Transcript Care provision fit for a future climate funded by: Joseph Rowntree

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:
Case Study A
• Case Study A (42 beds / 2005)
• Case Study B (23 beds / mid-late 19th c.)
Extra-care schemes:
• Case Study C (50 flats / 2006)
• Case Study D (60 flats / 2012)
Case Study B
Case Study C
Case Study D
% of occupied hours over threshold temperature
10
9
8
7
6
5
4
3
2
1
0
Case Study A
Case Study B
Current climate
2030
2050
Case Study C
2080
Staff office (SF, SW)
Lounge 1 (uGF, SE/SW
Flat 1 Living (FF, SE)
Flat 1 Bed (FF, SE)
Manager’s office (GF, SE)
Lounge 1 (GF, S)
Flat 2 Living (FF, NE)
Flat 2 Bed (FF, NE)
Staff office (B, NW)
Lounge 2 (GF, NE)
Bed 3 (FF, SW)
Manager’s office (GF, N)
Lounge (FF, NW/N)
Bed 3 (FF, SE)
Current and future overheating risks in the case studies
Static method: Indoor temperatures +26°C for up to 76% of monitored period
Case Study D
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… we’re 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
I’d 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 don’t 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 to–date 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