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The COVID-19 pandemic and the lockdown measures imposed as a result affected the lives of people in all parts of society across the world. In 2020, during the first UK national lockdown, older adults (aged 70 years and over) were told to 'shield' within their homes, as they were regarded as being at higher risk of serious COVID-19 infection compared to other age groups. This paper explores older adults' experiences of COVID-19 lockdown measures whilst living in housing with care schemes for older people. The purpose is to examine the impact of the lockdown measures on scheme life including social connections amongst residents and their general everyday wellbeing during this time. We present qualitative findings based on interviews with 72 residents who took part in longitudinal and cross-sectional interviews across 26 housing with care schemes. Data were analysed using a thematic framework approach to examine specifically their experiences of living in housing with care schemes during the 2020 UK lockdown. The paper highlights that COVID-19 restrictions had a detrimental impact on the social connections and interactions of older residents living in housing with care schemes, as well as on their feelings of autonomy and independence. Despite this, residents adapted and coped with self-isolation restrictions and sought out positive ways to maintain social contact with others inside and outside to the scheme. We further highlight the tensions that providers of housing for older adults faced in promoting residents' autonomy and connectedness whilst also trying to provide a safe living environment and protect residents from risk of COVID-19 infection. Our findings apply not only to a pandemic situation but to the broader understanding of how housing with care for older adults must navigate between autonomy and support., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

With over two-thirds of people with dementia living in the community and one-third of those living alone, it is important to consider the future housing needs of this population, particularly as symptoms of cognitive impairment increase. Policy in England has focused on enabling people living with dementia to remain in their own homes for as long as possible, often with the support of a family carer. However, many people struggle to maintain an acceptable quality of life in their own homes as their dementia advances, often due to the design limitations of mainstream housing and the challenge of finding specialist domiciliary care that is affordable and of sufficient quality. Extra care housing offers a model that aims to support older people living in their own apartments, whilst also offering specialist person-centred care as and when it is needed. This paper reports on a longitudinal project that explored how extra care housing can respond to the changing social care needs of residents, including those living with dementia. Participants included residents and staff from four extra care housing schemes, one of which was a specialist dementia scheme, in two regions of England. Interviews were carried with 51 residents across 4 rounds at 5 month intervals between October 2015 and June 2017. Interviews were also carried out with 7 managers, 20 care staff and 2 local authority commissioners of housing for older people. Key factors included person-centred care and support, flexible commissioning and staffing, appropriate design of the environment and suitable location of the scheme within the wider community. The challenge of delivering services that addresses these issues during a period of reduced public spending is acknowledged. Further research is suggested to compare different approaches to supporting people with dementia, including integrated and separated accommodation, and different stages of dementia.

Purpose: The process of individual ageing in the context of a care environment is marked by continuity and change. It is shaped by individual, health-related factors as well as by diverse social and environmental factors, including characteristics of the places where older people live. The aim of this paper was to explore how longitudinal qualitative research, as a research method, could be used to explore older people's changing care needs., Methods: The study used a longitudinal design to examine how the care and support needs of residents and their expectations of services developed over time and how these were influenced by changes in the organisation of their housing as well as in the make-up of the resident population. Residents were interviewed on four occasions over 20 months., Results: The study highlighted the complex ways in which some participants proactively managed the care and support they received, which we argue would have been difficult to discern through other methods., Conclusion: The study adds to the growing evidence base that supports the use of qualitative longitudinal research; the approach enables the researcher to capture the diverse and mutable nature of older people's experiences at a time of profound change in their lives.

Emerging research suggests autistic people are disproportionately represented in homeless populations. Less is known about how autistic people experience homelessness and what prevents them from exiting homelessness. This article presents findings from a narrative enquiry investigating the link between autism and homelessness. Ten autistic adults consented to participate in narrative interviews which explored their life histories and pathways through homelessness. This article considers how participants experienced rough sleeping and sofa surfing before attempting to access hostels. It then examines how participants navigated support systems, arguing that barriers to accessing services perpetuated homelessness. Because of these barriers, some participants disengaged with services, preferring to sleep rough. The extent to which participants could be said to have 'chosen' homelessness is balanced with consideration of the lack of autonomy autistic adults are able to exercise over their lives. This article concludes with discussion of practical implications for services and policy in England.

