Special Report on extra care housing

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.