Social care reform starts at the front door | #ForAccessibleHomes News

Paul Smith (picture below, left) joined Foundations – the national body for Disabled Facilities Grants and Home Improvement Agencies in England – as Director in 2015 after spending 25 years working in local government. Originally qualifying as a Building Surveyor and designing hundreds of home adaptations, Paul went on to manage two award-winning Home Improvement Agencies. For Accessible Homes Week 2026, he outlines why a discussion about improving adult social care is incomplete without considering the place where that care happens – their home.

Sometimes, the difference between needing help every morning and choosing how to start the day is the bathroom.

Imagine needing someone to help you wash every morning because you can’t climb into your bath. With a shower you could enter safely and with a seat in the right place, you might be able to wash yourself. You could choose when to get up, close the bathroom door and enjoy some privacy. Making changes to the bathroom to allow that to happen is a home adaptation.

Adaptations can be as simple as fitting a grab rail or as substantial as building an extension to provide an accessible bedroom and bathroom. What connects them is their purpose: making the home work for the person who lives there.

They also belong in the conversation about social care: the support people receive with everyday activities such as washing, dressing and preparing meals. How much help someone requires can depend partly on whether their home works for them, so a discussion about improving care is incomplete without considering the place where that care happens.

Habinteg’s research into public attitudes towards home adaptations brings this connection into focus. More than one in five UK adults say they or a family member have experienced serious consequences, such as a delayed return from hospital or a move into residential care, because a home could not meet their needs. These reported experiences don’t tell us how many situations an adaptation would have prevented. But what they do show is that, for many families, the relationship between housing and care is already very real.

The difference a home can make

Often, the difficulties build gradually. Someone stops using the bath, starts sleeping downstairs or only goes outside when a relative visits. Each adjustment helps them get through the day, but can also mean giving up something they value. What looks like ‘managing at home’ may involve considerable compromises.

The starting point is what the person wants to do. Showering before work, preparing a meal for their children or getting into the garden gives the conversation a purpose that a list of difficulties cannot capture on its own. Independence is personal, and it doesn't have to mean doing everything alone.

From worry to practical help

Recognising that a home is becoming difficult to manage doesn’t necessarily mean knowing what to do next. Habinteg’s findings reveal some understandable concerns: 46% of respondents identify cost, while 36% are concerned about whether their home could be adapted at all. Among renters, 38% put getting permission from their landlord among their top three concerns.

These are practical questions. What could be done? Can I afford it? Is financial help available? Will my landlord agree? Who can help organise the work? Clear answers make planning ahead possible. Without them, someone may put off asking for help or assume that nothing can change. A person managing a health condition or caring for a family member may also have little energy left for repeated calls and explanations to different organisations.

Improving delivery of home adaptations

At Foundations, we help councils, home improvement agencies and housing associations improve the way they deliver home adaptations. For housing associations that includes making the process easier for tenants and helping landlords access grant funding to support the work.

In England, a housing association can apply directly for a Disabled Facilities Grant, the council grant that helps fund home adaptations, to support a disabled tenant. The tenant doesn’t have to be the applicant. When the landlord applies, the tenant’s income and savings aren’t subject to the usual financial assessment, although the council still has to approve the proposed work. Government guidance supports this approach.

Working with the tenant, the landlord can bring together permission, the funding application and arrangements for building work. The resident remains central to decisions about their home, while the housing association takes on more of the organisational burden.

For someone struggling to use their bathroom, this could mean a clear plan, a named contact and fewer separate conversations to manage. It also gives landlords a practical response to the worries about cost, feasibility and permission that Habinteg’s research identifies. Every week saved in organising the work is a week less spent coping with an unsuitable home.

A place for housing in care reform

Building more accessible and adaptable homes would give people better choices from the outset. Alongside that, adapting existing homes offers a way to improve daily life for people already facing difficulties.

While adaptations will not remove everyone’s requirement for care, they can help people do more for themselves, support family members and make paid care easier to provide. Their value also lies in the privacy of closing the bathroom door, the freedom to choose when to get up and the confidence to leave the house. This gives housing a clear place in social care reform.

A conversation about someone’s support can also explore whether their home is making everyday activities harder, and whether a change would help. Housing associations, councils and care services each hold part of the answer. And when someone says, “I’m finding it difficult to manage at home,” the response should leave room for both care and changes to the home itself.