Summary
This Briefing seeks to provide information about Covid 19 to landlords and providers of social and supported housing.
It identifies “at risk” groups, explains why people are at risk and sets out (and adds to) the recently published “Social Distancing” guidance.
You can get the most recent daily updates on Covid 19 within the UK, EU & EEA here.[1]
It identifies the specific responsibilities that landlords and providers need to be thinking about and the actions you need to be taking.
It identifies Housing Proactive and Housing Proactive Plus as value generating interventions that are usually provided, installed and maintained, at nil cost (subject to welfare benefits eligibility) and that enable landlords and providers to increase human contact with tenants with additional needs whilst minimising infection risk and optimising staff deployment.
Introduction
I’m writing this Briefing whilst in self-isolation as a consequence of Covid 19 infection. Covid 19 impacts different people in different ways. For me my head throbs like a bell tower, my limbs ache, my voice strains through a throat that feels like I’ve swallowed a cheese grater, my chest is tight, and I am tired, really tired. But I’m writing this Briefing so I’m one of the more fortunate Covid 19 victims, and to be honest what bothers me more is the thought that my 96-year-old mother, or my son with learning disabilities might fall victim to it.
Being involved in supported housing, it is natural that the impact of Covid 19 on people with additional needs occupies my thoughts. People with a variety of additional needs are vulnerable to the physical effects of the virus, and also to the societal effects. Providers are struggling with the sheer enormity of what we are facing.
Part of the purpose of this Briefing is to suggest a solution that will genuinely help people. I’m a believer in things that generate value. Value Generation has 3 components:
- Positive outcomes for people (with additional needs)
- Cost-benefit
- Wider social/community benefit
But before we look at a solution, let’s take the measure of the problem.
Who is Most at Risk?
Emerging data show clearly that the people at most risk from Covid 19 infection are older people, and people with lung, heart and immunological problems of any age. The UK Government/Public Health England guidance on social distancing (see below) lists a much wider community of “at risk” groups.
The primary cause of Covid 19 mortality is lung infection, and this isn’t limited to older people although they are more susceptible to such infection and also to general immunological weakness.
The second most common cause is cytokine storm, which is the technical term for an overreaction of the body to infection and is most common in people over 75. At that age peoples’ immune systems are less effective and can overreact to infection potentially resulting in fever and organ failure.
Older people generally suffer more than their younger peers from one or more chronic illnesses. Findings from China, Italy and the USA show that it is a combination of age and pre-existing chronic illness that makes people especially vulnerable to the worst consequences of Covid 19 infection.
Public Health England on behalf of the UK Government has produced a Guidance Document: “Guidance on social distancing for everyone in the UK and protecting older people and vulnerable adults“[2] within which the following advice is given:
We are advising those who are at increased risk of severe illness from coronavirus (COVID-19) to be particularly stringent in following social distancing measures.
This group includes those who are:
- aged 70 or older (regardless of medical conditions)
- under 70 with an underlying health condition listed below (i.e. anyone instructed to get a flu jab as an adult each year on medical grounds):
- chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
- chronic heart disease, such as heart failure
- chronic kidney disease
- chronic liver disease, such as hepatitis
- chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
- diabetes
- problems with your spleen – for example, sickle cell disease or if you have had your spleen removed
- a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
- being seriously overweight (a body mass index (BMI) of 40 or above)
- those who are pregnant
How do we Respond?
Social landlords, their agents and provider organisations that operate accommodation-based (and other) services to people with additional needs should be mindful of the social distancing guidance document. Judging by our engagement with them they are very mindful of their obligations to people they house and support, but in common with society in its entirety they’re struggling with the enormity of the situation.
People are being told to self-isolate. People over 70, and those under 70 with a “chronic condition” (see the social distancing guidance) are being asked to do so for a period of 12 weeks.
