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Achieving closure - What happens to older people and staff when care homes close?

Published: 11 March 2021

A care home for older people may close for a number of reasons, with different approaches taken across the country. Prof Jon Glasby writes about how his new programme of research will help to understand the national picture and develop good practice to ensure that closures are managed as well as possible, and potential negative impacts for residents and staff reduced.

Care homes for older people are a crucial service, supporting some 400,000 people 24 hours a day and 365 days a year. Despite this, many care homes close every year, whether through an emergency (such as a fire or flood); councils making strategic choices to develop new service models; the cost of maintaining a dilapidated building becoming unsustainable; a private provider selling up or going bankrupt; or a regulatory intervention following the discovery of poor care.

In an era of austerity, care markets are increasingly fragile. The very logic of a ‘market’ implies that the risk of failure has to be real for there to be sufficient incentives for providers to deliver appropriate care at the right price. While all this was true prior to COVID, the tragic impact of the pandemic may only increase this fragility.

When care homes close, the received wisdom is that relocation can be detrimental to the health and wellbeing of residents – perhaps even contributing to increased mortality. Despite this, there is little formal evidence to guide closure processes, with councils historically having to develop their own approaches bottom up and reinvent the wheel locally. Indeed, closing care homes can be so controversial that the temptation can be to try to carry out closures as quietly as possible, without an opportunity to share lessons learned with others. How to manage care home closures effectively has always seemed to be a real gap in our knowledge.

A local evaluation of care home closures

My team and I at the University of Birmingham have been working on care home closures for a number of years. Initially, we carried out an evaluation of the closure programme in Birmingham, believed to be one of the largest programmes in the country and possibly beyond. Unusually, the council was adamant that this research should be public, so that our findings could be seen by local people and help others.

Contrary to conventional wisdom, we found that if initial services are less than optimal and if the process is designed well, it might be possible to close care homes in a way that doesn’t make things worse for many residents in the short term, and that might even improve outcomes for some people. This was an important finding, with scope to change the nature of the debates we usually have about closures, and to challenge people’s perceptions about these issues.

We then worked with the Association of Directors of Social Services (ADASS) to explore experiences in other local authorities and to create a guide for councils facing future closures. The guide was developed at the time of the closure of Southern Cross – then the largest care home operator in the UK – when there was significant anxiety and apprehension for many older care home residents, so the issues it outlines were very real.

Taking our research nationwide

Although our initial research was relatively small, it was believed to be one of the first studies of its kind, in the UK and internationally. Now, though, we have the opportunity to look at care home closures in more depth via a new national programme of research.

The £1.2 million three-year programme, funded by NIHR Programme Grants for Applied Research, will help us to understand more about what happens when care homes close and what works best. The research will involve:

  • Asking Directors of Adult Social Services to complete a survey about their experiences of care home closures, providing information about what is happening across England and how councils support older people at such potentially stressful times
  • Analysing Care Quality Commission data to understand broader trends across time
  • Working in four different areas to explore local closure processes, talking to older people, families, care staff and social workers about their experiences and what would improve these
    Collecting data on what happens to older people whose homes close, to see how their health and wellbeing are affected over time
  • Exploring what happens to low-paid care staff after closures and the impact this has on the care they give, their financial security and their future work
  • Exploring the cost implications for residents, family members, staff and wider society

We intend to make a difference through this research by developing good practice guidance to inform future closures, sending this to health and social care leaders across the country. We also plan to produce a free video for care staff who might not otherwise have access to training materials, and guidance for older people and their families.

This is believed to be the one of the first social care-related Programme Grants to be commissioned – and the funding awarded will make a significant difference in such a crucial (but often neglected) area of policy and practice.

Jon Glasby, Professor of Health and Social Care and NIHR School for Social Care Research Senior Fellow, University of Birmingham

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