Introduction Care provided in people’s own homes (domiciliary care) is an increasingly important part of long-term care. There are various services, including home visits, live-in care and housing with care. Some people directly employ care staff, called personal assistants. Services vary in quality, price and availability, and there is currently little evidence of the value these services provide to the public purse and individuals. This study protocol presents planned research to fill this important gap.Methods and analysis This will be a cross-sectional study based on surveys of care recipients, their unpaid carers as well as formal care providers. In the first half of 2026, we will survey 1850 people accessing domiciliary care either through a homecare agency, a housing with care scheme or by directly employing personal assistants and 400 unpaid carers, all based in England. We will conduct a cost-effectiveness analysis taking a ‘production function’ approach and use quality of life as measured by the Adult Social Care Outcomes Toolkit as the main outcome of interest.Ethics and dissemination The study received ethical approval from the School of Social Sciences Staff Review Committee at the University of Kent on 20 May 2025 (reference 1195) and the Health Research Authority, London—Camberwell St Giles Research Ethics Committee on 28 October 2025 (reference 25/LO/0652). Implications around consent, data protection and confidentiality, risk and participant payment are discussed. In addition to academic outputs (eg, academic articles, conference presentations), we aim to coproduce news items and blogs with people with lived experience of accessing long-term care and jointly present findings at events aimed at the care sector. Moreover, we will offer participating care providers benchmarking briefs based on our findings.

Co-production in social care research seeks to bridge the gap between academic inquiry, frontline practice, and lived experience by actively involving practitioners, researchers, and public members as equal partners throughout the research process. However, sustaining and balancing this three-way partnership remains challenging in practice. This paper reflects on the ‘Better Care Moves’ project, a co-produced study involving social care practitioners and managers, academic researchers, and public members with lived experience of life and care transitions, such as hospital discharges to care homes and moves into and between social care settings. The team shared reflections on their experiences of co-production in this project through questionnaires and semi-structured interviews, guided by the principles of co-production. Key lessons were identified under two themes: (1) including, valuing, and learning from all perspectives, and (2) power sharing and relationship building. The co-production approach in this project enabled recognition of diverse expertise - practice knowledge, lived experience, and research skills - while fostering mutual learning and skill development. Challenges included limited diversity among public members, demands on practitioner time, and navigating power differentials. Team members highlighted the importance of clarity in roles, mutual respect, and ensuring all voices were heard and valued. The project produced practical resources and strengthened cross-sector networks, demonstrating the tangible benefits of co-production for research and practice. Co-production is an evolving, relational process that requires sustained commitment to inclusion, valuing diverse contributions, and sharing power. While roles differ, equality of respect is essential. Future co-production should strengthen diversity, support consistent participation, and embed transparent decision-making. The ‘Better Care Moves’ project illustrates how co-production can generate accessible knowledge and practical tools for both research and practice to the benefit of those who experience social care services. This paper looks at the use of co-production to develop, manage and deliver a social care research project called ‘Better Care Moves’. Co-production is a collaborative approach to research where everyone involved – university researchers, social care practitioners such as care home workers, social workers and managers, and members of the public with lived experience – work together as equal partners. All team members share expertise, responsibilities, and decision-making, and are actively involved at all stages of the project. The ‘Better Care Moves’ project explored the experiences of older people and their families moving between care settings, such as from home or hospital to a care home. The research team was a three-way partnership made up of public members, practitioners or managers, and academics, following co-production principles throughout. The team shared their experiences of the co-production process through questionnaires and semi-structured interviews. These were grouped into two main themes: 1. Including, valuing, and learning from all perspectives. 2. Power sharing and relationship building. Co-production brought many benefits, such as shared learning and skills development. It also presented challenges in sustaining and balancing this three-way partnership, including limited diversity among public members, varying levels of practitioner involvement and managing different perceptions of power. The team highlighted the importance of clarity about roles, mutual respect, and ensuring everyone’s voices is heard and valued. The project also produced practical resources and strengthened links between researchers, practitioners and the public, showing how co-production can enhance social care research and practice.

