Catherine Homer Health Promotion Specialist, NHS Rotherham
This presentation presents independent research commissioned by the National Institute for Health
Research (NIHR) under its Research for Patient Benefit (RfPB) Programme
(Grant Reference Number PB-PG-0408-16041). The views expressed are those
of the authors and not necessarily those of the NHS, the NIHR or the
Department of Health.
Outline
• Background to KWILLT and how we did it• What we found• Pen Portraits• Assumptions• Next Steps
Aim: Keeping Warm in Later Life (KWILLT)
• A study to examine the knowledge, beliefs and values of older people with a focus on keeping warm at home and barriers to accessing help to keep warm
• With the findings we will develop solutions and strategies to overcome these barriers in an attempt to prevent seasonal excess deaths
So, why Rotherham?
• Approx population 250,000• Aging population• Poor health trends• High levels of Excess Winter Deaths and
Fuel Poverty• Challenges with type of housing stock• Uptake of affordable warmth interventions
How we did it
• Stage 1:50 older people (aged 55-95), face to face in
depth interviews, temperature/humidity measurements
25 health and social care staff, face to face in depth interviews
• Stage 2:Six focus groups with older people and frontline/strategic staff (n=42)
• Stage 3:Consultation event (today)
KWILLT Findings: Themes Situation or context factors Attitudinal factors Barriers
Money
Age
Social connections
Housing type and tenure
Health
Making ends meeto Thrifto Competing prioritieso Prideo Struggling
I can manageo Thrifto Hardinesso Stoicism
Its my businesso Mistrusto Prideo Privacy
I'm frightenedo Privacyo Personal
safety/vulnerability I'll stay as I am
o Struggle with changeo Like routineo Fearo Trust
Awarenesso Knowledgeo Informationo Experience
Technologyo Heatingo Informationo Banking
Disjointed systemso Fragmentation or
serviceso Local differenceso Lack of referral
systems Visibility
o Fuelo Moneyo Informationo Older people
Four Groups of Older People
Can’t afford Can afford
Cold Cold
‼ ‼
?Can afford Can’t afford
Warm Warm
Pen Portraits
Lonely, Pearle
Proud, Fred
Dependent, Meena
Getting by, Bob and Joan
Just about managing, Enid
Isolated, Pat
KWILLT Findings: the segmentation model for older people who are cold
Segmentation group Pen Portrait Name
Description
Isolated and not wanting to cause a bother
Pat Low income household and fuel poor, over 55, socially isolated and frightened, lacks information and understanding about keeping warm, private rented housing, long term mental health problems (depressions/anxiety)
Getting by cautiously Ben and Joan Low income household and fuel poor, over 65, some social connections but not well informed about keeping warm, privately owned house, live with a partner with chronic health problems
Dependent and poorly informed
Meena Low income household and fuel poor, over 55, limited social connections with strong cultural ties, poorly informed about keeping warm, privately owned housing, poor health and mobility and very dependent on close family.
Just about managing Enid Can pay for home heating but values thrift , over 70, some social connections but is private and trusts few people so is poorly informed about keeping warm, social housing, physical health problems and sensory impairment
Lonely and out of touch Pearle Financially secure but lives in a cold home, over 70, widowed, and socially isolated, poorly informed about keeping warm, privately owned house, physically well but bereaved.
Proud and wants to be self-sufficient
Fred Low income but not fuel poor, over 70, regular but superficial social connections, poorly informed but values stoicism and hardiness and think they don’t need any help, social housing, good health, minor ailments.
What is the model for?
