Every year many care homes close for a variety of financial, regulatory, political and practical reasons and this affects hundreds, even thousands of older people. In the current context and following a difficult decade for adult social care that began with the implementation of austerity measures and ended with the COVID-19 pandemic, there are fears that many homes might be ill equipped to survive the current cost-of-living crisis.
With more closures likely to occur, many different stakeholders in adult social care will be faced with the difficult questions of what happens when a care home closes? What constitutes best practice? What will the impacts be on older people and care staff?
Despite the growing significance of the topic, and the considerable importance of care homes in the English adult social care context (nearly 400,000 older people live in care homes), social research focusing on care home closures is limited. To date, such research has proven methodologically challenging and extremely sensitive (not least because of possible harm to older people, associated litigation and news media interest). As a result, closure processes are not currently grounded in a robust evidence base.
From the limited research that does exist, we do know that care home closures do not necessarily result in negative outcomes for older people – despite the received wisdom suggesting that they are likely to be disruptive and possibly harmful. Indeed, one study showed that closure and relocation can improve the health and wellbeing of residents if existing services were less than optimal and if closure is managed well. We also know the importance of effective communication during the closure process and the need to work at the pace of individual older people. However, there remain many gaps in our knowledge. Further research is required on outcomes – both for older people (i.e. mortality, health, wellbeing and social outcomes) and for care staff (in terms of wellbeing and financial/employment outcomes). Furthermore, we have little qualitative evidence about the experiences of the people most affected by closure: namely older people, their families and care staff. The perspectives of people who lead closures are also lacking and thus narratives of managing closures to reduce potential harm and maximise scope for positive outcomes lack depth. Finally, we know little about the economics of care home closures.
Here is where we believe our new research project ‘Achieving Closure’, funded by the National Institute for Health and Care Research (NIHR), is of huge value. We are conducting a study analysing care home closures in sites across England to build knowledge about how to conduct closures in such a way that minimises negative impacts on older people. This project uses a bespoke combination of mixed methods and has several dimensions. First, we are surveying Directors of Adult Social Services in all councils in England to explore experiences of closure, perceptions of outcomes, and strategies for handling legal and media issues. We are also analysing existing local protocols to identify themes relating to development and evaluation, timescales, the stakeholders involved and support for people with particular needs (such as those with dementia).
Furthermore, we are interviewing older people, their families and social workers during the process of closure to piece together how they experience and are affected by closure. Subsequently, older people are being surveyed at three timepoints to examine the impacts of closure on health and quality of life. The impacts of closure on care staff and care markets are also being examined through a combination of interviews and surveys with care staff before and after closure, supplemented with interviews with commissioners and service providers. The project is, finally, conducting a health economic analysis of the impacts of closure to understand the costs and potential benefits.
Ultimately, the project aims to provide a national good practice guide that will maximise outcomes for older people when care homes close. The project will also disseminate an accessible guide specifically for older people and their families that can be used to support and advise them during the very stressful period of closure and relocation, as well as guidance and training materials that focus expressly on care staff. Above all, we focus on the lived experience of people and staff involved in the closure process and on ways of minimising risks/maximising the potential for improved outcomes. In such a challenging post-pandemic and economic context, these sources of expertise will be crucial in managing future closures as best as possible and provide a fundamental part of any future solution.
Tom Douglass is Research Fellow on the ‘Achieving Closure’ project at the University of Birmingham.
Shazia Zafar is Research Fellow on the ‘Achieving Closure’ project at the University of Birmingham. Shazia is an expert in mixed method studies and works closely with vulnerable persons in research projects that benefit society as a whole.
Jon Glasby trained as a social worker, and is Professor of Health and Social Care at the University of Birmingham. He is the Director of IMPACT, the UK centre for implementing evidence in adult social care.
This project is funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (NIHR201585). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
What happens when care homes close? A review of the literature by Tom Douglass, Shazia Zafar, and Jon Glasby for the International Journal of Care and Caring is available on the Bristol University Press website here.
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