to health and social care objectives of reducing unplanned hospital admissions and delayed discharge. However, preventative support services remain vulnerable, when public funding is under pressure.
6.3 This recognition of the contribution and value of services which have a preventative focus - avoiding or delaying the need for more intensive services, or more importantly avoiding incidents which may lead to hospital admission - is shared with partners in health and social care. The whole Reshaping Care programme gives increasing priority to those services, which help prevent greater needs arising or 'anticipate' and plan for changing needs. Co-ordinated action across housing, health and social care in helping prevent unnecessary hospital and care home admission is a key theme of this strategy and the wider Reshaping Care programme.
6.4 In recognition of the importance of preventative support services, we have established an independently chaired Preventative Support Working Group, with a remit to consider how a range of housing-related preventative services can be developed in ways that are financially sustainable. As many of these services also support disabled people, the Group includes organisations representing their interests.
6.5 Our review of evidence has highlighted four areas where improvements or further development are needed. These are:
- Housing support services - explaining the benefits of greater investment in housing support services, as key low level services with a preventative focus, which support older people to live independently;
- Handyperson services - finding ways to extend the availability of handyperson and gardening services across all tenures to support older people living at home;
- Housing's role in supporting local communities - defining the current and potential contribution from housing organisations in building community capacity to support older people living in the local area and help reduce social isolation and loneliness; and
- Telecare - contributing to the mainstreaming of telecare and supporting the national commitment to ensure that all older people over 75 years are offered a telecare package tailored to their needs.
Housing support services
We want to see increases in housing support services with a focus on prevention, so that every older person has the opportunity to access services, which help them maintain their independence and have full and active lives.
6.6 Housing support services help people to live as independently as possible in the community. They range from low level services, such as community alarm systems in sheltered housing, to more intensive support, including assistance to claim benefits; manage a budget; keep the home safe and secure; and help with shopping and housework.
6.7 Housing support services currently play a small, but significant, role in supporting older people to remain living at home, with most services provided to residents of sheltered housing in the social rented sector. However, housing support does have the potential to play a greater role in supporting independent living for older people in mainstream housing in both the private and public sectors. Research in 2007 found that expenditure of £124 million on housing support services for older people and people with physical disabilities produced £137 million in benefits. 
6.8 The Better Futures  outcomes tool was launched in early 2011. It has been designed to enable housing support providers to work with people using their services to record their support needs over a period of time. In showing the 'distance travelled' over time, it is one of the few tools to capture the difference made by preventative support services. It also provides a means of measuring the 'counter-factual' (that is the situation that has been avoided through the provision of support), helping to evidence prevention. We will work to consolidate and extend the evidence about the role and contribution of housing support services and, through this, promote the development of further services as a part of the package of preventative services available to older people.
6.9 There are particular issues with proposals for changes to housing benefit rules for housing support services in supported accommodation, such as sheltered housing. The housing benefit budget for all supported accommodation is relatively small (1 - 2%), but reforms could have a big impact on residents of sheltered housing. Proposals to introduce a fixed rate of housing benefit could affect the rate that providers receive, leading to a deficit on housing management costs, and possible service cut-backs or higher charges. We will continue to press the UK Government to take account of these concerns.
Case study: Caledonia Housing Association's 'Home Help' service
Caledonia Housing Association runs a home help service for older people in Tayside and North-east Fife, providing practical assistance with tasks, such as shopping, laundry, cleaning and preparing light meals. The aim is to support people to live as independently as possible, by providing a personalised service doing some of the things they may struggle with, due to frailty or disability.
There is a flat rate charge to all service users, which enables the service to break even. When people sign up to the service, advice is provided to ensure they are receiving all the benefits to which they are entitled. A tailor made service is provided, based on what the individual wants. This means that the service can change each week, e.g. shopping one week, and help to clean the home the next. As staff are based in a geographical area, they can build up a relationship with clients, and the service ensures that people have regular visitors.
In a recent survey, 99% of service users were 'satisfied',
including 86% who were 'very satisfied'.
