Current understanding of housing need in later life is shaped by demographics, social policy, legislative responsibilities, and a growing, but limited body of research and guidance on supporting individuals with dementia to maintain independence with appropriate levels of care.
Informed by a survey of extra care housing provision and adopting a grounded theory approach, this study aimed to consider the appropriateness of extra care housing for people with dementia based on the experiences of those living and working in two extra care schemes. Focus groups and interviews revealed four themes to living well with dementia in extra care; a clear understanding of what extra care is and is not; a physical environment that helps people feel safe and find their way easily; a friendly, skilled and competent support team; and a well-developed community where residents can take part, develop friendships, and reduce unwanted isolation.
Set within two current discourses of care and support and management, the juxtaposition of social worlds theory and total quality and operational excellence theory helped to frame the issues raised by participants, offering a new model of extra care. The addition of ‘place’ in the new approach highlights the need to manage the spatial environment in extra care to ensure a cohesive and inclusive community. What mattered to residents, staff and managers was having a personalised and flexible service with the right processes and people in place to support people with dementia. Combining sociological and managerial perspectives puts residents and staff at the heart of establishing an approach that delivers.
This study contributes to knowledge development in three areas; understanding of extra care housing for people with dementia; interdisciplinary approaches to models of extra care provision; and methodology on researching living with dementia in a supported housing environment. Future research could evaluate the new approach to extra care proposed in this thesis.
