Care home bed availability

Background

Care homes are categorised as either residential or nursing homes. Residential homes are those that provide accommodation and help with personal care, such as washing, dressing and taking medicines. Nursing homes are those where there is always a registered nurse on duty to provide nursing care for people with more complex needs.

There has been an 8% increase in individuals aged 65+ years between 2015/16 and 2021/22. It is estimated that by 2050, around one in four people will be aged 65 and over. Demand for social care services has already risen from 2015/16 to 2021/22, and is forecast to continue to rise to support a population that is both ageing and increasingly susceptible to multiple long-term conditions. Significant elderly residential and nursing capacity will be required to meet increasingly complex care needs, so it is important to understand trends in the availability of care home beds. What’s more, life expectancy of people with learning disabilities has been increasing, as has the total number of older individuals with learning disabilities. This will also contribute to the requirement for specialised care homes suited to meet complex needs.

It is widely thought that people prefer to retain their independence and live at home for as long as possible, with other options for community-based support such as home care or supported living. Avoiding permanent placements in care homes for people with moderate care needs can be a means of delaying the development of more complex care and support needs. Reduced admissions to care homes from hospital can also indicate an improved ability of local health and social care services to work together to ensure people do not experience long hospital stays and are discharged to the right place. However, recent data on delayed discharges from hospitals suggests that a large number of people are waiting for a permanent place in a care home. For more information, refer to our report on publicly funded social care.

Care home bed availability for the elderly

Between 2012 and 2022, the total number of beds in both nursing care homes and residential care homes (together referred to as ‘care homes’) for older people declined from 11.3 per 100 people to 9.4 per 100 people – a 17% decrease. Likewise, the number of nursing home beds per 100 people aged 75 and over fell from 5.2 to 4.6 – a 12% decrease.

The shift in social care policy, changing preferences towards home care rather than residential care, and the development of services like supported living, may explain some of the fall in bed availability. However, there is no reliable data on the number of people receiving care at home, so it is difficult to measure changes in service provision. The decrease in bed availability could also indicate a significant fall in social care provision for older people, which comes at a time of expected growth in demand due to the ageing population.  A downward trend in the registration of new care homes, combined with an upward trend in closures, has resulted in a net reduction in the number of beds available. The fall in the number of nursing home beds is concerning as these provide more complex and specialist care that can usually not be provided elsewhere. Reports have highlighted that recruitment challenges for nursing staff in particular have led some care homes to stop providing nursing care or closing altogether.

Care home admissions 

The overall number of council-supported admissions of adults to care homes (residential and nursing homes) has decreased over time. This could be interpreted as being due to a shift in preference towards community-based social care (such as home care, supported living or extra care settings), but since there is no reliable data on these settings, this cannot be verified. However, there is evidence for why this represents a fall in overall social care provision. Most care home users are publicly funded, and recently published data for this group suggests a 13% decline in individuals over 65 receiving care home support. Fewer people meeting eligibility for publicly funded care could result in fewer admissions to care homes. While self-funding is an alternative, it tends to be unaffordable for most people due to the associated high cost; people who fund their own care pay 40% more than local authorities, on average. Significant challenges with the recruitment and retention of social care staff, in particular registered nurses, have led to reduced capacity and in some cases deregistration for nursing or closure. Over two thirds (66%) of care homes have reported workforce challenges that have negatively impacted their services.

For older adults (aged 65 and over), the rate of admissions to care homes decreased gradually from 659 per 100,000 people in 2014-15 to 584 per 100,000 people in 2019-20, before decreasing more substantially in 2020-21 during the pandemic and recovering slightly to 539 per 100,000 people in 2021-22. This represents an 18% drop in the rate of admissions to care homes between 2014-15 and 2021-22. During the coronavirus (Covid-19) pandemic, concerns have been raised about the financial stability of care homes and the possibility of increased closures. A recent report estimated that care home occupancy fell from a pre-pandemic average of 87% to a low of 79% in June 2020, due to excess deaths in care homes and fewer admissions.

For younger adults, aged 18 to 64, the rate of admissions to care homes has fluctuated over the last seven years between 12.8 per 100,000 people and 14.6 per 100,000 people; in 2021-22 the rate was 13.7 per 100,00 people.