‘Achieving closure’ – improving outcomes when care homes close

Care homes for older people are a crucial service, supporting some 400,000 people 24 hours a day/365 days a year. In an era of austerity, care markets are 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. However, when care homes close – whether through financial problems, care failings or other factors – the received wisdom is that subsequent relocation can be detrimental to the well-being of older residents. 

Funder:
National Institute for Health Research (NIHR)

Start date:
1 April 2021 (duration – 3 years)

Principal Investigator: 
Professor Jon Glasby (University of Birmingham)


Despite this, there is little formal evidence to guide services when undertaking such sensitive work, with local areas ‘reinventing the wheel’ each time a closure takes place/failing to share learning externally. Building on a previous pilot in Birmingham (believed to be the largest closure programme in the UK), this study explores what happens to older people and care staff when homes close, how best to manage closures in a way that minimises negative outcomes for older people and families, and key lessons for Councils as they manage future closures.

Aims of the project

In particular, the study asks:

  1. What is the pattern of care home closures nationally, how are they undertaken in different Councils and what do Councils consider to be best practice when supporting older people at such potentially stressful times?
  2. How do older people experience closures, what impact does closure have on health and quality of life, and how can any negative impacts be reduced?
  3. What impact do closures have on care staff and local care markets, and how can negative impacts be reduced?
  4. What are the costs and consequences of closures, and the key data required to make this estimation? Can we develop a modelling framework to drive appropriate data collection for future home closure prediction to mitigate adverse outcomes?
  5. How can future closures be planned and conducted in a more evidence-based manner, so that outcomes for older people are improved and negative impacts reduced?

To answer each question the following approaches will be taken:

  1. National survey of Directors of Adult Social Services, supplemented by CQC data
  2. Four case study sites:
    • Interviews with key stakeholders (commissioners, managers, Healthwatch and broader health partners).
    • Interviews with older people, families, care staff and social work assessors during the closure process.
    • Outcomes data (EQ-5D, ICECAP-O and outcomes identified in the literature on what older people value about care services) at initial assessment, 28-day review and one-year follow up.
  1. Survey of care staff (ProQOL) before and after closures, supplemented with individual interviews; interviews with local authorities (commissioners, provider services, social workers) and care home providers, supplemented with documentary analysis
  2. Preliminary model-based economic evaluation comparing the costs and consequences of alternative pathways of care for residents when homes close (including costs for residents, families, staff and local authorities)
  3. The study will provide clear/accessible guidance to improve outcomes for older people, supported by key implementation partners, to ensure that future closures are conducted in a more evidence-based manner. This includes a good practice guide sent to every DASS/CCG/Ambulance Trust in England; an accessible guide for older people/families; and a free training video for care staff.

Outputs & Impact

In addition to a detailed research report, we will work with our Advisory Board to produce:

  • A National good practice guide sent to every DASS/CCG/Ambulance Trust in England (see Glasby et al 2016 for a worked example from previous emergency admissions research
  • An accessible guide for older people/families disseminated via third sector/service user involvement partners
  • Good practice guidance focused on care staff (developed in conjunction with Care England and disseminated nationally via their networks)
  • A high-profile national launch
  • A free 15-min SCIE Social Care TV video (see a recent example from Glasby et al’s NIHR-funded emergency hospital admissions research)
  • Peer-review articles (such as the British Journal of Social Work and Journal of Social Policy) and academic/professional conference papers (e.g. Social Policy Association, British Geriatrics Society, NHS Confederation, International Association of Gerontology and Geriatrics)

Research Team

Jon Glasby, University of Birmingham
Chief Investigator

Humera Plappert, University of Birmingham
Programme Manager

Shazia Zafar, University of Birmingham
Research Fellow

Ayesha Iqbal, University of Birmingham
Research Fellow

Kerry Allen, University of Birmingham
Workpackage 2 co-lead

Matthew Bennett, University of Sheffield
Expert methodological input

Tom Douglass, University of Birmingham
Research Fellow

Phillip Kinghorn, University of Birmingham
Workpackage 4

Catherine Needham, University of Birmingham
Workpackage 3 co-lead

Tracy Roberts, University of Birmingham
Workpackage 4 co-lead

Magdalena Skrybant, University of Birmingham
PPI lead

Debs Smith
PPI advisor

Denise Tanner, University of Birmingham
Workpackage 2 co-lead

Beck Taylor, University of Birmingham
Workpackage 1 co-lead

Annie Topping, University of Birmingham
Workpackage 3 co-lead

Contact Us

For any enquiries please contact:

Humera Plappert
Programme Manager
School of Social Policy
University of Birmingham
Tel: 07887592558

Email:  h.plappert@bham.ac.uk

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