Special Report 36 - Special Housing Aid for the Elderly

Published on 03 November 2000

Background

In the early 1980s, voluntary agencies reported a number of cases of elderly people who had died prematurely where the poor state of their housing was a contributory factor. It was apparent that these people had neither the personal nor the financial capacity to carry out the necessary repairs themselves.

In 1982, the Government responded by introducing a scheme called Special Housing Aid for the Elderly to enable emergency repairs in such cases to be carried out and funded by the State. The intention was to carry out the repairs without imposing any burden on the elderly person in need of assistance and to administer the scheme with the minimum of bureaucratic formality.

This examination is concerned with the operation of the scheme and its outcome to date, some eighteen years after its introduction. The examination assessed how the scheme is implemented and how the implementing agencies measure the impact of the scheme on those in need and the systems and procedures in place to evaluate the scheme’s overall effectiveness.

Delivery and Outturn

The scheme is funded at national level by the Department of the Environment and Local Government. A total of £44m has been expended under the scheme since its inception in 1982. Funding of £6m was provided in 1999. From the beginning, the scheme has been overseen by a Task Force whose membership represents Government departments, local authorities, health boards and voluntary agencies.

Because of their contact with and knowledge of the conditions of elderly people, health boards were requested to operate the scheme at local level. The health boards agreed to do so provided they could adapt the scheme to suit conditions in their own areas. This combination of informality and flexibility is considered by the health boards to be one of the most important and successful attributes of the scheme.

The examination found that generally the scheme was being delivered across the health boards in three different ways

  • use of FÁS trainees
  • direct engagement of builders by boards
  • payment of grants to applicants.

The grant-based approach was used in 38% of cases. While administratively efficient, this places an onus on the elderly applicant in terms of engaging a contractor and all that entails (and possibly obtaining planning permission) and may serve to discourage take-up of the scheme by those it was most designed to serve. The effect of the diversity of approach is that the ability of elderly people to avail of the scheme and the manner in which they benefit from it depends greatly on where they happen to live.

The cost of administering the scheme in health boards range from £34,000 to £314,000 per annum. The variations can be accounted for in part by differences in the administrative costs of the various means of scheme implementation.

Two-thirds of the work carried out relates to necessary repairs to make a dwelling habitable for the lifetime of the elderly occupant living alone. This emphasis is consistent with the original intention of the scheme.

An average of 2,300 repair and improvement jobs of varying size and complexity have been completed each year since 1982. The average cost per job in the three years 1997 to 1999 varied from £599 in one board to £2,258 in another.

There is a growing waiting list of applicants for work to be carried out. Depending on the health board area, an applicant could be waiting from six months up to four years. However, all boards have systems in place to prioritise the most needy cases, generally using health criteria.

Current Difficulties

It has been estimated that £17m would be needed to clear the backlog of cases. However, most health boards report that they would be unable to absorb more funding due to pressure on administrative resources and a shortage of building labour. In the past, health boards relied on local contractors and FÁS trainees but the building boom has decreased the interest of local contractors in small scale projects typical of the scheme and has also resulted in less trainees being available to FÁS. Given the circumstances of those in need, the resultant delay is likely to have quite an adverse impact. An innovative and concerted effort is required at local and national level to identify ways of dealing with impediments to ensure priority work is carried out.

Evaluation

Recent reports suggest that a significant number of elderly people may still be living in very poor housing conditions and that this is having a detrimental effect on their health and life expectancy. In addition to an absence of strategic planning, the scheme has never been the subject of a needs analysis and there are no systems in place to evaluate its effectiveness. Consequently, it tends to be operated in reaction to cases coming to attention, rather than as a pro-active effort to address the problem. The absence of reliable information on need makes it very difficult to plan on a strategic basis or to articulate realistic and attainable objectives in the medium to long term. Given the length of time the scheme has been in existence and indications of unidentified need, there is a strong case for carrying out a comprehensive needs assessment at an early date.

Notwithstanding the problems identified, the scheme is implemented effectively by most health boards at local level and is valued by them as an effective tool in dealing with cases where an elderly person would otherwise need to be placed in an institution. Much of the credit for this effectiveness must go to health board staff who work to maximise the potential of the existing operation. However, their ability to impact on the problem would be appreciably improved if the scheme was reviewed and strengthened.

A significant proportion of elderly people are thought to require residential care due to poor housing conditions. In the light of the costs of hospital beds and long stay residential places, the scheme would appear to represent good value for money if it succeeds in creating conditions which facilitate elderly persons living in their own homes for as long as possible.