Care provision fit for a future climate funded by: Joseph ...

Care provision fit for a future climate funded by: Joseph ...

Heatwaves, vulnerabilities and climate change: problems for and with care provision for older people Prof Gordon Walker Lancaster Environment Centre, Lancaster University Oxford Brookes University Prof. Rajat Gupta (PI) Laura Barnfield Matt Gregg Lancaster University Prof. Gordon Walker (Co-I) Dr Louis Neven University of Manchester Dr Alan Lewis (Co-I) A heatwave is an extended period of hot weather relative to the expected

conditions of the area at that time of year. Met Office use the World Meteorological Organization definition of a heatwave which is "when the daily maximum temperature of more than five consecutive days exceeds the average maximum temperature by 5 C, UK Met Office Source: Heatwave Plan for England 2013 A health sector issue and process of response Source: Heatwave Plan for England 2013 Europe: temperature anomaly, 8th 19th August, 2003

Europe: excess mortality , 8th 19th August, 2003 (UNEP, 2004) 2, 139 1,400 14, 802 1,300 4,200 7,000 4,000 Principally not about heatstroke rather exacerbating existing health conditions

(cardiovascular and respiratory); particularly in bodies that cannot thermoregulate effectively Location of death during heatwave France Fouillet et al (2006) England and Wales National Statistics (2006) Where Home

Institutions / retirement homes Public hospitals Private hospitals and clinics Street Home Public Hospitals Hospice Nursing Home Residential Home % increase above expected 70% 90% 50% 20% 10% 33% 36% 0.2% 42%

29% Although national Heatwave plan and specific guidance for the health and care sectors, it is unclear how effective that guidance has been in changing awareness, preparedness or practice during heatwaves, in the short or longer term. Climate change is expected to result in hotter and drier summers, with heatwaves with greater frequency, intensity and duration. Care provision fit for a future climate Project aims 14-month study (February 2015 March 2016) funded by the Joseph Rowntree Foundation, which: Examined how far existing care homes and other care provision

in the UK are fit for a warming climate, and Considered the preparedness of the care sector (both residential and extra care) with a focus on overheating. Care provision fit for a future climate Mixed-methods approach Socio-technical case-study approach: Building surveys to identify design features that can enable or prevent occupants and their carers to control their thermal environment Climate modelling using future weather data (2030s, 2050s and 2080s) in dynamic thermal simulation Monitoring of environmental conditions in the four case studies (June 2015 September 2015) Qualitative Interviews with Scheme managers (5), Carers (7), Maintenance staff (2) and Residents (10) to assess how building design, management and occupant practices address overheating risks and vulnerabilities (September 2015) + reanalysis of interviews from previous project

Care provision fit for a future climate Case study schemes Care homes: Extra-care schemes: Case Study A Case Study A (42 beds / 2005) Case Study B (23 beds / mid-late 19th c.) Case Study C (50 flats / 2006) Case Study D (60 flats / 2012) Case Study B

Case Study C Case Study D Care provision fit for a future climate % o f o c c u p ie d h o u r s o v e r t h r e s h o ld t e m p e r a Current and future overheating risks in the case studies Static method: Indoor temperatures +26C for up to 76% of monitored period 10 9 8 7 6 5 4 3 2

1 0 Current climate 2030 2050 2080 Measured (2015) Care provision fit for a future climate Mismatch between climate modelling and monitoring results underplays present day risks from high temperatures Modelling indicates some risk of future overheating BUT little current overheating risk. However empirical monitoring

indicates prevalent and current risk of overheating, particularly during short-term heat waves. Care provision fit for a future climate A culture of keeping older occupants warm Prevalent perception, from designers to front-line staff, that older people feel the cold. Provision of warmth is associated with good care. Cold seen to represent a bigger threat to older occupants health there is less recognition that heat can also present a significant health risk. Residents will typically complain about the cold, but not the heat but drowsiness, lethargy issues cultural norms, recurrent phrases, a

way of getting attention? Heatwaves regarded as rare in the UK. Care provision fit for a future climate we haven't thought about AC or the environment getting too warm were probably more concerned about things being cold in winter rather than warm in summer (Managing Director). The biggest killer in the elderly is the cold, so Id rather they were hot (Manager C) Limited heatwave planning Managers aware of Public Health

