Evaluating Extra Care Housing for Older People in England: A Comparative Cost and Outcome Analysis with Residential Care

Theresia Bäumker, Ann Netten, Robin Darton, Lisa Callaghan
DOI: 10.4236/jssm.2011.44060                

Abstract

Extra care housing is an important innovation in the care and support of older people, and is a housing model that has considerable potential to support older people in leading active, independent lives. Based on cost-effectiveness analyses on statistically matched samples with physical functioning as the primary outcome measure, the study found that costs were lower when comparing equivalent people who moved into publicly-funded residential care homes in 1995, and similar to the more dependent type of person moving into care homes in 2005. Similar or lower costs combined with better outcomes mean that although extra care housing does not appear to provide a direct alternative, it can support some older people at risk of moving into a residential care homes in a cost-effective way.

Keywords

Extra Care Housing, Cost Effectiveness, Older People, Long Term Care

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Department for Communities and Local Government, “Lifetime Homes, Lifetime Neighbourhoods. A national strategy for housing in an ageing society”, Department for Communities and Local Government, London, 2008.
[2]	Department of Health, “A Vision for Adult Social Care: Capable Communities and Active Citizens,” Department of Health, London, 2010.
[3]	Department of Health, “Government Announces Funding for Extra Care Housing, Press Release 2003/0248,” Department of Health, London, 2003.
[4]	Department of Health, “Independence, Well Being and Choice: Our Vision for the Future of Social Care for Adults in England (Cm 6499),” The Stationery Office for the Department of Health, London, 2005.
[5]	Laing and Buisson, “Extra-Care Housing UK Market Re- port 2010,” 10th Edition, Laing and Buisson, London, 2010.
[6]	S. Evans, “Community and Ageing-Maintaining Quality of Life in Housing with Care Settings,” Policy Press, Bristol, 2009.
[7]	K. Croucher, L. Hicks and K. Jackson, “Housing with Ca- re for Later Life: A Literature Review,” Joseph Rowntree Foundation, York, 2006.
[8]	F. Wright, A. Tinker, J. Hanson, H. Wojgani and R. Ma- yagoitia, “Some Social Consequences of Remodelling English Sheltered Housing and Care Homes to Extra Care,” Ageing and Society, Vol. 29, No. 1, 2009, pp. 135-153. doi:10.1017/S0144686X08007630
[9]	T. B?umker, L. Callaghan, R. Darton, J. Holder, A. Net- ten and A. Towers, “Deciding to Move into Extra Care Housing: Residents’ Views,” Ageing & Society, 2011, Vol. forthcoming.
[10]	S. Evans and S. Vallelly, “Social Well-Being in Extra Ca- re Housing,” Joseph Rowntree Foundation, York, 2007.
[11]	L. Callaghan, A. Netten and R. Darton, “The Develop- ment of Social Well-Being in New Extra Care Housing Schemes,” Joseph Rowntree Foundation, York, 2009.
[12]	Department of Health, “Extra Care Housing for Older Pe- ople: An Introduction for Commissioners,” Department of Health, London, 2003.
[13]	T. B?umker, R. Darton, A. Netten and J. Holder, “The Development Costs and Funding of Extra Care Housing,” Public Money and Management, Vol. 31, No. 6, 2011, p. 31.
[14]	R. Darton, T. B?umker, L. Callaghan, J. Holder, A. Ne- tten and A. Towers, “The Characteristics of Residents in Extra Care Housing and Care Homes in England,” Health and Social Care in the Community, Vol. forthcoming, 2011.
[15]	F. Wright, “Review: Housing with Care for Later Life: A Literature Review,” Ageing & Society, Vol. 27, No. 1, 2007, pp. 165-174.
[16]	S. Winters, “Lifetime Housing in Europe,” Proceedings of the European Seminar and Colloquium, Living Tomo- rrow Starts Today, 4-5 December 2000, Hoger Instituut voor de Arbeid, Leuven, 2001.
[17]	M. E. Hunt, A. Feldt, R. W. Marans, L. Pastalan and K. Vakalo, “Retirement Communities: An American Origi- nal,” The Haworth Press, New York, 1984.
[18]	J. Citro and S. Hermanson, “Assisted Living in the United States,” American Association of Retired Persons, Public Policy Institute, Washington (DC), 1999.
[19]	J. Frank, “How Long Can I Stay? The Dilemma of Aging in Place in Assisted Living,” Journal of Housing for the Elderly, Vol. 15, No. 1/2, 2001, pp. 5-30. doi:10.1300/J081v15n01_02
[20]	S. Sherwood, H. S. Ruchling, C. C. Sherwood and S. A. Morris, “Continuing Care Retirement Communities,” Jo- hns Hopkins University Press, Baltimore (MD) and Lon- don, 1997.
[21]	C. Hawes, C. D. Phillips, M. Rose, S. Holan and M. She- rman, “A National Survey of Assisted Living Facilities,” The Gerontologist, Vol. 43, No. 6, 2003, pp. 875-882. doi:10.1093/geront/43.6.875
[22]	V. Regnier, “Design for Assisted Living: Guidelines for Housing the Physically and Mentally Frail,” John Wiley & Sons, New York, 2002.
[23]	D. A. Wolf and C. Jenkins, “Family Care and Assisted Living: An Uncertain Future?” In: S. M., G. and J. Hyde, Eds., The Assisted Living Residence: A Vision for the Future, The Johns Hopkins University Pres, Baltimore (MD), 2008, pp. 198-222.
[24]	J. Pynoos and P. S. Liebig, “Housing Frail Elders: Inter- national Policies, Perspectives, and Prospects,” The Johns Hopkins University Press Baltimore (MD) and London, 1995.
[25]	F. Heywood, C. Oldman and R. Means, “Housing and Home in Later Life,” Open University Press, Buckingham, 2002.
[26]	N. Appleton and M. Shreeve, “Now for Something Dif- ferent: The Extra Care Charitable Trust’s Approach to Retirement Living”, Old Chapel Publishing, Witney, 2003.
[27]	Housing Learning and Improvement Network, “Extra Ca- re Strategic Developments in North Yorkshire (Case Study No. 1),” Housing Learning and Improvement Net- work, Department of Health, London, 2003.
[28]	Department of Health, “New Report Shows that Stan- dards of Care for Older People in Homes are Improving,” Department of Health, London, 2004.
[29]	Office for National Statistics, “Ageing and Mortality in the UK: National Statistician’s Annual Article on the Po- pulation,” Office of National Statistics, London, 2008.
[30]	K. Lisenkova, R. W. McQuaid and R. E. Wright, “Introduction to the Economics of an Ageing World,” Journal of the Academy of Social Sciences, Vol. 5, No. 3, 2010, pp. 229-231.
[31]	T. Brown, “Housing an Ageing Population: The Extra Care Solution,” Keep Moat and Housing Learning and Improvement Network, London, 2011.
[32]	P. Fletcher, M. Riseborough, J. Humphries, C. Jenkins and P. Whittingham, “Citizenship and Services in Older Age: The Strategic Role of Very Sheltered Housing,” Housing 21, Beaconsfield, 1999.
[33]	Laing and Buisson, “Extra-Care Housing UK Market Re- port 2009,” 9th Edition, Laing and Buisson, London, 2009.
[34]	C. Oldman, “Blurring the Boundaries: A Fresh Look at Housing and Care Provision for Older People,” 2000 Edition, Joseph Rowntree Foundation & Pavilion Publishing Ltd., Brighton, 2000.
[35]	T. Baker, “An Evaluation of an Extra Care Scheme—Ru- nnymede Court, Estover, Plymouth,” Hanover Housing Association, Staines, 2002.
[36]	J. Bartholomeou, “A View of the Future—The Experience of Living in Extra Care,” Hanover Housing Group, Staines, 1999.
[37]	A. Bailey, “Making God Wait: An Alternative to Residential Care,” Housing, Care and Support, Vol. 1, No. 2, 1998, pp. 21-24. doi:10.1108/14608790199800019
[38]	Royal Commission on Long Term Care, “With Respect to Old Age: Long Term Care—Rights and Responsibilities: A Report by the Royal Commission on Long Term Care, (Chairman: Professor Sir Stewart Sutherland). Research Volume 2: Alternative Models of Care for Older People,” The Stationery Office, London, 1999.
[39]	R. Darton, T. B?umker, L. Callaghan and A. Netten, “The PSSRU Evaluation of the Extra Care Housing Initiative: Technical Report,” Personal Social Services Research Unit, University of Kent, Canterbury, 2011.
[40]	A. Bebbington, R. Darton and A. Netten, “Care Homes for Older People: Volume 2. Admissions, Needs and Outcomes. The 1995/96 National Longitudinal Survey of Publicly-Funded Admissions,” Personal Social Services Research Unit, University of Kent at Canterbury, 2001.
[41]	A. Netten, A. Bebbington, R. Darton and J. Forder, “Care Homes for Older People: Volume 1. Facilities, Residents and Costs,” Personal Social Services Research Unit, University of Kent at Canterbury, 2001.
[42]	A. Netten, R. Darton, A. Bebbington and P. Brown, “Re- sidential or Nursing Home Care? The Appropriateness of Placement Decisions,” Ageing and Society, Vol. 21, No. Part 1, 2001, pp. 3-23.
[43]	R. Darton, J. Forder, A. Bebbington, A. Netten, A. M. Towers and J. Williams, “Analysis to Support the Deve- lopment of the Relative Needs Formula for Older People: Final Report,” Personal Social Services Research Unity, University of Kent at Canterbury, 2006.
[44]	R. Darton, J. Forder, A. Netten, A. Bebbington, J. Holder, and A. M. Towers, “Slicing up the Pie: Allocation of Central Government Funding of Care of Older People,” Social Policy and Administration, Vol. 44, No. 5, 2010, pp. 529- 553. doi:10.1111/j.1467-9515.2010.00728.x
[45]	J. Forder and A. Netten, “The Price of Placements in Re- sidential and Nursing Home Care: The Effects of Contracts and Competition,” Health Economics, Vol. 9, No. 7, 2000, pp. 643-657. doi:10.1002/1099-1050(200010)9:7<643::AID-HEC528>3.0.CO;2-X
[46]	J. Beecham, “Collecting and Estimating Costs,” In: M. R. J. Knapp, Ed., The Economic Evaluation of Mental Health Care, Arena, Aldershot, 1995, pp. 61-82.
[47]	M. R. J. Knapp, “The Principles of Applied Cost Research,” In: A. Netten and J. M. Beecham, Eds., Costing Community Care: Theory and Practice, Ashgate, Aldershot, 1993.
[48]	J. Beecham, “Unit Costs—Not Exactly Child’s Play,” A Guide to Estimating Unit Costs for Children’s Social Care, Department of Health, Dartington Social Research Unit and Personal Social Services Research Unit at the University of Kent, London, 2000.
[49]	T. B?umker, A. Netten and R. Darton, “The Costs and Sources of Cost Variation in Extra Care Housing,” Personal Social Services Research Unit, University of Kent, Canterbury, 2011.
[50]	T. B?umker and A. Netten, “Costing Extra Care Hous- ing,” In: L. Curtis, Ed., Unit Costs of Health and Social Care 2011, Personal Social Services Research Unit, Can- terbury, Forthcoming.
[51]	A. Netten, “New Developments and Changes in Guidance on the Discount Rate,” In: A. Netten and L. Curtis, Eds., Unit Costs of Health and Social Care 2003, Personal So- cial Services Research Unit, University of Kent, Canter- bury, 2003.
[52]	Building Cost Information Service, “Indices and Fore- casts,” BCIS, Royal Institute of Chartered Surveyors, Kingston-upon-Thames, 2008.
[53]	L. Curtis, “Unit Costs of Health and Social Care”, Per- sonal Social Services Research Unit, University of Kent, Canterbury, 2008.
[54]	Department of Health, “National Schedule of Reference Costs 1998-2008,” The Stationary Office, London, 2008.
[55]	Laing and Buisson, “Care of Elderly People UK Market Survey 2009,” 22nd Edition, Laing and Buisson, London, 2009.
[56]	F. I. Mahoney and D. W. Barthel, “Functional Evaluation: The Barthel Index,” Maryland State Medical Journal, Vol. 14, No. 2, 1965, pp. 61-65.
[57]	J. N. Morris, B. E. Fries, D. Mehr, C. Hawes, C. Phillips, V. Mor and L. A. Lipsitz, “MDS Cognitive Performance Scale,” Journal of Gerontology: Medical Sciences, Vol. 49, No. 4, 1994, pp. M174-M182.
[58]	R. B. D’Agostino, “Propensity Score Methods for Bias Reduction in the Comparison of a Treatment to a Non-Randomized Control Group,” Statistics in Medicine, Vol. 17, No. 19, 1998, pp. 2265-2281. doi:10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B
[59]	S. Guo, R. P. Barth and C. Gibbons, “Propensity Score Matching Strategies for Evaluating Substance Abuse Ser- vices for Child Welfare Clients,” Children and Youth Ser- vices Review, Vol. 28, No. 4, 2006, pp. 357-383. doi:10.1016/j.childyouth.2005.04.012
[60]	P. R. Rosenbaum and D. B. Rubin, “The Central Role of the Propensity Score in Observational Studies for Causal Effects,” Biometrika, Vol. 70, No. 1, 1983, pp. 41-55. doi:10.1093/biomet/70.1.41
[61]	A. Basu, J. Heckman, S. Navarro-Lozano and S. Urzua, “Use of Instrumental Variables in the Presence of Hetero- geneity and Self-Selection: An Application to Treatments of Breast Cancer Patients,” Health Economics, Vol. 16, No. 11, 2007, pp. 1153-1157. doi:10.1002/hec.1291
[62]	A. Basu, D. Polsky and W. Manning, “Use of Propensity Scores in Non-Linear Response Models: The Case for Health Care Expenditures,” National Bureau of Economic Research, New York, 2008.
[63]	A. M. Jones, “Identification of Treatment Effects in Health Economics,” Health Economics, 2007, Vol. 16, No. 11, pp. 1127-1131. doi:10.1002/hec.1302
[64]	D. B. Rubin, “Matched Sampling for Causal Effects,” Cambridge University Press, New York, 2006.
[65]	I. Yanovitsky, E. Zanutto and R. Hornik, “Estimating Causal Effects of Public Health Education Campaigns Using Propensity Score Methodology,” Evaluation and Program Planning, Vol. 28, 2005, pp. 209-220. doi:10.1016/j.evalprogplan.2005.01.004
[66]	P. C. Austin, “A Critical Appraisal of Propensity-Score Matching in the Medical Literature between 1996 and 2003,” Statistics in Medicine, Vol. 27, No. 12, 2008, pp. 2037-2049. doi:10.1002/sim.3150
[67]	J. A. Smith and P. E. Todd, “Does Matching Overcome LaLonde’s Critique of Non Experimental Estimators?” Journal of Econometrics, Vol. 125, No. 1-2, 2005, pp. 305-353.
[68]	P. R. Rosenbaum and D. B. Rubin, “Constructing a Con- trol Group Using Multivariate Matched Sampling Metho- ds That Incorporate the Propensity Score,” The American Statistician, Vol. 39, No. 1, 1985, pp. 33-38. doi:10.2307/2683903
[69]	J. Dowie, “Why Cost-Effectiveness Should Trump (clinical) Effectiveness: The Ethical Economics of the South West Quadrant,” Health Economics, Vol. 13, No. 5, 2004, pp. 453-459. doi:10.1002/hec.861
[70]	M. Knapp, “Cognitive Stimulation Therapy for People with Dementia: Cost-Effectiveness Analysis,” The British Journal of Psychiatry, Vol. 188, No. 6, 2006, pp. 574-574. doi:10.1192/bjp.bp.105.010561
[71]	J. S. Hoch, A.H. Briggs and A. R. Willan, “Something Old, Something New, Something Borrowed, Something Blue: A Framework for the Marriage of Health Econometrics and Cost-Effectiveness Analysis,” Health Economics, Vol. 11, No. 5, 2002, pp. 415-430. doi:10.1002/hec.678
[72]	B. van Hout, M. J. Al, G. S. Gorden and F. F. Rutten, “Costs, Effects and C/E-Ratios Alongside a Clinical Trial,” Health Economics, Vol. 3, No. 5, 1994, pp. 309- 319. doi:10.1002/hec.4730030505
[73]	M. Hyde, R. D. Wiggins, P. Higgs and D. B. Blane, “A Measure of Quality of Life in Early Old Age: The Theory, Development and Properties of a Needs Satisfaction Model (CASP-19),” Aging and Mental Health, Vol. 73, No. 3, 2003, pp. 186-194. doi:10.1080/1360786031000101157
[74]	E. Fenwick and S. Byford, “A Guide to Cost-Effective- ness Acceptability Curves,” The British Journal of Psy- chiatry, Vol. 187, No. 2, 2005, pp. 106-108. doi:10.1192/bjp.187.2.106
[75]	E. Fenwick, B. J. O’Brien and A. Briggs, “Cost-Effec- tiveness Acceptability Curves—Facts, Fallacies and Fre- quently Asked Questions,” Health Economics, Vol. 13, No. 5, 2004, pp. 405-415. doi:10.1002/hec.903
[76]	T. B?umker, A. Netten and R. Darton, “Costs and Out- comes of an Extra Care Housing Scheme in England,” Journal of Housing for the Elderly, Vol. 24, No. 2, 2010, pp. 151-170. doi:10.1080/02763891003757098
[77]	T. B?umker, A. Netten and R. Darton, “Costs and Ou- tomes of an Extra-Care Housing Scheme in Bradford,” Joseph Rowntree Foundation, York, 2008.
[78]	K. Croucher, L. Hicks, M. Bevan and D. Sanderson, “Comparative Evaluation of Models of Housing with Care for Later Life,” Joseph Rowntree Foundation, York, 2007.
[79]	J. Manthorpe and J. Moriarty, “Housing or Care Workers? Who is Supporting Older People with High Support Needs?” Journal of Integrated Care, Vol. 19, No. 1, 2011, pp. 16-25. doi:10.5042/jic.2011.0032
[80]	W. Murphy and L. Miller, “Nomination Arrangements in Extra Care Housing: Factsheet No. 25,” Housing Learn- ing and Improvement Network, Department of Health, London, 2008.
[81]	S. Vallelly, S. Evans, T. Fear and R. Means, “Opening Doors to Independence: A Longitudinal Study Exploring the Contribution of Extra Care Housing to the Care and Support of Older People with Dementia,” Housing 21, London, 2006.
[82]	Elderly Accommodation Counsel, “Statistics on Specialist Housing Provision for Older People in England 2009,” Elderly Accommodation Counsel, London, 2009.
[83]	Homes and Communities Agency, “Housing Our Ageing Population: Panel for Innovation (HAPPI),” Homes and Communities Agency, London, 2009.
[84]	Dilnot Commission Report, “Dilnott Commission Report: Commission on Funding of Care and Support,” Depart- ment of Health, London, 2011. http://www.dilnotcommission.dh.gov.uk
[85]	S. Evans, “That Lot Up There and Us Down Here: Social Interaction and a Sense of Community in a Mixed Tenure UK Retirement Village,” Ageing and Society, Vol. 29, No. 2, 2009, pp. 199-216. doi:10.1017/S0144686X08007678
[86]	M. Bernard, B. Bartlam, J. Sim and S. Biggs, “Housing and Care for Older People: Life in an English Purpose-Built Retirement Village,” Ageing & Society, Vol. 27, No. 4, 2007, pp. 555-578. doi:10.1017/S0144686X07005983.