The everyday operation of models of social care provision within the extra care sector

Ailsa Cameron Completed   2018


Extra Care Housing (ECH) is housing with care, a community-based alternative to residential care. There is no definitive model of ECH. It is generally aimed at people over 55; residents have their own apartments usually with a small kitchen area; planned care and support is normally available 24 hours a day, 7 days a week; most schemes provide communal facilities such as a café, laundry and communal space, plus social activities for residents. Care and support is normally provided by an on-site team, but residents can choose to have them provided by an external agency.

To function effectively ECH is thought to need a balance of care needs between residents including some with no/minimal needs; those with medium levels and some with what is often referred to as high care needs.

Providing housing with care is a key element of contemporary adult social care policy.


This two-year study (2015–2017) explored how care is negotiated and delivered within ECH schemes.


Four ECH schemes were recruited, one a specialist dementia facility. 51 residents from the four schemes were interviewed on up to four occasions: 10 residents were male; ages ranged from 54–96; 22 were widowed; 14 were divorced/separated, 8 were married, and 7 single. Interviews explored reasons for moving into ECH, care received, changes in needs and experiences of living in ECH.

Managers and five care staff from each scheme, as well as local commissioners of ECH, were interviewed to explore strategic and operational issues including the impact of changes in funding and how care work is organised.


  • The flexible nature of care provision offered by Extra Care Housing (ECH) was appreciated by most older people participating in the study
  • Care workers described the support they provided in terms of ‘task and time’ which might undermine the flexible nature of care provided in ECH
  • There was some reported increase in care needs among residents moving into ECH, potentially undermining the original purpose of enabling residents to maintain their independence
  • Commissioners of ECH face financial pressures, increasing need for care and support, competing demands for land and the higher national living wage, which resulted in increased workforce costs ECH has the potential to support quality of life for people living with dementia if sufficient and flexible resources can be provided.


Launched at the Future of Extra Care Housing Workshop (March 2017), two videos, which focus on the ECHO Project, are part of the Housing LIN’s crowdfunded ‘Spotlight on Extra Care’ video series:

Journal papers

Smith R, Darton RA, Cameron A, Johnson EK Lloyd L, Evans S, Atkinson TJ, Porteus J (2017) Outcomes-based commissioning for social care in Extra Care Housing – is there a future?, Housing, Care and Support, 20, 60–70.

Smith R (2015) Longitudinal studies and housing with care in England: a review, Housing, Care and Support, 18, 1–11

Provision of social care in extra care housing: the ECHO study
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