The first thing to note when reading the literature on extra care housing is that there is no clear definition for what it actually is. Different providers place varying emphasis on the housing or care element, depending on what it is they are trying to promote (Croucher et al, 2006). The Department of Health (2004) state that extra care housing is a housing option that falls somewhere between traditional sheltered housing and residential care homes in terms of the levels of care and support available to tenants. There is however a common emphasis on promoting independence in private accommodation within a scheme (Darton et al, 2012). However, this is also true of sheltered housing. Usually, extra care housing has a care team based onsite which acts as a defining feature, and distinguishing it from sheltered housing. Often schemes also provide one meal a day to help integrate the community and keep tenants healthy. However, this is not the case in all extra care schemes, as research has found schemes to be idiosyncratic (Wright et al, 2010). The lack of definition for extra care housing creates issues for customers, as people do not know what schemes offer which makes it difficult for older people, their relatives and social workers to decide whether extra care is appropriate (Wright et al, 2010) . Older people usually want to stay in their own homes and often only move once they reach crisis point, making it essential that clear guidelines on their housing options are available to them.
68 It is important to note that without future funding from the governments’ Social Housing Grant for further extra care housing schemes; it is likely that the rate of growth of this type of housing will now slow. Between 2004 and 2010, the Department of Health's extra care housing fund provided local authorities, Social Services and housing associations with £227 million of capital funding in order to encourage them to build these innovative schemes in partnership with one another (Department for Communities and Local Government, 2008; Department of Health, 2003, 2005). The fact that this funding stream has now gone limits the amount of extra care housing available in the UK. One study found that for every unit in extra care, there were approximately sixteen units in care homes (Dawson et al, 2006). Therefore, it is not a housing option for all older people whose needs might be met by it.
Extra care housing is interesting because it is an example of a housing option for older people that is already integrated with the whole system of care. "While there are many staff working in housing with care services (extra care housing), there are other practitioners who ‘drop in and out’, such as visiting NHS practitioners, locum doctors, paramedics or other specialist staff" (Manthorpe and Moriaty, 2011). On top of this, extra care housing usually has an allocations board, where Housing, Health and Social Services are all represented. These boards discuss who will be offered a place in extra care. However, due to the lack of definition, each scheme has different criteria that they use. This can make it very difficult for people to know whether they are eligible for a place (Wright et al, 2009). A common model is to aim to have one- third of tenants with low care needs, one-third with medium care needs and one-third with high care needs to help balance staffing (Wright, et al, 2010). Whilst this is a logical approach, it is not easy to establish what an individual's care needs will be once they move into the scheme. It is common for people's level of care to be reduced once they have moved in due to their improved physical environment (Wright et al, 2010). With changes to older people's health happening frequently, maintaining the balance of individual's care needs in extra care housing is very difficult (Darton, et al, 2012).
However, despite its difficulties, extra care housing is still a good option for older people. One study found that the move to extra care reduced tenant’s unmet need,
69 with them experiencing improved quality of life, better social care outcomes and improved access to healthcare services (Bäumker et al, 2010). The improved access can be attributed to increased staff contact and support, meaning that staff are signposting other services to tenants to help improve their wellbeing. The majority of tenants interviewed in one study stated, “they had not experienced any problems with the services they received within the scheme” (Blood, 2012). Extra care housing contributes to the whole system of care by providing us with the only clear example of how the integration of housing into the system can benefit both tenants and local services. Whilst care homes are integrated into the system, the mechanisms for this integration are not clearly documented in the literature, whereas with extra care, they are. Extra care housing has become the preferred term for integrated housing with care in the UK (Bäumker et al, 2010; Laing & Buisson, 2009).
Health, Social Care and Housing all work together in the development and building of extra care housing (Burlumi and Tuck, 2008). A study in 2006 highlighted that “authority respondents reported that the most influential factor that encouraged and fostered the development of extra care housing was good working partnerships between Social Services and housing departments” (Dawson et al, 2006). The housing department needs to work with Social Services to ensure that the layout of the scheme is appropriate to meet tenants' and staffs requirements flexibly. This can help to prevent costly design mistakes.
Extra care housing contributes to the whole system of care as a housing option that offers a level of support and care between sheltered housing and residential care homes. As schemes are often new builds, and are therefore desirable places to live, they offer an option for the wider population who make a planned move instead of reaching crisis point (Darton et al, 2012). Extra care housing also contributes to the whole system of care on a theoretical level, as it is a model of housing that is already integrated into the system, through clear mechanisms including development and allocation management boards. It is possible to take lessons from the extra care model and apply them to other housing models to aid integration.