The hidden costs of adapting the homes of older and disabled people

May 11, 2018

By Lesley Curtis, Research Fellow at PSSRU Kent

The profile of home adaptations for older and disabled people was raised when the Care Act 2014 placed new obligations on Local Authorities to adapt the houses of those eligible.  The national allocation of funding for Disabled Facilities Grants (DFGs), the principal source of finance for publicly funded home adaptations, was subsequently doubled from £220 million in 2015/16 to £394 million in 2016/17 and is projected to increase to over £500 million by 2019/20.

The gatekeepers of home adaptations are occupational therapists who have launched a campaign to demonstrate that their service can ‘Improve Lives and Save Money’.  The Royal College of Occupational Therapists (RCOT) have some excellent examples on their website of how home adaptations can improve lives but the evidence for how much money can be saved is sparse, and when any cost savings are estimated, not all staff time is included.  An underestimation of costs could lead to a shortfall in Disabled Facilities Grants (DFGs) allocations and result in longer waiting times for people having their homes adapted. This in turn could lead to falls and preventable hospital admissions.

To support the RCOT campaign, we have worked with Foundations, the national body of Home Improvement Agencies (HIAs) and Handyperson Services to identify the process of providing home adaptations. We have also obtained the time inputs of staff involved in fitting seven of the most commonly required major adaptations (costing more than £1,000) and 11 of the most commonly required minor adaptations (costing less than £1,000). The most requested major adaptations were stairlifts and level access shower installations as well as the more costly home conversions. Fitting handrails were the most frequently requested minor adaptations, but others included widening doorways and installing lighting to outside steps. Using the information provided by the Local Authorities and Home Improvement Agencies recruited by Foundations and drawing on the PSSRU’s well established approach used in the Unit Costs of Health and Social Care volumes, we were able to estimate costs for each adaptation type.

We found that the total mean cost was £16,647 for major adaptations, ranging from £2,474 to £36,681, and £451 for minor adaptations, ranging from £63 to £1,424.  Staffing costs formed a large part of the cost of home adaptations but the study identified different ways in which organisations can optimise their staff mix to reduce these costs.

For detailed information, see the published article in the Kent Academic Repository or alternatively, search on the British Journal of Occupational Therapy website.