Home adaptations: When access becomes a barrier

Why home adaptations?

People’s ability to modify their own home to better suit their needs is key to facilitate healthy independent living. Home adaptations can be cost-effective in preventing falls and injuries, improving performance of everyday activities and improving mental health.

Our study, funded by the Centre for Ageing Better, aimed to understand motivations for and barriers to acquiring home adaptations, and their impact on quality of life.  By speaking with older people and practitioners, we found that a typical home adaptations journey covers four phases – triggers, access, installation and outcomes. These were informed by ‘contexts and capabilities’, shown in Figure 1 below.

Access as a barrier

Previous research shows that delaying installation of home adaptations until crisis point can reduce their effectiveness.  Within our study, ‘access’ (i.e. the process of identifying appropriate adaptations and the services/funding needed to deliver them), was a barrier which resulted in continued use of unsuitable home environments, or accessing adaptations inappropriate for people’s needs.

Barriers to access were often due to:

• Not understanding what home adaptations were available
• The processes required to access them
• Logistical issues (particularly long delays and waiting lists)
• Cost (including poor awareness of available funding)
• Tenure (notably in the private rented sector).

Unable to access an adaptation at the rear of her property due to ineligibility, one of our research participants fitted a temporary handrail, which she did not have confidence using (Figure 2).

“I would like a rail there. I’m finding it a bit wary about trusting them. And it’s too far to step. I’ve bought these artificial steps myself, but they’re not much good.”

She described the assessment process as being a barrier to acquiring further adaptations which she needed, stating she did not want to “cave in yet” as she was fearful of losing her Attendance Allowance and was “dreading getting assessed”.

For those who were applying for local authority grants and services, eligibility criteria was seen as a potential barrier to access, particularly for those who felt unfairly treated within financial assessments. Meanwhile, others were also unsure about what was available and at what cost.

“I don’t really need a stair lift because I’ve got the two bannisters. I can’t really afford one of them, anyway. Because you’ve got to pay for them – for stair lifts, haven’t you?”

Participants feared rejection on financial grounds and unnecessary delay, which deterred them from applying for local authority services. Along with this reducing the likelihood of accessing adaptations, it increased anxiety around self-funding due to it being too costly or resulting in a poor-quality job.

“The occupation health... She said you’re better off letting us put it in because it’ll be done properly. You might get somebody that puts it in and might... You know, unless you get a really good workman to do it.”

"I had to take out a loan"

Another participant had a very different experience and self-funded all of the adaptations in her home, including a new wet room. However, the salesman caught her at a vulnerable time, shortly after her husband had passed away, and she “just agreed to everything”.

“It was somebody knocking on the door […] the firm canvassed and it wasn’t a good firm at all … I had to take out a loan, so it’s going to be another five years before it’s paid off.”

Potential solutions

It isn’t all bad news!  Participants described a number of positive suggestions to help access home adaptations. Some expressed the importance of promotion, awareness and a supportive system, which aided positive experiences of installation and good outcomes.

For practitioners, a successful outcome focused on improving quality of life, independence and preventing deteriorating health. Practitioners also reflected on ways to improve the home adaptations journey, such as having access to up-to-date information, clear assessment processes and timelines, a ‘display’ shop demonstrating domestic spaces and use of home adaptations, and also the need to keep abreast of new developments, products and technology. Long-term there was agreement that ‘future homes’ need to be accessible but also acknowledgement of the issues surrounding this.

“Because land is that much at a premium, everything they’re building is three, four storeys. In 20, 30 years’ time, you’re not going to be able to adapt those properties” (Building Contractor)

What support is available?

The Disabled Facilities Grant (DFG) provides funding for home adaptations related to disability. DFG funding is provided by central government to local authorities who can then choose to add their own contribution. The total funding is then distributed to applicants subject to necessity, appropriateness, applicant’s needs and other considerations. Applicants are subjected to a means test, with their income and savings taken into account. Successful applicants may receive funding to pass on to contractors, or the local authority may organise and pay for work directly. In addition to the DFG, many local authorities provide minor adaptations (under £1,000) such as grab rails, without a full assessment.

To find out more about our project, please visit https://www.ageing-better.org.uk/publications/homes-that-help.

Dr Gemma Wilson, Dr Catherine Bailey, Dr Phillip Hodgson, Dr Dominic Aitken are researchers at Northumbria University.