FINAL REPORT OF THE EVALUATION

Home safety checks for independently living elderly people with sight loss: an evaluation of a Thomas Pocklington Trust pilot service in South Birmingham.

1. Backgroundand context: the need and value of home safety checks.

Older people’s organisations report that age is a risk factor associated with living in poor quality and unsafe accommodation: in 2006 Age Concern estimated that 32% of pensioner households lived in housing which failed the Decent Homes Standards and that older women living alone were at particular risk of living in poor or unsafe housing. That Age Concern study also suggested that older people are less able to deal with housing difficulties than younger people and that this may reflect a mix of low expectations, lack of confidence, fear of costs and anxiety about disruption. It may be that other issues exacerbate housing difficulties faced by older people, such as communication difficulties and inaccessible information.

Ageing of the eye and age related eye conditions mean that many older people have a degree of sight loss that affects their daily lives. This exacerbates theirhousing experiences and situationsand suggests a need for a service that offers safety checks on homes and portable electrical appliances.

A large body of research evidencepoints to the value which older people with sight loss place on services that help them remain independent, safe and confident in their own homes (Appendix 1).

Current public policy priorities that reflect these findings include:

  • reducing falls among older people;
  • reducing risks and improving housing safety;
  • preventative health care;
  • supporting independent living in the community;
  • crime reduction through safety and security measures;
  • reducing the need for care home admissions;
  • supporting hospital discharge

Some voluntary organisations, home improvement agencies and local authorities provide support to live at home through:

-information and advice about home safety issues (such as Help the Aged/ Age Concern’s ‘Home Checker’ advice leaflet)

-assessment and installation of aids and adaptations

-targeted work around particular aspects of safety such as installing smoke alarms, or providing external lighting to reduce crime and fear of crime.

The pilot service described here took an approach to safety at home that encompassed a range of issues and was offered through one to one support for householders from an experienced electrical contractor and a support worker. Together they visited older people with sight loss in their own homes, conducted a home safety check and supported follow up action required.

2. The South Birmingham pilot service

The idea for a hands on service offeringpeople with sight loss a free home safety check and portable appliance tests arose from collaboration between the Manager of Pocklington Place (an extra care sheltered housing service for older people with sight loss managed by Thomas Pocklington Trust) and the Team Manager for Birmingham City Council (BCC) Social Services. Both recognised the particular challenges and importance of home safety for people with sight loss and together developed a proposal for a pilot service. They successfully applied to a BCC staff incentive scheme (BEST) for funding.

A BEST award supportedan initial pilot to trial the service, and this was matched by Thomas Pocklington Trust (which also allocated staff time to develop systems and procedures). An expert contractor offered low cost and in-kind support for electrical and gas appliance tests in up to 40 homes. To ensure that lessons were made available to inform further work Pocklington also provided funds for a limited evaluation.

a) Aims of the pilot service

The ‘pilot’ service aimed to provide a free,expert home safety check for the homes of up to 40 people with sight loss living in south Birmingham. The trial aimed to:

-demonstrate whether or not a home safety check (largely of gas and electrical systems and appliances) may support independent living of older people with sight loss

-develop and trial procedures for such checks

-identify the nature of any follow-up support needed after checks

-identify potential improvements to the service, together with recommendations for extension or continuation after the pilot.

b) Home safety checks

The pilot service involved an experienced electrical contractor and a specialist support worker to assess safety on behalf of a householder. This relatively resource intensive approach was chosen because it was felt that sight loss makes it harder for householders to use leaflets and that targeted resources focused on single interventions, such as smoke alarms or crime, may omit more general safety issues such as damp or flooring that might be likely to cause trips and slips.

The home safety checks in the pilot service were visual and addressed eleven areas of the home (including visual tests of gas and electrical fittings and systems’ loft insulation and an overview of wall and floor surfaces, windows and decoration; see Appendix 2) as well as portable electrical appliance testing of items selected by the contractor as appearing or most likely to be a safety risk.

Checks were carried out by an experienced and qualified contractor with expertise in electrical safety. A specialist support worker accompanied the contractor and together they explained the purpose and nature of the check. The support worker recorded activity and dealt with participants’ questions and undertook follow up work as required.

