The care home sector is experiencing pressures arising from the fall-out of the COVID-19 pandemic and the impact of Brexit on staff shortages, especially impacting on the registered nursing workforce. This is compounded by longer-term financial pressures and on-going staff recruitment concerns, particularly following the latest proposed changes to immigration policy.
The introduction of a new inspection ratings system for care homes and domiciliary support services in Wales from April 2025 has focused attention on the availability of good quality care services “to help people receive the best possible care”. In the residential care home sector, this system aims to help inform the decisions individuals and families need to make regarding the choice of care home from those available in their locality.
In our paper recently published in the International Journal of Care and Caring, changes in geographical patterns of access to registered residential and nursing bed places in older adult care homes in Wales were highlighted for the period spanning lockdowns, from March 2019 to May 2022. This research suggests that while information on the quality-of-care of such homes will be useful in helping to make informed decisions, ratings need to be considered alongside the degree of choice available in different parts of Wales.
Our research demonstrates that the limited choice available in some regions could result in out-of-area placements some distance away from the family home. This may be compounded where there is a need for advanced nursing care for those with more complex health needs requiring specialist nursing care/dementia care provision.
A recent Market Insight report found that in Wales, between 2020 and 2023, 40 elderly care homes closed and only four new homes opened. The fall-out from ongoing concerns facing the sector, such as increases in the real living wage and the rise in employer national insurance contributions, may lead to a further reduction in existing capacities following potential closures. This could have major implications for spatial patterns of provision forcing residents to look farther afield for placements.
By mapping the locations of care homes and the numbers of beds available at each site, in relation to potential demand, our research has measured the degree of choice available, and the distances needed to travel to access care places. Through an investigation of geographical patterns of access, this has identified those areas of Wales which were most severely impacted by closures, and/or reductions in bed places, in adult care homes during this time period.
The situation in Wales may be even more profound given the nature of a sector that tends to be based on smaller, often family-owned, residential care homes. In such circumstances, while data on the quality of provision will be useful, the overriding concerns for some families may well revolve around the lack of availability in their immediate vicinity, irrespective of quality.
This in turn re-iterates the need for geographical approaches to carefully monitor the current and projected availability of care home places at detailed localised scales, alongside such inspection ratings, as part of an overall package of information resources related to care provision.
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