Extra care housing has been hailed by the government as the future “dominant model” of accommodation for vulnerable older people over the next generation, writes Maria Ahmed.
Set out in the adult green paper as one of the “innovative” models of care, it is designed to give greater choice to older or disabled people whose needs might traditionally have been met by residential care by allowing people to live in their own homes with support.
Currently, an estimated 20,000 older people live in self-contained extra care schemes, compared with nearly half-a-million residents in care homes.
With government money earmarked for schemes for the next few years, extra care housing looks set to expand, but is the government’s enthusiasm matched by social care organisations?
Residential v extra care?
| Louisa Stevens |
Many social care commentators are quick to caution that extra care should not become the “dominant” care scheme for older people, forming instead one of a range of options to meet differing levels of support need.
Some are particularly keen to ensure extra care does not signal the death knell for residential care.
John Dixon, Association of Directors of Social Services co-chair of the disability committee says: “It should not be the only kind of housing and we will still need residential and nursing care as we know it.”
Louisa Stevens, director of public affairs at the English Community Care Association (ECCA) supports the expansion of extra care while arguing that residential care homes cannot be replaced as they are “crucial to continuum of care.”
Extra care, extra money?
The government has showed its commitment to extra care by laying out its funding plans in the adult green paper. The Department of Health has initiated the Extra Care Housing Fund to provide £87 million in 2004-2006, alongside £93 million from the Housing Corporation in the same period, to enable social services and their housing partners to provide new extra care housing. A further £60 million will be available for 2006-2008.
But will it be enough?
Social care organisations are questioning the comparative costs of residential and extra care.
ECCA predict that extra care could be more expensive to provide than residential care, and are calling on the government to work out the differences in cost.
While Dixon claims the costs will be “much of a muchness to the public purse,” Stephen Burke, chief executive of Counsel and Care suggests that the costs of the type of care on offer will be less, but the type of accommodation needed could be more expensive.
“Costs will vary according to different models of provision,” Burke says.
A report on extra care housing markets published by social care analysts Laing and Buisson earlier this year found that while the cost of providing a self-contained flat was greater than providing a room in a care home, residents' greater independence could be expected to reduce the care costs.
Independence, wellbeing and choice?
The mantra of independence, wellbeing and choice that forms the backbone of the government’s current rhetoric on adult social care is fleshed out in the model of extra care.
“It scores highly on all three counts,” Dixon says. “Extra care means that even very frail people can still have control over their housing, and they are not segregated from the mainstream.”
Social life is an added bonus in extra care schemes where young and older disabled adults are able to mix, according to Burke.
But ECCA warns that independence, wellbeing and choice should not become the sole preserve of extra care.
“Independence is a state of being, not a location,” Stevens says.
While extra care is broadly welcomed by social care organisations, questions remain for the future.
Stevens points to the uncertain future of family support for those who are reliant on carers in extra care schemes.
“Families are becoming increasingly disjointed. Is it realistic to think, for example, that a daughter-in-law will look after their husband’s mother in the future?” she asks.
Stevens also raises concerns over the need for proper regulation of extra care similar to care home standards.
“If extra care is more dominant then more regulations need to be put in place,” she says. “There are issues around medication administration – would it be kept in a person’s flat or in a central area, for example.”
Extra care will also need a strong workforce to ensure its success, according to Dixon.
“Extra care depends on the ability of people to work together and deliver close support,” he says.
Independence may be the key selling point of the scheme, but it is evident vulnerable older people will need guaranteed, sustainable support to ensure the aims of the adult green paper are achieved.