Each check took an average of 30 minutes to deliver. In addition time was spent in the initial contact with participants, in setting up appointments and in follow up actions. Together this amounted to an average of two hours per participant.

c) Staff and skills

Pocklington deployed a specialist support worker to work with the contractorand participants during delivery of the service. The care and support worker has been employed by Pocklington Place for two and a half years and with prior experience in a variety of roles involving contact with the public she brought good experience and skills to the role.

The contractor who conducted the home safety checks had several years experience of this type of work through his work as an electrical and plumbing contractor with Thomas Pocklington Trust (at its Birmingham and Wolverhampton Centres) and two nursing homes, other related work and his direct experience of letting properties. In addition he mentioned whilst being interviewed that he had an “eye impediment, and as a result only have vision in one eye, so I’m probably more aware than most people”.

The policies, procedures and protocols for the service were defined by Pocklington care and managerial staff informed by Birmingham University (INLOGOV) work to ensure that the project reflected good practice in social care research and would secure research governance approval. As a new service this work required a substantial amount of time and the expertise of care and managerial staff at Pocklington Place. The policies, procedures and protocols included:

-evaluation consent forms (for participants, support staff and contractor)

-information sheets about the pilot service (for participants, support staff and contractor)

-individual participant protocol / checklist for completion by the support worker including records of contacts, next of kin and emergency contacts

-record of visit by the support worker

-record of check by the contractor

-information leaflet about the home safety check appointment

-checklist and guidance notes for staff about sources of support and follow on work with participants.

d) Participants

In January 2009, 40 potential participants in the service were identified from among people with sight loss who used day services provided by BCC or were in contact with Birmingham Focus, the local voluntary organisation that supports people with sight loss.

Contact was made with each potential participant by letter while policies and procedures for the pilot service were being developed. Contact with those who used the BCC day service was made via the day service and when that service ended contact with potential participants was lost. Meanwhile contact with potential participants identified via Birmingham Focus continued. Half the potential participants from that source dropped out during preparation of the pilot due to death or ‘gone away’. The final number of participants for whom records are available was 10, representing 25% of the target but 50% of those with whom Pocklington had continued and direct contact during planning and preparation of the service. All ten had been recruited via Birmingham Focus.

Appointments were confirmed by ‘phone prior to the date/time and together with a leaflet describing the service a letter confirmed the appointment.

All participants had been referred to the pilot because they had a degree of sight loss that affected their daily living and independence but not all were registered blind or partially sighted. One was registered blind. The age, style or condition of the housing of participants was not known before the home safety visits.

The pilot eventually recorded visits and checks in the homes of seven women and three men. Six people lived alone (including two of the three men). Others lived with a spouse, sibling or child(ren). Their housing status was not known, but at least two lived in social housing. The socio economic profile of participants was not known.

Because recruitment of participants relied on avenues through the two organisations described above people who were not in touch with any sight loss services were not engaged with the project.

3. The evaluation

a) Aims

An integrated evaluation aimed to address one main question:

  • How do Home Safety Checks assist independent living of elderly people with sight loss?

In order to answer this, the evaluation addressed three sub-questions:

  • How useful is this service for householders with sight loss?
  • How satisfied are the users of the service?
  • To what extent is it feasible to implement the serviced on a larger scale?

b) Research governance approval

Research governance approval for the pilot service and evaluation was granted by Birmingham City Council. The application was made on behalf of Pocklington by Birmingham University (INLOGOV) which supported the development of the trial and defined the evaluation framework.

c) Methods and procedures

(i) Activity

A home safety check and a record sheet was completed for each visit. These were available for analysis to indicate patterns of activity and generate quantitative information about home safety in the sample homes.

(ii) Experiences and outcomes

Qualitative information was collected though an interview programme with staff and service users which addressed their experiences the outcomes for service users.

Specialist support worker and contractor experiences: ‘before and after’ interviews:

Both staff were interviewed twice. The focus interviews ‘before’ the service was delivered was to record staff perceptions, expectations and any concerns about the pilot service.Interviews ‘after’ the service had been delivered had two objectives.

