Health Policy July 24, 2019
UK care homes: Legacy, nostalgia, the future

By Kenneth MacKenzie - Accountable Care Journal

Where were you when…?

Our lives are marked by striking events that remain in our memories. For many of us, April’s Notre Dame fire will be one of those; in this case not for loss of life (thankfully), but instead mourning for a landmark building. People generally love historic buildings, and past generations have left us an impressive legacy of architecture which we often feel nostalgic about.

Older properties, however, are not always great to live in; they can be draughty, may have multiple problems and be totally impractical for modern living.

Care homes are no different. Around 75 per cent of the UK stock was built pre 2000, less than 25 per cent of registered beds have appropriate en-suite (wetroom) facilities and a further 25 per cent have no en-suites at all. Over 50 per cent of elderly care home buildings are dated conversions, less fit for modern care and support, with unsuitable, or often no, en-suites i.e. comprising only a WC and wash hand basin.

Knight Frank’s recent UK Healthcare Development Opportunities research report cited a worryingly long list of sector headwinds, including rising National Living Wage, insufficient funding (publicly funded residents), unfit for purpose buildings and failing care standards as the main reasons for care home closures.

Target Fund Managers recently collated Q1 2019 data for care homes in England which showed a significant 46 homes, with 1502 beds, closed over that period. Earlier this month, Responsible Life revealed that nearly 10,000 care home beds for the elderly have been lost in five years across half of England’s local authorities.

Kenneth MacKenzie

Will anyone feel this loss? Perhaps the sense of loss is less for the building and more for the friendships and familiarity of the surroundings. However, in the wider sector should we be concerned with the loss of this segment of care home stock? Experience tells us most were probably not fit for purpose; incompatible with the dignity and comfort required for their residents.

Those same Q1 statistics also told us that 667 new beds opened, and a further 398 beds were re-registered (reopened), the latter figure being a bit unsettling; let’s hope they have been brought up to a modern standard. The net result is an overall loss of 437 beds, something of a trend recently. The UK does not therefore just have issues with the current quality of care home stock; it is also going to experience a chronic shortage of beds unless development steps up a gear. Wetrooms with all bedrooms are now market standard in new homes, yet, as said, 75 per cent of current rooms do not have these.

The Association of Directors of Adult Social Services (ADASS) in England recently advised that local authorities are reaching financial breaking point. Almost 50 per cent cannot use the Adult Social Care Precept (“ASCP”) to raise extra council tax in 2019/20, in line with the requirement that it should not exceed 6 per cent over three years. Income from the ASCP, two historic one-off government grants and the ‘Better Care Fund’ are therefore tailing off; with the extra £2.3 billion in 2017/18 and £1 billion in 2018/19 reducing to an estimated £0.35 billion in 2019/20.

However, it is not all doom and gloom. A recent freedom of information exercise found occupancy stable around 90 per cent across the UK, while publicly funded fees are rising on average by inflation.

While the sector awaits the Social Care Green Paper, recently delayed for the sixth time, stakeholders throw ideas in the (Green Paper) ring for Westminster to ponder, from the 'Independent Age and Centre for Policy Studies' Think Tank through to Damian Green MP.

Recent headlines include ‘1.2m people being denied care’ and ‘Retiree numbers in the UK overall are currently forecast to grow by 59 per cent by 2030’. Sobering; but, in conclusion, we can predict there will be no lack of future demand for fit-for-purpose care homes, with all bedrooms including a suitable wetroom.

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