Background When care homes close, it can be detrimental to older people’s well-being. However, there is little formal evidence to guide services when undertaking such important work. Objectives This study explores what happens when homes close, how best to minimise negative outcomes for older people and families, and key lessons for councils as they manage future closures. Methods Background literature review, national survey of Director(s) of Adult Social Services and analysis of national Care Quality Commission data. Interviews with older people, families, care staff, social workers and broader managers/partners in four case study sites, together with outcomes data (EQ-5D, ICEpop CAPability measure for Older people and outcomes from the literature on what older people value about care services) at initial assessment, 28 days’ review and 1 year. Survey of care staff (Professional Quality of Life survey) before and after closures, supplemented with individual interviews; interviews with commissioners and service providers. Preliminary model-based economic evaluation comparing the costs and consequences of care home closures. Distillation of key messages into a national policy guide, an accessible guide for older people/families and a guide/free training video for care staff. Findings People assume that a care home is a home for life – but this is sadly not always the case. Care homes can close for all kinds of reasons (e.g. to do with funding, buildings, care quality, etc., but also due to broader factors beyond the control of the care sector). There can be significant differences between emergency closures (which can be especially traumatic) and more planned closures (when at least in principle there is more time to work at the pace of individual residents). Local policies vary significantly, and there may be scope for a more evidence-informed, consistent approach. Closures can be extremely difficult for everyone involved – and should perhaps only ever be a last resort. Closures are particularly traumatic for residents, who are losing their home and valued relationships. For some people, this may be similar to a bereavement. The needs of care staff – in terms of meaningful information, emotional and financial well-being and employment support – are often overlooked. This leaves people unsupported and might also reduce their ability to support others. Councils seeking to shape local care markets often lack the levers to be able to do this effectively. Care home closures can create financial pressures on the public sector, costing around £1500 per resident, while families and staff may face varying expenses, such as top-up fees and travel costs. Unplanned and emergency closures are slightly more expensive, and result in poorer outcomes for residents. We have limited long-term data, but it may sometimes be possible to manage closures in a way that minimises negative outcomes for some (especially if existing services were less than optimal and where closures are well planned). Limitations Collecting data from older people, families and staff during care home closures, and in a challenging policy context, is complex, and the amount of data it is possible to collect in such circumstances is inevitably limited in a number of ways. In reflecting on this, we nonetheless draw attention to: The novel nature of the research, filling key gaps in knowledge around such a significant topic. The diverse and multifaceted perspectives which only a programme of research could hope to include. The importance of our policy and practice materials, given the significance of the issues at stake and the lack of previous evidence on which to draw. Conclusions Care home closures can happen for many different reasons, and are always a logical possibility in a ‘care market’, which seeks to use choice and competition to keep costs down and promote quality. This study has identified a series of practical lessons and experiences shared by participants which might help others in future – made available to different audiences via a series of policy, practice and training materials. However, none of this should, in any way, minimise the distress experienced by residents, which can be very significant and may well be long lasting. Moving beyond the specific focus of this research, insights from interviews with local commissioners and providers may have broader implications for the extent to which local authorities have sufficient powers and practical tools to be able to deliver on their ‘market shaping’ responsibilities under the Care Act. Future research on care home closures could usefully focus on: The needs/experiences of people who may have additional or specific needs that might otherwise be overlooked, such as people living with dementia and people from minority ethnic communities or different faith groups. The knock-on effect that care home closures may have on partner agencies. More effective ways of managing emergency closures, and how best to support people after the closure with the trauma they may have experienced. Larger sample sizes might also generate additional insights around individual outcomes and around the implications of particular resident/staff characteristics or types of closure – but this may need to be balanced against the difficulty of conducting such research and the cost to funders of even larger studies. Study registration This study is registered as IRAS project ID: 297258. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: NIHR201585) and is published in full in Programme Grants for Applied Research ; Vol. 14, No. 2. See the NIHR Funding and Awards website for further award information.
Glasby et al. (Thu,) studied this question.