Climate Resilience of Care Settings

Lead Research Organisation: University College London
Department Name: Bartlett Sch of Env, Energy & Resources


As a result of global climate change, the UK is expected to experience hotter and drier summers and heatwaves are expected to occur with greater frequency, intensity and duration. According to recent climate change projections by the MetOffice, increases in mean daily temperatures could be up to 5.4 deg. C during the summer months and 4.2 deg. C during winter by 2070 under a High emissions scenario. In 2003, 2,091 heat-related deaths were reported in the UK alone as a result of the European heatwave, meaning future temperature increases could lead to a parallel rise in heat-related mortality.

The UK also currently has a rapidly growing number of old people, with people aged 75 or over expected to account for 13% of the total population by 2035, compared with 8% in 2012. Older populations are more vulnerable to climate-induced effects as they are more likely to have underlying, chronic health complications, making them more vulnerable to heat stress. The 2003 heatwave demonstrated that older people in care settings are at the highest risk of heat-related mortality.

People aged over 65 years spend more than 80% of their time in residential environments or care settings, and people aged over 85 years more than 90%. Therefore, the indoor environment is a huge moderator of heat exposure in older populations: Poor building design and the lack of effective heat management in care settings may contribute to increased indoor heat exposure with detrimental health impacts falling on the most vulnerable residents. Care facilities function as both a home for residents and a workplace for staff, meaning that the people sharing those spaces can have diverging needs and preferences making overheating prevention measures difficult to enforce. Interactions between staff and residents play an important role in preventing overheating in care settings and it has previously been noted that staff are often made to prioritise warmth due to wide recognition of the detrimental effect cold weather can have on old-age health, leading to overheating risks being overlooked.

Understanding factors that contribute to indoor summertime overheating in care homes is crucial in developing methods to prevent overheating and the subsequent negative health impacts. Previous research by the applicants has indicated that care facilities are already overheating even under non-extreme summers, highlighting the need to develop timely prevention measures given the way temperatures are expected to rise in the UK over the next century. A key target for climate adaptation in care settings is to limit such risks by introducing passive cooling strategies via building design and occupant behaviour. Development of passive cooling strategies will reduce the likelihood of uptake of mechanical cooling, which would undermine government efforts to reduce greenhouse gas emissions.

Therefore, the principal aim of the project is to undertake preliminary work to develop methods that will support a system of care provision in the UK that is adequately prepared for rising heat stress under climate change. The project will undertake pilot work in five care settings in the UK to monitor the thermal environment and conduct surveys with residents, frontline care staff and care home managers. Within these buildings, it will test novel approaches for understanding the comfort levels of the residents and relating this to the thermal environment. It will also test novel measurement techniques for assessing impact of heat on the health of the residents. Via detailed modelling work, it will then test methods to assess future overheating risks and to evaluate the effectiveness of overheating mitigation strategies. Throughout the project the work will bring together multidisciplinary research perspectives with those of care home practitioners and other stakeholders. Via these packages of work, plans for the large-scale project that is so urgently needed in this area will be developed.

Planned Impact

Direct beneficiaries of the research project are UK policymakers, such as Government departments and other regulatory agencies, who are responsible for developing and introducing climate mitigation and adaptation policies, and policies for the improvement of the social care sector in the UK. Developing a number of effective policy interventions aims to protect the UK from the challenging effects rising temperatures will impose on UK infrastructure and the health and social care system. Further policymakers, such as Local Governments, will also benefit from the work as responsibility for local care settings fall under their remit and, therefore, protecting the health of the vulnerable individuals in said settings is of utmost priority.

There is currently wide recognition of the negative health effects associated with exposure to cold weather in older populations, meaning overheating risks can be overlooked. Given the way external temperatures within the UK are expected to rise due to climate change, there may be large impending health effects if the research area remains neglected, causing a future strain on the national health system. Thus, public health professionals will also benefit indirectly from the work as they aim to protect the wider population health, specifically that of vulnerable communities within society, such as the target population. Understanding factors which contribute to overheating in care settings using a holistic approach (e.g. considering building characteristics, occupant behaviour and interactions between staff and residents) allows for the development of effective mitigation strategies which can be implemented into care settings in a timely manner. Targeted interventions are more cost-effective, reducing the financial costs needed to implement policies and the subsequent health burden on the national health system. The built environment research sector also stands to benefit from the work as it will contribute to the understanding of measures which reduce overheating risk, specifically in the care sector but also applicable more generally to other domestic buildings.

