The Cost Implications of the Changing Population and Characteristics of Care Homes

The Government’s Performance Assessment Framework and Best Value regime (2,3) emphasise the importance of reducing costs, increasing the downward pressure on prices being paid by local authorities for care home places. At the same time, there are pressures to increase the standards of care provided. Under the Care Standards Bill, a National Care Standards Commission will be established to apply a common set of standards to residential and nursing homes. If homes are going to maintain an adequate standard of care they must be able to meet their costs from fee income. It is important, in the evaluation of both the use of performance indicators and the claims of home managers, to have an understanding of the range of factors affecting costs of care and the degree to which these change over time.

The analyses presented in this paper are based on data for homes collected in a national survey of residential care and nursing homes for elderly people conducted in 21 local authorities in England in the autumn of 1996. Small homes, those with fewer than four places, were not included. The survey was commissioned by the Department of Health, and the fieldwork was undertaken by Research Services Limited (now IPSOS-RSL). Information about the home was collected in a personal interview with the home manager, who was then asked to complete a questionnaire about individual residents. Information was obtained for 673 (82 per cent) of the selected homes. Full information for homes principally catering for people over 65 was obtained for 617 homes (75 per cent). Within the homes, information was collected about a sample of residents, accounting for 11,900 residents from a total of 20,200 individuals. For the descriptive analyses, the data have been weighted to ensure representativeness and to adjust for varying selection probabilities and response rates.

The survey was designed to be comparable with a survey conducted in 1986 (5). The 1986 survey included private and voluntary residential and nursing homes for elderly people and for the principal younger client groups, although over 90 per cent of nursing homes included elderly people in their clientele.

The main measures of resident dependency used in the analyses of prices for this paper were the Barthel Index of Activities of Daily Living (4) and the MDS Cognitive Performance Scale (CPS) (11). Scores on the Barthel Index range from zero (highest level of dependency) to 20, and scores on the MDS CPS range from zero (intact) to six (very severe impairment). Although these could not be derived for the previous survey, other measures could be derived for both surveys, including the Index of Activities of Daily Living (8). A single question on mental confusion was included in the previous surveys, and the scores on the MDS CPS have been grouped into three categories to enable an approximate comparison.