England Heatwave Plan other staff unaware. Aspects of the plan implemented on ad-hoc basis: checking occupants clothing, pushing fluids, providing electric fans. Ingrained practices of staff and residents dont shift during heat waves: meals, clothes, washing. Natural ventilation limited by window restrictors, and concerns about

draughts, security and insects. Need for cool rooms, additional staff, and consultation with occupants GPs questioned. Care provision fit for a future climate Lack of effective heat management due to design and management issues Confusion among staff and occupants about how to operate heating, and who is responsible.

Heating system was in operation 24/7 including during the summer months in all of the case study buildings. Reports of heating being on when windows are open. Centralised heating and hot water systems can lead to unwanted heat gains due to pipework. Lack of investment in features that would enable better heat management, particularly with regard to ventilation

and solar shading. Care provision fit for a future climate Recommendations The aim of becoming more resilient to overheating and heatwave risks in the care sector should be to ensure that no additional (excess) mortality (death) or morbidity (illness) occurs during future heatwaves. Given that vulnerable residents are within settings that should be providing care and therefore protection against thermal risks as they already do against cold weather conditions - this is a reasonable aim, and both building design and ongoing management and care practices need to become better focused towards this goal National policymakers and practitioners Recommendation Challenge the culture of warmth and increase awareness of the current and short-term future risks of climate change and overheating in the care sector and promote best practice in terms of both design and management measures that enable resilience and future adaptation.

Key Stakeholders DoH; PHE; CQC; Care providers; Design, commissioning and development teams Care provision fit for a future climate There is a difference between pleasant summertime warmth and sunshine, and heatwave periods that can have serious impacts on health. The transition into a heatwave period therefore necessarily entails non-normal conditions and responses in which routines and priorities should be expected to be significantly disrupted, although for a relatively short period. Vulnerability to heat is generally focused on older people, but specifically on those with particular health conditions. This differential susceptibility needs to be understood, identified amongst residents in care settings, prepared for and responded to. Whilst keeping older people warm is important for their health, the general culture of seeing the cold as dangerous, and warmth as good, can become a

problem if it dominates over understanding the health risks inherent within significantly higher and extended heatwave temperatures. Whilst significant heatwaves have been rare todate in the UK, this is expected to change, with the heatwave of 2003 expected to be a more frequent occurrence by the 2050s. Therefore what is understood as normal is not a good guide to what may come in the future. Being prepared for that different future is important, just as is being prepared for the growth in the older population over coming decades. National policymakers Recommendation Develop more detailed national guidance on monitoring and minimising overheating risk in the care sector Key Stakeholders DoH, PHE with others The PHE Heatwave plan guidance should be strengthened and added to in a number of ways:

Recommending at level 0 the development of a local site-specific heatwave plan, which is then embedded into management practices and staff induction and training. Provide guidance on training required. Adding a first key step (at level 2) that all heating systems are completely turned off, so that the amount of heat being added internally is minimized. This will need to include being clear about how this is done and whose responsibility it is to switch off the system. Considering whether the recommendations on the creation of cool rooms are likely to be feasible in practice for certain configurations of care/extra-care homes. Further discussion should be had in terms of how to provide cool areas in a practical and feasible way. Include guidance on an overheating detection protocol using smart sensors and based on harmonised overheating thresholds; preferably with stepped warnings relating to thermal comfort as well as healthrelated temperatures. DoH, PHE with others Develop and implement an overheating detection protocol for raising awareness PHE, DoH; CQC; and early identification of the risk of overheating using smart sensors and other governmental

surveys during summer months in buildings with vulnerable occupants and bodies working in Care provision fit forthea care future climate promote this in the Heatwave Plan. sector

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