Case study: Highland Home Carers
Highland Home Carers provides housing support services to people in their own home, enabling them to remain at home for longer periods then would previously have been anticipated. Support includes assistance with budgeting, shopping and domestic tasks.
Highland Home Carers became a limited company in 2001 and has grown to be one of the major independent providers of home care and support services in Highland region. In 2004, ownership of the company was placed into the hands of employees (now referred to as partners), and a Board was elected to oversee the business. Shares are given to qualifying partners each year to signify their ownership of the company.
In 2007, Highland Home Carers embarked on its first period of social accounting, enabling the company to account for its social, environmental and economic performance. This has proved a useful tool for gauging the company's impact on its main stakeholders and receiving vital feedback on performance and areas which require improvement.
Without the services, many service users would have to be
admitted to long term care, which would then disable them further.
They would also not have the opportunity to use the skills they
already have, making them more dependent on the care sector.
What we will do
6.10 We will promote increases in housing support services by:
- Promoting the benefits of housing support. We will publicise and extend understanding of the role, contribution and benefits of housing support services, particularly in relation to their value for money. We already have evidence of these benefits, but we are aware that more is required if older people and those commissioning services are to be convinced of the importance of investment in this area, particularly when public resources are stretched. We will use the evidence we have about the effectiveness of housing support services, together with additional information which becomes available, to inform the preparation of the 'business case' for housing. This is being taken forward as part of our work to improve strategic leadership.
- Exploring opportunities for social enterprise. We will explore the feasibility and, if appropriate, support the development of services operating as social enterprises, which are income generating, to provide housing support and potentially other services. Public funding cannot provide housing support for all older people who would benefit from it, so we need to find ways to offer services which older people trust and consider to be value for money. Our assessment of the potential for different business models may also be relevant to providing older people with support in moving home, and the provision of handyperson and small repairs services, including by housing associations and organisations such as Care and Repair.
We want all older people to be able to access handyperson type services, either as an integral part of their tenancy, or for a charge at a level that does not act as a disincentive to uptake.
6.11 Handyperson services, such as hanging pictures or replacing light bulbs, deal with smaller tasks than repairs services, which are discussed in Chapter 5 . Unlike repairs, they do not usually form part of a landlord's responsibilities in terms of the tenancy agreement, whether in the social rented or the private sector. That 'little bit of help' is not always available to older people from family or neighbours, but it is known that without it, older people can take unnecessary risks by trying to do the work themselves or have their confidence in being able to live independently undermined. Research undertaken for the Department for Communities and Local Government identified four outcomes from the provision of handyperson services: 
- Reduced risk of falls (where work is part of a falls prevention package);
- Improved or maintained independent living;
- Improved quality of life and wellbeing; and
- Easier access to other appropriate services.
6.12 Handyperson services are provided by a range of organisations, but are often difficult for older people and disabled people to find, and there is a need for greater awareness of what is available. Sometimes, services are at a price that people do not consider to be value for money, or provided by traders that they don't trust. We need to change that situation so that older people and disabled people can get these basic services, which are so important for sustaining their independence and wellbeing.
6.13 Most Care and Repair projects provide handyperson services, and they are very popular. Care and Repair has an established network of projects across Scotland offering a wide range of different services, but there are many more older people and disabled people who could benefit from these services.
Case study: Lomond and Clyde Care and Repair
Lomond and Clyde Care and Repair has established a social enterprise to meet gaps in the provision of its services to older and disabled people and to make the organisation less reliant on grant funding.
Care and Repair Extra was incorporated as a subsidiary of Lomond and Clyde Care and Repair in 2010. Following a feasibility study, it is planned to widen the existing small repair service on a commercial basis to people outwith the current client group.
Any income generated by Care and Repair Extra will allow the service to continue to be provided free of charge to older, disabled and other at risk residents in West Dunbartonshire. The aims of the service include the provision of a quality repairs service which gives value for money; the creation of local jobs; and the extension of staff skills.
