THE ESSENCE PROJECT

Extra-care housing

Evidence

A comparative cost and outcome analysis with residential care
Baumker T Journal of Service Science and Management, 40, 523-539. 2011

Extra care housing is a housing model that has considerable potential to support older people in leading active, independent lives.

Demonstrating the Health and Social Cost-benefits of Lifestyle Housing for Older People
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2017

This report, commissioned by Keepmoat Regeneration/ENGIE, sets out the evidence for the benefits of developing specialist retirement housing for people aged over 55, including cost savings. It focuses on the benefits of age restricted retirement housing or sheltered accommodation, care villages and specialist extra care housing with services and care on-site. Part one lists key facts and figures on the health and social care cost-benefits of lifestyle housing for older people. Part two provides more detailed findings of the potential benefits including the areas of: social connectedness and reducing loneliness; life expectancy, keeping couples together and supporting informal carers, financial savings in adult social care and the NHS, and preventing the need for institutional care. References and links are listed at the end of the document.

Developing your Local Housing Offer for Health and Care
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2016

Updated in 2016, this tool acknowledges the significance of housing as a partner and contributor to achieving the aims of health and social care services. With references to latest policy and practice, it is aimed at helping housing and support articulate and demonstrate the value of their services in terms of their partners’ targets and outcomes.

Evaluation of Extra Care Housing in Wales
Batty E, Foden M, Green S Welsh Government, Cardiff. 2017

This report presents a comprehensive, independent assessment of the current role of extra care.

The findings aim to help inform discussion about the role that extra care should play in delivering the strategic vision on housing for older people in Wales.

The evaluation included a literature review and the collection and analysis of primary and secondary quantitative data.

Case studies were undertaken in six local authority areas, in each area up to 10 key stakeholders were interviewed and in total over 80 extra care residents were engaged in the research.

Extending the Housing Options for Older People: Focus on Extra Care
Petch A Institute for Research and Innovation in Social Services, Glasgow. 2014

This Insight summarises the evidence on policy and practice issues for housing with care and support for older people, focusing on extra care provision, and the extent to which different models provide an effective alternative to residential and nursing care. The review begins by providing a short overview to the policy context in Scotland. It then looks at the evidence in the following areas: location, support arrangements, quality of life, provision for dementia, building design, end of life and cost. The Insight covers ‘extra care’ that offers self-contained accommodation units, support accessible 24 hours, some collective meal provision and a range of leisure and other facilities on site.

Financial Benefits of Investment in Specialist Housing for Vulnerable and Older People
Frontier Economics Frontier Economics, London. 2010

This report recommends that the HCA should continue to prioritise investment in specialist housing provision, to include making the best value of existing stock. In addition, it states that the needs of vulnerable and older people should be embedded in the Agency’s Local Investment Planning process and that older and vulnerable people should be considered contributors to, and customers of initiatives and programmes outside of specialist schemes

Get Well Soon
Studdert J, Stopforth S, Parker S, et al New Local Government Network, London. 2016

This report from New Local Government Network (and supported by Midland Heart) argues that the health service in its current form is not sustainable, and sets out a new plan for shifting the system to focus on preventing illness, shorten stays in hospitals and help people live independently for longer.

It makes a number of references to housing interventions and the care efficiencies that can be achieved and recommends that any new resources for health announced by government should be designated to support a transition to place-based health and a renewed focus on people’s wellbeing to drive a reduction in health inequalities.

In addition, with devolution in mind, it calls for metro mayors and council leaders to be in charge of pooled budgets and other financial models that ensures places rather than institutions are held to account for health.

Health at Home: A New Health and Wellbeing Model for Social Housing Tenants
Peabody Peabody Group, London. 2018

The report from Peabody is based on research with some of their general needs residents aged 50 and focuses on helping them to improve their understanding and confidence around managing their own health. It looked at how:

services can be delivered effectively at lower cost?
self-care can be encouraged for the most vulnerable customers and reduce dependency on direct support?
partnerships with other agencies can ensure a coordinated response to support residents’ complex and multiple health needs?

The report shows how housing associations can play an important role in empowering residents to stay healthy and also demonstrated the value of a person-centred approach to build more system resilient.

