Exploring variation in the quality of care home services in England: A National cross-sectional study using administrative data
What were we trying to do?
Our aim was to provide a service-specific analysis focussing on care homes providing services to older people with dementia. We wanted to understand whether certain care home characteristics and geographical risk factors significantly predicted care home quality ratings.
We used publicly-available administrative data on care homes that provide services to older people with dementia, registered with the CQC as of January 2020. Distinction was made between care homes that offered nursing services and those that did not.
Why was this important?
In England, almost 4% of people aged 65+ (one in seven aged 85+) live permanently in residential or nursing homes. Demographic projections (from 2017 to 2040) show that England will face an increase of 49% in its 65+ population which will further increase demand for adult social care services.
The CQC inspects and regulates different care services in England which have to meet certain requirements. They conduct regular inspections of registered social care organisations and provide overall quality ratings for each service, along with a focus on five different aspects of care provision.
The CQC’s quality ratings act as a signal for expected care outcomes. However, this information is not always easily available and accessible to consumers.
This study was intended to help understand which care home characteristics determine long-term sustainability in terms of better quality ratings, while also identifying the characteristics associated with a poor rating. This will help local and national commissioners and care service providers develop and design tailored policies aimed at boosting quality ratings.
How did we do it?
We used publicly-available administrative data on care homes to answer the following questions:
- Was there any significant difference in the rating of homes offering nursing services from those which did not? Which quality domains were most affected?
- Was there any significant difference in quality according to the care home ownership types?
- Was there any significant difference according to the size of the care home?
- How did the location of care homes impact their quality ratings?
- How did the length of time a care home had been operating in the market impact on their quality ratings?
- What actions could be promoted to improve care home quality?
Findings
In the paper Effects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study, we aimed to examine whether the financing and organisation of care homes was associated with regulator assessments of quality.
The main findings were:
- All 3 for-profit ownership types had lower overall ratings on average than not-for-profit homes. This was especially the case with independent care homes and private equity chain care homes which were more likely to be rated as ‘requires improvement / inadequate’.
- Independent care homes scored better than private equity chains in the categories of ‘safe’, ‘effective’ and ‘responsive’, but worst in the ‘well-led‘ category.
Who did we work with?
Downloadable resources
- Publication
Patwardhan S, Sutton M, Morciano M. (2022) Effects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study. Age and Ageing.
- Blog
- Bridging the quality gap: How care homes in Greater Manchester stand with respect to the rest of England? (published in November 2023)
More information
Senior Programme Lead