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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.

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.

This article reports on a study assessing the incentives and deterrents to long-term care (LTC) supply in two local markets in England. The supply of LTC in many countries is facing the issues of rising demand, (lack of) workforce and the interaction of the public and private sectors. Findings from qualitative interviews of local council and provider stakeholders exploring barriers and enablers faced by LTC providers in two local authorities (LAs) are presented and discussed. The interviews provided insight in three main areas: staffing, demand and stakeholder relationships. Staffing, in particular, is crucial and we found that there are many difficulties for providers in maintaining their workforce. Consistent with previous research, we also found that public spending levels on LTC puts pressure on providers striving to maintain a good quality service, including improved remuneration of staff.

Abstract With the growth in the numbers and proportion of older people in the population the funding and incentive structures around long‐term care are of international concern. A study of the circumstances of self‐funded admissions to care homes allowed the comparison of self‐funders with publicly funded admissions to care homes in the UK, the influences on self‐funders in their decision to move into a care home and resources on which they were able to draw. These findings contribute to our understanding of the impact of current policy on self‐funders and our thinking about the way that future policy and practice changes could improve the way we use society's resources in the provision of long‐term care.

PurposeThis paper describes an evaluation of 19 extra care schemes allocated funding from the Extra Care Housing Fund.Design/methodology/approachInterviewers collected information about the expectations and experiences of 1,182 new residents, and demographic and care needs information for those who received a care assessment (817 individuals) to correspond to previous surveys of care homes. Follow‐up information was collected at six, 18 and 30 months. Comprehensive costs were estimated for individuals based on capital costs, care and support costs and living expenses.FindingsEntrants to extra care were much less physically and cognitively impaired, on average, than entrants to care homes, although residents in several schemes had high levels of physical disability. Overall, residents appeared to have made a positive choice to live in a more supportive and social environment ("pull" factors) rather than responding to a crisis ("push" factors). Outcomes, in terms of physical and cognitive functioning, for residents with similar characteristics to care home residents were better, and costs were no higher, while mortality rates were lower.Research limitations/implicationsOutcomes could not be measured for those who dropped out, and residents with deteriorating mental health were more likely to drop out.Practical implicationsExtra care can provide a positive option for people planning ahead, but appears to be less suitable for crisis moves. Further work is needed on supporting those who are more dependent.Social implicationsTo encourage downsizing, extra care needs to be sufficiently attractive to those making a lifestyle choice.Originality/valueThis was the first major study of costs and outcomes in extra care housing.

One of the key objectives of the community care legislation, implemented in the UK in 1993, was the development of care management systems. Subsequent studies based on limited samples of local authorities have indicated that there is much variation in the forms and types of arrangements being developed. This paper explores whether typologies of care management arrangements for older people can be discerned through the analysis of a series of key indicators. Data were drawn from a survey of all English local authorities, undertaken as part of the PSSRU study: Mapping and Evaluation of Care Management Arrangements for Older People and Those with Mental Health Problems. Care management arrangements were categorized using a limited number of key indicators chosen on an empirical and an a priori basis. This resulted in the formulation of six categories of care management arrangements for older people, within which approximately 80 per cent of local authorities could be included.

Cover -- Title Page -- Copyright Page -- Contents -- Preface -- Part I: Policy and background -- 1 A developing context -- The Care in the Community demonstration programme -- The structure of the book -- 2 The demonstration programme in policy context -- The 1983 Care in the Community Circular -- The demonstration programme -- Hospital closure -- Community care -- Joint working -- The value-for-money imperative -- The mixed economy -- User choice -- 3 The pilot projects -- The projects -- Local project objectives -- Reassessing local objectives -- From interpretation to implementation -- 4 The evaluation methodology -- The research agenda -- Research questions -- Promotion, monitoring and evaluation -- The production of welfare framework -- Research design -- Comparison groups -- From demonstration to implementation -- 5 People and lives in hospital -- Background characteristics -- Reasons for admission to hospital -- Life on the inside and links with the outside -- Hospital residents' views and feelings -- Skills, behaviour and presentation -- Explaining client selection for projects -- People and lives in hospital -- Part II: Resources and processes -- 6 Resources and processes of community care -- Client numbers and accommodation -- 7 Financing community care -- Pump-priming programme grants -- Social security financing -- Joint finance and dowry transfers -- 8 Community accommodation and service utilisation -- Service principles in practice -- Accommodation in the community -- The service components of care packages -- Service development - summary -- 9 Staffing community services -- Preparation and forecasting -- Staff recruitment and selection -- Work organisation, rotas and shifts -- Staff morale and turnover -- Training, development and support -- Conclusion -- 10 Case management -- Case management policies -- Case finding and referral

Purpose
– Appropriate housing for the growing population of older adults is becoming an international concern. The purpose of this paper is to report on a review of UK and international literature carried out as part of a project exploring the commissioning and delivery of social care in housing with care settings. The paper also considers housing with care in the context of UK policy and practice.


Design/methodology/approach
– The peer literature review process used a range of academic databases as well as government and third sector web sites, drawing on relevant material in English published from 1990 to 2012.


Findings
– Findings are presented within three main themes: how care and support is provided; the role of the built environment; and the benefits for resident well-being. The review found a paucity of literature focusing specifically on care and support in housing with care settings, particularly in terms of how social care is delivered, but the evidence base suggests that housing with care is in a strong position to deliver on most if not all UK government aspirations.


Practical implications
– Despite a growing literature both in the UK and internationally exploring the characteristics and benefits of housing with care for older people, substantial gaps remain in the research evidence.


Originality/value
– This paper presents an up to date review of the housing with care literature in the context of current UK policy.