Emerging research suggests autistic people are disproportionately represented in homeless populations. Less is known about how autistic people experience homelessness and what prevents them from exiting homelessness. This article presents findings from a narrative enquiry investigating the link between autism and homelessness. Ten autistic adults consented to participate in narrative interviews which explored their life histories and pathways through homelessness. This article considers how participants experienced rough sleeping and sofa surfing before attempting to access hostels. It then examines how participants navigated support systems, arguing that barriers to accessing services perpetuated homelessness. Because of these barriers, some participants disengaged with services, preferring to sleep rough. The extent to which participants could be said to have 'chosen' homelessness is balanced with consideration of the lack of autonomy autistic adults are able to exercise over their lives. This article concludes with discussion of practical implications for services and policy in England. Recent research suggests many autistic people experience homelessness. However, little is known about the types of homelessness autistic people experience and what barriers autistic people face when trying to exit homelessness. This study involved gathering life stories of autistic people who had experienced homelessness. Ten autistic participants talked about their pathways through homelessness and the difficulties they had in accessing support. After first becoming homeless, participants tended to experience rough sleeping and sofa surfing. When participants approached housing and homelessness services, they were often told they were not eligible for support. This could happen when support workers were not aware of autism, or when autism was not considered 'severe' enough. Overcrowding, confrontation and lack of control over routine and environment were particular issues for participants when they entered homelessness hostels. Some participants chose to sleep on the streets rather than stay in environments which increased social anxiety and sensory difficulties. This study discusses ways in which homelessness and housing services can increase accessibility and improve engagement for autistic people. It is important to increase awareness of autism while understanding that autistic people who experience homelessness may have complex needs. In addition, services need to listen to autistic people with lived experience of homelessness to decide what changes will have the most impact. [ABSTRACT FROM AUTHOR]

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents' attempts to manage this boundary. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focusses on the emergence of ideas about outcomes-based commissioning (OBC) in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing.Design/methodology/approach The review of strategic and operational commissioning in adult social care in England (and Scotland in brief) is based on both policy documents and a review of the literature, as are the sources addressing OBC in adult social care particularly in extra care housing settings.Findings The core of this paper focusses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding, increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in other relevant settings.Originality/value Addressing the implementation of OBC in adult social care in England in the context of extra care housing. [ABSTRACT FROM AUTHOR]

Purpose: This paper reports the findings of the evaluation of the Supporting People Health Pilots programme, which was established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper highlights the challenges of working across housing, health and social care boundaries. Method: The evaluation of the six health pilots rested on two main sources of data collection: Quarterly Project Evaluation Reports collected process data as well as reporting progress against aims and objectives. Semi-structured interviews--conducted across all key professional stakeholder groups and agencies and with people who used services--explored their experiences of these new services. Results: The ability of pilots to work across organisational boundaries to achieve their aims and objectives was associated not only with agencies sharing an understanding of the purpose of the joint venture, a history of joint working and clear and efficient governance arrangements but on two other characteristics: the extent and nature of statutory sector participation and, whether or not the service is defined by a history of voluntary sector involvement. In particular the pilots demonstrated how voluntary sector agencies appeared to be less constrained by organisational priorities and professional agenda and more able to respond flexibly to meet the complex needs of individuals. Conclusion and discussion: The pilots demonstrate that integrating services to support people with complex needs works best when the service is determined by the characteristics of those who use the service rather than pre-existing organisational structures. [ABSTRACT FROM AUTHOR]