Lomond and Clyde Care and Repair is the first Care and Repair
service in Scotland to establish a social enterprise. The business
plan is being updated, and Care and Repair Extra will be marketed
as a top of the range small repair service, whose staff can be
trusted and whose pricing has no hidden costs.
6.14 One important task of handyperson services is the installation of smoke alarms, which can improve chances of escape from a fire by giving early warning of danger. This is particularly important for older people, who may be less able to escape quickly from a building. Alarms may be audio-based or visual, depending on the needs of the individual.
6.15 Gardens are important to many older people, and a well-maintained garden can significantly enhance emotional wellbeing. However, many people find it more difficult to manage their gardens as they get older, and they can become the source of considerable concern. Services which help people to maintain gardens, sometimes on a reciprocal basis, can be a great help to older people and also a source of community cohesion.
Case study: Angus Care and Repair's Home safety check
Angus Care and Repair undertakes home safety checks for older people and disabled people, in partnership with Tayside Fire and Rescue. The check seeks to identify any hazards in the home that may cause an accident, slip or fall, such as faulty wiring, rugs or mat hazards or a need for grab rails or other adaptations. Any faults that can be corrected by the Small Repairs Officer are done, and the client is advised if further work is needed. A falls survey is also undertaken to assess the prevalence of falls in the home.
A follow up survey of clients who had received the service,
following a fall in the previous year, found that all had carried
out the recommendations. All felt a lot safer in their own home,
and only 14% had had a further fall.
Case study: Signpost Handyperson Service
Signpost Handyperson Service is one of three partner organisations, along with Cairn Housing Association and Care in Strathnairn, providing handyperson services to people aged over 65 and disabled people in Inverness-shire, Nairn, Badenoch and Strathspey.
The service is provided by volunteers, who help with tasks, such as minor joinery, painting and decorating, as well as gardening. As well as offering a trustworthy service, the volunteers provide social contact that people may otherwise not have. This helps to support independent living and can also help to facilitate hospital discharge. The last two winters have been particularly severe, and volunteers came out in terrible conditions to clear steps and paths to ensure that people were not trapped indoors.
The service offers meaningful opportunities for volunteers, some of whom are long term unemployed or on community service programmes. Seeing jobs through from beginning to end, and the benefits they bring to clients, gives a huge sense of achievement and builds self-esteem and confidence. It also increases employability.
There are currently over 1,800 clients, who are able to remain
healthier, happier and safer in their own homes, due to the help
they receive. Volunteers have also benefited, and several have now
moved into full-time employment.
What we will do
6.16 We will promote the development of handyperson services by:
- Assessing the role of social landlords. We will assess the role of social landlords in providing handyperson type services as part of their landlord responsibilities, in areas where these services are not available. We know social landlords recognise the difficulties that older people face and help where they can, but we also know that there are financial pressures facing them. These services offer value to the public purse by reducing the risk of accidents and the need for more expensive services. Landlords have an obvious role to play, as they are in contact with tenants and other household members who are vulnerable.
- Exploring options for extending the role of Care and Repair. We will look at options for extending the role of Care and Repair and businesses operating as social enterprises, to include handyperson type services.
Housing's role in supporting local communities
We will encourage and support housing organisations to play a full part in building the capacity of communities to support older people living in the local area.
6.17 A supportive local community and a strong social network are recognised as important in supporting older people, particularly single older people, to reduce loneliness and live independently at home. It is particularly important in remote and rural areas, and also for people living in the private sector, who don't benefit from the support of social landlords. People with strong social networks are generally better placed if they need other types of support, and befriending services can play an important part. The Reshaping Care programme has a strong focus on building the capacity of local communities to support older people living in them. Volunteer networks can play an important role here, and social enterprise can also provide a means of delivering services, while building community cohesion.
Case study: Queensferry Churches' Care in the Community's Befriending service
Queensferry Churches' Care in the Community provides a befriending service for older people in North-west Edinburgh.
The befrienders are volunteers, who provide much needed social support and contact to older people, who may have become isolated following illness or bereavement. The service allows them to re-connect with their wider community, through going on outings, using the local knowledge of the befriender to link in with appropriate activities and services. This helps to build up confidence and self esteem. For people who are unable to leave their home, the service provides companionship, support and most of all, a listening ear.
