Physiotherapist housing referrals: a guide for practitioners

Physiotherapists regularly see patients whose recovery and wellbeing is affected by their housing conditions. Damp and cold homes impair respiratory function, uneven floors and broken stairs increase fall risk, and inadequate space for mobility aids hinders rehabilitation. This guide is for physiotherapists and allied health professionals who want to support patients facing housing problems.

How housing affects physiotherapy outcomes

Housing conditions can significantly affect a patient's recovery, particularly for:

• Musculoskeletal conditions, broken stairs, uneven flooring, and inadequate heating make rehab exercises harder and increase injury risk
• Respiratory conditions, damp, mould, and cold homes worsen asthma, COPD, and other breathing difficulties that affect exercise tolerance
• Neurological conditions, patients recovering from stroke or managing neurological conditions may struggle in homes that lack adaptations
• Post-operative recovery, cold, damp homes slow wound healing and increase infection risk after orthopaedic procedures
• Elderly patients, older people in cold or structurally unsuitable homes face a disproportionate risk of falls and serious injury

Identifying housing problems in clinical practice

Signs that a patient's housing may be affecting their health include:

• Persistent symptoms that improve when the patient is in a different environment
• Symptoms that worsen in winter or in damp conditions
• A patient reporting visible mould, cold rooms, or broken fixtures in their home
• Inability to carry out prescribed exercises because of limited space or hazardous conditions (broken flooring, insufficient handrails)
• Falls at home linked to environmental hazards

Asking about housing conditions as part of a holistic assessment can reveal problems that would otherwise go unidentified.

Referral pathways you can access

Environmental health

If a patient's home has disrepair, damp, cold, structural hazards, broken fixtures, that the landlord has failed to fix, the council's environmental health team can inspect the property and, if needed, serve a notice requiring the landlord to act. A letter from a physiotherapist setting out the clinical impact of the housing conditions on the patient's recovery can support a priority inspection request.

Housing disrepair legal claim

If a patient rents privately or from a housing association and the landlord has failed to carry out repairs, the patient may have a legal claim for compensation. A physiotherapist's letter documenting the impact of housing conditions on the patient's musculoskeletal or respiratory health is useful evidence for a personal injury element of a disrepair claim.

Support for Tenants handles housing disrepair claims on a no-win no-fee basis and accepts referrals for vulnerable patients.

Disabled facilities grant

If a patient needs adaptations to their home, handrails, a shower seat, a stairlift, a ramp, they may be entitled to a Disabled Facilities Grant. The grant is administered by the local council and an occupational therapy assessment is typically required. Physiotherapists can support patients in making this application by documenting their mobility needs.

Housing register

If a patient's home is fundamentally unsuitable (for example, a wheelchair user in a flat with no lift access), applying for a transfer or for the housing register with supporting medical evidence may be appropriate. A physiotherapist's letter explaining why the current property is unsuitable for the patient's needs can support an application for higher priority.

Writing a housing support letter

When writing to support a patient's housing disrepair or housing needs application, include:

• Your professional role and relationship with the patient
• The patient's name and address (with consent)
• The specific housing conditions you are aware of
• The clinical link between those conditions and the patient's health or recovery
• Any relevant assessments or diagnoses
• Dates of clinical contact

Be specific rather than general. "The patient's recovery from knee replacement surgery is being impeded by the broken staircase and cold, damp conditions in their bedroom, which I observed on a home visit on [date]" is more useful than "poor housing is affecting this patient."

When should I contact Support for Tenants?

Support for Tenants handles housing disrepair claims for tenants across England on a no-win no-fee basis. We welcome professional referrals.

Call us on 0800 030 4669 to discuss a patient referral.

Sources

• Section 11, Landlord and Tenant Act 1985 (legislation.gov.uk)
• Homes (Fitness for Human Habitation) Act 2018 (legislation.gov.uk)