The two online participatory workshops were organised as part of the ClimaCare project (www.climacare.org). The project aimed to provide evidence and insights to help strengthen the resilience of care provision to rising temperatures, and enhance our understanding of individual behaviours, organisational capacity and governance to enable the UK's care provision to develop equitable adaptation pathways. The participatory workshops specifically aimed to investigate the causes of overheating in the care sector and to develop appropriate solutions, by obtaining a better understanding of the underlying system structure and identifying effective places to intervene in the system. Both focus group sessions comprised of a multidisciplinary stakeholder platform, involving experts from the built environment, social care, and public health policy. The first workshop addressed the actions currently taken in response to overheating, their ownership and governance, as well as the possible solutions relating to building design and adaptation, and behavioural, operational and social factors. The participants were initially presented with a simple Causal Loop Diagram (CLD), based on preliminary findings from the ClimaCare project, that differentiated between fundamental and symptomatic solutions. Following the joint modification of the initial CLD and the joint search for solutions, an extended structure depicting the complex interactions and mechanisms that drive overheating and climate adaptation emerged. The second workshop built on the first to identify additional cross-domain interconnections, map evidence in relation to the strength of relationships, and prioritise the variables and relationships deemed to have the highest scale of impact.As a result of global climate change, the UK is expected to experience hotter and drier summers, and heatwaves are expected to occur with greater frequency, intensity and duration. In 2003 and 2018, 2,091 and 863 heat-related deaths, respectively, were reported in England alone as a result of heatwaves, meaning future temperature increases could lead to a parallel rise in heat-related mortality. The UK also currently has a rapidly ageing population, with people aged 75 or over expected to account for 13% of the total population by 2035. Older populations are more vulnerable to climate-induced effects as they are more likely to have underlying, chronic health complications, making them more vulnerable to heat stress. The indoor environment is a principle moderator of heat exposure in older populations, who tend to spend the majority of their time indoors. Poor building design, the lack of effective heat management and diverging needs and preferences between staff and residents in care settings may contribute to increased indoor heat exposure with detrimental health impacts falling on the most vulnerable residents. Maladaptation to a warming climate, such as the uptake of air conditioning, could increase fuel bills in care homes, increase operational costs for businesses in the already financially stretched care sector, and increase building carbon emissions, thus undermining government efforts to reduce greenhouse gas emissions. The one-year pilot project 'Climate Resilience of Care Settings' and previous small-scale studies led by our research team have shown that UK care homes are already overheating even under non-extreme summers. A key target for climate adaptation in care settings is to limit such risks by introducing passive cooling strategies via building design. However, preliminary modelling as part of the pilot project also demonstrated that common passive cooling strategies may not adequately mitigate overheating risk in the 2050s and 2080s. Further research into advanced passive cooling strategies, combined with human behaviour and organisational change is required to identify optimum climate adaptation pathways for UK's care provision. The main aim of the project is to quantify climate related heat risks in care settings nationwide and enhance understanding of human behaviour, organisational capacity and governance to enable the UK's care provision to develop equitable adaptation pathways to rising heat stress under climate change. Building on the foundations of the pilot project, this novel, interdisciplinary project will collect, for the first time in the UK, longitudinal temperature and humidity data in a panel of 50 care settings in order to quantify the recurring risk of summertime overheating. We will also identify and assess social, institutional and cultural barriers and opportunities underpinning the governance of adaptation to a warmer climate in care and extra-care homes through surveys with residents, frontline care staff, managers and policy stakeholders.

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