The ECHO Project (Provision of Social Care in Extra Care Housing) is a longitudinal study which aims to explore how care is negotiated and delivered in extra care housing schemes for older people. The research is funded by the National Institute for Health Research School for Social Care Research (NIHR SSCR).
On 26th April, members of the ECHO Project Team held a workshop at the University of Bristol for commissioners, strategic and local providers, scheme managers, and consultants to share and discuss some of the Project’s initial findings, alongside findings from The ASSET Project (Adult Social Services in Environmental Settings), which was also funded by the NIHR SSCR. The event was supported by the British Society of Gerontology.
As the UK population ages, the number of older people living on their own and requiring formal care is increasing. While these demographic changes have significant implications for adult social care policy and practice, they also draw attention to the pressing need for sufficient and appropriate housing that enables older people to live independently. In this context, the provision of extra care housing, which provides opportunities for older people to maintain independence while, at the same time, receiving social care, if required, has become a key element of contemporary adult social care policy.
The ECHO Project’s workshop provided an opportunity for an exchange of ideas about enhancing the provision of social care in extra care housing settings between the research community, commissioners, and managers of extra care housing. Three papers were presented, the slides of which are available on the ECHO Project webpage.
The workshop was chaired by Jeremy Porteus, Director of the Housing LIN. The Housing LIN is a leading knowledge transfer partnership that creates opportunities to share learning and exchange ideas on innovative practice, and supports service improvement on housing with care matters for older people. The Housing LIN was established by the Department of Health (DH) to support the implementation of its 2004-2011 Extra Care Housing Fund and now hosts the online directory of all DH funded schemes, including Phases One and Two of the 2013-2018 Care and Support Specialised Housing Fund. Jeremy stressed the importance of social care researchers, commissioners, and practitioners coming together to think about and discuss how Extra Care Housing (ECH) can best be delivered.
Our first speaker was The ECHO Project’s Principal Investigator and Senior Lecturer at the University of Bristol’s Centre for Research in Health and Social Care, Ailsa Cameron, who spoke about integrating housing and care for older people. Ailsa began by providing some context for the afternoon’s session. She noted how recent figures indicate that people over the age of 65 account for almost 51% of local authority spending on social care (Oliver et al 2014) and, furthermore, that current projections indicate that a growing proportion of older people will, in the future, be living on their own and will require formal care (Kings Fund 2014). While these demographic changes have significant implications for adult social care policy they also demonstrate the need for sufficient and appropriate housing that enables older people to live independently. It is in this context that the provision of appropriate housing for individuals who require social care has become a key element of UK government policy.
Ailsa noted that various models of housing with care have emerged, with ECH offering the potential to combine housing and social care in the same setting. Indeed, Ailsa noted that the integration of housing alongside individualised care means that ECH is viewed as ‘a viable alternative to and possible replacement for residential care’ (Beach 2015: 7).
Drawing on findings from The ECHO Project and The ASSET Project, Ailsa’s presentation focused on considering what potential the integration of housing and care has for older people living in the UK. This involved an examination of the different models of integrating social care with housing, and the advantages, as well as some of the challenges which these models might face. Drawing upon early findings from The ECHO Project, Ailsa considered the implications of integrating housing and care from the perspective of those managing ECH schemes, as well as from care workers, and older people themselves.
Next, Simon Evans, Principal Investigator of The ASSET Project and Principal Research Fellow and Head of Research at the University of Worcester’s Association for Dementia Studies, spoke about the Community Hub approach to Extra Care Housing. Simon began by outlining some of the growing evidence for the benefits of housing with care for older people which included: a good quality of life, better physical and cognitive ability, and opportunities for social interaction (Atkinson et al 2014, Netten et al 2011, Evans and Vallelly 2007, Bernard et al 2007).
Many housing with care schemes have a range of services and facilities that can be accessed by people in the surrounding community, reflecting a more integrated approach to health and social care. Simon noted that interest in this ‘community hub’ model is growing among commissioners and providers in line with current government policy and drivers for change. The Department for Communities and Local Government (2009), for example, perceives the model as contributing towards the integration of older people’s housing with local health and social care economies.
Drawing upon findings from The ASSET Project’s survey of housing with care schemes and in-depth case studies, Simon explored the potential of housing with care schemes to act as a community hub and also highlighted a range of benefits, barriers and facilitators of this model/ approach. The potential benefits of the community hub approach include the integration of older people’s housing, reduced isolation and cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Simon noted that a range of wider social benefits of the community hub approach might also be envisaged, particularly in terms of increased acceptance of older people within society and more intergenerational contact.
Lastly, we heard from Robin Darton, Senior Research Fellow at the Personal Social Services Research Unit at the University of Kent. Robin spoke about the role of commissioners in developing the market for housing with care. Drawing upon interviews conducted in The ECHO Project and The ASSET Project, Robin’s key focus was on examining the strategic response of commissioners to the process of developing and shaping the provision of housing with care.
Robin outlined how, in recent years, the central role of housing in the development of effective community care services has become widely recognised. For example, in setting out the general duty of local authorities to promote well-being, the Care Act 2014 relates well-being to the suitability of an individual’s living accommodation. In particular, housing with care has become increasingly popular, and has been seen by policy-makers and commissioners offering a cost-effective alternative to residential homes.
Robin noted that, despite the popularity of ECH, the organisation of housing with care is complex, with a range of funding arrangements and the need to provide housing services together with care and support. Furthermore, commissioners of services have to respond to multiple, and possibly conflicting, changes in policy and practice, for example personalisation, the introduction of personal budgets, changes in eligibility criteria, spending reductions and welfare changes. Robin highlighted that, in this context, there is a danger that, by concentrating on contracts and services, commissioners may lose sight of the more strategic aspects of commissioning necessary to facilitate high quality care and support (Smith 2015).
The workshop was a great opportunity to share some of the findings from The ECHO Project and The ASSET Project with key stakeholders but, also, for members of the team to engage in discussion with those working and operating in the Extra Care Housing sector. We hope to organise a series of similar workshops as findings from The ECHO Project continue to emerge. In the interim, those interested in the project’s progress can keep updated via our webpage or by following us on Twitter (@ECHOproject123).