This study aims to explore how architects perceive their role in designing Extra Care Housing (ECH) environments in the UK, focusing on the impact of architectural design on the quality of life (QoL) for older residents.
Background
ECH represents a housing model for older adults that emphasizes independence, community integration, and access to care services. While existing literature examines ECH from healthcare and policy perspectives, little is known about how architects approach its design. This study addresses that gap by investigating architects’ perspectives on designing ECH to enhance residents’ autonomy, safety, and social inclusion.
Methods
Semi-structured interviews were conducted with 12 architects across seven UK locations who specialize in ECH projects. Data were analyzed using thematic analysis, supported by qualitative software tools (Atlas.ti and NVivo), applying a primarily deductive coding approach based on six QoL domains. Code concurrence was assessed through cross-tabulations to explore interconnections between sub-themes.
Results
Findings reveal three overarching themes—Sense of Community, Health and Safety, and Choice and Control—each encompassing subthemes that illustrate how design supports autonomy, social interaction, and spatial orientation. Additionally, the study identifies a cross-cutting theme, Mobility, Sensory, and Cognitive Stimulation, as a critical yet often overlooked dimension in ECH design. Participants also highlighted persistent challenges, including regulatory constraints and limited financial resources.
Conclusions
Architects view ECH design as a balance between promoting independence and accommodating care needs. Their insights underline the importance of community-connected design, flexible spaces, and unobtrusive safety features. These findings inform future ECH practices and underscore the need for interdisciplinary collaboration in housing design for older adults.
AbramssonM.AnderssonE. (2015). Changing preferences with ageing – housing choices and housing plans of older people. Theory and Society, 33(2), 217–241. https://doi.org/10.1080/14036096.2015.1104385
2.
AgreeE. M.FreedmanV. A.SenguptaM. (2004). Factors influencing the use of mobility technology in community-based long-term care. Journal of Aging and Health, 16, 267–307. https://doi.org/10.1177/0898264303262623
3.
AntonC. E.LawrenceC. (2014). Home is where the heart is: The effect of place of residence on place attachment and community participation. Journal of Environmental Psychology, 40, 451–461. https://doi.org/10.1016/J.JENVP.2014.10.007
4.
AtkinsonT. J.OatleyR.EvansS. (2023). Advantages and challenges of extra care housing in the UK for people living with dementia: a scoping review. Housing, Care and Support, 26, 84–102.
5.
BarnesS.TorringtonJ.DartonR.HolderJ.LewisA.McKeeK.NettenA.OrrellA. (2012). Does the design of extra-care housing meet the needs of the residents? A focus group study. Ageing and Society, 32(7), 1193–1214. https://doi.org/10.1017/S0144686X11000791
6.
BarnettD. W.BarnettA.NathanA.Van CauwenbergJ.CerinE. (2017). Built environmental correlates of older adults’ total physical activity and walking: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1). https://doi.org/10.1186/s12966-017-0558-z
7.
Berglund-SnodgrassL.NordC. (2019). The continuation of dwelling: Safety as a situated effect of multi-actor interactions within extra-care housing in Sweden. Journal of Housing for the Elderly, 33(2), 173–188. https://doi.org/10.1080/02763893.2018.1534181
8.
BraunV.ClarkV. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
9.
BraunV.ClarkV. (2021). Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Counselling and Psychotherapy Research, 21, 37–47.
10.
BruggencateT. T.LuijkxK. G.SturmJ. (2018). Social needs of older people: A systematic literature review. Ageing and Society, 38(9), 1745–1770. https://doi.org/10.1017/S0144686X17000150
11.
BrymanA. (2016). Social research methods. Oxford University Press.
12.
BurtonE.SheehanB. (2010). Care-home environments and well-being: Identifying the design features that most affect older residents. Journal of Architectural and Planning Research, 27(3), 237–256.
13.
