Getting out of the bath used to be a tortuous process for 52-year-old Janice Assante. Crippled with arthritis, the mother-of-three would slowly twist her body, grabbing the side of the bath, until she could raise herself with her right hand.
Terrified that she might slip, the former childminder, who has lost all mobility in her left side, contacted her housing association. Within days, technicians fitted a small grab-rail above the bath, making bath times once again safe and enjoyable.
Such minor adaptations can transform lives and safeguard people in their home and help them to maintain their independence. Yet, according to a new report, Assante is one of the lucky ones. All too often, people requesting minor works costing as little as £50 face huge delays from a system that is bureaucratic, inflexible and over-professionalised. Indeed, many people unable to cope at home end up in residential care or, worse, in hospital while waiting to be assessed.
Now, the joint report from the College of Occupational Therapists and the Housing Corporation is urging an end to such persistent and dangerous waits.
Sheelagh Richards, outgoing chief executive of the college, describes the situation as intolerable. Speaking at the launch of the report, Minor Adaptations without Delay, she said: "I am willing to bet there are many thousands of older people waiting for minor works. We have situations where it is seen as acceptable for older citizens to be kept on waiting lists for a year, or maybe two, for a simple handrail that will help them get up the stairs to bed at night."
A big part of the problem is that it has become common practice for housing associations to refer people to occupational therapists for assessments for even the most basic equipment. This practice must be scrapped, says the report, which highlights examples of good practice where tenants' needs are met quickly.
Assante, who has lived in her three-bedroom home in south London for the past 25 years, is one such tenant. Five years ago, she began to suffer arthritis. But it was only last year that it became acute, with pain spreading from her left shoulder to her hands and her feet.
"I am in agony a lot of the time," she says. "I used to enjoy gardening. I can't do that any more, or even simple things like putting curtains up. At one stage, even having a bath became very uncomfortable. I couldn't use my left hand to get out and I had to twist around, which was almost impossible. It was agonising. I am now on a waiting list to have keyhole surgery to file some of the bone away."
Assante says she is fortunate that she lives on a development of 90 homes built by the Habinteg Housing Association, which specialises in providing accessible housing. Set up 30 years ago by leading figures from the former Spastics Society (now Scope), the association provides more than 2,000 "lifetime" homes in 65 schemes from Cornwall to Humberside. Tenants' needs are met by special community assistants, who are trained in disability issues and are allowed to order work to be done of up to £150 in value for each tenant at any one time.
Request for help
It was to her local community assistant that Assante turned for help last year when bathing became almost impossible. Within 48 hours, a grab-rail - one of the most widely used adaptations - was fitted. "In our minds, a minor adaptation should be a routine service," says Paul Gamble, Habinteg's director of development. "If a tenant has a faulty gutter, they expect it to be repaired quickly. The same goes for adaptations, which don't have to be hideously utilitarian. These days you can get them from John Lewis or Ikea."
Gamble estimates that Habinteg carries out some 200 minor adaptations a year - ranging from grab-rails and lever taps to rails by the toilet and flashing doorbells. "There is no doubt that as well as supporting people's independence, there are savings that are being accrued by other organisations," he says. "The Department of Health saves money as a result of earlier discharges from hospital and from fewer admissions because there are fewer falls."
Falls are a very real hazard for older people struggling to overcome practical obstacles in their homes. Statistics from the British Geriatrics Society suggest that up to 40% of people over 65 living in the community fall at least once a year.
In Nottingham, adaptations are offered to anyone over 60 who fears, or has had, a fall. Operated by occupational therapists (OTs), the Nottingham Pad (Preventative Adaptations for Older People) scheme was set up by the city council's housing department, social services and the Nottingham City primary care trust. In a much-praised display of partnership working, each contributes to the £200,000 project budget and minor adaptations costing up to £750 can be approved.
The scheme is run by social services on behalf of other services and offers a huge range of minor adaptations that can be fitted without an assessment by an OT. Most items cost less than £100 and vary from grab-rails and stair-rails to the removal of door thresholds and other tripping hazards. Three OT technicians carry out the works and undertake a risk assessment for people in case further work needs to be done. More complex cases are passed on to a fully fledged OT.
Jake Jacobs, service manager for Nottingham Pad, says the scheme has proved extremely successful. Around half the referrals have come from clients themselves, the remainder coming from professionals such as housing officers, wardens of sheltered housing and the local branch of charity Age Concern.
"A telephone assessment is made about what needs to be done and how quickly," Jacobs says. "We try to get a fitting done in a couple of weeks, but it can take longer if we are getting more calls because of bad weather."
The College of Occupational Therapists and the Housing Corporation stress that a variety of approaches can be taken to overcome the practical problems of setting up "no-visit" schemes. However, partnership working to create a joined-up service is paramount.
Diverse rural county
This has been shown in Gloucestershire, where agencies face the challenge of providing services in a diverse rural county covered by five housing authorities and five social services offices. Four years ago, after a study revealed that hundreds of people needing minor aids were languishing on OT waiting lists, agencies introduced a fast-track scheme for adaptations.
The scheme exists through the cooperation of Gloucestershire social services, the six Gloucestershire home improvement agencies, Stroud district council and various housing associations. Customer service officers, taking referrals from social services, put straightforward requests straight through to the home improvement agencies after checking with an OT manager.
To qualify, clients must be older people or have a permanent and substantial disability. The cost limit is £250 and work is carried out within two weeks. The average cost of a fitting is £63. The results have been astonishing. Figures from the council show that in seven months, 777 minor adaptations were carried out, saving 777 visits by a community OT.
Rosie Callinan, the scheme's service manager, says: "As soon as we introduced the scheme, waiting lists went down dramatically. Many of the calls we get involve people having problems getting in and out of the bath.
"A lot of other social services departments are looking at our scheme, which still has an OT input. It avoids the delay of waiting for a visit. For relevant cases it is five or 10 minutes of OT time rather than two hours, allowing for travel, visit and paperwork."
According to the charity Care and Repair England, the potential gains of these kinds of schemes are enormous. In a recent report, it claimed it is possible to employ a handyperson undertaking small repairs and adaptations for hundreds of older people for the cost of one residential care home place - let alone the cost of hospital admission and care for a hip fracture resulting from a fall.
For Assante, who is due to have an operation on her shoulder this month, the prompt fitting of a bath grab-rail has helped make life tolerable over the past few months."I dread to think how I would have coped without it," she says. "It would have meant relying on my 15-year-old son to get me in and out of the bath. That is not something either of us should have to do."
· Minor Adaptations Without Delay is published by the College of Occupational Therapists: www.cot.co.uk
