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Market insight


The author contacted them for a comment on how they have fared filling the new beds but has had no responses to date in this respect – I imagine it will have been a slow process.


Closures are down, that’s good isn’t it?


In the first quarter closures were up by 2 per cent year on year, but the number of beds lost actually dropped by 19 per cent. Furthermore, from April onwards closures dropped even further by 31 per cent year on year.


That is probably due to homes that may have otherwise closed found themselves committed to continuing as they shielded their vulnerable clients from the outside world, and were hopefully buoyed by whatever got through to them from the £4.3 billion of extra funding the government gave to local authorities to help with public services, of which £600m was ringfenced for social care. The second wave that started in September saw a spike in new Covid-19 cases, albeit with deaths being very much down on the initial crisis and a younger age profile of those testing positive. Yet lockdown restrictions on social gatherings have once again be tightened, and there are still no clear guidelines as to visiting care homes.


All this could well mean that strict shielding within care homes will continue through what will be the harder winter months. Should this be the case, a further tranche of money will be needed to support those homes that would otherwise have to close.


Effect on openings, closures and occupancy levels


Over recent years, I have used the rule of thumb that for every care home that open two have closed. In 2020, it is more like two openings for three closures and, with the new homes being larger, by the end of August we lost 365 beds compared to 1,850 in the same period in 2019. Based on the information available from various sources, I have had a shot at estimating the change in occupancy levels in care homes between April and the end of August (see Table 1). The generally recognised average occupancy levels across residential and nursing homes is around 90 per cent, so 360,000 of the approximate 400,000 care home beds in homes registered for older people are filled.


The CMA Care Homes Market Study 2017 estimated 41 per cent of care home beds were taken up by self-funders, with


the remaining 59 per cent local authority funded. According to the Office for National Statistics, there were around 66,000 deaths in care homes between April and August, including 14,683 attributed to Covid-19.


Therefore, without any re-admissions, the care home population would have dropped below 300,000 - an average 73 per cent occupancy level. According to CQC estimates in June, there has been a reduction in the number of re- admissions to around 35 per cent of last year for self-funders, and 72 per cent of those funded by local authorities. When you multiply these percentages by the Nuffield Trust’s average admissions for every 100,000 population aged 65-plus in 2018/19, we can see that new admissions are much lower than those lost through deaths during the same period. If that is accurate, occupancy levels would be down from 90 per cent in April to 76 per cent at the end of August. That means care homes would be missing the weekly income from around 55,000 residents or a reduction of 15 per cent, which is a massive financial loss of income against already tight, and probably now negative, margins. Knight Frank research published in September stated that they believe occupancy levels have more recently recovered to just above 80 per cent, but still well below the pre-Covid levels. Yet of course this is average. Supply levels and


November 2020 • www.thecarehomeenvironment.com


therefore occupancy levels will vary greatly on a local basis.


Furthermore, there has not been a consistent Covid-19 death rate in all homes, with many not experiencing any deaths - although still tarred with the same brush with regard to new admissions - while other homes will have lost much higher than the average number of residents.


The CQC has declined to report on Covid-19 deaths by home for commercial and confidentiality reasons, although they are quite happy to publicly brandish these same commercial ventures as anything between Outstanding and Inadequate via their inspections.


There is of course a longer-term worry, and that is with regard to future capacity expectations for care homes in England. Should the existing concerns as to the safety of, and accessibility to, loved ones within a care home continue, admission rates will stay low. However, there are somewhere between two- thirds and three-quarters of care home residents who are living with dementia at various levels of dependency. It is difficult to know what other environment could properly manage a person’s dementia once it has reached a certain level of dependency. It could well be that people with earlier stages of dementia, who would previously been moved into a care home, may well be cared for longer in the community, which


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