Extra Care housing can and does meet the needs of many people with dementia, but not everyone with the condition.
No two extra care schemes are the same, and there are many variables which will determine how successfully, and for how long, they continue to support people with dementia, enabling them to "live well" with the condition. The following are just some of these variables:
- The design of the Extra Care scheme and the physical environment generally
- Staffing levels, skills and approach - the quality and flexibility of care and support
- Ethos, policies and procedures
- Team working and effective co-ordination and communication
- Opportunities for meaningful occupation, involvement and social interaction
- Attitudes of other tenants
- The sorts of behaviours and needs that are manifest
- The availability and suitability of additional services such as specialist mental health or nursing care
There is not a great deal of evidence of what works best for people with dementia in Extra Care housing. The Housing and Dementia Research Consortium (HDRC) (opens new window) seeks to promote relevant and useful research into housing with care for people with dementia.
The first piece of work undertaken by the HDRC was a "Scoping Review of the Literature from 1998 - 2008" into "Extra Care Housing and People with Dementia (opens new window)" (May 2009). Funded by the Joseph Rowntree Foundation, key aims of this literature review were to identify recent published and grey literature relating to people with dementia living in extra care housing with a focus on evidence relating to the following elements:
- Design and use of the built environment
- Facilities, furnishings and equipment
- Care, support and therapeutic services
- Organisation and management
- Outcomes in relation to health, wellbeing, policy and cost.
Page 4 asks the question "Is Extra Care an Appropriate Living Solution for People with Dementia?" and summarises findings from the studies included in the review.
Section 6.3, starting on p27 covers UK studies into the suitability of Extra Care for People with dementia.
A distinction needs to be made between the level of needs that people have at the point when they are considering moving to extra care, and the ability of extra care to continue supporting people who develop dementia while living in an Extra Care scheme. "There is strong evidence and general agreement that it is not appropriate for people to enter extra care when they already have advanced dementia" (pp 5 and 103). Whether or not the person with dementia is one of a couple will have a bearing on this (See the podcast on Stanton Lodge (opens new window), a small extra care scheme with flats for sale to couples where one has dementia)
An important research study "Opening Doors to Independence - A Longitudinal study exploring the contribution of Extra Care Housing to the Care and Support of Older People with Dementia" was published by the Housing Corporation and Housing 21 in 2006. The full report can be purchased via the Housing 21 website, but a presentation based on the findings was given to the Extra Care Housing and Dementia - Commissioning for Quality event in September 2006 (opens new window) (Scroll down to Event Document - Simon's is the 5th document)
Extra Care Housing is not the Answer for Everyone with Dementia (opens new window) - Housing LIN Viewpoint No4 is an article first published in Dementia Care. Sue Garwood explores whether Extra Care Housing is a suitable accommodation and care solution for everyone with dementia and concludes for a variety of reasons that choice and a range of services are needed.