Geographical and temporal variations in the provision of registered older people long-term care home places in Wales

Accessing the most appropriate forms of care in the right places and at the right time is a primary concern for people receiving care and their families. The residential and nursing care home sector is faced with numerous deep-seated problems, many of which have been exacerbated by the impacts of the COVID-19 pandemic and the recent cost-of-living crisis (Welsh Parliament/Senedd, 2022; Douglass et al, 2023). This situation presents challenges for those charged with commissioning and providing care and support services. At a personal level, this may result in out-of-area placements away from family members and friends where care seekers have been unable to access more specialist health services within their local community. This study adopts spatial analytical approaches to investigate changes in the provision of residential and nursing bed places in relation to potential demand for older adult care homes registered in the period spanning the COVID-19 lockdowns from March 2019 to May 2022.

There is evidence nationally that the overall number of residential and nursing home places is decreasing compared to the size of the elderly population (Bottery and Jefferies, 2022). However, somewhat contradictory evidence presented to the Public Accounts and Public Administration Committee of the Welsh Parliament/Senedd (Welsh Parliament/Senedd, 2022) has pointed to areas of potential over-supply of residential beds in some parts of the country. This has possibly been aggravated by the impacts of the COVID-19 pandemic, which led to a loss of residents of up to 20 per cent in the year to March 2021 (BBC News, 2021). Meanwhile, it has been suggested by such commentators as Butler (2022) that care home closures may have resulted in ‘nursing home deserts’ in some areas.

Given this complex and potentially confusing landscape, a clear understanding of trends in the local demand for services and the extent to which they have been kept in balance with an ever-changing pattern of local provision is an essential prerequisite for informed decision making and the intelligent deployment of limited resources. To date, there have been relatively few attempts to investigate changing patterns of care home provision at a sufficiently granular level of analysis to adequately support care home commissioners and social care providers in this task. In this study, we suggest an approach that can be used to monitor the impact of further changes in care home networks, adopting advanced spatial analytical methods to quantify and benchmark changes in the provision of residential and nursing bed places in relation to potential demand.

Our method of quantifying service accessibility levels uses the so-called ‘two-step floating catchment area analysis’ technique, which compares localized levels of supply to nearby demand, with both being mitigated by distance, to evaluate how effectively care home places are being supplied through ‘local’ or ‘nearby’ establishments. By drawing attention to potential geographical variations in the provision of care home places that includes both the location and size of care homes, these findings can be included as part of the population needs assessments and market stability reports being prepared by local and regional commissioning bodies to plan future care and support services in their areas. From a provider perspective, they can also be used to examine the local market for care home places and to better understand the ‘competition’ arising from alternative types of provision.