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Extra care housing enables older people to remain in their ‘own home’, while providing appropriate housing and access to health and social care services that are responsive to their needs. This type of provision is very much in line with the government policy of fostering people's sense of control and independence, and is a priority area for expansion. We explored the current levels of development and expansion of extra care housing in terms of the numbers of schemes and places and factors that contributed to and were problematic in its development.

Extra care housing has developed from sheltered housing and has increasingly been seen as a popular option by policy‐makers for a number of reasons. These include the inability of conventional sheltered housing to be an adequate solution for a growing population of very old people, the decline in popularity and high costs of residential care and perceived problems with older people staying in mainstream housing. There is, however, no agreed definition of extra care housing, even though a growing number of government grants are becoming available for this type of housing. This is causing confusion for providers and for older people and their families who are not sure exactly what is provided. This lack of clarity means that this form of housing has become an erratic and piecemeal form of provision.

In this article we first give the facts on what extra care is. Second, we make a few points on what really helps improve commissioning. The article draws on innovative and up‐to‐date material developed for the Department of Health's Housing Learning & Improvement Network by Moyra Riseborough from CURS at the University of Birmingham and Peter Fletcher of Peter Fletcher Associates. To see more about the Housing LIN and its work, readers should go to its website at www.doh.gov.uk/changeagentteam/housing‐lin.htm.

Extra care housing is increasingly prominent as a strategic solution to the issues presented by an ageing population and low demand in traditional sheltered housing and (in some cases) as an alternative to residential care. However, it is proving difficult to assess rigorously its long‐term benefits and cost‐effectiveness compared with other housing and care models ‐ a task which must be undertaken in preparation for the Supporting People regime. This article reviews Anchor's own research on extra care housing and is intended to stimulate a wide‐ranging debate on the methodological difficulties that such an agenda represents.

Extra care housing has now been around for a long time. People are referred as tenants because they can no longer cope at home and many already have dementia or have developed it while living in extra care. While extra care does promote independence, can it really provide support for people with dementia? Here, Rachael Dutton presents the conclusions of a study that asked this question and looks at the practicalities behind the answer.

The perspectives of people with dementia and their care partners regarding “extra care” housing are currently unknown. The purpose of this paper is to report findings of a consultation study exploring the perceived barriers and facilitators of a relocation to extra care housing, from the perspective of people living with dementia, and their care partners.

Fieldwork consisted of paired or 1-1 interviews and small focus groups with potential users of an alternative model of extra care support for people living with dementia in the South of England. The consultation took place between June and August 2013. The interviews and focus groups were audio recorded, transcribed verbatim. The transcripts were analysed thematically.

Benefits of extra care were identified as the opportunity for couples to remain living together for longer, creating a supportive, dementia-friendly community, and a reduction in the strain experienced by the care partners. Barriers centred on a sense of loss, stress and uncertainty. Living and caring at home was perceived as preferable to shared care.

The findings presented here have limited generalisability for two reasons. First, the shared care approach consulted on was very specific. Second, the participants form a purposive sample and as such are not representative of a wider population. Despite best intentions, the voice of people with dementia, are underreported in this consultation. Only one person with early on-set dementia was interviewed and the remaining two people with dementia were interviewed alongside their care partner.

The findings cast doubt on the viability of extra care facilities, designed for couples living with dementia, if extra care continues to be conceptualised and marketed as a preventative lifestyle choice. The findings indicate the value of consulting with people with dementia, and their care partners, when designing new forms of housing with care specifically for people living with dementia.

The findings of this consultation exemplify the wish of couples living with dementia to remain together, in what they perceive to be “home”, for as long as possible. Couples living with dementia are therefore unlikely to wish to move into an extra care facility as a lifestyle choice option, early into their journey with dementia. This raises questions about the suitability of extra care, as a form of housing with care, for couples living with dementia.

This paper contributes to the body of literature, exploring the feasibility of new and innovative alternative care and housing options, for people with dementia. This paper is one of the first to explore extra care as a housing and social care option for couples with dementia.

Extra care housing is an increasingly popular form of housing with care for older people, largely because of its potential for maximising independence by providing flexible care and support. However, far less attention has been paid to another important aspect of quality of life, social well‐being. This article reports on a research project that explored good practice in promoting social well‐being in extra care housing. We identify several key factors in supporting the social lives of residents and present recommendations for good practice.

This paper describes an evaluation of 19 extra care schemes allocated funding from the Extra Care Housing Fund.

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.

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.

Outcomes could not be measured for those who dropped out, and residents with deteriorating mental health were more likely to drop out.

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.

To encourage downsizing, extra care needs to be sufficiently attractive to those making a lifestyle choice.

This was the first major study of costs and outcomes in extra care housing.

In July 2007, Housing 21 began an exploration of how changes to the system of social care called personalisation might impact on specialist housing provision in England. Personalisation now forms the basis of English social care policy focusing the delivery of public services on what people might want or choose, in the context of eligibility criteria and means testing. It is designed to promote greater choice and control of the support that people receive.However, there have been concerns that the views of older people living in extra care housing settings have not been heard in the implementation of personalisation. In 2008‐09 Housing 21 engaged older people and other groups with an interest in sheltered and extra care housing to debate the implications of personalisation for current and future housing, care and support services. This article discusses what arose from this consultation and its relevance to housing providers and commissioners.

The benefits of “green dementia care”, whereby people living with dementia are supported to connect with nature, are increasingly being recognised. Evidence suggests that these benefits span physical, emotional and social spheres and can make a significant contribution towards quality of life. However, care settings often present specific challenges to promoting such connections due to a range of factors including risk-averse cultures and environmental limitations. The purpose of this paper is to report on a project that aims to explore the opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in residential care and extra care housing schemes in the UK.

Data were gathered from 144 responses to an online survey by managers/staff of extra care housing schemes and care homes in the UK. In depth-case studies were carried out at three care homes and three extra care housing schemes, involving interviews with residents, staff and family carers.

A wide variety of nature-based activities were reported, both outdoor and indoor. Positive benefits reported included improved mood, higher levels of social interaction and increased motivation for residents, and greater job satisfaction for staff. The design and layout of indoor and outdoor spaces is key, in addition to staff who feel enabled to promote connections with nature.

This paper is based on a relatively small research project in which the participants were self-selecting and therefore not necessarily representative.

The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes.

Outdoor activities can promote social interaction for people living with dementia in care settings. The authors’ findings are relevant to the recent policy focus on social prescribing.

The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes.