Extra care housing

Extra care housing can provide an alternative to residential care, nursing care, supported living and sheltered housing. It aims to provide 'a home for life' for many people even if their care needs change over time.

Extra care housing is different from the more traditional forms of care and housing because:

• People are living in their own home
• It is about quality of life not just quality of care
• People have their own self-contained home within their own front door
• Couples and friends can stay together
• There is a mix of people with differing levels of need
• 24-hour care services are located on site
• People receive support to maintain their independence
• There are organised activities people can join in with if they wish
• People have control over their own finances
• There is housing security - the aim is a home for life

Extra care is sometimes called 'very sheltered housing' and provides facilities and 24-hour care services which allow people to remain independent for as long as possible.

Extra care housing is provided by:

• Registered social landlords
• Voluntary sector
• Private companies

It provides a higher level of support than sheltered housing as there are on-site staff (both care and housing support staff) available 24 hours a day.
Depending on the provider, some developments are available for:

• Purchase
• Rent
• Either market or socially rented
• Or there could be a mix of the two within the same development

Essentially, extra care is 'housing with care' and the two elements will more often than not be provided by two or more separate organisations, for example:

• A housing association to manage the housing element
• A care provider to manage the care element 

In most cases, care will be purchased from the on site care team, however, this would not preclude residents making their own arrangements where necessary.

The majority of extra care housing will be flats or bungalows that could range from one to three bedrooms. Flats will have a kitchen area to enable residents to prepare their own meals, with assistance if needed, and some may have access to garden or patio areas.

Communal facilities should be provided, such as a café/dining area for those who may wish to purchase some of their meals. Other facilities may include a hairdresser, a shop, a pub, an IT suite and a laundry room. Local healthcare facilities may also be located within some developments.

Some of these amenities will be accessible by the public as well as the residents themselves, although if so they will be in areas kept strictly separate from the tenant's own private accommodation.

Extra care housing can also be incorporated into retirement or care villages which provide a range of accommodation in one area. They could include houses, flats and bungalows, usually with a care home or nursing home on-site to cater for the widest range of care needs. In these schemes there is a possibility that residents will be able to move to different types of accommodation as their care needs change.

The geography and communities of Wiltshire lend themselves well to what is known as a 'hub and spoke' model of extra care. This is sometimes referred to as 'community' extra care, as it can offer services and facilities to the wider community, as well as to residents of the scheme. This means that care support is provided from a central point over a defined geographical area to people within the surrounding community; it can ensure that smaller schemes in rural areas are cost effective. Wiltshire council is beginning to work on this model in Pewsey where personal care is provided from a base to people living in the surrounding area in their own homes.

Many schemes are directed at older people with a view for providing a home for life. However, because of the nature of care provision available extra care settings may also be suitable for other people such as those with physical or sensory impairments and those with learning disabilities. Individual schemes should state in their eligibility criteria the requirements for the scheme.

Most extra care developments will cater for a wide range of care needs, from those who are still fairly independent, to those who are very frail and require substantial support. Some people particularly after a crisis such as an accident, bereavement or illness, may feel that they are unable to remain living independently and consider moving to a residential care home. They may have lost confidence and relatives may be concerned about their safety especially if they live a long distance away. Extra care housing can provide that degree of security, care and support and be a real alternative.

People have their own home, control over their finances, privacy and choice about how much they mix with the other residents. The care staff will support people in looking after themselves for as long as possible so that they can keep up their usual routines and activities in the local area. 

Most people who develop dementia after moving into extra care can continue to be supported in their familiar home surroundings by staff and friends as before. Some extra care housing may have a special wing for new residents with dementia; others support residents with different needs across the whole scheme. The benefits of extra care housing are apparent where one of a couple has dementia and this means that they can continue to live together and be supported.

It is expected that people's needs will change over time and with the right support available people may regain skills. There may be times when people need a lot of care and support, times when they need very little support, or a mixture of the two. The care staff will be flexible and sensitive in asking residents about what they need. If people develop nursing needs they may be supported by the community nursing teams who support people living in their own homes.

If needs change, a new assessment may need to be done to ensure that care needs continue to be met and any equipment or aids required can be provided to allow the person to stay living independently in their own home.

Extra care housing aims to provide people with a home for life and wherever possible would aim to support people through the last stages of their life.