Enabling people to live independently for as long as they can is an ambition set out in the Welsh Government’s long-term vision for health and social care.
This is a crucial priority in the context of our ageing population. By 2034, it’s estimated that nearly 1 in 4 people in Wales will be aged 65 or over.
Although people are living longer, the average healthy life expectancy – the years someone is expected to live in ‘good health’ – has been rising at a slower pace. This means people in the future are likely to live more years with illness, frailty or disability.
It’s widely accepted that the social care sector may struggle to meet the demands of an ageing population without reform. But there’s less discussion about whether the housing system in Wales will be able to support a growing number of older people to live healthy lives.
This article looks at three challenges that the existing housing stock poses for the Welsh Government’s ambition to support healthy and independent living, and why problems in the housing sector might lead to increased pressure on health and social care services in future.
Poor quality or unsafe housing
The most recent available data shows that, in 2017-18, nearly 1 in 5 homes in Wales had a Category 1 hazard, which are regarded as posing a serious risk to a person’s health and safety.
Poor quality housing can be detrimental to the health and wellbeing of people of all ages, but it’s particularly harmful to older people and those with health problems.
The presence of fall hazards due to the design and condition of a property is one of the most commonly identified problems, with many people in Wales living in old, narrow terraced housing or homes built on steep hillsides. Falls amongst older people can lead to injury or injury-related disability, whilst living in fear of falling can contribute to reduced physical activity and a worse quality of life.
Cold and damp conditions are also a major driver of housing-related health problems.
Care & Repair Cymru argues that the state of older people’s housing in Wales is putting people at risk of ill health, injury and a long-term loss of independence.
A shortage of accessible and adaptable housing
The number of people experiencing mobility problems or difficulties carrying out daily domestic tasks is projected to increase significantly in the coming years.
Homes can often be adapted to meet people’s physical needs as they get older or following the onset of illness or disability. However, disability charities have highlighted that many homes in the UK are not suitable for adaptations, often due to a lack of space or structural factors.
In 2018, an Equality and Human Rights Commission report on housing and disabled people in Wales concluded that:
With an ageing population and the number of disabled people increasing, the demand for accessible and adaptable homes is going to significantly increase in the coming years. Unless action is taken to address this, disabled people will increasingly be subjected to living in homes, places or contexts that deny them their right to independent living.
Disabled people of all ages already face difficulties in finding accessible accommodation. A survey commissioned by Leonard Cheshire in 2022 found that 1 in 4 (25%) people in the UK with housing accessibility needs find it difficult to get into their own homes.
Research has shown that accessible housing can help to reduce the risk of trips and falls, improve independence and social participation, and delay or avoid the need to move to residential care.
A lack of housing options for older people
In a 2017 report, the Welsh Government’s Expert Group on Housing an Ageing Population argued that the housing supply in Wales was not reflective of people’s wants and needs as they age.
People can face substantial practical challenges in remaining in their current home as they get older. Structural aspects of housing - such as steps and stairs - can become a barrier to getting around and contribute to a loss of independence. Meanwhile, the design of external environments and the quality of public transport connections can restrict people’s ability to stay active or take part in social activities, leading to increased social isolation.
Although research has shown that older people tend to want to stay in their current home for as long as possible, there is also evidence to suggest that some would consider moving if given the opportunity. The likelihood of considering a move is higher amongst older people who have a disability or long-term illness, and those who feel isolated or vulnerable in their home.
However, the Centre for Ageing Better has argued that people’s ability to make a positive move in these cases is constrained by the availability and accessibility of options which offer a better quality of life in a suitable location.
Others have suggested that a lack of specialist retirement housing or housing with care means there are limited options for people who would benefit from easier access to care and support services as they get older.
Demands on health and social care services
As the number of older people in Wales increases, there’s a risk these housing problems could contribute to increased demand on health and social care services.
Poor quality or unsuitable housing increases the risk of injury for older people and disabled people, and a larger number of older people in poor-quality housing could increase demands on health services. For example, the Welsh Government has projected that the number of people experiencing falls leading to a hospital admission will reach 24,429 in 2035, an increase of 63% compared with 2017.
A lack of suitable and safe housing options can mean that people who have experienced injury or illness have to remain in hospital for longer than necessary before being discharged, or have no option but to move to residential care when they would prefer to live independently.
Housing conditions can also play an important role in shaping people’s care needs. Research has found that older people who live in poor quality housing are more likely to experience an earlier onset of care needs.
What’s being done to tackle these issues?
The Welsh Government has set out some of the steps it’s taking to address these challenges in its 2021 Strategy for an Ageing Society, and in its 2019 framework and action plan on the Right to Independent Living. These include:
- tackling fuel poverty and supporting people to improve the energy efficiency of their homes through the Warm Homes Programme;
- ensuring older people have equal access to good quality, timely adaptations that support their independence; and
- ensuring all Welsh Government grant-funded new housing complies with Lifetime Homes Standards.
As policy makers continue to grapple with the implications of an ageing population, there is likely to be an increasing focus on the role that housing plays in enabling people to age well and live healthily for longer.
Article by Gwennan Hardy, Senedd Research, Welsh Parliament
