Care-home closures in England: causes and implications

Abstract

In the United Kingdom, as in many other developed countries, there is an established market in the provision of long-term care-homes for older people. Implicit in the market mechanism is the assumption that homes will close, but it was not until 1999-2000 that closures of care-homes received widespread public attention. This paper draws on a multi-method study that investigated home closures in England from several perspectives. The rate of home closures rose substantially between 1998 and 2000 and, although sources give different estimates, it subsequently appears to have remained at about five per cent each year. The net result has been a reduction in capacity, particularly in smaller homes. While their emphases differed, both regulators and providers broadly pointed to the same factors behind the closures : the local authorities, the majority purchasers of care-home places, were under pressure to keep fees down, and national policies that raised costs were coming into force or were anticipated, notably the National Minimum Wage and the National Care Standards. Other factors, such as problems in recruiting suitable staff, particularly those with nursing qualifications, also played a role. The government's response, driven primarily by concerns about the effect on delayed discharges from acute hospital beds, was to retreat on the Standards and to increase funding to local authorities. While this has been a helpful step, more needs to be done to prevent good homes closing and to provide incentives that will retain and promote diverse provision.

Exploring the Limits to Local Authority Social Care Commissioning: Competing Pressures, Variable Practices, and Unresponsive Providers

“…Nevertheless, Drake and Davies (2006, p. 185) found some LAs had a strategy of retaining perceived ‘mission critical’ skills in‐house to facilitate new strategic developments such as re‐ablement services. In residential care the switch to the independent sector had largely already occurred but further cost containment was achieved by uprating fees by less than inflation (Laing and Buisson 2011) and by failing to meet the costs of higher minimum care quality standards and minimum employment standards (Forder and Netten 2000; Knapp et al 2001; Darton et al 2003; Netten et al 2005; Angel 2007).…”

‘It ain't what you do it's the way that you do it’: lessons for health care from decommissioning of older people's services

“…This has sometimes been an individual care home, which has experienced a major incident of some sort, or where a local authority is closing its own homes and commissioning alternatives from the independent sector. This is the result of longstanding changes in the care home market following the social security reforms of the mid-1980s and the community care reforms of the early 1990s (Means & Smith 1998, Netten et al 2005, Scourfield 2004, see also annual reports by analysts Laing & Buisson (2010) for a summary of key trends over time). Over time, the care home sector has become increasingly dominated by independent providers, with some local authorities transferring residents from in-house provision and exiting the care home market altogether (Holden 2002).…”

Long‐Term Care and the Housing Market

“…Netten et al . () highlight the effects of the introduction of the National Minimum Wage and National Care Standards as contributory factors to a substantial increase in care home closures in England between 1998 and 2000.…”