Extra Care Housing: The Current State of Research and Prospects for the Future

Abstract

Extra care housing aims to meet the housing, care and support needs of older people, while maintaining their independence in self-contained accommodation. Evidence from several studies suggests that it has benefits for residents in terms of costs and outcomes, and can provide a supportive environment for people with dementia, although the benefits for residents with greater care needs are less clear. Budgetary pressures and increasing eligibility criteria are altering the balance of care between residents and resulting in more task-focused, less personalised care. An increasing shortfall in provision and incentives for developers to concentrate on ‘lifestyle’ provision raise questions about the long-term viability of the model for supporting local authority-funded residents. Responses to the coronavirus pandemic also raise questions about future housing and care arrangements, and these need to be addressed in the government’s long-delayed plans for social care.

Provisions for people living with dementia in housing with care settings in England

“…Currently, there is no universally accepted terminology for HwC within the sector. Other terms used in the UK include "extra care housing", "assisted living", "very sheltered housing", "independent living", "service-enriched housing", "integrated care", "supported housing", "supported living", "continuing care", "flexi-care", "retirement villages", "retirement communities" and, most recently, "integrated retirement communities" (Howe et al, 2012;ARCO, 2021;Elderly Accommodation Counsel, 2021b, 2022. All these terms are used to describe types of retirement living that provide more services and facilities than traditional sheltered and retirement settings (Elderly Accommodation Counsel, 2022).…”

“…HwC provides independent living, with each resident having their own front door and the full legal rights associated with being a tenant, homeowner or shared owner, and access to communal facilities and 24-h on-site care delivered flexibly according to changing needs (Evans, 2014; Riseborough et al , 2015). There are a multitude of models under this one umbrella with apparently no single mode of delivery, making it difficult to carry out larger-scale studies (Atkinson et al , 2014; Darton, 2022). Huge variations exist in terms of built form, services and facilities provided, management arrangements and pricing structures (Elderly Accommodation Counsel, 2021b).…”

“…A growing body of evidence suggests that, for older people, HwC offers an effective alternative to residential care, prolonged residence in the same home, a good quality of life and social life and can delay or even prevent moves to nursing care (Netten et al , 2011; Bäumker et al , 2012; Atkinson et al , 2014; Darton, 2022). However, an increasing number of residents with complex health and care needs, including chronic illness and advanced stages of dementia, can create a challenge for HwC in supporting residents to live independently (Atkinson et al , 2014; Cameron et al , 2020; Darton, 2022).…”

Advantages and challenges of extra care housing in the UK for people living with dementia: a scoping review

“…This includes older people living with dementia, however, there remains little evidence as to what works best, and for whom, with respect to ECH for people living with dementia (O’Malley and Croucher, 2005; Dutton, 2010; Twyford, 2016). Darton (2022, p. 303) notes that although “research studies have identified the potential benefits and challenges of providing specialist housing […] a number of issues require further research, for example supporting people with dementia”.…”

“…The benefits of ECH for the general population are now more widely understood (Darton, 2022; Evans and Vallelly, 2007; Holland, 2015), although it should be noted more recent research has suggested financial pressure can result in more task-centred care (Cameron et al , 2020; Darton, 2022). However, there are approximately one-fifth of residents in ECH living with dementia (Barrett, 2020a) where little is known about their experiences of different models of ECH (Dutton, 2010; O’Malley and Croucher, 2005; Twyford, 2016).…”