In the 2021 census there were over 278,000 people aged 65 years and over living in care homes in England and Wales. Older people living in Care Homes may well have significant needs and many will be living with dementia. Despite this a number of care homes close every year, sometimes at short notice and often causing significant distress to residents and to everyone involved. When an older person moves into a care home as a permanent residence it's their home and they assume it's going to be for life. For many people that's the case but for some people a home will have to close.
Care homes close for all kinds of different reasons. Perhaps because the owner thinks it's time to retire or because there's a problem with the home and the regulator says it's absolutely got to close, or because there's a change of plan with that home or a whole chain of homes. There are some care homes who close for regulatory reasons and sometimes as well they close because it's difficult to get staff, or indeed they might have to make some capital improvements to comply with things like the new regulations on, for example, Net Zero and sometimes that's just not possible for a care home to do so. There are a range of reasons, up until now there's been very little research to guide people when they're making decisions and designing and carrying out closure processes.
We carried out a study in Birmingham a number of years ago which was a pilot for the present research and was one of the first studies of its kind to look at closures in that degree of detail, and to focus on the experience of older people families and care staff. Thanks to support from the National Institute for Health and Care Research we're really fortunate to have been able to carry out a national study now that looks at these issues in much greater detail across a range of different areas of the country. Trends in care home closures over time, the experience of directors of social services during closures, the experience of older people, families, care staff and social workers, outcomes for older people and for care staff, the economics of care home closures and so on.
We've turned that up into a national guide for policy makers, decision makers and practitioners with 10 top tips based on the experiences of older people, families and staff. In our case study sites - all of whom have been in homes that were closing - and we're making that available through the guide, through additional guides for older people and families, and for care staff, to help anyone involved reflect on the process but perhaps particularly frontline staff and decision makers, to reflect on their practice and to find ways to try and make a difference to older people and families and reduce the levels of distress that can be caused.
It might have been too distressing to film people while their home was closing but we wanted to make sure that their experiences were centre stage. The film therefore includes older people who have helped to advise and shape the overall study, reading quotes from people and families who took part.
Tip one: closures are inherently distressing.
It has affected me emotionally. I had two days of crying for no reason, I couldn't have told you why and it's just one of those things. I woke up this morning and I'm there saying to myself, what do I do? I've got to start all over again it's like there were two people a day leaving the care home their homes were taken and everything and it feels strange suddenly seeing them not sat in their seat. But that's just the way it is.
Closures are inherently distressing, they're distressing for older people and families, for care staff and for everybody involved. The older people who've taken part in our research were really angry, really upset, really anxious for the future. I really don't want it to close at all it's my home, I've lived here for eight years and it's the only home I've got. I've just been happy here with my friends, I think they're lovely and I shall miss them.
A care home closure has an enormous impact on an older person. It's like you're losing your home and the community that you've got used to and people that you love, and so it has to be dealt with great sensitivity so that you can make a good transition to whatever is coming next. You know if you think about moving home being one of the most stressful things you can do imagine that if you're facing that stress and you might be very frail and might have cognitive impairment, you've probably gone into that care home thinking that this is the place you will spend the rest of your life and suddenly that's not going to be possible.
There's people here now that are getting ready to go that have no idea what it's all about. They're in their 90s. I can say what I feel but a lot of them can't and I think that's a sad, a very sad thing. I can't say anything more I'm very upset I'm very sad. I just thought a miracle would happen and it would carry on.
Obviously it's your home, it's where you live. You lose that feeling of choice, that feeling of control. Families can often be quite frustrated because they spent a lot of time finding what they think or where they think is the best place for their loved one or relative to live. We just looked around the lounge and everybody just looked in complete shock as to what had happened and what we'd all been faced with. There were various emotions of shock upset and people who were very very angry. My mum is 80 but some of the other residents were over 100, so having to move at that time of your life is not nice, particularly when they've been told, oh, the care home is closing you're going to have to move in the next 6 weeks.
That's very real, isn't it? Now the rest of our top tips hopefully give you things that you can be thinking about to try and reduce that distress or support people through it, but it doesn't take away from the fact that this is inherently distressing for everybody.
Tip two: care workers matter too.
We've seen in this country how important it is for care workers to feel comfortable in their role, to feel supported in their role and have a real sense of well-being in their role, and so it's really important in this project that we've been able to recognise and highlight not only how important and valuable that work is, but also it's important that when there are care home closures that they're supported throughout the whole process.
For the people who work in care homes, obviously as a group of people they've probably made friendships, they've made bonds. They've made bonds with the residents and with each other, and again they may not be in a situation where they all move together to a new environment, so there's uncertainty. They're wonderful and I'm sorry for them they need a job.
One of the things that you find in care services is that staff have relationships with the people they support, they get to know them and they're very precious to them and then suddenly those relationships are changing, so it has an impact on staff; and staff also might have the thought about what they will do for their next career move and how will they earn a living if this particular job is no longer there.