Introduction: Faced with rising numbers of older people in need of care and restrictions on public expenditure in the UK, extra care housing (ECH) has been hailed as an integrated model of housing with care that allows older people to live independently, while also having access to care and support if required. Despite the proposed benefits of ECH, however, little is known about how responsive it is to the needs of older people as their care needs change. Theory/Methods: This presentation reports on findings from the ECHO project, which explored the perspectives and experiences of those living and working in ECH settings. Longitudinal qualitative research was undertaken at 4 ECH settings (including one dementia-specialist scheme), based in 2 areas, over the course of 2 years. Residents were interviewed on 4 occasions to explore how their care needs and experiences of ECH changed over time. Managers were interviewed twice, at the beginning and end of the study, and care workers were interviewed on one occasion. Results: Residents appreciated the flexibility in the way that care was provided and felt that the ECH model allowed them some control over when and how their care was delivered. Some residents, care workers and managers reported an increase in care needs amongst people moving into ECH and amongst existing residents as they aged in place. Interviews with care workers revealed that their work was organised in a time/task manner. This resulted in frustration for some care workers who felt unable to provide care in a flexible and personalised way. Some care workers found ways to compensate for this approach by providing 'favours', doing tasks beyond their role. Discussions: The organisation of work in the 4 ECH schemes imitated patterns of work at some traditional care homes and it appeared that there was very little slack in the system. This is problematic given that there is an expectation of ECH to meet the changing care needs of residents in a timely and responsive manner. Such problems appear to be exacerbated by the changing context of ECH which means that the population whom it serves now has higher and more complex needs. Conclusions (including key findings): ECH's integrated model of housing and care has the potential to support quality of life for older people, including those living with dementia. However, while the ECH model promises to allow for increased flexibility and a more personalised approach to care delivery, cost saving forms of work organisation can undermine this approach. Lessons learned: Longitudinal research is a beneficial way to examine how older people's care needs are responded to in integrated housing and care environments. Limitations: Though a longitudinal approach allowed us to consider how participants' experiences altered over time, and in relation to contextual change, this approach was not as effective with residents living in a dementia-specialist ECH scheme. Suggestions for future research: Further research is required to establish whether ECH is the most appropriate form of integrated housing and care for older people living with dementia. [ABSTRACT FROM AUTHOR]

Introduction: Between 2012 and 2032 it is estimated that the populations of 65-84 years old and those over 85 in the United Kingdom will increase by 39 and 106% respectively (Kings Fund 2013). Recent figures suggest that people over the age of 65 account for almost 51% of gross local authority spending on adult social care (Oliver et al 2014). Current projections indicate that a growing proportion of older people will, in the future, be living on their own and will require formal care (King's Fund 2014). While these demographic changes have significant implications for adult social care policy they also draw attention to the pressing need for sufficient and appropriate housing that enables older people to live independently (Atkinson et al 2014). Practice: Not surprisingly the provision of appropriate housing is a key element of UK government policy (Garwood 2015). Various models of housing with care have emerged in recent years with Extra Care Housing (ECH) offering the potential to combine housing and social care in the same setting. Indeed the integration of personal housing alongside individualised care means that Extra Care Housing is viewed by many to be 'a viable alternative to and possible replacement for residential care' (Beach 2015:7). Extra Care Housing, compared to other models of housing, has several characteristics: it is primarily for older people; accommodation is almost always self-contained; social care can be delivered flexibly, usually by staff based on the premises; support staff are available on the premises 24 hours a day; domestic care is available; communal facilities and services are available; meals are usually available and charged for when taken; it aims to be a home for life and finally, it offers security of tenure (Laing and Buisson 2010). Key findings: Drawing on results from the Adult Social Services in Environmental Settings (ASSET) project (https://assetproject.wordpress.com/) and initial findings from our longitudinal study of Extra Care Housing (both funded by the National Institute for Health Research, School for Social Care Research) this paper will consider what potential the integration of housing and care has for older people living in the UK. It will consider the different models of integrating social care within housing and the advantages, as well as some of the challenges therein. The implications of integrating housing and care will be considered from the perspective of those managing schemes as well as from care workers and older people themselves. Conclusion: Despite the potential of Extra Care Housing to provide integrated care for older people the current economic context of the UK threatens to undermine the model. Reduced public spending and increased targeting of social care on those people thought most in need could weaken the preventive aims of Extra Care Housing. [ABSTRACT FROM AUTHOR]