While much lip service is paid to the principle of evidence based practice. In the fields of social care and housing there are considerable challenges in converting this to practical outcomes. This is partly due to the dearth of evidence and partly due to a culture that does not naturally turn to the evidence that does exist. In times of financial stringency it is particularly important that we do make good use of evidence if we are to deploy increasingly limited resources to best effect.
Extra care housing is a particular case in point. Extra care housing aims to meet housing, care and support needs while maintaining the independence of the individual in their own private accommodation. There are a wide variety of models but they have in common self-contained accommodation so people have their own front door, a range of accessible communal facilities and access to 24 hour care.
Extra care housing ticks a lot of policy priorities: it provides personalised support, encourages independence and adds to the diversity of options for people as they age. Previous governments have invested substantial sums in stimulating provision. The Extra Care Housing Fund (ECHF), administered by the Department of Health provided £227m capital funding between 2004 and 2010.
However, levels of provision are still very limited when compared with other housing and care options: in 2009 there were just 43,300 dwellings in England compared with 455,000 places in care homes. If extra care housing is to be a real option for older people we will need to invest more. But can we – is it affordable? And should we – is it a good use of limited resources?
As part of the Department of Health funded programme of work at the Personal Social Services Research Unit at Kent we undertook a longitudinal evaluation of over 800 residents who moved into 19 new schemes, including three retirement villages, funded under the first two waves of the ECHF.
We found that people moved in with positive expectations, which were largely met. A linked study funded by the Joseph Rowntree Foundation showed that 90% of people had made new friends a year after moving in and most had a good social life and felt fully occupied in activities of their choice. The schemes' communal facilities played an important role in supporting people's social life and activities. Analyses suggested lower levels of mortality than would be expected if people had moved into a care home and that, for the most part, it was proving to be a 'home for life'. Importantly, we found that, when like is compared with like, extra care housing is cost-effective compared with care homes for a substantial proportion of older people.
This is an important finding at a time of funding restraint and when government is seeking more cost efficient ways of meeting the housing and care needs of older people. It suggests it is worth investing in extra care housing. But faced with reduced levels of funding, some housing associations are considering cutting facilities such as communal meals. Such cuts could undermine the very positive impact that the evaluation identified.
It is important to draw on evidence when attempting to improve efficiency: we found joint housing support and care arrangements were associated with lower cost, for example, and higher costs with problematic staff turnover.
Diverse sources of funding and the variety of agencies involved in extra care mean that any one agency will have only a partial view of the consequences of their actions. In the absence of information about both costs and outcomes, decision makers are therefore not well placed to identify the consequences of their decisions.
There is a need for both more evidence from research and ongoing monitoring data that could be collected by schemes to ensure that we make best use of our very limited resources in future and which could provide the evidence base for cost effective options in later life.
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