6. Care home beds
There are fewer places in nursing and care homes.
Why is this important?
The number of places1 in care and nursing 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. Support is provided in people’s own homes, in community settings, such as day care and other day services, and in services such as Shared Lives. In addition, the data captures the number of places, but not whether they are occupied or whether the occupancy is permanent or for short-term services such as respite or rehabilitation.
What was the annual change in 2019/20?
The overall number of places increased very slightly between 1 April 2019 and 1 April 2020, though this comprised a small increase in the number of nursing home places from 221,000 to 223,000 and a small decrease in care home places from 235,000 to 234,000.
What is the long-term trend?
Over the past decade, there has been slight fall in the total number of residential care places. The trend is more obvious when population size is taken into account. In 2012, there were 11.3 care home places and 5.2 nursing home places for every 100 people over the age of 75,2 but by 2020 this had fallen to 9.6 and 4.7 respectively. However, there is a great deal of regional variation with the West Midlands seeing an increase in nursing home places of more than 10 per cent but Yorkshire and the Humber seeing a fall of nearly 10 per cent. Similarly, London has seen a fall of more than 16 per cent in care home places, while the East Midlands has seen an increase of more than 6 per cent.
The number of care and nursing homes has fallen more quickly than the number of places in them because older, smaller homes are closing and larger, purpose-built ones are being opened.
What explains this?
An overall fall in the number of people using residential care would be consistent with the broad policy direction of supporting people in their own homes, rather than in residential care. Office of National Statistics data suggests that the percentage of adult social care expenditure on residential and nursing care has fallen from 45.3 per cent in 1996/97 to 32.3 per cent in 2018/19 (though the fall has largely levelled off since 2014/15). The growth in Disabled Facilities Grants and NHS England’s Home First approach to discharge from hospital are examples of this policy direction.
However, it is not clear that social care support for people in their own homes has increased as this policy would require. In 2019/20, 574,000 people were receiving community-based long-term support (outside prisons) compared to 597,000 in 2015/16. And while the number of Care Quality Commission (CQC)-registered domiciliary care agencies has increased from 7,400 in 2013 to more than 10,000 in 2020, it’s not necessarily an indicator of an increase in the number of people using home care: we don’t know how many people they support.
Finally, while the number of people entering care homes fell between 2014/15 and 2018/19 – as you’d expect with a policy encouraging care at home – the trend has slowed and in 2019/20 it reversed. The reasons for this are not clear: it could relate to pressure to empty hospital beds, cost (care homes may be cheaper than very intensive domiciliary care packages) or increased acuity of older people needing care.
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 would be no surprise if more homes are being built in areas with higher numbers of self-funders.
What is likely to be the impact of Covid-19?
The chief executive of the CQC, Ian Trenholme, told the Public Accounts Committee in April 2021 that care home closures had slowed during 2020 and the first quarter of 2021, with the result that there were around 1,000 more beds in the market than might otherwise have been expected. Government financial support during Covid-19 is likely to have been a key factor in this.
Longer term, it is possible that Covid-19 will decrease demand for residential care, which might speed up a decline in places. In the early stages of Covid-19, when there was wide reporting of the deaths in care homes, admissions to larger providers covered by the CQC’s market oversight scheme fell by 28 per cent for council-funded clients and 65 per cent for self-funders. This, and the high rate of residents’ deaths, saw occupancy levels fall to around 80 per cent (down from 90 per cent).
While occupancy rates may have recovered to some extent, it seems likely that some self-funders and local authority commissioners will give greater consideration to home care, live-in care and extra care housing as alternatives to residential care. Lower occupancy will also put further financial pressure on struggling care homes. The National Audit Office found that Covid-19 could have short- to medium-term consequences for the market’s financial sustainability. Some homes may have to adjust their layouts and design to cope better with infection, particularly as most UK care homes were built before 2000.
However, while few people may aspire to live in a care home, many people in practice need to. Care homes have therefore – despite a poor, if largely undeserved, public image – remained a key element of the social care landscape and are likely to remain so for the foreseeable future.
- 1. We use the term ‘place’ rather than the overly medical term ‘bed’. Both terms, as used here, mean the total number of people that could be accommodated at one time if occupancy was 100 per cent.
- 2. Though care homes are also used by working-age adults, the Competition and Markets Authority estimated that 95 per cent of places are for older people.