Social isolation is harmful, especially for older people. It can result in high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease……..”.[3] None of these conditions are good at any time, but with Covid 19 risk many of them become cast into sharper, more urgent focus. Social isolation exists, and is dangerous, without Covid 19 so any solution to help with it should be present after the Covid 19 threat has gone.
According to Age UK “…..more than 2 million people in England over the age of 75 live alone, and more than a million older people say they go for over a month without speaking to a friend, neighbour or family member.”[4] Many of these people will be social housing tenants in general needs and sheltered accommodation, much of the latter is now physically unstaffed.
It isn’t just supported housing that contains a multiplicity of vulnerabilities to Covid 19 infection. The population of so-called “general needs” social housing exhibits very significant levels of additional need. According to the ONS: “One-quarter (24.7%) of disabled people in 2019 rented social housing, compared with just 8.2% of non-disabled people.”[5]
We should be mindful of the “at risk” groups identified in the social distancing guidance, for example, age, respiratory disease, heart and kidney disease, “neurological” issues such as Parkinson’s Disease, Motor Neurone Disease, Multiple Sclerosis, learning disability, cerebral palsy, diabetes. Also sickle cell and spleen-related conditions, HIV/AIDS and other immunological deficiencies and obesity.
In addition, people with mental health needs, substance misuse needs and other conditions where self-care may be compromised may be susceptible to Covid 19. Homeless people, people at risk of domestic violence & abuse, asylum seekers and refugees and other needs groups are also more likely to slip through the medical/social net as well.
Housing Proactive/Proactive Plus
Housing Proactive is a telephone/tablet-based system that, at its most basic level requires users to press a button on their ‘phone or device that says, “OK Each Day” (supplied free) by a specified time of day, assuming everything is OK with regard to their property and tenancy in general. If a tenant doesn’t press that button by the agreed time, they get a ‘phone call from a real person asking them if everything’s OK at home. If they don’t pick up the call then a call is immediately made to the landlord, provider, family member or whomsoever has been agreed as the point of contact in such circumstances.
With Covid 19 the challenge for landlords and providers is to increase two-way social contact without infection risk. Housing Proactive does this by providing a telephone and/or tablet-based communication service that enables social landlords to communicate directly to individuals and groups of tenants verbally or by message. Similarly, tenants can contact you. In addition to letting you know they’re OK by pressing their “OK Each Day” button by an agreed time/times, they can also let you know they’re not OK.
Given the many changes in procedures required and challenges with staffing, the need to communicate quickly and effectively with people is critical, especially for higher needs and more at-risk groups.
Housing Proactive has an add-on capacity (known as Housing Proactive Plus) in the form of what’s called “Envosense”, which is a sensor that detects changes in temperature and humidity and alerts you when either or both are not what they should be.
As temperature falls in a home, blood pressure goes up – putting people at greater risk of stroke, heart attack or other cardiovascular problems. Furthermore, as temperature falls susceptibility to influenza, colds and other viral infections such as Covid 19 increases.
Housing providers may have a duty of care, particular in sheltered and supported housing where it is understood that tenants have higher needs and greater health challenges to ensure temperature ranges are in appropriate ranges.
Furthermore, excessively high temperatures in a property can be an indicator that someone is unwell (as they have turned their heating up in response), or might be an indicator that the tenant is at higher risk of energy related arrears.
Public Health England reviewed the literature on the impacts of temperature and humidity on people, older people in particular, and their findings are given sharper focus given the risk factors associated with Covid 19 infection discussed above:
“The evidence from the small number of epidemiological studies identified suggests an association between raised blood pressure with exposure to indoor temperatures of around 18°C or colder in the general adult population.
When the effects of cold in older people were compared with those in younger people, the studies showed in general that the changes in outcomes such as blood pressure, clotting factors, cholesterol and in core and skin temperature were more profound, with slower recovery, in older people. Several studies also demonstrated reduced thermoregulatory control and thermal perception/discrimination with ageing.
