'Achieving closure?' What happens to older people when care homes close?

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham

“The crucial element here is having the time and space to plan and manage closures well, and to work at the pace of individual residents.”  

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Care homes for older people are a crucial service, supporting some 400,000 people across the UK, 24 hours a day and 365 days a year. In an era of public service austerity, however, current care markets seem increasingly fragile, and 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.

The problem is that care isn’t like other markets.  If a care home closes, the people who live there (who may be very frail and/or have dementia) will have to move elsewhere, and the received wisdom is that the potential trauma of this can be extremely detrimental to residents’ health and well-being (possibly even culminating in increased mortality).

Despite this, there is very little formal evidence in the UK or beyond to guide policy makers and local leaders when undertaking such sensitive work, with local services potentially ‘reinventing the wheel’ each time a closure takes place. This is partly because the priority has to be supporting residents and their families (rather than evaluating the closure process), but also because closures can be so controversial locally that it can be difficult to share lessons learned in an open and transparent manner. 

Against this background, researchers at the University of Birmingham’s School of Social Policy have published findings from what is believed to be the largest care home closure programme in the UK.  During the late 2000s, Birmingham City Council sought to modernise its services for older people, closing a number of often dilapidated Council-run care homes and building a series of new ‘special care centres’, buying extra beds from the private sector and developing more housing-based services for older people (such as extra care sheltered housing).  Uniquely, they commissioned the University of Birmingham to evaluate the process and outcomes of these closures, and to publicise findings so that other Councils could learn from Birmingham’s experience.

Contrary to popular opinion, the study found that outcomes for some of the older people who took part often stayed the same, and sometimes even improved, up to a year after the closures – even though the participants were one year older and frailer.  Overall, the research concludes that – where closures are managed well, and where previous services were less than optimal – it may be possible to close care homes and support older people into new services in a way which does not make things worse for people currently using services (and which might even improve thing for some people).  However, the crucial element here is having the time and space to plan and manage closures well, and to work at the pace of individual residents. This means that if future homes close for whatever reason, we need to build in significant time (we would estimate at least 3 to 6 months) for Councils to resettle older people in a way which safeguards their well-being.  

When a high-street shop closes, it has implications for staff and for creditors – but customers can often take their custom elsewhere.  With care homes, we need appropriate safeguards to ensure that care companies can’t exit the market or cease trading without adequate time for Councils to prepare, and for older people to make crucial choices about their future living and care arrangements.  

The findings of the evaluation are available free of charge via: Glasby, J., Allen, K. and Robinson, S. (2018) ‘A game of two halves?’  Understanding the process and outcomes of English care home closures: quantitative and qualitative perspectives, Social Policy and Administration, doi.org/10.1111/spol.12412.

A guide for Councils who are overseeing care home closures has also been commissioned by the Association of Directors of Adult Social Services.

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