The following are quotes from older people who receive the
service: "I agreed to the service quite reluctantly as I thought
the person might come in and try to "take over". How wrong I was.
We are now real friends and have such good chats". "The big thing
for me is I have some carers who come in, and they are paid to do
this, but my befriender is a volunteer, and she comes to visit me
because she wants to".
Case study: The Food Train
The Food Train was established in Dumfries and Galloway in 1995. It provides shopping, handyperson and befriending services, under a contract with the local authority, for older people who are unable to manage these tasks themselves. The objective is to support them to live independently at home. In providing these services, Food Train also offers a wide range of supported volunteering opportunities and has developed a unique partnership between communities and private sector retailers.
Growth and development has been led by the needs of local people, and there are now three main services:
- Grocery shopping. Volunteers visit weekly to collect the shopping list, buy the shopping, and then deliver and put it away. There is a £3 charge per delivery.
- Food Train EXTRA. Volunteers visit monthly to provide help with household tasks, with a befriending element of increased social contact. Jobs cost £3 each.
- Food Train FRIENDS. This service provides telephone calls, home visiting and trips out for older people, who are isolated. There is an annual £10 charge for this service.
The service has expanded to West Lothian and Stirling and will
shortly start in Dundee. Annual surveys of customers show that Food
Train helps them feel more independent; better able to plan and
prepare meals; and that they get great enjoyment from the
volunteers' visits. As Food Train services are delivered entirely
by volunteers, they also produce a huge increase in community
6.18 Housing associations have had specific funding to support activities wider than simply housing services. This recognises their role in and strong relations with local communities, which make them particularly well placed to provide support. This wider involvement by all housing organisations, not simply housing associations, has the potential to support the efficient and effective delivery of local services.
Case study: Craft Café
Cassiltoun Housing Association has managed the Craft Café in the Castlemilk area of Glasgow, in association with Impact Arts, since 2008. The café was established to help alleviate social isolation amongst older tenants, while promoting health improvement and addressing poverty and community decline.
There was a lack of activities for older people that were accessible, in terms of location and cost. Craft Café activities include painting, jewellery making, knitting and woodwork. It is free, but a social enterprise culture is encouraged, where participants sell some of their work. This raises funds for the project, but also helps participants recognise that their creations are valued by other people.
Craft Café is vibrant and welcoming and has expanded from
one day a week to three to cope with demand. Members have a strong
social network, becoming friends and offering advice and support.
They also take an active part in promoting and leading the
programme, working together on group projects or sharing skills and
interests. Health benefits have been recognised by local doctors,
who recommend Craft Café to patients suffering from
depression and isolation.
Case study: Silver Deal Active
Silver Deal Active is delivered in partnership by Glasgow Housing Association, Glasgow Life and the Northeast and South Sector Community Health Partnerships. It aims to get Glasgow residents aged 60+ more active, more often to support health improvement and personal confidence and reduce social isolation - helping them to live independently for longer. It currently provides 81 free physical activity and arts sessions each week in 41 different community venues across Glasgow. Over 1,100 participants are registered.
There are three elements:
- Easy exercise sessions, including chair aerobics, indoor bowling, Tai Chi, and easy dancing;
- Active arts sessions, including glass, ceramic and textile painting; clay modelling; mosaic crafting; and jewellery making; and
- Subsidised and free social events for regular participants, which provide an opportunity for people from different areas to meet and socialise, with outings such as the pantomime and the Falkirk Wheel. These have proved popular and helped support new friendships.
Each year, a customer satisfaction survey is carried out. The
most recent survey in 2011 shows an overall satisfaction level of
99% with the Programme.
Case study: The Evergreen project
The Evergreen project was an ambitious and innovative three way partnership between Global Action Plan, Hanover (Scotland) Housing Association and BSkyB in east and central Scotland. It ran from 2009 to 2011, involving 645 older people from 26 sheltered housing developments. The project aimed to support Hanover staff and residents to reduce their impact on the environment by reducing energy waste and increasing recycling. It also aimed to improve residents' quality of life, through increased participation with the community.
