This report summarises the results of a
Department of Health (DH) funded evaluation
of 19 extra care housing schemes that opened
between April 2006 and November 2008, and
which received capital funding from the
Department‘s Extra Care Housing Fund. Key
findings on delivering outcomes, costs and costeffectiveness, and improving choice were that:
Delivering person-centred outcomes
• Outcomes were generally very positive, with
most people reporting a good quality of life.
• A year after moving in most residents enjoyed
a good social life, valued the social activities
and events on offer, and had made new friends.
• People had a range of functional abilities
on moving in and were generally less
dependent than people moving into
residential care, particularly with respect
to cognitive impairment.
• One-quarter of residents had died by the
end of the study, and about a third of
those who died were able to end their lives
in the scheme.
• Of those who were still alive at the end of
the study, over 90 per cent remained in
the scheme.
• For most of those followed-up, physical
functional ability appeared to improve or
remain stable over the first 18 months
compared with when they moved in.
Although more residents had a lower level
of functioning at 30 months, more than a
half had still either improved or remained
stable by 30 months. • Cognitive functioning remained stable for the
majority of those followed-up, but at 30
months a larger proportion had improved
than had deteriorated.
Costs and cost-effectiveness
• Accommodation, housing management and
living expenses accounted for approximately
60 per cent of total cost. The costs of social
care and health care showed most variability
across schemes, partly because most detail
was collected about these elements.
• Comparisons with a study of remodelling
appear to support the conclusion that new
building is not inherently more expensive than
remodelling, when like is compared with like.
• Higher costs were associated with higher
levels of physical and cognitive impairment
and with higher levels of well-being.
• Combined care and housing management
arrangements were associated with lower costs.
• When matched with a group of equivalent
people moving into residential care, costs
were the same or lower in extra care housing.
• Better outcomes and similar or lower costs
indicate that extra care housing appears to
be a cost-effective alternative for people with
the same characteristics who currently move
into residential care.
Improving choice
• People had generally made a positive choice
to move into extra care housing, with high
expectations focused on improved social
life, in particular. • Alternative forms of housing such as extra
care housing are seen as providing a means of
encouraging downsizing, but although larger
villages appeal to a wider range of residents,
different expectations among residents can
create tensions and misunderstandings
about the nature of the accommodation and
services being offered.
• While the results support the use of extra care
housing as an alternative to residential care
homes for some individuals, levels of supply
are relatively low.
• Funding of extra care housing is complex and,
particularly in the current financial climate, it is important that incentives that deliver a
cost-effective return on investment in local
care economies are in place if this is to be a
viable option for older people in the future.
• More capital investment and further
development of marketing strategies are
needed if extra care housing is to be made
more available and more appealing to
more able residents. Without continuing
to attract a wide range of residents,
including those with few or no care and
support needs as well as those with higher
levels of need, extra care housing may
become more like residential care and lose
its distinctiveness.