Care Homes for Older People: FACILITIES, RESIDENTS AND COSTS

Care Homes for Older People VOLUME 1 FACILITIES,RESIDENTS AND COSTS Ann Netten Andrew Bebbington Robin Darton and Julien Forder PSSRU at the University of Kent at Canterbury, the London School of Economics and the University of Manchester Care Homes for Older People Volume 1 Facilities,Residents and Costs Ann Netten Andrew Bebbington Robin Darton and Julien Forder PSSRU at the University of Kent at Canterbury, the London School of Economics and the University of Manchester © 2001 Personal Social Services Research Unit ISBN 1-902671-24-4 First published in 2001 by the Personal Social Services Research Unit,University of Kent at Canterbury. This work received support from the Department of Health.The views expressed in this publication are those of the authors and not necessarily those of the Department of Health or other funders. Printed by the University of Kent at Canterbury Print Unit. C O N T E N T S Contents Preface.............................................................................................................v Acknowledgements.......................................................................................vi 1 The Homes and Their Services .................................................................1 Background..............................................................................................................................................1 Who owned the homes.......................................................................................................................3 The size of homes..................................................................................................................................4 Buildings and facilities............................................................................................................................5 Living arrangements ..............................................................................................................................8 Occupancy rates and turnover ..........................................................................................................8 Admissions and retention policies.....................................................................................................9 Additional services and equipment ................................................................................................10 Activities and services.........................................................................................................................11 Proprietors’ involvement in private homes...................................................................................11 Staffing levels ........................................................................................................................................11 Staff availability and sickness cover..................................................................................................12 Staff qualifications and training ........................................................................................................13 Social climate .......................................................................................................................................14 Conclusion.............................................................................................................................................16 2 The Population in Residential Care ........................................................17 Background ...........................................................................................................................................17 Who pays? ............................................................................................................................................17 Admission and length of stay ...........................................................................................................18 Age and gender ...................................................................................................................................21 Levels of dependency .........................................................................................................................22 Comparisons with previous surveys ..............................................................................................24 Conclusion ...........................................................................................................................................26 3 What Influences Costs and Pricing.........................................................27 Background............................................................................................................................................27 The independent sector:costs and prices.....................................................................................27 Local authority homes:costs.............................................................................................................31 Conclusion.............................................................................................................................................33 iii C O N T E N T S 4Prices and Supply...................................................................................35 Background............................................................................................................................................35 The London problem..........................................................................................................................36 Standard Spending Assessments.......................................................................................................36 Actual variations and the ACA.........................................................................................................38 What causes price variations?...........................................................................................................38 Matching demand to supply...............................................................................................................39 Comparing prices in the private sector.........................................................................................40 Variations in the past...........................................................................................................................41 Labour cost variations........................................................................................................................42 Should care homes be local?.............................................................................................................42 Conclusion.............................................................................................................................................42 5 The Policy Implications............................................................................43 Background............................................................................................................................................43 The impact of the 1990 NHS and Community Care Act..........................................................43 The cost implications of rising dependency levels.......................................................................44 Local authority homes:use and costs ............................................................................................45 Regulating residential and nursing homes......................................................................................46 Self-funding residents..........................................................................................................................47 Equality of access to care...................................................................................................................47 Local authority purchasing policies,strategies and procedures................................................48 Variations in the supply of care .....................................................................................................48 Standards of care..................................................................................................................................49 Conclusion.............................................................................................................................................50 Appendix .......................................................................................................51 Sample selection,response rates and weighting...............................................................................51 References.....................................................................................................55 iv ... - tailieumienphi.vn