Care transitions in later life are challenging for older people and their carers. Social care practitioners, including social workers and other professionals, play a significant role in supporting these transitions, such as hospital discharges to care homes and moves between settings, but often face difficulties in providing effective support. This qualitative study explores the challenges experienced by older people, their carers and social care practitioners during transitions, and examines ways to improve transition-related practice. It involved semi-structured interviews with older people who have experienced or are planning to move (n = 6), family/friend carers (n = 11) and social care practitioners (n = 10). Using inductive data-driven thematic analysis, the study identified four themes: (1) unmet practical and emotional needs for older people and their carers, notably in decision-making; (2) barriers to effective practice, including communication, sourcing funding, and system challenges, such as a fragmented health and social care system; (3) strategies to improve practice, including person-centred strength-focused approaches, better communication and information access, and understanding diverse care settings; and (4) the importance of supporting practitioners. This study emphasizes the need to equip social care practitioners with necessary tools, training, and systemic support to facilitate proactive decision-making, and improve care transitions and outcomes for older people.

Context: Moves between care settings in later life present significant challenges for older people. Social care practitioners play a significant role in supporting these moves, but sometimes lack the skills, confidence and resources to meet the needs of older people and their carers. Objectives: To identify and synthesise unmet move-related needs of older people, the approaches used by social care practitioners, and ways to improve move-related practice. Methods: We searched 7 electronic databases and grey literature from 25 websites, screening 8535 records published between 2010 and 2021. Findings: Thematic synthesis of 39 documents focussed on two themes: (1) challenges and unmet needs of older people and their carers, particularly during the planning, decision-making and moving in stages; and (2) insights from good practice schemes and ways to improve move-related social care practice. These include applying a person-centred approach, involving older people and their carers in planning and decision-making, adopting proactive approaches, exploring alternatives to care homes, promoting effective communication and information sharing, and ensuring continuity of care and cross-sector coordination throughout moves. Limitations: The chosen inclusion criteria resulted in the omission of potentially interesting insights regarding short-term intermediate care and post-move long-term settlement in new settings. Implications: The review highlights the critical need for comprehensive support and guidance during older people’s moves between care settings. It emphasises the importance of practice-oriented information and evidence-based approaches to support older people, their carers, and social care practitioners throughout these transitions.

Extra care housing aims to meet the housing, care and support needs of older people, while maintaining their independence in self-contained accommodation. Evidence from several studies suggests that it has benefits for residents in terms of costs and outcomes, and can provide a supportive environment for people with dementia, although the benefits for residents with greater care needs are less clear. Budgetary pressures and increasing eligibility criteria are altering the balance of care between residents and resulting in more task-focused, less personalised care. An increasing shortfall in provision and incentives for developers to concentrate on ‘lifestyle’ provision raise questions about the long-term viability of the model for supporting local authority-funded residents. Responses to the coronavirus pandemic also raise questions about future housing and care arrangements, and these need to be addressed in the government’s long-delayed plans for social care.

This article reports on a study assessing the incentives and deterrents to long-term care (LTC) supply in two local markets in England. The supply of LTC in many countries is facing the issues of rising demand, (lack of) workforce and the interaction of the public and private sectors. Findings from qualitative interviews of local council and provider stakeholders exploring barriers and enablers faced by LTC providers in two local authorities (LAs) are presented and discussed. The interviews provided insight in three main areas: staffing, demand and stakeholder relationships. Staffing, in particular, is crucial and we found that there are many difficulties for providers in maintaining their workforce. Consistent with previous research, we also found that public spending levels on LTC puts pressure on providers striving to maintain a good quality service, including improved remuneration of staff.

Home modification or adaptation is an important global issue, especially for older people living with disabilities in ordinary housing of varying ages, and pre-dating concerns about accessibility in design. Comparisons of research from five developed nations identify common themes: variation in integrated service development; public and private financial investment; deferred health costs; workforce expansion and training; and the value of the user perspective. Further discussion identifies the importance of retrofitting alongside new build, and argues for sustainable housing that recognizes population aging but also issues of climate change and the need for more inclusive design of housing for all ages.

This special issue focuses on the role of home modification/adaptation1 in supporting older people living in ordinary community-based accommodation, with the aim of providing cross-cultural perspec...

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.

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.

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.

Extra care housing (ECH) has been lauded as an innovative model of housing with care for older people that promotes and supports independent living. The study used a qualitative design to explore how care is delivered in four extra care settings in England over 20 months during 2016-2017. This paper reports findings from semi-structured interviews with 20 care workers and seven managers. The article argues that, despite being heralded as a new model, care workers in ECH face similar organisational pressures as those working in more conventional settings and, in turn, the care which they are able to provide to residents mimics traditional forms of care.