Olfactory dysfunction (OD) describes a range of issues associated with the sense of smell, including the inability to smell (anosmia), a reduced sense of smell (hyposmia) and a distorted sense of smell, where things smell different to the way they should (parosmia).

Pre-Covid European population studies have suggested that persistent anosmia affects 1-5% of the population, with all forms of olfactory disorders affecting about 20%, increasing over the age >60 ^1-3; Based on European estimates⁴, anosmia is more prevalent in the UK than reported rates of profound hearing loss or blindness.

OD affects all age groups but is particularly prevalent in the older section of the population; many people will start to lose their sense of smell as part of the ageing process. Based on European population studies of OD and analysis of the UK population as of 2021, existing data shows that approximately:

• 13% of people between the ages of 60-69 (just under 1 million people) may have OD
• 25% of people between the ages of 70-79 (around 1.5 million people) may have OD
• 55% of people above the ages of 80 (over 1.8 million people) may have OD
• 4.2 million people over the age of 65 live alone, more than 1 in 4 of them may have OD

The impact of olfactory dysfunction on people’s physical and mental health, wellbeing and safety is significant.  People can often experience poorer mental health by being unable to smell their partners and children, the places they visit or enjoy the flavours of their food and drink. Physical health can then suffer as people’s diet changes, which subsequently impacts nutrition. Safety and wellbeing at home is put at risk through being unable to smell gas, smoke or knowing when food has gone off and is unfit to eat. The fear and anxiety caused by being unable to smell these dangers further exacerbates the toll on mental health.

There is also a growing body of evidence pointing to olfactory dysfunction as being a significant factor in poorer health in later life. Research has demonstrated links between a poor sense of smell and frailty, as an early indicator of neurodegenerative disease, and of increased risk of mortality.

However, people don’t always realise they have a poor sense of smell, particularly if it deteriorates gradually over time.  The fact that testing of the sense of smell happens, at present, in a relatively small number of specialist clinics is a factor in this too. 

There are things that can be done to help people live well with a smell disorder, starting out with an awareness and understanding of the issue and how it can affect people’s lives, along with food tips, safety advice, peer support and more, all of which are part of the information and services provided by Fifth Sense, the charity for people affected by smell and taste disorders.

Information provided by Duncan Boak, CEO and founder, Fifth Sense
Fifth Sense is registered as a charity in England and Wales No. 1175553 and as a Private Company Limited by Guarantee No. 10255303.  Our registered office is at Unit 2, Franklins House, Wesley Lane, Bicester OX26 6JU

posted 4 July 2023

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The Office for Health Improvement and Disparities has issued guidance on damp and mould which outlines that there are four types of damp:

• Rising damp
• Penetrating damp (due to structural defects)
• Traumatise damp (from leaks/bursts, inside the building)
• Condensation damp

The main four causes of damp and mould in homes are:

• lack of ventilation
• leaks
• structural
• and condensation.

Poor ventilation leads to excess moisture being generated, whilst poor insulation such as poor thermal properties of external walls also plays a part. Fuel poverty or faulty heating systems leading to irregular heating potentially lead to damp and mould occurring, as well as other factors. These include leaks and structural defects such as leaking pipes, blocked gutters or a leaking roof. A defective old damp proof course can also potentially cause damp and mould, as can condensation where relative humidity is above 70%. High occupant density in a room should also be avoided in terms of people, pets and plants.

The health risks linked with damp and mould are well documented, including general respiratory effects, allergies, skin infections and eye irritations. While more research is required, other reported symptoms include headaches, lethargy, memory loss and mental health issues. Those with pre-existing health conditions, older people and those with disabilities are most likely to be affected.

It is believed that around 3% of homes in this country are affected by damp and mould in at least one room.

Housing conditions that put people at an increased level of risk tend to be in deprived or polluted areas and when windows are not opened due to concerns about security, noise, or high outdoor pollution. Small room sizes and building disrepair also have a bearing in terms of risk.

There are five legal standards that are relevant to damp and mould in rented homes and whilst almshouses do not, of course involve tenancies, almshouse charities are advised to abide by the following legal standards in their provision of accommodation:

• The Housing Act 2004
• The Environmental Protection Act 1990
• The Homes (Fitness for Human Habitation) Act 2018
• The Decent Homes Standard
• The Energy Efficiency (Private Rented Property) (England and Wales) Regulations 2015

Should residents report damp and mould in their almshouse, it is important that the level of their vulnerability is assessed to determine whether they are at higher risk. The resident’s vulnerability should be used as a means of prioritising work, damp and mould should be taken seriously and handled sensitively as it could be causing the resident considerable anxiety.

It is important to seek evidence of damp in a building, such as mould, mould odour or water damage in order to assess health risks and the need to take remedial action. When mould is present, it is most likely to be evident in frequently used rooms.

