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Social care 360: providers

6. Care home places

The total number of care home places has declined slightly 

Since 2012 there has been a consistent fall in the number of nursing and residential home places in England compared to the size of the older population

Why is this indicator important? 
The number of places1 in residential and nursing homes (collectively called ‘care homes’) is an important measure of social care capacity and usage. However, it is only a partial measure because social care support is far wider than care homes: much care is provided at home, for example, but there is no publicly available measures of home care capacity. In addition, the data captures the number of places, but not whether they are occupied, and occupancy levels have fallen in the wake of the Covid-19 pandemic.  
What was the annual change? 
There was a fall in the number of residential and nursing home places during 2021/22, down by 1,785 and 589 places respectively. However, the older population also fell so the number of places per 100 people over 75 in the population remained steady at 9.4.  

What is the longer-term trend? 
Over the past decade, there has been slight fall in the total number of care home places, made up of a 15,000 decline in residential home places, offset by a 9,000 increase in nursing home places.  

The trend is more obvious when population size is taken into account. In 2012, there were 6.1 residential home places and 5.2 nursing home places for every 100 people aged over 75, but by 2022 this had fallen to 4.8 and 4.6 respectively.   

However, there is a great deal of variation within regions and between sectors, with the South East seeing a 12 per cent increase in overall nursing home places since 2013, the East of England 11 per cent and the West Midlands a 10 per cent increase but Yorkshire and the Humber seeing a fall of 12 per cent. Similarly, London has seen a fall of 19 per cent in residential home places and the South West 11 per cent, while the East Midlands has seen a 9 per cent increase.    

Between 2013 and 2022, the number of nursing home places has risen substantially in some regions and fallen substantially in others
Between 2013 and 2022, almost all regions saw a fall in the number of residential home places

What explains this? 
Any explanation is hampered by a lack of data about people who fund their own care home places; most of this section is based on available data about people who are publicly funded. 

An overall fall in the number of people using care homes is consistent with the broad policy direction of supporting people at home. It is also consistent with a people’s frequently stated preference to remain independent in their own homes.  
Covid-19 may have accelerated this trend because the high number of deaths in care homes, and the limitations on visiting, meant some people were reluctant to move to or use care homes

In 2019/20, 584 per 100,000 population had their publicly funded long-term care needs met by admission to a care home but in 2020/21 – at the peak of the Covid-19 crisis – that fell by 15 per cent  to 498 per 100,000 population. In 2021/22, this had increased to 538.5. 
However, it is not clear that long-term social care support for people in their own homes has increased as this policy would intend. In 2021/22, 574,000 people were receiving publicly funded community-based long-term support (outside prisons) compared to 597,000 in 2015/16.   
The shift away from residential care to nursing care might suggest that those people who do enter care homes have higher needs. However, the growth in nursing care is surprising given that the number of registered nurses working in social care fell sharply from 51,000 in 2012/13 to 32,000 in 2021/22.  
The regional variation in care and nursing home places is at least in part explained by the market for care. Self-funders of care typically pay around 40 per cent more for their places than council-funded residents so it is no surprise that there are more care homes places in areas with higher numbers of self-funders
What has happened in 2022/23? 
In December 2021, the government announced that £1.4 billion would be available to local authorities over three years to reduce or eliminate the self-funder subsidy through introduction of a ‘fair price of care’. Elements of these reforms began to be implemented in 2022/23, though wider charging reforms were postponed until October 2025.