There are a number of quite serious health issues related to living to excess moisture. A relative humidity of 60 per cent or above provides optimum conditions for microorganisms and airborne allergens, such as dust mites or mould spores to thrive. Black mould in particular is highly toxic and can cause respiratory infections.
Our homes also suffer if humidity is too high. Excess moisture will rot wood, corrode electronics and appliances, spoil instruments or books, cause food to go stale, and trigger the proliferation of mould and mildew, which can damage wallpaper and soft furnishings, and even compromise the structural integrity of a building.
Maintaining a relatively constant humidity level indoors, between 40 per cent and 50 per cent, can bring great benefits.
Below this, and influenza and other air-borne viruses can thrive – and are more easily transmissible, above this – mould, and other bacteria begin to thrive which can cause significant respiratory and allergic issues, impair the immune system, increase illness and begin to physically damage properties. Wood also rots faster at these higher humidity levels.”[6]
Landlords will know that the management of temperature and humidity in their properties is one of the obligations of the The Homes (Fitness for Human Habitation) Act 2018 and Schedule 1 of the Housing Health and Safety (England) Regulations 2005. Envosense as part of Housing Proactive Plus is an aid to compliance.
Staff Deployment
More efficient staff deployment is a necessity at times like this. Social housing and provider organisation staff are stretched at the best of times. Covid 19 adds the additional challenge of a social distancing requirement to reduce infection risk and higher staff demand. Using Housing Proactive enables social landlords and providers to deploy staff in a different way. They can focus on those people who they know are in difficulty for whatever reason because they didn’t press their “OKEachDay” button and they didn’t respond to the call from Housing Proactive’s call centre that would result from a failure to press their button. Similarly, tenants have the ability to call you if all isn’t well with their property or tenancy in general. Being part of an integrated system drastically reduces the necessity for face-to-face contact whilst actually increasing the level of other human contact and the mutual reassurance that goes with it.
That mutual reassurance is in place 24 hours every day, every week all year round.
Cost
The fundamental principle of Housing Proactive and Envosense is to enable the housing provider to manage their properties, tenancies and facilities more effectively and efficiently. As such it is Housing Benefit/Universal Credit/Pension Credit eligible, so people entitled to those benefits don’t pay for it and neither does the landlord/provider. The equipment is free; the installation is free (above a certain number of units) and there are no servicing or other costs. This is a Value Generation proposition that has a great deal of value to offer in a time of significant challenge. In addition to the direct benefits it brings in this time of unprecedented challenge it also provides important byproducts: a reduction in social isolation, more efficient staff deployment and the detection of changing needs. These factors will remain after Covid 19 has gone.
Please Get in Touch
Housing Proactive has an established track record and is deployed by 40+ housing providers across the UK for a variety of needs groups. We didn’t anticipate the Covid 19 emergency, but the fact is that Housing Proactive is in the right place at the right time to be part of your integrated approach to managing this unprecedented situation.
Remember that, subject to welfare benefits, eligibility it’s effectively free of charge. Even where people aren’t eligible for Housing Benefit/Universal Credit/Pension Credit it generates huge value for a minimal weekly cost.
Please click here to email us an inquiry or call Alertacall on 0808 208 1234 and mention this Briefing.
Michael Patterson 24th March 2020
[1] European Centre for Disease Prevention and Control Situation update for the EU/EEA and the UK https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea
[2] Public Health England (March 2020):https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults
[3] US National Institute on Ageing, April 2019 https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks
[4] Age UK quoted in https://www.nhs.uk/conditions/stress-anxiety-depression/loneliness-in-older-people/
[5] Office for National Statistics: “Disability & Housing, UK: 2019” Housing outcomes for disabled adults, with analysis by age, sex, impairment type and country using Annual Population Survey (APS) data. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/bulletins/disabilityandhousinguk/2019
[6] Public Health England, 2014: “Minimum home temperature thresholds for health in winter – A systematic literature review” https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/776497/Min_temp_threshold_for_homes_in_winter.pdf
(Added to site Tuesday, March 24th, 2020)
