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This article considers some of the legal complexities involved in developing extra care housing for people with dementia.

Extra care housing (ECH) is housing for older people that aims to provide flexible care while fostering independence. The purpose of this paper is to examine the impact that some of the successes and failures in improving accessibility during remodelling had on care provision, in order to offer advice to social housing providers planning to remodel existing properties into ECH.

The data consisted of an inventory of accessibility features and assistive technology (AT) items in flats and common areas. The data were drawn from ten ECH schemes in different regions of England.

Most of the AT found was low-technology supporting independence, such as grabbers; some was specific to care provision, such as hoists. Even after remodelling, the design and layout of most buildings did not fully comply with accessibility standards, leading to increased provision of care for some tenants: a care-negative situation.

This multidisciplinary, original research on remodelling into ECH presents successful examples of accessibility, AT and care integration that required active tenant involvement and creative design input from care staff, architects and builders who were AT and accessibility aware. It is argued that for new and remodelled ECH buildings to be care-neutral, designers need to work towards the most inclusive model of ECH.

This is original research that has produced guidance for builders, developers, policy makers and other stake holders.

The purpose of this paper is to explore the potential of housing with care schemes to act as community hubs. The analysis highlights a range of benefits, barriers and facilitators.

Data are presented from the Adult Social Services Environments and Settings project which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews.

Most housing with care schemes have a restaurant or café, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having on-site facilities that are accessible to the public.

This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings.

The purpose of this study was to measure the bias on a binary option's effect estimate that appeared in the types of questions asked and in the placement changes of public service users.

The author designed Monte Carlo simulations with the analytical strategy of latent trait theory leveraging a probability of care-placement change. The author used difference-in-difference (DID) method to estimate the effects of care settings.

The author explained the extent of discrepancy between the estimates and the true values of care service effects in changes across time. The time trend of in-home care for the combined effect of in-home care, general maturity, and other environmental factors was estimated in a biased manner, while the bias for the estimate of the incremental effect for foster care could be negligible.

This study was designed based on individual child-unit only. Therefore, higher-level units, such as care setting or cluster, county, and state, should be considered for the simulation model.

This study contributed to illuminating an overlooked facet in causal inferences that embrace disproportionate selection biases that appear in categorical data scales in public management research.

To model the nuance of a disproportionate self-selection problem, the author constructed a scenario surrounding a caseworker's judgment of care placement in the child welfare system and investigated potential bias of the caseworker's discretion. The unfolding model has not been widely used in public management research, but it can be usefully leveraged for the estimation of a decision probability.

The purpose of this paper is to explore and compare the motivations and expectations that older people have when choosing to move into either a private or housing association (HA) extra care housing (ECH) scheme, and any effects this had on its residents.

This qualitative study is based on findings from four HA schemes in Tower Hamlets, London, and one private scheme in Warwickshire. Eight semi-structured interviews were conducted with five women and three men of varying backgrounds, from schemes managed by different associations and companies. Interview transcripts were coded and analysed thematically.

All residents moved into ECH in response to deteriorating health. However, almost all residents had felt obliged to move by others, generally their children. Few residents had any expectations of ECH on arrival, but many developed high expectations of an increased sense of independence and security and of an improved social life. ECH appeared to be beneficial for residents’ health and well-being.

The inability to recruit an equal number of people from HA and private scheme, alongside the small sample size, may compromise the external validity of any conclusions drawn from any comparisons.

This research identifies a lack of knowledge about ECH among the general population and offers insight into areas of poor management within ECH schemes which could be improved.

Inadequacies in the ECH model could be attributed to failures in the current health and social care system. Differences between expectations and perceptions of HA vs private schemes should be acknowledged and responded to.

This is a rare example of research exploring the relationships between ECH residents’ motivations and expectations (Hillcoat-Nallétamby and Sardani, 2019), and between those in HA vs private schemes.

This article draws on research into care managers' roles and tasks in the evaluation of planned care. Its approach reinforces the significance of evaluation skills in a work context where there may be different interpretations of the notion of review. It emphasises the need to strike a balance between the demands of evaluation and audit and recommends that care managers be encouraged to develop evaluation skills as part of their continuing professional development and to use such skills to inform strategic service planning.

This paper aims to describe a literature review and online survey to explore the provisions and support for people living with dementia in housing with care (HwC) settings within England.

