Improving housing with care choices for older people: the PSSRU evaluation of extra care housing

Purpose - This paper describes an evaluation of 19 extra care schemes allocated funding from the Extra Care Housing Fund. Design/methodology/approach - Interviewers 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. Findings - Entrants 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/implications - Outcomes could not be measured for those who dropped out, and residents with deteriorating mental health were more likely to drop out. Practical implications - Extra 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 implications - To encourage downsizing, extra care needs to be sufficiently attractive to those making a lifestyle choice. Originality/value - This was the first major study of costs and outcomes in extra care housing.