The subject of damp and mould in properties raises the importance of charities ensuring that they are inspected regularly in order that problems may be detected at an early stage and any necessary remedial action taken.

Further reading:
Almshouse Gazette (almshouses.org) – page 10, Combatting the causes and effects of condensation

posted 5 June 2023

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What is hoarding?

Hoarding is now recognised as a mental illness known as Hoarding Disorder. It is a complex interplay between social, psychological, and environmental factors.

A person who hoards may:

• become extremely attached to items and experience great difficulty in getting rid of possessions
• experience problems in social, occupational, or daily living activities
• experience distress and have difficulty making decisions
• fill area with clutter so it can no longer be used as intended
• find it hard to organise or categorise items
• find relationships with family and friends are affected
• keep or collect items of no monetary value
• present a risk to personal safety and that of others due to hoarding
• struggle to manage everyday tasks such as cooking cleaning or paying bills

People often do not have the energy to sort thing out and the task becomes overwhelming. Feelings of guilt or shame may prevent people from seeking help or allowing access to their home.

Research with people who hoard has shown that hoarding may be a linked to specific traumatic life events or could be symptoms of another condition such as obsessive-compulsive disorder, acquired brain injury, dementia, depression, or autistic spectrum disorder.

People who hoard often have logical reasons why they hoard e.g., throwing things away is wasteful, or harms the environment or the item is unique or special or holds special memories or ‘it makes me happy’.

Hoarding may develop over a period of time due to declining health both physically and mentally. Therefore, building relations as early as possible to offer help and support and minimise the hoarding is important.

How can we help and support someone who hoards?

It is important to challenge our own prejudices and assumptions. Everyone is different and we cannot fully understand why an individual hoards. The situation can be frustrating, worrying and difficult. Often, the individual does not want or feel they need help. The following suggestions might help.

• Educate yourself about hoarding disorder first – it’s a complex condition with no quick solutions.
• Always use respectful language – don’t refer to things as junk or clutter. The item may hold a special meaning for the person. Use the same language as they do about their possessions.
• Don’t tell the person what to discard or touch their possessions without consent.
• Be gentle – you cannot force someone to change their behaviour. Any attempts to do so will make matters worse and is likely to cause distress.
• Build trust and be patient – this is a slow process and may take many months. Once someone acknowledge they need help it can take a long time before they are ready to make changes. Let them know you are there and are not judging them.
• Don’t pressure them to let you into their space – as you build a relationship it may help to consider other places you could meet.
• Help them celebrate small successes  – try celebrating after they clear a small area. The whole task maybe overwhelming so reassure and help them to take things one step at a time.
• Focus on aspects of safety and well-being – talk about how you can work together to reduce the risk of accidents or eliminate things that could cause harm. This can often start the process off.
• Do not consider forced clean-ups – focus on a ‘harm reduction strategy’.
• Don’t make decisions for the person – encourage them to make achievable goals no matter how small.
• Help them to seek treatment and support – help them know you will support them to seek help when they are ready.
• Listen to what they want.
• Always include the person in decisions to call the authorities and explain why this is necessary – they may be reluctant but if you have built a trusting relationship and have focused on safety and well-being this will help.
• Do not let professionals make surprise visits.
• With the person’s consent, try to engage family or a friend to give additional support.
• Record your interventions to enable statutory organisations to have a clear picture of actions taken so far.

What professional help is available?

The person’s General Practitioner can be of help with diagnosis and linking you to other statutory services.

A multi-agency approach is the best way to work with people who hoard. Social services and mental health services can carry out risk assessments and develop risk management plans. They can use the care planning process, or the care programmed approach to try and ‘mitigate the risk of serious self-neglect that can result in significant harm’. Do ask to be included in multiagency meeting or at least send a report on the situation and what action you have taken so far. They can carry out a Mental Capacity Assessment which may help determine if the Court of Protection has the powers to make an order regarding a decision on behalf of an individual. However, application of the Mental Capacity Act can be very complex in relation to self-neglect. Hoarding is a complex issue and often the statutory authorities do not legally have the powers to intervene.

Relevant legislation

• The Care Act 92014) Statutory Guidance- self neglect is included as a category under adult safeguarding.
• Mental Health Act (2007)- If a person is believed to have a mental disorder and they are living alone and are unable to care for themselves a magistrate’s court can authorise entry to remove them to a place of safety.
• Mental Capacity Act (2005) s16(2)(a)- the court of protection has the power to make an order regarding a decision on behalf of an individual. The court’s decision about welfare of an individual who is self-neglecting may include access to assess capacity.
• Public Health Act (1984) s 31-32- local authority environmental health could use powers to clean and disinfect premiss but only for the prevention of infectious diseases
• The Housing Act 1988-a landlord may have grounds to evict a tenant due to breaches of the tenancy agreement
• Article 8 of the Human Rights Act – gives us a right to respect for private and family life. However, this is not an absolute right and there may be justification to override it, for example, protection of health, prevention of crime, protection of the rights and freedom of others.