So our research has looked at the experiences of care workers involved in closures we think really for the first time in a meaningful way and it's really important that we pay attention to the health and the well-being of care workers, the training and the future opportunities that people will have to move and hopefully to stay in a care role in future. And just as an aside we also suspect that that might have an added advantage, that care workers matter because they matter full stop, but also supporting care workers is a good way of supporting older people in terms of making sure that there's that reassurance and consistent information available, that people will often get word of mouth from somebody they like, somebody they trust, somebody they know well, so for many reasons carers matter too.
Tip three: time matters.
I think initially we were absolutely shocked. It just seemed to come out of nowhere. The staff that worked at the care home had no idea it was coming, it blindsided us all really. We were just in complete shock.
When a home closes time really, really matters we found in this project and when we've been talking with older people and their families and also care home staff that the timing of care home closure is really important. It could be in an emergency and you don't have very much time available and so some of the other top tips might come into play in helping you afterwards, but with a more planned closure, or if you have a little bit of notice, anything that you can do to eek out time to more fully work at the pace of the individual, and to help people plan and come to terms and work through the implications of what's happening will make a difference.
Having said that time was quite a complex issue in our study. Some people wanted to know as soon as there were problems in case there was a future closure, other people didn't want to know until there was definitely going to be a closure. So these things are highly, highly individual and it just reinforces the importance of working at the pace of the individual.
For families they want to have time to really think about the options open to them and make the right choices, not just for the person they love and they care for, but also for them as a family. They don't want, for example, their family member to be living in a care home that's a long way for them, or where there are complicated transport links. But for care home staff they need time to make decisions, to process the changes that are happening, but also plan their next career move or what's going to happen to them as a consequence of the care home closing.
Tip four: however much you're trying to communicate it's never enough.
I'm a bit unsettled because I don't really know for certain where I'm moving, I know where I might be going but I haven't heard that I've really got it. I'm a bit anxious really.
It's really important for people living in care homes and for their families to have information in a way that's accessible to them as often as possible. I've spent £275,000 in the first care home and they hadn't even got the courtesy to let me know there was a problem so that's very distressing. It would have been nice to have known if there was a problem and what might possibly happen but there was none of that.
You can't communicate enough in these situations, even if there's nothing new to say, people appreciate knowing that there's nothing new and having an update. Putting that time and effort in to really communicate with people early and clearly is time that's incredibly well spent, because the more comfortable people feel at the start of a process the more they're able to manage things throughout the process as it progresses.
The social worker was wonderful throughout, really supportive a really good communicator and any updates that she had she would communicate them to myself and I would distribute that information to my sisters. The staff here have been marvellous with us, they've tried to reassure us, tried to help us in any way they could. People have appreciated communication that's available in different formats, whether it's spoken or written or with pictures. They've appreciate information that's consistent and from people that they they know and trust - but communication really, really matters.
Tip five: people value having as much choice and control as possible.
I was booked to go to a care home and I went to see it and when I saw it I said no I'm going to miss my family here. We don't want to go but we have no choice. We were just told it was closing and that was the end of it. I'd do anything for it not to close if we had the right to change our minds all of us would still be here none of us would be going.
I'm not sure we actually discussed with my mother whether she'd like to go to that care home because basically she said she didn't. Every time you would try and have discussion with her she didn't want to move, so in a sense we made the decision for her.
One of the things that is the most distressing thing that you can have happen to you in your life is to be feeling that you're powerless. When a care home closes a lot of things have happened that have been beyond their control, so it's really important that when we're working with older people throughout a home closure we give them as much information as possible to empower them to make the choices that are right for them. It might be visiting a series of new homes before you move, it could be trying to stay together with friends from or staff from the current home it might be having a say about the decor or the type of bedroom that you have anything that gives you extra control over a process where you may initially have had very little control can only be a good thing.
Tip six: focus on the basics.
I think more specialist help and assistance will be very useful, for example I asked is there a list of care homes at a certain price level and nobody could supply me with one, which I thought was ridiculous. If somebody's got a list like that they should make it public.
It felt very much like it was just a numbers game of we've got to move this many people to other places. You couldn't really offer blame or fault to them as individuals, I think it's the system, it doesn't seem to have any compassion for the situation.
When a care home closes there's lots of things that an individual worker can't influence. What we can do is be responsible for the things that are within our control and often it's what's described as the basics that really matter. Communicating sensitively and regularly and well, showing empathy and providing reassurance and focusing on practical things that can make a difference to families or to older people.
Providing information, helping people know where to go for advice, being clear about some of the practicalities involved, those kind of things really make a difference to people. From our experience we'd say just deal with people like they are people. It's bringing it back to what's important to the older person and they should be absolutely at the centre of anything, any discussions that are made about Care Home closures.
Tip seven: pay detailed attention to people's individual needs.