The project harnessed corporate volunteering through BSkyB and involved the local community, including primary schools. Recycling facilities were installed, and workshops held on recycling and energy efficiency. There were also gardening activities, including tree planting and installation of raised beds and greenhouses, enabling residents to grow their own vegetables.
The project successfully reduced carbon emissions from the housing developments, improving energy efficiency, saving money and creating a healthier environment and lifestyle for the residents. Residents quickly became excellent recyclers. They also reported that they had made new positive connections and friendships with other people in the community.
The environmental savings will continue, as the project provided
residents with facilities to recycle and compost. Hanover
(Scotland) Housing Association is now working towards implementing
a volunteering programme for its own staff.
What we will do
6.19 We will help to support wider activities by the housing sector by:
- Showcasing effective practice by social landlords. We will identify the role currently played by housing providers, particularly the social rented sector, in building capacity and supporting social networks for older people and the potential for extension of this role. We intend to publicise case illustrations, giving examples of social landlords working with local communities to support older people.
We will encourage the development of telecare, as a key element in support for older people to live independently at home.
6.20 Many older people receive telecare services, most frequently in sheltered housing, but also in mainstream housing. Telecare involves remote delivery of care services within the home, by telecommunications or computerised services, and usually takes the form of sensors or alerts which are triggered with the occurrence of events such as falls, floods, fire or other extremes of temperature. Alarms may be audio-based or visual, depending on the needs of the individual. Integration of telecare with the remote provision of health services in the home, known as telehealth, is also under development. There is clear evidence that telecare, with effective monitoring and response, can provide significant benefits for older people and carers, as part of a package of support to maintain independence and wellbeing.
6.21 Awareness of telecare needs to be increased to realise the full benefits. Recognition and acceptance are likely to increase, with the ageing of younger people, who are more familiar with technology.
6.22 Telecare to 2012: An Action Plan for Scotland  provides the strategic direction, along with support for the development and implementation of local telecare programmes. It aims to promote telecare-enabled care as an essential means of supporting as many people as possible to live at home for as long as they want to, in comfort and safety, with the best possible health and quality of life. This strategy is being taken forward by the Scottish Centre for Telehealth and Telecare (within NHS 24). An integrated telecare and telehealth strategy is expected to be in place from April 2012.
Case study: Lochalsh and Skye Housing Association's Care and Repair Service
Lochalsh and Skye Housing Association's Care and Repair Service is working in partnership with NHS Highland and Highland Council to deliver telecare and telehealth monitoring devices cost-effectively to older people and disabled people in their homes.
Telehealth devices are most commonly used to monitor long term conditions such as Chronic Obstructive Pulmonary Disease, heart disease and certain mental health conditions. Daily test results are automatically sent to the Highland Hub Call Monitoring Centre, which generates an alert if any abnormality is identified. This increased monitoring reduces travel time for people in remote rural areas to and from hospital and has a corresponding reduction in stress levels.
The Handyperson Service has also set up a demo/assessment room within Portree Hospital, which acts as a training facility for home carers, clients and community nurses to better understand the use and benefits of the devices.
Telehealth makes a real impact in providing care which is
quicker, personal and closer to home, producing better health
outcomes and helping people to remain independent in their
communities. More widely, this will help to focus the emphasis
towards preventative medicine, involving people in managing their
condition and reducing emergency hospital admissions.
What we will do
6.23 We will help support the continued development of telecare by:
- Promoting expansion of services. We will continue to develop telecare and telehealth through the Change Fund for Older People's Services and local partnerships. The Scottish Government is also committed to driving forward and utilising the benefits of telecare through the £10 million Delivering Assisted Living Lifestyles at Scale ( DALLAS) programme, which will further develop and extend telecare services across Scotland.
Our vision for 2021 is that preventative support services will have contributed to a reduction in the need for care homes and emergency admission to hospital, as well as improving people's quality of life.
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