Award Title: 'Achieving closure?’ Improving outcomes when care homes close
Funder: Department of Health and Social Care

Abstract: Care homes for older people are a crucial service, supporting some 400,000 people 24 hours a day/365 days a year. In an era of austerity, care markets are increasingly fragile, and the very logic of a  market  implies that the risk of failure has to be real for there to be sufficient incentives for providers to deliver appropriate care at the right price. When care homes close –whether through financial problems, care failings or other factors – the received wisdom is that subsequent relocation can be detrimental to the well-being of older residents. Despite this, there is little formal evidence to guide services when undertaking such sensitive work, with local areas  reinventing the wheel  each time a closure takes place/failing to share learning externally.  Building on a previous pilot study of care home closures in Birmingham, this study explores what happens to older people and care staff when homes close, how best to manage closures in a way that minimises negative outcomes for older people and families, and key lessons for Councils as they manage future closures. The study asks:  1.What is the pattern of care home closures nationally, how are they undertaken in different Councils and what do Councils consider best practice when supporting older people at such potentially stressful times?  2.How do older people experience closures, what impact does closure have on health and quality of life, and how can negative impacts be reduced?  3.What impact do closures have on care staff and local care markets, and how can negative impacts be reduced?  4.What are the costs and consequences of closures, and key data required to make this estimation? Can we develop a modelling framework to drive appropriate data collection for future home closure prediction to mitigate adverse outcomes?  5.How can future closures be planned and conducted in a more evidence-based manner, so that outcomes for older people are improved and negative impacts reduced?  To answer question the following approaches will be taken:  1.National survey of Directors of Adult Social Services, supplemented by CQC data  2.Four case study sites:    Interviews with key stakeholders (commissioners, managers, Healthwatch, broader health partners)  Interviews with older people, families, care staff and social work assessors during the closure process  Outcomes data (EQ5D, ICECAP-O and outcomes identified in literature on what older people value about care services) at initial assessment, 28-day review and one-year follow-up      3.Survey of care staff (ProQOL) before and after closures, supplemented with individual interviews; interviews with local authorities (commissioners, social workers) and care home providers, supplemented with documentary analysis  4.Preliminary model-based economic evaluation comparing the costs and consequences of alternative pathways of care for residents when homes close (including costs for residents, families, staff and Councils)  5.The study will provide guidance to improve outcomes for older people, supported by key implementation partners, to ensure that future closures are conducted in a more evidence-based manner. This includes a good practice guide for every DASS/CCG/Ambulance Trust in England; an accessible guide for older people/families; and a training video for care staff.

Lay Abstract: We all want to be cared for with dignity when we are older, and we want the same for our families. Being looked after in a care home is expensive, and we have high expectations of the care delivered. But due to increasing pressures, more and more homes are closing. This can affect the wellbeing of people in care homes and the people that work there. Despite this, there is very little research to guide this important process.  If care homes have to close (perhaps because of a financial problem, a problem with the building or due to poor care), we want this to be well managed, so that older people are supported, families are reassured, and care staff are helped to find new work and stay in care roles. While we ve done some initial work in Birmingham, we want to understand more about what happens when care home close and what works best by:    Asking Directors of Adult Social Services to complete a survey, providing information about what is happening across England and how they support older people at such potentially stressful times  Working in four different areas to explore local closure processes, talking to older people, families, care staff and social workers about their experiences and what would improve these  Collecting data on what happens to older people whose homes close to see how their health and wellbeing are affected over time  Exploring what happens to low-paid care staff after closures and the impact this has on the care they give and their financial security/future work  Exploring the cost implications for residents, family members, staff and wider society      Closures can be very upsetting for residents, families and care staff. Because of this, we have built an experienced research team (e.g. our lead is a qualified social worker by background, and has previously been a care assistant). We will also be supported by a  Advisory Board  of experts who understand what it is like to live in a care home, to work in one, to run one and to close one. This includes national charities such as Age UK, as well as local organisations such as Agewell (a group of older people with lived experience of care services). This Board will help to produce the materials we use in the study (e.g. information sheets/interview questions), help us approach areas where homes are closing and ensure our findings have an impact on policy/practice.  We will make a difference by:    Developing good practice guidance to inform future closures, and sending this to health and social care leaders across the country  Producing a free video for care staff who might not otherwise have access to training materials  Producing guidance for older people/families

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: GENERIC HEALTH RELEVANCE