• Six pen portraits have been developed using the model to illustrate how some older people experience the factors that influence their ability to keep warm
• The pen portraits help staff and organisations to:- Find people who are at risk- Recognise people at risk- Understand the reasons why they are cold, the context,
attitude and behaviour that contribute to this- Support staff and organisations in the design and delivery of
acceptable and accessible services- Identify strategies to overcome barriers- Promote strategies to support self management to keep warm
Ben and Joan
• Mid 60s• Low income, now retired• Ben =chronic ill health• Joan = carer • Children nearby but Ben and
Joan don’t like to be a bother• Some social contact• Live in an old mid-terrace
(Right to buy)• Central heating system old,
not serviced and use supplementary heating
• Pay for fuel by direct debit but don’t understand how they work
Ben and Joan: Drivers of behaviourFactors that drive Ben and Joan’s decisions and behaviour include:
ThriftPride and being debt adverseFear of disruption in the homeMistrust of organisations likeenergy companies and banksFear of technology
Own and friends experience and media accentuates mistrust and difficulty dealing with change:
“Oh yes, because I was trained to be frugal, it was part of my upbringing. You didn’t have a lot so you were careful with what you did have. And with the costs rising now, I’m certainly not extravagant with the heating, I’m very wary”
(Older person participant in KWILLT)
“Oh yes, because I was trained to be frugal, it was part of my upbringing. You didn’t have a lot so you were careful with what you did have. And with the costs rising now, I’m certainly not extravagant with the heating, I’m very wary”
(Older person participant in KWILLT)
” We changed from 'Company A' to go to 'Company B', and it was a nightmare, and I spent hours on the phone trying to get money back that they owed me. And you inform them and they say oh you can ring this number and you can get help. They did nothing! They said they would but they did nothing! I had to do it all myself and I bet that went on for over six months and I said well if that’s changing I’m never going to change again. It was a nightmare”. (Older person participant in KWILLT)
” We changed from 'Company A' to go to 'Company B', and it was a nightmare, and I spent hours on the phone trying to get money back that they owed me. And you inform them and they say oh you can ring this number and you can get help. They did nothing! They said they would but they did nothing! I had to do it all myself and I bet that went on for over six months and I said well if that’s changing I’m never going to change again. It was a nightmare”. (Older person participant in KWILLT)
“I can put that heater on and that’s plenty for me in the daytime, I don’t want anything else, and therefore it can’t be as expensive as heating the whole house”.(Older person participant in (KWILLT)
“I can put that heater on and that’s plenty for me in the daytime, I don’t want anything else, and therefore it can’t be as expensive as heating the whole house”.(Older person participant in (KWILLT)
Beliefs and valuesBen and Joan are thrifty, proud
and fear being in debt. They want to be in control of their life but would be reluctant to ask for help. They will cut down on other things to afford fuel
They often think it’s not worth putting the central heating system on. As it doesn’t work properly it will take a while to work and it doesn’t seem as responsive and warming as the electric fire
A Day in the Life of Ben and Joan
Ben and Joan wake up in a cold bedroom and a cold house. The day starts at seven when they get up and make a cup of tea which they drink whilst making breakfast. They use the cooker to heat the kitchen whilst they make breakfast. They sit in the living room to eat their breakfast with the electric heater on
They don’t heat the whole house and especially the bedroom as they were brought up and a belief that hot bedrooms are bad for you
They often think it’s not worth putting the central heating system on. As it doesn’t work properly it will take a while to work and it doesn’t seem as responsive and warming as the electric fire
“When we were little we had coal fires. I can remember the oven top and in the winter my mum used to take the trays out of the oven, they were about that thick, and she used to wrap them in a blanket and put them in bed for us. I can’t get into a warm bed. It has to be cold for me to get into…. not too warm, that’s unhealthy isn’t it”? (Older person participant in KWILLT)
What could help Ben and Joan?
• Warm Front• Energy Companies and social tariff • Swopping providers• Green Deal• Fuel Payments• Winter Fuel Payments.
So in the future how will people like Ben and Joan ….
• Manage their energy bills?
• Engage with advances to new technology?
• Respond to policy changes?
So what do we know?
• It’s a complex picture!
• People don't always do what you think they will do
Assumptions!• People aren’t cold these days• Its only the really old who are effected• Only people who are fuel poor are cold• Other people are tackling the problems• Family will help• People know that there are health impacts of being cold• People are aware of what healthy room temperatures are• People know how to use technology – heating and banking• Vulnerable people read and act on information from
organisations such as energy companies, banks and Government bodies
• People will access interventions to help e.g. Social fuel tariffs and affordable warmth interventions e.g. Green Deal
• Vulnerable people will engage with processes to obtain help• Interventions don’t have adverse consequences
Next steps
• Develop an e-learning resource for front line staff from all organisations to develop their knowledge of the pen portraits and how to identify and support householders they work with
• Produce a DVD to raise issues of affordable warmth and fuel poverty with front line staff and householders
• Gain funding for a research study focussing on Children and Families and cold homes