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

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.

Learning from the experience and effectiveness of retirement village and extra care housing responses to the COVID-19 pandemic

Purpose This paper aims to describe the RE-COV study and to summarise its findings. It focuses particularly on the implications of lessons learned for national, operational and building design policy and practice. Design/methodology/approach Invitations to take part in a RE-COV study survey were emailed to the operators of 270 retirement villages and older people’s extra care housing schemes in England which were known to the Elderly Accommodation Counsel. Completed questionnaires were returned from 38 operators, online or electronically, between December 2020 and February 2021. Findings Survey findings evidenced the breadth and depth of the operators’ responses, the effects these had on residents’ lives and worthwhile changes which could be made. Outcomes demonstrated included higher levels of protection for residents from the COVID-19 virus compared to older people living in the general community, and high levels of residents feeling safe, supported and reassured. Practical implications The findings are used to offer evidence-based recommendations for housing operators, building designers and policymakers which could enhance resident, staff and operators’ health and well-being, both going forward and during possible future pandemics. Social implications There is evidence that retirement villages and extra care housing provided safe, resilient and supportive environments during the first year of the pandemic which were highly valued by residents. Originality/value This study addressed a knowledge gap regarding how the COVID-19 pandemic had impacted housing-with-care stakeholders, evidencing specifically how operators had responded, and what their response achieved.

Social capital in retirement villages: a literature review

Retirement villages are a model of extra-care housing, offering purpose-designed housing that incorporates both care services and a range of non-care-related facilities and activities. These generate opportunities for formal and informal social activity, and promote community engagement, solidarity between residents, and active and independent ageing. Providers suggest that retirement villages are able to foster an environment rich in social capital. This study's purpose is to review and summarise key findings on the topic of social capital in retirement villages in the gerontological literature. Social capital is defined as both an individual attribute of single actors and a feature of communities as a whole. A clear conceptualisation of social capital is used to organise the reviewed studies along different dimensions: on an individual level, social networks, trustworthiness and obligations are differentiated, while the collective level distinguishes between system control, system trust and system morality. Thirty-four studies are reviewed. While retirement villages are generally described as friendly places with widespread helping behaviour where new friends are made, research has also highlighted the difficulty of socially integrating the frail and very old. While, in particular, social networks and system morality have received much attention, there is a clear need for future research into the other domains of social capital.

Older people's perspectives on living in integrated housing and care settings: the case of extra care housing

PurposeThis paper explores residents' perceptions and experiences of extra care housing as an integrated model of housing with care.Design/methodology/approachData were collected in a longitudinal qualitative study based on four extra care housing schemes. Data from interviews with residents, care workers, managers and local commissioners were analysed thematically.FindingsThe integration of housing with care enabled many older people to manage their care proactively. However, the increasing number of residents with complex health and care needs, including chronic illness, led some residents to question the ability of the model to support residents to live independently.Research limitations/implicationsThe study struggled to recruit sufficient residents from the specialist dementia setting who were able to communicate their consent to take part in the research. In addition, the quality of qualitative data collected in interviews with participants at this setting reduced over successive rounds of interviews.Practical implicationsThe study suggests the need to ensure that residents are fully informed about levels of care and support is available when considering a move into extra care housing.Originality/valueThis paper provides a timely opportunity to consider extra care housing as an example of an integrated housing service, particularly in light of the current challenges facing the sector.

Extra care housing: exploring motivations, expectations and perceptions

Purpose The purpose of this paper is to explore and compare the motivations and expectations that older people have when choosing to move into either a private or housing association (HA) extra care housing (ECH) scheme, and any effects this had on its residents. Design/methodology/approach This qualitative study is based on findings from four HA schemes in Tower Hamlets, London, and one private scheme in Warwickshire. Eight semi-structured interviews were conducted with five women and three men of varying backgrounds, from schemes managed by different associations and companies. Interview transcripts were coded and analysed thematically. Findings All residents moved into ECH in response to deteriorating health. However, almost all residents had felt obliged to move by others, generally their children. Few residents had any expectations of ECH on arrival, but many developed high expectations of an increased sense of independence and security and of an improved social life. ECH appeared to be beneficial for residents’ health and well-being. Research limitations/implications The inability to recruit an equal number of people from HA and private scheme, alongside the small sample size, may compromise the external validity of any conclusions drawn from any comparisons. Practical implications This research identifies a lack of knowledge about ECH among the general population and offers insight into areas of poor management within ECH schemes which could be improved. Social implications Inadequacies in the ECH model could be attributed to failures in the current health and social care system. Differences between expectations and perceptions of HA vs private schemes should be acknowledged and responded to. Originality/value This is a rare example of research exploring the relationships between ECH residents’ motivations and expectations (Hillcoat-Nallétamby and Sardani, 2019), and between those in HA vs private schemes.

