Helen Brown, an experienced Occupational Therapist and PhD researcher, delves into the complexities of providing person-centred housing solutions for older adults. Drawing on her 8 years of professional experience at Rotherham Metropolitan Borough Council and her current research at the University of Sheffield, Helen explores the gap between the aspirations of older people and the housing services available to them.
Housing professionals and practitioners, including occupational therapists, describe their professional practice as person-centred when offering housing solutions and related services to older people. The Department of Health and Social Care (2021) define person-centred care as being able to provide “genuine choice and control about personalised care and support”, which can “enhance quality of life and promote independence in a way that matters to individuals.” This blog aims to discuss the extent to which housing services can be person-centred from the perspective of older people who need housing and related support in later life.
Whilst housing practitioners aim to be person-centred, this can be a challenge due to the limited housing solutions available to draw upon to meet the expectations of older people. This is especially so when faced with a heterogeneous group of older people with diverse housing needs and aspirations. As a result, the risk is that housing professionals treat older people as a homogenous group to be offered ‘one size fits all’ solutions to their housing needs. For instance, policies which encourage older people to downsize assume that less space is needed in later life, such as a second bedroom. However, evidence suggests that even when the older person lives alone, the space to undertake valued hobbies, such as crafting or jigsaws, or provide caring responsibilities, especially for grandchildren, is hugely important to well-being in later life. Yet the offer of a one-bedroom bungalow or apartment so that the older person does not under-occupy a property is often made without considering the potential use of the ‘spare’ bedroom.
Another example of the potential disconnect between older people and housing professionals is illustrated through discussions around technology. Assistive technology is often seen by service managers as a panacea in terms of managing resources and preventing, reducing or delaying older people from coming into services (UK Parliament, 2014). However, technology is framed very differently by older people who discuss technology in terms of meaningful activities, for instance, using an iPad to play games or WhatsApp video through their smartphones to speak to family or the internet to volunteer and support others. Older people rarely frame technology as a means to be independent, which illustrates that if housing practice is to be client-centred, then a better understanding of what it means to live well in later life cannot be reduced to the provision of a call alarm. The limited range of assistive technology, adaptations and equipment available, and the expectation that many of these items are self-funded, is in contrast to the principles of person-centred care and risks further disadvantage of older people in the greatest need.
A further concern is that the opportunity for practitioners to be person-centred may be reduced if they have large caseloads and long waiting lists, which limits the time spent with older people to really try to understand what is meaningful and essential to them regarding housing. As a result, the emotional attachment to the home and neighbourhood, even items within the home, is often underestimated by practitioners who are faced with having conversations about potential housing options with older people, which are based on physical practicalities. The assumption is that older people make housing decisions with the same priorities as professionals. However, some older people make decisions based on an emotional connection to the home rather than practicalities relating to, for example, accessibility. Yet the space, time and information for older people to consider their housing options and make an informed decision about the different housing possibilities available can be constrained. For example, older people may feel pressured to decide quickly about a housing offer, especially when there are penalties for refusal, such as dropping down the housing waiting list or having a medical priority removed. This is not person-centred and offers limited consideration of whether the offer can meet the older person’s housing aspirations.
So where do these tensions leave practitioners working in the arenas of housing and related support who aim to be person centred when serving older people. In conclusion, here are three suggestions from practice and research to enable person-centred practice. Firstly, listen. Take time to really listen to older people and respect their subjective preferences as individuals. Secondly, we should not make assumptions about what older people need in terms of housing and support; instead, we shouldn’t focus on the physical environment alone. Thirdly, advocate for and with older people by encouraging the delivery of a range of housing possibilities, thereby creating a choice to enable people to realise their housing aspirations in later life.
Department of Health and Social Care (2021). People at the heart of care: Adult social care reform white paper. Available at: People at the Heart of Care: adult social care reform white paper – GOV.UK (www.gov.uk) (Accessed: 05/09/2024).
UK Parliament. (2014). Care Act 2014. Available at: https://www.legislation.gov.uk/ukpga/2014/23/enacted (Accessed: 05/09/2024).
