Extra care housing aims to meet the housing, care and support needs of older people, while helping them to maintain their independence in their own private accommodation. In , the Department of Health announced capital funding to support the development of extra care housing, and made the receipt of funding conditional on participating in an evaluative study. Drawing on information collected directly from residents in schemes, this paper presents findings on the factors motivating older people to move to extra care housing, their expectations of living in this new environment, and whether these differ for residents moving to the smaller schemes or larger retirement villages. In total, people responded, who had moved into the smaller schemes and into the villages. Of the residents who moved into the villages most (%) had not received a care assessment prior to moving in, and had no identified care need. There was evidence that residents with care needs were influenced as much by some of the attractions of their new living environment as those without care needs who moved to the retirement villages. The most important attractions of extra care housing for the vast majority of residents were: tenancy rights, flexible onsite care and support, security offered by the scheme and accessible living arrangements. The results suggest that, overall, residents with care needs seem to move proactively when independent living was proving difficult rather than when staying put is no longer an option. A resident's level of dependency did not necessarily influence the importance attached to various push and/or pull factors. This is a more positive portrayal of residents' reasons for moving to smaller schemes than in previous UK literature, although moves did also relate to residents' increasing health and mobility problems. In comparison, type of tenure and availability of social/leisure facilities were more often identified as important by those without care needs in the villages. Therefore, as in other literature, the moves of village residents without care needs seemed to be planned ones mostly towards facilities and in anticipation of the need for care services in the future.KEY WORDS -extra care housing, older people, relocation, decision to move, push and pull factors.
Extra care housing aims to meet the housing, care and support needs of older people, while helping them to maintain their independence in their own private accommodation.It has been viewed as a possible alternative, or even a replacement for residential care.In 2003, the Department of Health announced capital funding to support the development of extra care housing, and made the receipt of funding conditional on participating in an evaluative study. This paper presents findings on the characteristics of the residents at the time of moving in, drawing on information collected from the 19 schemes in the evaluation and a recent comparable study of residents who moved into care homes providing personal care. Overall, the people who moved into extra care were younger and much less physically and cognitively impaired than those who moved into care homes. However, the prevalence of the medical conditions examined was more similar for the two groups, and several of the schemes had a significant minority of residents with high levels of dependence on the Barthel Index of Activities of Daily Living. In contrast, levels of severe cognitive impairment were much lower in all schemes than the overall figure for residents of care homes, even among schemes designed specifically to provide for residents with dementia. The results suggest that, although extra care housing may be operating as an alternative to care homes for some individuals, it is providing for a wider population, who may be making a planned move rather than reacting to a crisis. While extra care supports residents with problems of cognitive functioning, most schemes appear to prefer residents to move in when they can become familiar with their new accommodation before the development of more severe cognitive impairment.
SummaryThat transfer of older people from one institution to another is detrimental to well-being, health and survival has been reported for 50 years. This has led to fear, anger and legal challenges when closures occur. Previous reviews identified accounts of relocation followed by adverse outcomes and others where problems were avoided or benefits claimed. This paper reviews the last twelve years of literature on health outcomes following involuntary relocation between nursing homes. Reports of post-move mortality, physical or psychological health suggest and confirm that relocation without preparation carries higher risk of poor outcomes than moves that are orderly and include preparation. The literature on the care home closure process, admissions and individual transfers offers insights into practices that might help minimize adverse outcomes. A number of agencies have produced helpful guidelines. How these are implemented needs to be monitored and linked to in-depth studies of sample closures.
The allocation of central government funds is a critical element in the equitable provision of local authority commissioned and provided services. A variety of approaches to allocating funding for social services for older people have been used over the years, most recently based on needs-based formulae. In 2004, the Department of Health for England commissioned research to help inform the improvement and updating of the formula. The results of individual-level analyses were compared with the results obtained from analyses of small area (ward-level) data on service users. Both analyses were affected by problems of data availability, particularly the individual-level analysis, and the Department of Health and the (then) Office of the Deputy Prime Minister decided that the formula calculations should be based on the results of the small area analysis. However, despite the differences in approach, both methods produced very similar results. The correlation between the predicted relative needs weights for local authorities from the two models was 0.982. The paper discusses the strengths and weaknesses of each approach and developments that could allow a normative approach that would incorporate future policy objectives into formulae that, to date, have inevitably been based on historical data and service patterns.
EVOLVE is a tool for evaluating the design of housing for older people. It is used to assess how well a building contributes to the physical support and personal well‐being of older people. Developed from research into extra care housing, it can be used for a variety of building types, including sheltered housing and individual private houses. The tool can be used by architects, housing providers, commissioners, researchers and individual tenants or home owners. EVOLVE can be used as a briefing document or an aid to design. It can provide a rational basis to the selection of proposals in a competitive procurement process. The EVOLVE tool can also be used to evaluate existing housing stock, including schemes where remodelling is under consideration.
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