CameronA.JohnsonE. K.EvansS. (2020). Older people's perspectives on living in integrated housing and care settings: The case of extra care housing. Journal of Integrated Care, 28(3), 281–290.
14.
CarnemollaP.BridgeC. (2014). The potential of a home modification strategy-A universal design approach to existing housing. Assistive Technology Research Series, 35, 259–268. https://doi.org/10.3233/978-1-61499-403-9-259
15.
CarnemollaP.BridgeC. (2019). Housing design and community care: How home modifications reduce care needs of older people and people with disability. International Journal of Environmental Research and Public Health, 16(11), 1951. https://doi.org/10.3390/ijerph16111951
16.
CroucherK.HicksL.BevanM.SersonD. (2007). Comparative evaluation of models of housing with care for later life. Joseph Rowntree Foundation.
17.
CurrinM. L.ComansT. A.HeathcoteK.HainesT. P. (2012). Staying safe at home. Home environmental audit recommendations and uptake in an older population at high risk of falling. Australasian Journal on Ageing, 31(2), 90–95. https://doi.org/10.1111/j.1741-6612.2011.00545.x
18.
Evans, S. C., Atkinson, T., Cameron, A., Johnson, E. K., Smith, R., Darton, R., Porteus, J., & Lloyd, L. (2020). Can extra care housing support the changing needs of older people living with dementia? Dementia (London, England), 19(5), 1492–1508. https://doi.org/10.1177/1471301218801743
19.
FuschP. I.NessL. R. (2015). Are we there yet? Data saturation in qualitative research. The Qualitative Report, 20(9), 1408–1416. https://nsuworks.nova.edu/tqr/vol20/iss9/3
20.
GuestG.BunceA.JohnsonL. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82. https://doi.org/10.1177/1525822X05279903
21.
HousingLIN. (2020). Factsheet 6: Design principles for extra care housing. The Housing Learning and Improvement Network.
JungS.UttleyL.HuangJ. (2022). Housing with care for older people: A scoping review using the CASP assessment tool to inform optimal design. HERD: Health Environments Research & Design Journal, 15(4), 299–322. https://doi.org/10.1177/19375867221113359
24.
KallioH.PietiläA. M.JohnsonM.KangasniemiM. (2016). Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965.
25.
KharichaK.IliffeS.ManthorpeJ.Chew-GrahamC. A.CattanM.GoodmanC.Kirby-BarrM.WhitehouseJ. H.WaltersK. (2017). What do older people experiencing loneliness think about primary care or community based interventions to reduce loneliness? A qualitative study in England. Health and Social Care in the Community, 25(6), 1733–1742. https://doi.org/10.1111/hsc.12438
KingstonA.RobinsonL.BoothH.KnappM.JaggerC. (2018). Projections of multi-morbidity in the older population in England to 2035: Estimates from the population ageing and care simulation (PACSim) model. Age and Ageing, 47, 374–380. https://doi.org/10.1093/ageing/afx201
28.
LewisA.TorringtonJ.BarnesS.DartonR.HolderJ.McKeeK.NettenA.OrrellA. (2010). EVOLVE: A tool for evaluating the design of older people’s housing. Housing, Care and Support, 13(3), 36–41. https://doi.org/10.5042/hcs.2010.0709
29.
LindahlL.AnderssonM.PaulssonJ. (2018). Perceived safety in extra-care housing for senior residents. Journal of Housing for the Elderly, 32(1), 58–72. https://doi.org/10.1080/02763893.2017.1393487
30.
MarquardtG.JohnstonD.BlackB. S.MorrisonA.RosenblatA.LyketsosC. G.SamusQ. M. (2011). A descriptive study of home modifications for people with dementia and barriers to implementation. Journal of Housing For the Elderly, 25(3), 258–273. https://doi.org/10.1080/02763893.2011.595612
31.
MatlabiH.ParkerS. G.McKeeK. (2011). The contribution of home-based technology to older people's quality of life in extra care housing. BMC geriatrics, 11, 1–9. https://doi.org/10.1186/1471-2318-11-68
32.
