Extra care housing in the UK: a scoping review

Extra care housing is a model of housing for older people where residents live in self-contained accommodation with flexible care and support available at all times. Ageing populations, seen globally and in the United Kingdom, mean increasing demand for this type of housing. While extra care housing may help people live longer independently, its provision poses challenges (e.g. resourcing flexible care). By identifying existing evidence, this scoping review will inform future research into extra care housing, to support the development of schemes that meet the needs of older people.

To identify the volume, focus/questions, study design, quality and main findings of empirical research and evaluations relating to extra care housing in the United Kingdom.

We conducted a scoping review of evidence syntheses and primary research. Applied Social Sciences Index and Abstracts, Cumulated Index in Nursing and Allied Health Literature, MEDLINE, Health Management Information Consortium, ProQuest Dissertations and Theses Global, Social Policy and Practice (SPP) and Web of Science, along with relevant websites, were searched for studies (June 2024). We also completed citation-chasing on included studies. We included systematic reviews and empirical evaluations published since 2010, conducted in the United Kingdom, focused on extra care housing for older people, and investigating any outcome. Data were tabulated and summarised narratively. Critical appraisal was conducted using the Mixed Methods Appraisal Tool checklist (primary studies) or A MeaSurement Tool to Assess systematic Reviews 2 (systematic reviews). Consultation with stakeholders and extra care housing residents informed the review.

Ninety-eight publications were included. Thirty-seven were qualitative, 28 were quantitative, 19 took a mixed-method approach and 2 were modelling studies using secondary data. Older people were participants in 57 studies. Many studies provided limited information on the characteristics of participants and the included extra care housing schemes. Included studies had three overlapping areas of focus: (1) the supply of extra care housing and older people's decision-making regarding relocation; (2) living in extra care housing (e.g. impact on quality of life, residents' experiences of community, physical infrastructure); and (3) leaving extra care housing (there was little research in this area). While much of the available research supports the provision of extra care housing as a model of housing with care for older people, studies were variable in their methodological quality and reporting. Consultation with extra care housing residents raised topics that corresponded with the findings of included studies (e.g. the importance of care provision in supporting independence).

Extra care housing is known by different names (e.g. assisted living). This created challenges in finding studies and understanding whether the housing model being studied met our definition of extra care housing. As we took an inclusive approach, some included studies may have focused on other types of housing with care.

There is a growing body of evidence regarding the provision of extra care housing as a model of housing for older people. However, given the changing health and social care landscape and increasing care needs of the population, further research is needed to support the future development of extra care housing.

High-quality research on effectiveness and cost-effectiveness is needed, as well as on specific topics (e.g. whether extra care housing can be a home for life).

The protocol was published on Zenodo (https://doi.org/10.5281/zenodo.12698241).

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR174287) and is published in full in Health and Social Care Delivery Research; Vol. 14, No. 26. See the NIHR Funding and Awards website for further award information.