Home from Hospital: How Housing Services are Relieving Pressures on the NHS
Copeman I, Edwards M, Porteus J National Housing Federation, London. 2017

This report shows how housing services are helping to relieve pressure on the NHS by reducing delays in discharging people from hospital and preventing unnecessary hospital admissions. It features 12 case studies to show the positive impact these services have on people’s lives and the cost benefit to the NHS. The case studies highlight services that will benefit people most at risk of delayed discharge, such as older people, people with mental health problems and people experiencing homelessness. The case studies also demonstrate a diversity of housing and health services including: ‘step down’ bed services for people coming out of hospital who cannot return to their own home immediately; hospital discharge support and housing adaptation services to enable timely and appropriate transfers out of hospital and back to patients’ existing homes; providing a new home for people whose existing home or lack of housing mean that they have nowhere suitable to be discharged to; and Home from Hospital services to keeping people well at home who would otherwise be at risk of being admitted or readmitted to hospital. The report also considers the impact and additional savings that could be made by housing providers if this work were to be scaled up.

Housing, Prevention and Early Intervention at Work: A Summary of the Evidence Base
Porteus J Housing Learning and Improvement Network, London. 2011

This Viewpoint provides an overview of the evidence base and personal account of the key housing and housing with care and support issues relating to prevention and early intervention. It was written to help inform priority area 4 of the Department of Health’s Caring for our Future: Shared ambitions for care and support consultation and the work of the NHS Future Forum

Improving Housing with Care Choices for Older People: An Evaluation of Extra Care Housing
Netten A, Darton R, Bäumker T, et al Personal Social Services Research Unit and Housing Learning and Improvement Network, London. 2011

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.

Improving Housing with Care Choices for Older People: Evaluation of the Extra Care Housing Initiative
Darton R, Bäumker T, Callaghan L, et al Personal Social Services Research Unit, Kent. 2011

The Personal Social Service Research Unit (PSSRU) and Housing LIN have jointly published the evaluation of the Department of Health’s Extra Care Housing Fund.

Innovative Funding and Delivery Options in Extra Care Sheltered Housing
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2012

Housing LIN ‘Get Smart’ Guide – Public sector capital investment constraints necessitate the need for innovation and radically different ideas to come forward to meet the proven need for new older peoples housing. The guide seeks to summarise and assess new financial options available to local public sector and not for profit organisations that may be available for new build extra care accommodation arising from Housing Revenue Account reform; the anticipated introduction of Real Estate Investment Trusts; Tax Incremental Financing; and other options. ‘Get Smart’ brings together a number of experts involved in procuring, designing, constructing, funding, costing and developing extra care housing and captures their personal views to drive inward investment and innovation in the sector. They include:

Extra care: unlocking the market potential by Melville Knight, Castleoak
Private sector investment into older persons housing by David Dent, Elliott Dent
A long-term game for an old age problem by Darren Crocker, Gleeds
Extra care housing – financed by institutional investment by Niall Henderson, independent consultant
Funding structures for extra care housing by Coralie Foster, PKF Accountants
Delivering extra care housing – the Local Authority route? By Steve Partridge, Chartered Institute of Housing
Innovation in extra care housing – capital investment by Charlotte Cook, Winkworth Sherwood LLP, and
Extra care housing: innovative funding approaches & support for development by Tina Hothersall, Homes and Communities Agency

Integrated Homes, Care and Support
Holland C, Garner I, O’Donnell J et a Extra Care Charitable Trust, Coventry. 2019

This report provides an overview of the research findings from the collaborative research project between Aston Research Centre for Healthy Ageing (ARCHA) and the ExtraCare Charitable Trust, collated by Professor Carol Holland, Centre for Ageing Research (C4AR), Lancaster University. This report extends the findings of the 2015 report, covering the period from 2012 to 2018. Throughout the report, the focus is on the benefits to residents generated through ExtraCare villages and schemes, including sustained improvements in markers of health and well-being for residents and subsequent cost implications for the NHS.

Local Area Impact Assessment of Retirement Living and Assisted Living Developments
Institute of Public Care at Oxford Brookes University McCarthy & Stone, Bournemouth. 2014

This report by the Institute of Public Care at Oxford Brookes University considers a local area economic impact assessment of Retirement Living and Assisted Living Extra Care developments across England, Wales and Scotland. Commissioned by McCarthy and Stone, is aims to provide independent, objective and robust evidence about the extent to which there is a case for Retirement Living and Assisted Living Extra Care schemes in terms of the local economic and wider social impact of these schemes.

Money Matters: Reviews of Cost-effective Initiatives
Institute of Public Care The Institute for Research and Innovation in Social Services, Glasgow. 2011

This set of eight case studies, produced by the Institute of Public Care on behalf of IRISS (the Institute for Research and Innovation in Social Services), provides detailed analysis of the cost-effectiveness of a series of recent social care initiatives, ranging from nationwide and relatively high-profile schemes such as individual budgets to those thus far unique to one country, city or local authority area in the UK.