-First, comparing responses with the before interview made it possible to identify any change in perceptions and if expectations had been borne out or concerns vindicated

-Second, the utility of the pilot’s process and procedures could be assessed and lessons identified to inform any extension/continuation of the service after the pilot phase.

Participants

It was envisaged in planning the evaluation that 25% of the projected 40 participants would be invited to share their experiences through an interview after the home safety check had taken place. Because 10 people used the service it was decided to invite each person to take part in an interview, and each accepted. Interviews took place within two weeks of the home safety check.

The purpose of these interviews was to collect experiences about the service provided, find out if and how the service was valued by users and any outcomes from the check.

d) Findings

To make the most of the quantitative and qualitative data collected findings are presented within themes identified during the evaluation. Thequestions which the pilot and the evaluation set out to address are ‘answered’ inconclusions and recommendations.

(i) Participation and the sample of homes

Recruitment of potential participants before the service policies and procedures or the integrated evaluation had been defined appeared to have three main effects on the sample of houses in the pilot.

First, it was not possible with hindsight to establish exactly how participants were recruited, whether there had been immediate refusals (and, if so, on what grounds) and the influence that the recruitment methods may have had on the nature of the sample of people (and houses) who were invited or later participated in the pilot service.

Second, the delay between initial invitation to participate and the delivery of the service had an impact on final levels of participation. During that period some potential participants died or moved away and these drop outs may have affected the sample of people (and houses) who participated in the pilot. Due to contact arrangements via BCC contact was lost with potential participants who used a day service.

Third, loss of contact with potential participants identified among BCC day service users may have led to a reduction in levels of need across the final sample. We cannot know if this is so, but because referral to the BCC service followed a needs assessment those potential service users had a defined level of need which is likely to have been higher than that of the potential service users identified by FOCUS, for no LA needs assessment is required to use those services.

At the same time recruitment processes to the pilot did not collect information about the socio- economic or housing status of potential or actual participants or the degree or cause of their sight loss. In the event participants all lived in houses (mixed tenure) that is relatively modern.

Taken together these points mean that we cannot know how representative the sample is of the homes of people with sight loss but we can suggest that it is not likely to be fully representative and that it may under represent houses that are more unsafe than those in the sample.

(ii) Home safety

Analysis of the records of visits and the contractor’s checklist showed that all homes had been defined as having gas / boiler systems, electrical supply systems and appliances, flooring, decoration and windows that were visually safe.

Thirty four portable electrical appliances were tested using PAT procedures. Appliances were selected from among all those in each home according to the likelihood of a safety issue and this was defined by the contractor by reference to the apparent age of the appliance and knowledge of its likely durability and level of use. In most homes four items were checked. All items checked were found to be safe.

Safety issues were identified in four homes. One exhibited three issues, another exhibited two issues, and the other two exhibited one issue each (both were smoke alarms)

-smoke alarms (3, lack of or need for batteries to be changed)

-leaking taps, considered of a degree that could create health and safety risks (2)

-damp and a leak in bathroom that were of a degree to create health and safety risks (1)

-gas fire (1, needing vents)

-exterior maintenance / garden (1).

Follow on actions included

-advice on new taps

-referrals to the fire brigade for action on smoke alarms

-provision of information about local handyman/.gardening services

-referral and support to seek remedial works by a landlord.

The levels of safety seemed high, and the contractor suggested that this reflected the sample (which was largely homes of an age where safety issues have not yet arisen). However those issues identified were potentially serious and action would be important in ensuring that safety was not compromised.

(iii) Aspirations, concerns and uncertainties

Specialist support worker

When asked about her thoughts on the project before the home safety visits had taken place, she expressed the belief the project would be beneficial to the participants. One outcome she hoped for was that participants, would cease to be “a forgotten part of the community, which they seem to be at the moment”.

The specialist support worker was unsure if all stakeholders fully understood what the pilot entailed, or what her role would be especially because, as the project’s processes had developed,her role had increased. In the event the limited number of participants meant that the project could be accommodated with other duties. There was some uncertainty about processes if safety problems were found: “If there is a problem, do I have to go out with the contractor again, or is that left to the contractor”? and “Am I the one to get in touch with family members”?Because limited safety problems were identified these concerns did not materialise.