A few years ago, the state of Utah launched a novel strategy to combat its chronic homeless problem. It just gave everybody a home.
On the surface, this sounded like a crazy move. Most of the state’s 2,000 chronically homeless population had significant mental health issues and substance addictions.
Frankly, they didn’t seem like ideal candidates to be trusted with the keys to a house. (The traditional approach had always been to place the homeless into shelters until they were deemed ‘housing ready’.)
And yet, the idea worked like a dream.
In retrospect, it’s not hard to see why. Given a secure environment, most of the homeless proved much better able to deal with their underlying issues. Put simply, it’s a lot easier to stop drinking, or remember to take medication, when you’re not sleeping under a bridge.
Homeless-related crime dropped. Very few went back to the streets. In just a few years, the chronically homeless population in Utah fell by 74 per cent.
And here’s the rub: ultimately, it was the cheaper option.
At the time, the average annual cost to the state of managing one homeless person (with all the attendant shelter costs, hospital visits and police work) was around $20k. That’s more than double the cost per person – $8k – of providing a home and care support.
And by helping their target group get their lives on track, instead of waiting for their situation to deteriorate further, they nipped a major problem in the bud.
Just think. The Utah government drastically improved the lives of a troubled group. They saved countless hours of police and medical time. They brought peace to residents who’d previously had to deal with anti-social behaviour. And they saved money doing it.
Slow to react
So why did it work?
There are two big reasons. One, the legislators in Utah recognised that the status quo just wasn’t working and so changed their strategy. And second, they had the courage to spend money upfront (on the homes) in the recognition they would save even more later.
All of which brings us back smartly to the on-going social care crisis in England.
Far from proactive, the English approach to managing low-level health and social needs pretty much embodies the dictionary definition of ‘reactive’. (“Act in response to a situation rather than…controlling it.”)
When people – particularly older, more vulnerable people – start to show signs of ill health or frailty, there’s often a slow reaction time during which their condition can easily worsen. Here’s a quick example that illustrates a painfully familiar story.
Older man has a fall. Slightly twists ankle. Stuck at home. Can’t make it to the shops. Has no family nearby. Doctor visits. Worried about malnutrition and how they’ll cope. Admitted to hospital. Upset to leave home. Sent back home a few days later. Still feeling a bit sore. Confidence has taken a knock. Wary of going outside. Condition starts worsening again. Re-admitted to hospital.
This grim scenario is played out numerous times every day across England. As you read, some stage of the unhappy tale will be playing out in a town or city near you.
And apart from the emotional cost to the poor chap, the actual financial cost of such situations can run into hundreds, even thousands, of pounds.
And what’s most frustrating is that it’s largely unnecessary.
All that man really needed was someone to call round the house a few times in the days following their fall: to arrange some adaptations to the home; deal with any outstanding bills or paperwork; sort out some help with the housework and shopping.
That’s exactly what our support at home service does – and it’s no accident that this kind of work is also known as preventative care. Because that’s the whole point.
After all, that man didn’t want to go to hospital. The hospital staff didn’t want an unnecessary (in medical terms) addition to their heavy workload. The government didn’t want to spend three thousand quid to cover the cost.
And yet it still happened. All because there wasn’t an alternative plan in place.
The idea behind preventative care is very basic, and grounded in common sense principles.
In many ways, it mimics how we live our everyday lives. When groceries start to run low, we go shopping. If a coat hook comes a bit loose, we’ll screw it back in. Fixing things before they get worse is how we get by – except when it comes to healthcare.
Imagine a man owns a bath with a crack in it. Each time he fills it, water leaks out and he has to call an emergency plumber to fix on a temporary cover. As the leak grows worse, the plumber suggests coming round when the bath is empty to fix the problem properly.
No, says the chap. When it’s dry, it’s just as good as any man’s bath.
That’s essentially where we are in this country when it comes to treating people (especially older people living alone) with small-scale health concerns. Things very likely will get worse – everyone can see what’s coming a mile off – but the system isn’t geared to kick in until it actually happens.
That’s why the Red Cross is so helpful. By getting in early to provide a bit of extra help, our support workers take control of potential crisis situations before they have a chance to escalate.
It works really well – and saves money. A recent study by the London School of Economics estimated that cost savings relating to the Red Cross’ support in these cases are equivalent to £880 per person.
Just like the legislators in Utah, the Red Cross – and many other organisations – has recognised that the current system isn’t working and adopted a new approach.
It will be difficult, sure. For politicians, particularly, it goes against the grain to spend money now in order to prevent something that literally hasn’t happened yet.
And you can already see the argument against: ‘How on earth can we waste money helping Person A at home when our budget is already being eaten up by Person B in hospital?’
Because, of course, the truth is that Person A has a habit of turning into Person B. But with early support, that doesn’t always need to happen.
Do the right thing
The biggest argument against preventative care is always that we can’t afford it, but the irony is that – in the medium to long-term – it will save money.
By looking at an old problem with fresh eyes – and showing a bit of courage – our leaders could help thousands of people and change the entire social care landscape.
Of course, there will always be nay-sayers who doubt the efficacy of such an approach. And in many ways, it does sound almost too good to be true.
But as the people of Utah discovered, sometimes it literally pays to do the right thing.
This blog is the sixth instalment in an ongoing series: Tackling the social care crisis.
Read the other instalments: Why people are scared of growing older, Five reasons why the NHS needs the Red Cross, Tale of two pensioners, Volunteering landed me a job and How a former patient became a volunteer.