Green dementia care in accommodation and care settings: a literature review

Purpose The purpose of this paper is to examine the recent evidence relating to green (nature-based) dementia care for people living with dementia in long-term accommodation and care settings (housing for older people that provides both accommodation and care, such as residential care homes, nursing homes and extra care housing schemes). The review formed part of a pilot study exploring interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK. Rather than a comprehensive systematic or critical literature review, the intention was to increase understanding of green dementia care to support the pilot study. Design/methodology/approach The review draws together the published and grey literature on the impacts of green (nature-based) dementia care, the barriers and enablers and good practice in provision. People living with dementia in accommodation and care settings are the focus of this review, due to the research study of which the review is part. Evidence relating to the impacts of engaging with nature on people in general, older people and residents in accommodation and care is also briefly examined as it has a bearing on people living with dementia. Findings Although interaction with the natural environment may not guarantee sustained wellbeing for all people living with dementia, there is some compelling evidence for a number of health and wellbeing benefits for many. However, there is a clear need for more large-scale rigorous research in this area, particularly with reference to health and wellbeing outcomes for people living with dementia in accommodation and care settings for which the evidence is limited. There is a stronger evidence base on barriers and enablers to accessing nature for people living with dementia in such settings. Research limitations/implications The literature review was conducted to support a pilot study exploring green (nature-based) dementia care in care homes and extra care housing schemes in the UK. Consequently, the focus of the review was on green dementia care in accommodation and care settings. The study, and thus the review, also focussed on direct contact with nature (whether that occurs outdoors or indoors) rather than indirect contact (e.g. viewing nature in a photograph, on a TV screen or through a window) or simulated nature (e.g. robot pets). Therefore, this paper is not a full review of all aspects of green dementia care. Originality/value This paper presents an up-to-date review of literature relating to green dementia care in accommodation and care settings. It was successful in increasing understanding to support a pilot study exploring opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK. It demonstrated the impacts, value and accessibility of nature engagement in these settings and identified gaps in the evidence base. This review and subsequent pilot study provide a strong platform from which to conduct future research exploring green dementia care in accommodation and care settings.

Connections with nature for people living with dementia

Purpose The benefits of “green dementia care”, whereby people living with dementia are supported to connect with nature, are increasingly being recognised. Evidence suggests that these benefits span physical, emotional and social spheres and can make a significant contribution towards quality of life. However, care settings often present specific challenges to promoting such connections due to a range of factors including risk-averse cultures and environmental limitations. The purpose of this paper is to report on a project that aims to explore the opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in residential care and extra care housing schemes in the UK. Design/methodology/approach Data were gathered from 144 responses to an online survey by managers/staff of extra care housing schemes and care homes in the UK. In depth-case studies were carried out at three care homes and three extra care housing schemes, involving interviews with residents, staff and family carers. Findings A wide variety of nature-based activities were reported, both outdoor and indoor. Positive benefits reported included improved mood, higher levels of social interaction and increased motivation for residents, and greater job satisfaction for staff. The design and layout of indoor and outdoor spaces is key, in addition to staff who feel enabled to promote connections with nature. Research limitations/implications This paper is based on a relatively small research project in which the participants were self-selecting and therefore not necessarily representative. Practical implications The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes. Social implications Outdoor activities can promote social interaction for people living with dementia in care settings. The authors’ findings are relevant to the recent policy focus on social prescribing. Originality/value The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes.

Ageing in extra-care housing: preparation, persistence and self-management at the boundary between the third and fourth age

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents’ attempts to manage this boundary.