The launch of new research into the benefits of extra care housing. In July 2011, Andrew Dilnot published the report of the Commission on funding of Care and Support. Within the report, the Commissioners highlighted the potential role for extra care housing. They said “the Commission hopes that more people will be able to consider extra care housing in the future, if they are more aware of this type of provision and can be more certain over their financial planning.” Extra care housing represents an integrated model of housing and social care support that potentially holds fiscal and wider benefits for older people and the state. In addition, extra care housing might offer a way of unlocking the housing wealth of the ‘baby boomer’ generation approaching retirement, therefore providing a real alternative to the spectacle of people selling their homes to pay for residential care when their needs become acute. Yet for extra care to be a sustainable option for the funders of care, it is vital that we know more about the cost effectiveness and efficiency of extra care housing as a model. This event brought together three speakers to review some of the main debates surrounding extra care housing as well as to present some new findings. Over the last year, ILC-UK has been undertaking a major piece of research into the benefits of extra care housing through examining resident outcomes. Using longitudinal data from 3 providers, Extra Care Charitable Trust, Retirement Security Limited and Audley, with additional funding provided from Housing Learning and Improvement Network (Housing LIN), we have undertaken a review which explores the characteristics of residents, the notion of extra care housing as a home for life, the health outcomes of residents, and patterns of health service usage of residents. We have also explored the costs and benefits associated with our findings. This new research, presented by Dr Dylan Kneale, also explores how the outcomes of residents in extra care could differ from the outcomes of older people living in the community in receipt of domiciliary care. Since 2004, the Department of Health has funded a large number of extra care schemes. The the University of Kent’s Personal Social Services Research Unit (PSSRU) have been undertaking a major evaluation of these schemes and Robin Darton, Senior Research Fellow and project lead, will present the early findings. Housing LIN has been a long standing proponent of models of housing with care, and Jeremy Porteus, Director of the organisation, will discuss the findings in greater detail and identify future directions for the sector. This event was supported by the Housing LIN. We are grateful to our partners: Extra Care Charitable Trust, Retirement Security and Audley, for making this research possible.

1. Tuesday 13 September 2011 Extra Care – A Sustainable Solution to the Care Crisis? www.ilcuk.org.uk

2. Baroness Sally Greengross ILC-UK Extra Care

3. Dylan Kneale ILC-UK Extra Care

4. Establishing the extra in Extra Care: Perspectives from three Extra Care Housing Providers Dylan Kneale International Longevity Centre, September 13 th 2011

7. Extra care housing What do we know about extra care housing?

11. Characteristics of residents

12. Extra care as a home for life I Length of time until exit (all exits) First quartile (25%) Median (50%) All residents 3.1 6.5 Gender Male 2.6 6.0 Female 3.4 6.7

13. Extra care as a home for life II: Competing Risks Framework Risk 1: moving to an institution Risk 2: death All residents 8.2% (6.7-9.9) 25.0% (22.4-27.5) Gender Male 6.4% (4.3-9.1) 30.6% (26.0-35.3) Female 9.1% (7.2-11.3) 22.0% (19.2-25.1) Health Status/Care Needs on Arrival No additional support package 5.5% (4.0-7.3) 16.8% (14.2-19.6) Level 1 (very low package needs) 12.8% (6.8-20.8) 29.6% (20.0-39.7) Level 2 (low support package) 17.5% (11.7-24.4) 39.8% (31.6-47.6) Level 3 (moderate support package) 11.9% (5.2-21.5) 41.0% (28.3-53,1) Level 4 & 5 (high or very high support package) 9.9% (4.9-17.1) 56.9% (46.1-66.3) Age Group 50-64 6.8% (2.8-10.9) 10.2% (5.8-16.3) 65-69 6.2% (3.1-11.0) 13.0% (8.2-19.1) 70-74 6.0% (3.4-9.8) 18.2% (13.3-23.7) 75-79 9.0% (5.8-13.0) 24.6% (19.4-30.2) 80-84 8.0% (4.8-12.3) 27.2% (21.3-33.5) 85+ 12.7% (8.5-17.7) 49.0% (41.8-55.8) N 1,189 1,189

14. Extra care as a home for life III All community match sample Domiciliary care match sample Age 65+ Model 1 Age 75+ Model 2 Age 80+ Model 3 Age 65+ Model 4 Age 75+ Model 5 Age 80+ Model 6 Models adjusted for Age, Sex, Living Arrangements, Year Sub-hazard ratio of moving to an institution Sub-hazard ratio of moving to an institution Sub-hazard ratio of moving to an institution Sub-hazard ratio of moving to an institution Sub-hazard ratio of moving to an institution Sub-hazard ratio of moving to an institution Extra care housing 1.776 1.216 0.905 0.694 0.532* 0.316** (0.659) (0.471) (0.463) (0.207) (0.167) (0.121) N 1714 1034 624 1630 1028 634

19. Extra care and overnight hospitalisation II

26. Robin Darton PSSRU Extra Care

27. The PSSRU Evaluation of Extra Care Housing Robin Darton Extra Care ‒ A Sustainable Solution to the Care Crisis?, International Longevity Centre ‒ UK, 13 September 2011

35. PSSRU Evaluation: Response (November 2010) No. No. resids No. with data No. with Res Q No. with Ass Q No. Ass Q + 6m No. Ass Q + 18m No. Ass Q + 30m Smaller schemes 16 996 680 620 645 390 187 114 Villages 3 896 568 562 172 63 61 9 Total 19 1894 1248 1182 817 453 248 123

36. Entrants to Extra Care (2006-10): Require Help with IADLs

37. Entrants to Extra Care (2006-10): Require Help with ADLs

38. Entrants to Extra Care (2006-10) & Care Homes (2005): Barthel Index of ADL

39. Entrants to Extra Care (2006-10) & Care Homes (2005): MDS CPS

40. Entrants to Extra Care (2006-10): Change in Dependency by Follow-Up Follow-up % deteriorated % improved Barthel Index of ADL 0‒6 months 9 12 0‒30 months 22 8 MDS CPS 0‒6 months 8 6 0‒30 months 6 14

41. Entrants to Extra Care (2006-10): Location at End of Study Number % Still in scheme 458 56.1 Moved 69 8.4 Nursing home 29 3.5 Care home 16 2.0 Elsewhere/not known 24 2.9 Died 161 19.7 Died in scheme 62 7.6 Died elsewhere 99 12.1 Lost to follow-up 129 15.8

42. Entrants to 11 Extra Care Schemes (2006-07): Mortality & Survival Number of individuals 374 Number of deaths 115 Mean time to death 20 months % died by 30 months (≥65) 34% Predicted median (50%) survival from model: Extra care (≥65) 32 months Care home (2005) 21 months Nursing home (2005) 10 months

50. Jeremy Porteus Housing LIN Extra Care

51. Extra Care – a sustainable solution to the care crisis? Jeremy Porteus 13 September 2011

57. Tuesday 13 September 2011 Extra Care – A Sustainable Solution to the Care Crisis? www.ilcuk.org.uk