They made sure that her room at the new home was the same layout and that everything looked very similar to the room she'd been in. So there was a lot of care and consideration to make it comfortable and as smooth and pleasant for my mum as possible.
Always pay detailed attention to people's needs. These are individuals, these are human beings, they're moving home. It's really important to understand what that means for them. We're all of us different and it's important that we're supported in ways that work for us but some people might find closures even more distressing or difficult. Maybe if you have dementia, if you have a form of sensory impairment, if you don't speak English as a first language, if you don't have family support available to you. Locally the system needs to treat us as individuals and pay attention to any additional needs that we might have.
Tip eight: don't exploit families and make sure that people don't lose out if they don't have family nearby.
I just spent hours and hours on the phone trying to make some headway with it all I sat at the desk just trying trying desperately to get mum somewhere that she'd be happy and content and cared for.
When a person chooses a care home it's a really personal decision, but quite often there are lots of people involved in that decision making. So it may be the older person themselves but then also their family members, their sons their daughters, other relatives. So when a care home closure takes place and somebody has to choose where else to live, it's really important to involve those same people in that same decision-making process.
My brother's disabled so a lot of it falls on to me, and I still have my own business. I was selfishly thinking not so much about how it's going to affect my mum but how am I going to manage to sort it all out. I'm not close to where my mother's care home is and neither is my brother, we're both about hour and a half away.
We shouldn't exploit those family relationships, take it for granted or make those families do it because there isn't any other form of support available to them. It has to be an active choice that people and families make. Equally we need to be really alive to the fact that lots of people age without children or may not have local family support available to them and they shouldn't lose out because of their circumstances.
Tip nine: the little things make a difference.
Sometimes when big changes happen it's really easy to focus on the bigger things to make things go smoothly, make sure all the transitions are in place, are as good as they can be and it's easy to lose sight of the small things, but it's the small things that matter most. You need to let the people who are living in the care service and their families define what's important to them. That may seem little to us but it's important to them.
I'm going to go and dig my tree up. We bought a tree for the queen and we think the gardens are going to get bulldozed. I'm going to take my tree with me. Mom's things went missing like clothes and personal items.
The little things matter but they're not little things at all. They're the things that help you feel at home where you are now and that will really make a difference to wherever you're going next. So it's things like: what do you like for breakfast? How many bed clothes do you like? Is there something you need special help with? It's very important that that information travels with you because it'll help you to settle much more quickly wherever else you're going and it'll really help the staff do the best possible job to make you feel at home.
Tip 10: it might get worse before it gets better but it can sometimes get better.
I feel better now that I've got a place it's not having another place to go to that's the worry.
Nobody likes change and change is difficult for everybody and I think it's important to recognise and acknowledge that initially when that change takes place it's not going to be easy. We have to remember that for some people things will get worse before it gets better and we need to be honest about that because it is disruptive to move and the uncertainty can cause distress, but we should also remind people that often the move is for good reasons, so we're going to a better environment, it's better quality and hopefully there's a better quality of life at the end of it.
In our pilot study which was a planned closure and an attempt to improve local services, the outcomes for older people stayed about the same for the first month or so after the closure, and a year later things are either the same for people or for some people they had actually improved even though everyone was a year older and a year more frail when we came back to see them again.
Now we've got very limited data from our current study it's very difficult to tell but it does seem that if existing services were less than optimal to start off with and if you manage the process well there might be scope to keep things about the same for people in the medium term and maybe even to improve outcomes for some people in the longer term.
Although mum was confused for a little while on the whole she does seem to be in a better place, so I'm just glad and relieved that it's all worked out for the best.
In terms of next steps we have the study itself and the report that we produced, but more important than that is the policy guide which will go to every social care leader in the country with these ten top tips based on the experience of older people, families and staff. We have this video to help people reflect on the process and think about their own approaches and their own practice, we'll be producing particular guidance for older people and families with some of our partners and for care staff who are often neglected in these issues and are overlooked, and then we have a series of policy and practice partners who've helped to badge this video and our guides, who are working on our advisory board to share what we've learned from the research with their networks and with their members so that the research can have as much of an impact as possible.
We haven't had research like this before so the sector really welcomes it and directors of adult social care across the country I'm sure will be very, very interested in what it has to say, but also what the research does is it gives us some really good firsthand personal lived experience and some accounts which I think would very much chime with our own understanding. When there's a future closure it must feel like you're losing all control if you're an older person but the guide that's been produced as part of the research does give you some pointers to what you can do and, of course, if you've got a family or you've got friends things that they can do to get you the best possible outcome.
Well I think the guides from this process are going to be absolutely invaluable because they will be built on the experience of people who've been through this process. They will have identified what works and then they'll have a clear decision tree and a way of focusing the process so that you know exactly what you're doing, how you're communicating with residents, families and staff about the closure and these guides will help you have a step-by-step approach and it will be based on what's worked best in the past.
For further information, to get a copy of any of the guides or to download electronic versions, please see the links and contact details shown here.
