By Rachael Hardbattle, CHS Manager, Midlands and north of England
For the first time, more care home beds are closing than new facilities opening. Two independent reports have cast some statistical light upon overall capacity in the care home sector. They show total bed numbers have fallen by 3,000 in a single year and for every home that opens, two other homes close.
Perhaps the most surprising thing is how little attention both these reports have received across the media. Hospital bed numbers, pressures and occupancy fill the national press on a weekly basis. Yet neither of these two reports on community based beds made more than a ripple in the news cycle.
LaingBuisson’s Care of Older People market report provided an analysis of overall capacity, compiled from care home registrations and closures (October 2014 to March 2015). Their report noted a 3,000 fall in capacity; the first time that there has been a net decrease.
Social care property advisers Healthcare Property Consultants also covered the same issue from a different angle, reporting that for every two care homes that close, only one new home is opened. Their report noted that smaller, independent care homes were more likely to face closure and the new care homes opening are typically larger and run by national chain providers.
The LaingBuisson report notes that in 2014 there were 433,000 older or physically disabled people living in residential care settings, with 487,000 beds available. That means care home occupancy rates of 90 per cent: a five year high that is comparable to occupancy levels in many under-pressure hospitals.
It is important to note that there is huge regional variation, depending on the funding streams for the care home sector in each area. Where most residents are self-funders, care homes are faring fairly well. Where most are state funded, the squeeze is most acutely felt.
At CHS Healthcare, we have a clear vantage point to observe these variations: we run hospital discharge schemes throughout the country, including a large number of services from hospitals in the south-east and north-west of England. Inevitably, in the north-west, where more care homes are heavily dependent upon state funded residents, capacity pressures are very clear.
In Preston, for example, we have been a running hospital discharge support service since 2012, finding care home places for 80 to 90 hospital patients each month. We know the work flows required to enable patients to move into community based care and we have rigorous performance indicators to ensure all steps are taken without delay. However, increasingly, no matter how well we manage the process discharge, the challenge is this: for some patients, the community based beds our patients need are simply not there.
In Preston alone, eight care homes closed during the last 12 months. Additionally, when two homes re-registered, they both changed to residential beds only, with no nursing capacity. A further three homes are currently open but on staged admissions, due to issues raised in CQC inspections. This means they can only accept a smaller number of admissions each week (usually one to three). When there is an immediate suspension, the priority for nursing places within that area goes to people resident in that suspended home (their priority being higher than a person who is in hospital and waiting for a nursing bed).
What this all means is that the staff working in our experienced team in Preston can struggle to find care for patients who have nursing needs, particularly if those needs are complex.
Care homes tell us it is no longer viable for them to admit people with complex nursing needs because local authority funding has not increased and because they struggle to recruit qualified nurses.
Across the country, people with low (residential) needs, self-funders and the minority who are able to pay large top-up fees generally have a good choice of care homes. For those with complex nursing needs, there can be little or no choice: typically, it will take many phone calls, discussions and often involve a delay until a home is willing to accept these patients. Meanwhile, they wait in hospital, even though everyone recognises this is not the best place for them.