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Length of stay in care homes
- Authors:
- FORDER Julien, FERNANDEZ Jose-Luis
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2011
- Pagination:
- 28p.
- Place of publication:
- Canterbury
Care home placements constitute the majority (57%) of net council spending in England on social care for older people. Information about the expected length of stay for people admitted to a care home is important for predicting lifetime costs. This study investigates the length of stay of care home residents by drawing on information about all 11,565 residents that died in Bupa care homes in the period Nov 2008 to May 2010. Residents of the 305 Bupa homes are largely representative of the England average in relation to age, sex and funding source, but Bupa has more people in nursing beds with a higher level of frailty. In the Bupa sample, the average length of stay was 801 days, but with a considerable tail of long-stayers. Half of residents had died by 462 days. Around 27% of people lived for more than 3 years, with the longest stayer living for over 20 years. People had a 55% chance of living for the first year after admission, which increased to nearly 70% for the second year before falling back over subsequent years. Adjusted results estimated to more closely reflect the situation in England are provided. The length of stay information is combined with information about the weekly costs of a care home placement to calculate expected costs of care for people newly admitted to care homes. At £550 per week (before inflation), an 832-day expected stay would cost £65,400.
Explaining the fees gap between funding types in the English care homes market
- Authors:
- ALLAN Stephen, GOUSIA Katerina, FORDER Julien
- Publisher:
- University of Kent. Personal Social Services Research Unit
- Publication year:
- 2017
- Pagination:
- 47
- Place of publication:
- Canterbury
This paper quantitatively assesses the economic reasons behind the difference in prices paid by care home residents in England. It is generally believed that the price paid by private payers is higher than that paid for publicly-supported residents, and this is often attributed to the market power wielded by local authorities as the dominant purchaser in local markets. Using data on local authority expenditure for residential and nursing home care together with overall care home price data for 2008 and 2010, the authors create local authority-level estimates of average self-funded prices. The estimates, based on a number of assumptions, suggest that the average self-funder price for England is in the range of £609-£663 per week, and that the average self-funder price is £170-£196 per week greater than the average price paid by local authorities. The results show that the reasons for this gap in fees is caused by greater market power of both local authorities and care home providers, and that higher care home quality also accounted for some of the difference in fees. The paper also found that the effect of the market power of providers and the local authorities depend on one another. In areas where there are lots of care homes (high competition) the local authority has a much greater impact on the difference in fees, whereas in areas with less competition between care homes the impact of the local authority on the fees gap is reduced. (Edited publisher abstract)
Impact of changes in length of stay on the demand for residential care services in England: estimates from a dynamic microsimulation model
- Authors:
- FERNANDEZ Jose-Luis, FORDER Julien
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2011
- Pagination:
- 13p.
- Place of publication:
- Canterbury
Residential care services constitute the largest component (approximately 60%) of social care expenditure in England. Understanding the level of demand for residential care services in the future, and the associated costs, is paramount to planning for an efficient and equitable social care system. This paper explores the impact of changes in the length of time that individuals spend in residential care once admitted, in order to gauge the impact of likely improvements in the survival of residents in the future. This analysis uses a dynamic microsimulation model to estimates future changes in demand and levels of use of residential care services in England. The central assumptions of the model include a constant age and gender specific prevalence of disability, gains in life expectancy, and real-terms increases in unit costs. Care home unit costs are assumed to start at £550 per week on average and grow by 1.5% until 2016/7 and by 2% thereafter. The implications of length of stay and costs are made in terms of their impact on the projected level of funding required to support future numbers of older people with care needs. The analysis highlights how relatively modest changes in survival in residential care will lead a higher levels of demand and expenditure. It also shows the significant impact of changes in the growth of the weekly person costs of care home services.
The impact of a tightening fiscal situation on social care for older people
- Authors:
- FORDER Julien, FERNANDEZ Jose-Luis
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2010
- Pagination:
- 8p.
- Place of publication:
- Canterbury
The purpose of this paper is to assess the effects of a reduction in funding for care. In the current difficult fiscal climate, a cut in funding for social care seems likely. This paper illustrates the consequences of a reduction in the budget available to fund social care for older people. In particular, it looks at the effects of a 6.7% per annum real terms reduction in the total budget available for social care in the 2 years after 2010/11 (the reduced-budget scenario). It also considers an alternative scenario where funding is assumed to increase sufficiently to allow the current need eligibility thresholds and financial threshold to remain unchanged (the demand-led scenario). The reduced-budget scenario results in net public expenditure falling to around 80% of the level required in the demand-led scenario in 2012/13. The total number of older people that would be state-supported would fall by nearly one half of the level of the demand-led case. The reduction would mostly affect people receiving home care services rather than residential care because they tend to have less severe needs and therefore are more likely to be affected by an increased needs eligibility threshold. Unmet need as measured in the model would nearly double in the reduced budget case.
Securing good care for more people: options for reform
- Authors:
- HUMPHRIES Richard, FORDER Julien, FERNANDEZ Jose-Luis
- Publisher:
- King's Fund
- Publication year:
- 2010
- Pagination:
- 63p., bibliog.
- Place of publication:
- London
The purpose of this report was to: refresh and update The King’s Fund’s 2006 review Securing Good Care for Older People: Taking a long-term view using a dynamic micro-simulation model to provide new estimates of projected costs and benefits; to reflect new policy developments and the implications of political and financial uncertainty; and to assess the funding options set out in the Green Paper Shaping the Future of Care Together and how these compare to the funding options modeled in this report. The report reasserts the case for change. Trends and developments that have occurred since the 2006 review and the different circumstances in which the reform of social care funding and delivery must now be viewed are discussed. The results of a funding analysis are then reported. The analysis was applied to three funding options over the period 2015-2026: the existing system unreformed; free personal care (FPC); and a revised, less generous version of the 2006 review’s partnership model in which the state funds 50% of everyone’s care and support costs and matches every £2 contributed by the individual with a further £1. The analysis indicated that both FPC and the King’s Fund partnership model would help many more people than the existing system but at a higher cost. FPC involves the highest cost to the public purse without a commensurate improvement in outcomes. Attendance allowance is also discussed. The review recommends integrating support for care costs from Attendance Allowance into the care system to improve targeting of resources. The authors make several suggestions for reform to achieve more sustainable funding of care.