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

In a paper (opens new window) published in Social Policy & Society last year, I examined a number of studies to consider the reported benefits of extra care housing for residents. The evidence 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.

The spectrum of care diagram in the HAPPI Report positions specialised housing, including extra care housing, between mainstream housing and care homes. The studies discussed in the paper include comparisons between residents living in each type of accommodation. However, although extra care housing supply has increased steadily over time, there is much less provision than in care homes or in sheltered and retirement housing, and a continuing shortfall relative to demand, as discussed in the recent Mayhew Review (opens new window).

Comparisons between residents living in the different types of accommodation have indicated that, as expected, residents in extra care were less able to undertake personal and domestic tasks than people in mainstream housing but were younger and less physically and cognitively impaired than those who moved into care homes. In a recent study, the care needs of residents appeared to be increasing, in line with changes in local authority adult social care eligibility criteria.

Various studies have suggested that extra care housing schemes can accept people in the early stages of dementia and can support people who develop the disease while they are residents. Levels of severe cognitive impairment among residents were much lower than in care homes, even among schemes designed specifically for residents with dementia. However, with increasing levels of dementia among the population, extra care housing is being seen as offering a model for supporting people with dementia. Recent research by the University of Worcester’s Association for Dementia Studies, also funded by the National Institute for Health and Care Research School for Social Care Research (NIHR SSCR), has examined the relative roles of specialist and generic extra care housing, but integration can be unpopular with other residents, putting residents living with dementia in generic schemes at risk of social exclusion. It may be easier to provide more dementia-friendly design in specialist schemes, but this would appear to be at the cost of promoting independence.

Studies of the costs and outcomes for residents have indicated that living in extra care housing can help to reduce care needs and the need for hospital admissions, achieving cost savings and benefits to quality of life. Significant reductions have also been reported in the costs of providing social care services compared with in the wider community. A comparison of matched groups of residents also found that costs were slightly lower in extra care schemes than in care homes. Although a study of one scheme found that the overall cost per person increased after moving in, this was associated with improvements in quality of life.

Research evidence suggests that extra care housing can provide improved social care outcomes and help to reduce care needs compared with residential care and mainstream housing. However, budgetary pressures and increasing eligibility criteria appear to be altering the balance of care and resulting in more task-focused, less personalised care. Furthermore, shortfalls in provision and incentives for developers to concentrate on ‘lifestyle’ provision raise additional questions about the long-term viability of the model for supporting local authority-funded residents. Further research is needed on supporting people with dementia and on the needs of people in ethnic and other minority groups. Research has tended to concentrate on detailed studies of relatively small numbers of schemes, and the alignment of housing with other forms of provision also needs to be supported by broader cost-benefit analyses.

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If you found this of interest, view a range of other resources on evaluating extra care housing curated by the Housing LIN here.

Acknowledgements/disclaimer

The paper discussed in this blog was funded by the NIHR Policy Research Programme (reference 103/0001). It drew on research funded by the former Department of Health and the NIHR SSCR. The views expressed are those of the author and not necessarily those of the NIHR, the NIHR SSCR or the Department of Health and Social Care.