An initial scoping literature review was conducted to synthesise the evidence relating to residents living with dementia in HwC settings and informed the development of an online survey distributed to HwC housing managers to explore the provisions, policies, procedures and support services relating to people living with dementia in HwC settings.

The findings provided a picture of HwC settings in England and the residents, particularly those living with dementia, in terms of policies and procedures, reasons for moving into HwC, reasons for denying entry, reasons for leaving, positive outcomes, staff knowledge and training, environmental design, challenges and successes.

The survey responses were from a self-selected sample of HwC providers and scheme/village managers; thus, it may be the case that the settings involved were doing more to support residents living with dementia. It should also be appreciated that the responses were based on the perceptions of the individual staff members completing the survey, not those of the HwC residents.

This study presented a picture of the current state of provisions and support for people with dementia within HwC settings in England, providing an essential platform from which to undertake targeted research to help shape future provision and enabling housing providers to assess their current schemes within the wider context.

In the light of projected climate change impacts on buildings and their occupants, climate change adaptation for built environment to climate change is crucial. The risk of overheating is a key concern, particularly given its effect on heat-related health problems for elderly people. The purpose of this paper is to propose, test, and evaluate the strategies for climate change adaptation to minimise present and future risks of overheating for a new purpose-built care home and extra care accommodation near York.

The overheating risk was assessed through dynamic simulations, using probabilistic projections for 2030s, 2050s and 2080s. Suitable adaptation measures were tested and compared using industry metrics. A stakeholders’ workshop compared the relative effectiveness of the identified measures and made a broader evaluation using defined criteria. Highest-ranked measures were combined into “adaptation packages” in order to populate adaptation timelines for the project.

Results show that the original design presents a severe overheating risk. Increasing thermal mass and slightly improving ventilation are adequate for the 2030s; however solar shading and further improvements of ventilation are necessary for the 2050s. The stress test revealed that even the most effective passive measures combined would be insufficient to maintain comfortable conditions by the 2080s, and mechanical cooling would be needed.

The comparative analysis of adaptation measures using normalised CIBSE TM52 criteria improved risk communication and engagement with the client and the design team. The integration of quantitative and qualitative evaluation criteria led to an appropriate and timely strategy for adaptation.

The purpose of this paper is to report the experiences of older people who use council-managed personal budgets (PBs) to fund home care services and their satisfaction with the level of choice and control they are able to exercise.

Data were collected from 18 older people from eight home care agencies across three councils in England. All interviews were semi-structured and face-to-face.

Despite some optimism about improvements in choice and flexibility experienced by older people using home care services, the findings from this small study suggest that the gap between the “ideal” of user choice and the “reality” of practice continues to be significant. The level of choice and control older people felt able to exercise to tailor home care services to their personal needs and preferences was restricted to low level choices. Other choices were constrained by the low levels of older people's PBs and council restrictions on what PBs can be spent on. Older people's understanding of limitations in public funding/pressures on agencies and their reluctance to play an active consumer role including willingness to “exit” from unsatisfactory care arrangements appeared to further challenge the potential for achieving greater choice and control through council-managed PBs.

The English government's policy emphasis on personalisation of care and support and new organisational arrangements for managed PBs aim to promote user choice and control. This is the first study to report the experiences of older people using managed PBs under these new arrangements. The paper highlights areas of interests and concerns that social care staff, support planners and commissioners may need to consider.

The purpose of this paper is to stimulate a wider debate around the coordination of workforce planning in non-statutory services (in this case, specialist housing for older people or those with long-term health and social care needs, such as learning disabilities). The authors argue that current NHS reforms do not go far enough in that they fail to include specialist housing and its workforce in integration, and by doing so, will be unable to optimise the potential efficiencies and streamlining of service delivery to this group.

The paper used exploratory study using existing research and data, enhanced by documentary analysis from industry bodies, regulators and policy think tanks.

That to achieve the greatest operational and fiscal impact upon the health care services, priority must be given to improving the efficiency and coordination of services to older people and those requiring nursing homes or registered care across the public and third sectors through the integration of service delivery and workforce planning.

Whilst generalisable and achievable, the model proposed within the paper cannot be fully tested theoretically and requires further testing the in real health and social care market to evidence its practicality, improved quality of care and financial benefits.

The paper highlights some potential limitations to the current NHS reforms: by integrating non-statutory services, planned efficiency savings may be optimised and service delivery improved.