In each case, the report provides an overview of the initiative – its origins, including previous variants of the scheme, who it is intended to help, and how it works in practice – before justifying claims of cost-effectiveness by reference to detailed comparative costings, using one illustrative implementation of the scheme where the initiative is nationwide. Based on the analysis, the report sets out the initiative’s applicability to other settings as well as potential impediments to broader implementation.

The eight initiatives scrutinised are:

A study of Shared Lives schemes in south east England for providing care in the carer’s own home for individuals placed there by the local authority.
An extra-care housing scheme completed in Bradford.
Health in mind – social inclusion support for people with mental health needs in Bradford based round a series of mental health “well-being cafes”.
LinkAge Plus – analysis of nationwide DWP-funded pilot schemes for an holistic approach to provision of services for older people.
The Rapid Response Adaptations Programme – a Welsh initiative for providing adaptations such as ramps to let people return to their own homes.
A project in north west England to guide older people with low-level needs through a self-assessment process.
Analysis of various pilot sites taking different approaches to individual budgets, based on a broader evaluation conducted in 2008.
A project in two acute trusts in London to reconfigure hospital discharge procedures to emphasise rehabilitation.

The Business Case for Extra Care Housing in Adult Social Care: An Evaluation of Extra Care Housing schemes in East Sussex
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2013

This Housing LIN Case Study no 78 provides a synthesis of the detailed evaluation of extra care housing schemes undertaken by East Sussex County Council to inform future decisions related to financial investment in extra care housing. In particular, to ascertain whether extra care housing:

acts as a preventative model, supporting independence and avoiding admissions into residential care; and
is a more cost effective model of care delivery than other models, including residential care and care in the community

The resultant findings revealed that the financial impact of the findings was considerable, with the evaluation indicating that the cost of extra care housing was on average half the gross cost of the alternative placements. This has given pause for thought about the future strategic direction of extra care housing and has helped inform growth plans.

The economics of housing and health: The role of housing associations
Buck D, Simpson M, Ross S King's Fund, London. 2016

This report, based on work commissioned by the National Housing Federation from The King’s Fund and the New NHS Alliance, looks at the economic case for closer working between the housing and health sectors. The authors demonstrate how housing associations provide a wide range of services that produce health benefits, which can both reduce demand on the NHS and create social value.

The report concludes that there is no one piece of economic analysis that will persuade health providers or commissioners to work with or commission housing associations. However, the case studies in the report illustrate the economic benefits that housing association can provide through:

providing safe, decent homes that enhance wellbeing. This has health impacts that are valued, and can save the NHS money
alleviating the overall cost burden of illness and treatment
helping to offset and reduce costs of delivering health care to individuals
demonstrating cost-effectiveness in helping to meet the objectives of the NHS and of improving health more broadly
demonstrating the cost–benefits of their interventions in terms of the value of improvements to people’s health and savings to the NHS.
The report is one of a set of three commissioned by the National Housing Federation; the second report focuses on how housing associations can develop a business case that will be better understood by the health sector and the third explores how the health and housing sectors differ in their approach, language and terminology, roles, and use of evidence.

The Long Term Care Revolution
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2013

This Housing LIN Report comprehensively outlines the case for a revolution in long term care and captures some of the supporting material that has aided the development of the TSB’s Assisted Living Innovation Platform’s, ‘Long Term Care Revolution’ programme.

It sets out a vision for an alternative to institutional care, drawing on substantial evidence about the views of older people and their carers in the UK, lessons from abroad, the implications for industry/providers and makes recommendations to government and industry leaders on key factors for revolutionizing long term care for older people, including mainstream and specialist living environments.

Valuing Retirement Housing: Exploring the Economic Effects of Specialist Housing for Older People
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2016

This report:

Explores the potential economic effects of specialist retirement housing
Estimates the financial value of these economic effects drawing on relevant social survey, administrative and population data;
Aggregates the total estimated financial value of a single unit of new specialist retirement housing across the lifetime of its first resident

This report looks at how specialist retirement housing can influence:

Health and care costs
Local authority adult social care expenditure
First time buyers ability to get on to the property ladder, and their subsequent retirement wealth and housing costs.

The report estimates that the development of a single new specialist retirement housing unit may result in savings to the state.

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Social Care Research