Nursing home closures: effects on capacity and reasons for closure.
OBJECTIVE
to identify the rate of closure of nursing homes for older people, the types of homes closing and the reasons for closure.


METHODS
mixed method study including a census and telephone survey of registration and inspection units and interviews with independent providers.


METHODS
81 of 96 health authority and joint registration and inspection unit managers in England completed the census and 39 managers participated in a further telephone survey. Twenty-five independent providers were interviewed.


RESULTS
closures resulted in a net loss of 6% of nursing homes and 4.9% of nursing places during 2000-2001. Smaller homes were more likely to close and were increasingly seen as unviable. The majority of closed homes were reported to have provided good quality care. Shortages of nursing staff were of widespread concern. The dominant combination of factors identified by providers was low fees and concerns about the cost implications of the new care standards. Changes in demand were reflected in the placement of high dependency residents in residential rather than nursing homes.


CONCLUSIONS
in the absence of policy interventions capacity will continue to reduce, with smaller homes most likely to disappear. There is an urgent need to address the supply and efficient use of nursing staff skills in care homes. While fee levels are the primary concern the effect of the proposed care standards was clearly having an effect. Even with subsequent amendment to these standards, unless authorities use capacity funding to raise fees and improve expectations, providers are likely to continue to exit the market.
Netten
Ann
A
Personal Social Services Research Unit, University of Kent at Canterbury, Canterbury, Kent CT2 7NF, UK. A.P.Netten@ukc.ac.uk
Darton
Robin
R
Williams
Jacquetta
J
D000368:Aged; D006271:Health Facility Closure / Q000639:trends*; D006297:Health Services Accessibility; D006302:Health Services Research; D006299:Health Services for the Aged / Q000639:trends; D006707:Homes for the Aged / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D009735:Nursing Homes / Q000191:economics*; D006113:United Kingdom