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Working to keep people out of care homes – Paul Smith

Paul Smith, Director of Foundations, the national Government-funded body for home improvement agencies, discusses how Disabled Facilities Grants can be put to greater good:

The comprehensive spending review last year announced a significant increase in funding for Disabled Facilities Grants.

But with it came the expectation that the extra DFGs investment would “prevent 8,500 people from needing to go into a care home in 2019-20”.

Foundations’ research in late 2015 highlighted how home adaptations can help delay entry into care homes – and keeping people out of care homes is a long standing health service objective.

So what is it about home adaptations that does seem to prevent people needing to go into care homes, and what else do we need to consider if we’re going to meet the Chancellor’s target?

From the many studies into the subject there are five main reasons why older people go into residential care:

  • following a fall/fracture
  • following an acute illness
  • because of a general deterioration in their health and their ability to look after themselves
  • as a result of increasing pressure on their carer
  • because of loneliness

Of course, people are much more complicated than that and in many cases there is a combination of these events with around half of all admissions also preceded by a hospital stay. So how could DFG funding be used to address these issues?

There have been many falls studies on what works well to prevent them – and they conclude that a range of interventions are required. This includes home safety programmes that identify and eliminate hazards among older individuals most at risk of falling, but not in the general older population. Falls prevention services targeted at frail older people could become a standard part of the work of handyperson services.

For acute illnesses, where a hospital stay is likely to be involved, the issue is likely to be the swift provision of adaptations to aid discharge. Around two-thirds of home improvement agencies are already providing the home modifications that allow people to return home sooner, and DFG funding could be used to make this happen everywhere on sufficient scale to make a real difference.

With a slower deterioration in health, particularly where dementia is involved, then there is potential to make proactive changes to the home environment. The Social Care Institute for Excellence (SCIE) has a range of resources on dementia friendly environments from clear front cupboards to circular garden paths and, as the Prime Minister’s Dementia Challenge points out, DFG could fund these to allow someone to remain living safely in their own home for much longer.

Recent research from Australia shows that carers can benefit significantly from the provision of home adaptations – reducing their care giving hours by up to 60%. However, DFG is typically provided to meet the needs of the disabled person. Foundations suggests in our evidence to government, DFG could be used to support carers too.

It could be argued that as home adaptations increase a person’s independence, they reduce reliance upon carers and this could lead to increased isolation. With studies showing that loneliness is as bad for your health as smoking 15 cigarettes a day, the intervention of a home improvement agency to put people in contact with clubs, groups or befriending services could be part of a more holistic DFG process. Assistive technology could also play a role.

Whichever options commissioners choose, it will be important for all interventions to include reference to the NHS number of the disabled person. This will allow the link to care home admissions to be monitored and prove that 8,500 people have been prevented from needing to go into a care home – as well as all the other benefits to health and social care that would come from any of these interventions.


Paul SmithPaul Smith is director of Foundations, the Department for Communities and Local Government-funded national body for home improvement agencies and Disabled Facilities Grants.

Paul joined Foundations in 2015 having previously worked as a senior housing and care commissioner for Staffordshire County Council.

Prior to this he managed two award-winning home improvement agencies for Telford & Wrekin Council and Cannock Chase Council. In these roles he set up home safety, handyperson and health through warmth services as well as a national HIA means-testing model for disabled facilities grant applicants.

Paul is a qualified building surveyor and member of the Chartered Institute of Building. His first job was designing and contract-managing adaptations, including hundreds of level access showers.

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