NordinS.ElfM.McKeeK.WijkH. (2015). Assessing the physical environment of older people’s residential care facilities: Development of the Swedish version of the Sheffield care environment assessment matrix (S-SCEAM). BMC Geriatrics, 15(1), 1–11. https://doi.org/10.1186/1471-2318-15-3
33.
NordinS.McKeeK.WallinderM.von KochL.WijkH.ElfM. (2017a). The physical environment, activity and interaction in residential care facilities for older people: A comparative case study. Scandinavian Journal of Caring Sciences, 31(4), 727–738. https://doi.org/10.1111/scs.12391
34.
NordinS.McKeeK.WijkH.ElfM. (2017b). Exploring environmental variation in residential care facilities for older people. Health Environments Research and Design Journal, 10(2), 49–65. https://doi.org/10.1177/1937586716648703
OrrellA.McKeeK.TorringtonJ.BarnesS.DartonR.NettenA.LewisA. (2013). The relationship between building design and residents’ quality of life in extra care housing schemes. Health and Place, 21, 52–64. https://doi.org/10.1016/j.healthplace.2012.12.004
37.
ParkerC.BarnesS.MckeeK.MorganK.TorringtonJ.TregenzaP. (2004). Quality of life and building design in residential and nursing homes for older people. Ageing and Society, 24(6), 941–962. https://doi.org/10.1017/S0144686X04002387
38.
PizziM.ChalmersJ.BunoutD.OsorioP.FernándezV.CusatoM.AvendañoV.RiveraK. (2013). Physical barriers and risks in basic activities of daily living performance evaluation in state housing for older people in Chile. Housing, Care and Support, 16(1), 23–31. https://doi.org/10.1108/14608791311310519
39.
RodiekS. D.FriedJ. T. (2005). Access to the outdoors: Using photographic comparison to assess preferences of assisted living residents. Landscape and Urban Planning, 73(2–3), 184–199. https://doi.org/10.1016/j.landurbplan.2004.11.006
40.
ShinJ. H. (2018). Listen to the elders: Design guidelines for affordable multifamily housing for the elderly based on their experiences. Journal of Housing for the Elderly, 32(2), 211–240. https://doi.org/10.1080/02763893.2018.1431585
41.
SixsmithA.SixsmithJ. (2008). Ageing in place in the United Kingdom. Ageing International, 32(3), 219–235.
42.
TangM.WangD.GuerrienA. (2020). A systematic review and meta-analysis on basic psychological need satisfaction, motivation, and well-being in later life: Contributions of self-determination theory. PsyCh Journal, 9(1), 5–33. https://doi.org/10.1002/PCHJ.293
43.
van HoofJ.JanssenM. L.HeesakkersC. M. C.van KersbergenW.SeverijnsL. E. J.WillemsL. A. G.MarstonH. R.JanssenB. M.NieboerM. E. (2016). The importance of personal possessions for the development of a sense of home of nursing home residents. Journal of Aging and Environment, 30(1), 35–51. https://doi.org/10.1080/02763893.2015.1129381
44.
Van SteenwinkelI.Dierckx de CasterléB.HeylighenA. (2017). How architectural design affords experiences of freedom in residential care for older people. Journal of Aging Studies, 41, 84–92. https://doi.org/10.1016/j.jaging.2017.05.001
45.
VickeryJ. (2024). A role for Cultural Rights in local decision making.
46.
WilesJ. L.LeibingA.GubermanN.ReeveJ.AllenR. E. S. (2012). The meaning of “Aging in Place” to older people. The Gerontologist, 52(3), 357–366. https://doi.org/10.1093/GERONT/GNR098
47.
WillisP.BeachB.PowellJ.VickeryA.CameronA.SmithR. (2023). There isn't anybody else like me around here”: The insider-outsider status of LGBT residents in housing with care schemes for older people. Frontiers in Sociology, 8.
