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Long read

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 places 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 are 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 fell in the wake of the Covid-19 pandemic.

What was the annual change? 

Overall, there was a small fall in the number of care homes places in 2022/23, down from 457,000 to 455,000. This was made up of a small increase in the number of residential home places but a slightly larger fall in the number of nursing home places. Overall, the number of care home places per 100 people aged over 75 in the population fell marginally to 8.8.

What is the longer-term trend? 

Since 2012, there has been a slight fall in the total number of care home places, made up of a 14,000 decline in residential home places, offset by a 6,000 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 2023 this had fallen to 4.6 and 4.3 respectively.

However, there is a great deal of variation within regions and between sectors, with the South East and West Midlands seeing an 11% increase in overall nursing home places since 2013 and the East of England seeing a 9% increase, but Yorkshire and the Humber seeing a fall of 17%. Similarly, London has seen a fall of 19% in residential home places and the South West 11%, while the East Midlands has seen a 9% increase.

Between 2013 and 2023, the number of nursing home places has risen substantially in some regions and fallen substantially in others
Between 2013 and 2023, almost all regions saw a fall in the number of residential home places

The average size of care homes has also increased over time. In 2012 the average residential home had 19 places (beds) but by 2023 this had increased to 22, and the average nursing home had increased from 46 to 52 places.

What explains this? 

An overall fall in the number of people using care homes is consistent with the broad policy direction of supporting people at home (this applies to publicly funded care: we have less knowledge about trends in decisions made by people who pay for their own care). It is also consistent with 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 of the over-65 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% to 498 per 100,000 population. However, in 2022/23, this had increased once again to 561. 
Despite the fall in nursing homes places in 2022/23, the longer-term shift has been away from residential care to nursing care. This 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 33,000 in 2022/23.  
The regional variation in care and nursing home places is explained, at least in part, by the market for care. Self-funders of care typically pay around 40% more for their places than council-funded residents so it is no surprise that there are more care home places in areas with higher numbers of self-funders.