The ultimate beneficiaries of the project, supported by the introduction of appropriate policies, will be the target population who live in care settings and are currently at risk of being exposed to high indoor temperatures leading to detrimental effects on health. Further details of the project beneficiaries and associated pathways to impact are provided in our Pathways to Impact section.

Multiple routes will be pursued to maximise stakeholder benefit and allow for effective sharing of expertise as part of our Pathways to Impact Plan. Specific Investigator and PDRA resources, and a whole Work Package are dedicated to our research impact activities that will help translate our research findings into meaningful outputs for policymakers, co-create knowledge and identify optimum pathways for dissemination amongst other relevant stakeholders. We will also assemble a Project Advisory Board (PAB) including representatives of each stakeholder group and organise three PAB meetings combined with stakeholder workshops throughout the duration of the project. This will create an interdisciplinary, collaborative environment between our research team, policymakers and practitioners that will encourage two-way conversations. It is expected that the project outputs will be used to inform and update current industry standards, such as CIBSE guidance, and public health risk assessment approaches, such as the CQC inspection processes. Other platforms of dissemination include our planned closed collaboration with the UKRI UK Climate Resilience Champion, the MetOffice, the CQC, PHE, CIBSE, the UCL Public Engagement Unit, the UCL Media Relations team and the Bartlett Strategic Communications team, who will support engagement activities between our research group, interest groups outside academia and the wider public.
Description The project findings show that the care home building construction age may play a critical role in overheating. Staff and residents in older, heavyweight buildings were less likely to feel hot in the summer. Monitored summertime temperatures were generally higher in bedrooms than lounges, with mean internal temperatures in the five case studies during the heatwave period remaining predominantly above the PHE-recommended 26 °C threshold. Care home staff described their conditions as consistently warmer than residents but were willing to tolerate uncomfortable temperatures if in the residents' best interest. According to modelling results, internal temperatures are projected to remain at significantly higher levels under the future climate scenarios tested. The implementation of appropriate passive design strategies resulted in a significant reduction of indoor temperatures. Overall, modern buildings were found to benefit more from passive interventions rather than older buildings, with the latter maintaining slightly lower temperatures at all times. Night ventilation emerged as the single most impactful passive technique for all building types.

Indicative findings from the sample testing of telemetric gastro-intestinal temperature monitoring showed that variation in core temperature throughout the day is closely related to activity. Further work on this was postponed due to the COVID-19 outbreak.
Exploitation Route The target population who live in care settings are currently exposed to high indoor temperatures leading to detrimental health effects. This work and its follow-up Governing the Climate Adaptation of Care Settings aim to provide practical advice for staff on managing heat, prioritise overheating mitigation actions and assist the identification of temperature comfort thresholds for vulnerable groups of people, such as occupants with health problems and those of older age. There will potentially also be improvements in thermal comfort, sleep quality and sense of wellbeing for the vulnerable demographic living in care facilities and improved productivity for care staff. The reduction of old-age morbidity and the improvement of wellbeing for both residents and staff in care facilities can foster economic growth within the care industry and contribute to the wider UK initiative of climate adaptation.
The work will be of interest to relevant stakeholders from the built environment, social care, public health and policy development. It will also be of interest to other disciplines, such as epidemiology, climate risk management, psychology and social sciences. The wider academic community will benefit from the research as it will produce a blueprint of methods for overheating mitigation, applicable to both domestic and non-domestic premises and benefiting specifically the vulnerable communities within society. Direct beneficiaries of the research study are UK policymakers, such as Government departments and other regulatory agencies, who are responsible for developing and introducing climate mitigation and adaptation policies, and policies for the improvement of the social care sector in the UK. It is also expected that the project outputs will be used to inform and update public health risks assessment approaches, such as the Care Quality Commission inspection processes, PHE's heatwave advice for care settings and current industry standards, such as CIBSE guidance.
Sectors Communities and Social Services/Policy,Construction,Energy

Description The findings of this work have contributed to the following non-academic outputs: • Climate Change Risk Assessment 3 (CCRA3): evidence has been provided to inform CCRA3 on the impact of climate change risks on care homes in the UK. • Chartered Institution Of Building Services Engineers (CIBSE): a research insights document was published alongside an associated #GrowYourKnowledge webinar. • Greater London Authority (GLA) Care Home Overheating Audit Pilot Reports: evidence provided in relation to the indoor overheating of care homes. • Futurebuild built environment event: brief overview of the project and its main findings. • MHCLG/BEIS/DHSC.seminar: presentation of the project findings. • ClimaCare project workshop: half-day workshop discussing project output with experts from built environment, social care, public health and policy making.
First Year Of Impact 2020
Sector Construction,Energy
Impact Types Policy & public services