Thanks to Helen Boyd for providing the above information

posted 24 May 2023

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Question time in Parliament is bringing to the fore the increased government focus on the Social Housing, Affordable Housing and Private Rented Sector.

MPs are seeing a rise in complaints from tenants about housing conditions that they must act on (see recent example of a Q&A at the end of this article). Almshouse charities could find themselves in the position of receiving a letter of complaint from their local MP on behalf of a resident, to which they must respond.

We are in no doubt that members will always respond in their usual positive and courteous way, however, we have been asked to give a quick bullet point check list that some may find useful.

If you receive a letter from your MP acting on behalf of a complainant:

• Respond quickly – a speedy response often takes the frustration out of a situation and allows the MP to see that you are treating it as a priority.
• If you need time – respond positively but say you will investigate thoroughly and respond by …………. Give a date you are confident you can meet.
• Investigate the complaint or ask further questions of the MP.
• Once investigated, if the complaint is already resolved, check with all parties concerned and be brief but clear in your response, thanking the MP for their interest.
• If the complaint is fair and as yet unaddressed, try to resolve the situation, then, once you have done so, inform the MP that it is either being resolved or has been. Giving a brief outline of the situation if needed.
• Remember, when you receive a letter from an MP, they are doing their job, taking up cases on behalf of their constituency and they may not be aware of the detail or fully understand the situation relating to almshouses. Your response may reassure and impress them and this may actually be a good opportunity to engage with your MP. In the moment, it does not feel like a positive situation but inviting the MP to the almshouse to meet you and meet your residents may have a beneficial long term outcome.
• If you are concerned – if the complaint is genuine and you don’t have an answer – please call us and we will work with you on a solution.

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CAF Bank – commitment and dedication

“Commitment and dedication is at the heart of the almshouse movement, with many members having served their communities for hundreds of years. Whilst CAF Bank is, by comparison, relatively youthful at just 37 years old, next year our parent organisation, the Charities Aid Foundation, celebrates its centenary.

Throughout that time, CAF Bank has understood the challenges of the sector and that stems from being part of the charitable landscape.  Our research, and work with charities, and donors, all inform our thought process and product design.  For example, when inflationary pressures, energy costs, wage demands, and a tightening of disposable income all started to form what we now know as the ‘Cost of Living’ crisis, we responded by creating a Cost of Living Resources hub (visit https://www.cafonline.org/charities/resource-hub) as well as engaging with all of our borrowers to see what help they might need, based on their circumstances.

We know that there are further challenges to come. Decarbonisation, affordability for residents and housing quality are areas that continue to be priorities. Members that are Register Providers will already have these challenges on their agendas but they are all the more difficult for those members whose almshouses are historic.  Green loans are very much on our plan for future product development.

That said almshouses do move with the times.  No longer are almshouses solely the preserve of the widowed or the retired.  Housing challenges are ever present in modern day society and almshouses are well-placed to respond to this.  A good example of this is The Poland Trust which recently completed on a once in a generation expansion of their stock.  A real highlight of the project was the average age of the first 4 new residents – around 30.  Those 4 individuals would have likely had to move out of the area they grew up in if it wasn’t for the commitment and hard work of the trustees of The Poland Trust.

Our lending function reached its 10^th anniversary in 2022 and we have come a long way from that initial blank piece of paper and now stand with a loan book of £224m* of drawn and committed balances.  It’s perhaps no surprise that our second-ever loan was to an almshouse and our support of the movement remains.  When The Almshouse Association reached its 75^th anniversary in 2021 we celebrated by committing a budget of £20m of  loans to almshouses with a reduced arrangement fee of 0.75%. 

We have created a dedicated almshouse page (see https://www.cafonline.org/caf-bank/secured-loans/flexible-finance-for-almshouses) on our website where you can find out more information and read case studies. We aim to build long-term relationships with our customers, as we believe this helps them to continue long-term relationships with their beneficiaries.”

CAF (Charities Aid Foundation) Bank, April 2023

posted 12 April 2023

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The Almshouse Association was delighted to welcome Mark Law, Partnership Manager at Careline365 to present a webinar on the digital switchover on 15th March 2023.

Mark went through how the change will impact charities with an alarm system in their properties, the technology available and how members can prepare.

A recording of the webinar is available via the link below:

The digital switchover is happening in 2025 so the earlier you prepare for this the easier the transition will be.

16 March 2023

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