Softening the blow for residents when a care home closes

Care home closures are “inevitable”, adult social care leaders warned this week. This follows mounting concern over the sustainability of the sector. Just a few days ago councils and charities met for crisis talks on how they would handle a mass exodus of providers from the market. And when care homes close, it has an impact on vulnerable residents and their families.

Greg Jeffreys, from Bedfordshire, has seen first-hand what happens when a care home closes suddenly. His aunt Anne Jeffreys, 88, had been a resident of the Old Village School Nursing Home in Bedfordshire for just over a year when it was forced to close this August after regulator the Care Quality Commission (CQC) found it to be inadequate and unsafe (pdf); the report states: “People were at serious risk of harm.”

The first Jeffreys heard of the closure was when he got a phone call from Merton clinical commissioning group, which arranged his aunt’s care, around two days before the home closed. He was shocked: “Going in on a daily basis I’d seen no indication that there was any particular issue with her care.”

Jeffreys managed to find his aunt a place in another nursing home in Bedfordshire, but on the day of the move itself, he says, there was “no structure, no plan”. Due to a delay getting the magistrate’s order needed to close the home, residents were being moved throughout the evening, with five moved after 10pm on a Friday night. For Jeffreys and his aunt, the move was traumatic, as Miss Jeffreys developed a blocked catheter and was in severe pain. “She was screaming with agony,” says Jeffreys. There was a nurse on site from the local hospital who helped them, but his aunt had to be admitted to hospital for several weeks. “We almost lost her,” says Jeffreys. “She almost died on the spot, and eventually got taken into A&E that night, and spent weeks in hospital recovering from it.” Miss Jeffreys is now in a new nursing home and stable, but the experience has “definitely taken her general condition down from how she was”, Jeffreys says.

In a statement, Merton CCG said: “Patients’ safety and their quality of care are always our top priorities. When the CCG was alerted to the proposed closure of the home following the unannounced CQC inspection, the liaison officer took immediate steps to find suitable alternative care for this patient, working with the family and local health and social care teams and following her individual needs assessment and care plan.”

But one of the main issues with the closure, Jeffreys says, is that several different organisations were involved – the council, different clinical commissioning groups and the CQC – and none took overall responsibility for managing the situation. He says: “There was a meeting for the residents that was arranged … a couple of days later and there was a whole litany of horror stories.”

In a joint statement, Central Bedfordshire council and Bedfordshire clinical commissioning group said: “Once the closure notice was issued, in light of the magistrate’s ruling and the timeframe, health and local authorities present in the home worked collectively to identify alternative placements for the remaining patients based on the views of health professionals regarding their needs.”

When contacted for a comment, Woodgate Healthcare, the provider that ran the Old Village School home, said: “We very much regret what has happened. Our priority throughout the closure process was to ensure the health, wellbeing and safety of the people we support. The decision to close the home by the CQC is currently being appealed, and we cannot comment further at this stage due to ongoing legal proceedings.”

The issue of care homes closing has been around since the community care reforms of the 1990s. As Jon Glasby, head of school of social policy at Birmingham University , says: “Ever since we’ve had a market for care home places, homes have closed and have opened and local authorities have had to try and manage and plan that process as best they can.”

In 2008, Birmingham city council decided to close all its local authority-owned homes in one of the biggest programmes of care home closures undertaken in the UK. As this was a planned series of closures the council arranged for Glasby and other academics to conduct a study of residents’ and family members’ experiences (pdf).

Perhaps contrary to expectations, they found that 77% of those using services (which also included those using day centres) said life had either got better or stayed the same since the move or change. Glasby says the researchers concluded that if care home closures are managed well – “and that’s quite a big if” – residents’ health and wellbeing needn’t be negatively affected, and can even be improved.

The Birmingham findings echo those in another key paper, from Jacquetta Holder and David Jolley in 2012. They looked at the research since 2000 on how moves between nursing homes affected residents’ health, and found: “Ill-planned or casually implemented closures and relocations are stressful and linked to adverse outcomes in terms of symptoms, health and survival.” But, when closures were carefully planned, or when residents moved to higher quality homes, outcomes were better.

Holder and Jolley found that negative impacts of a care home move included increased falls, hospital admissions, and depression as well as deterioration in cognition and behaviour. Death rates varied from nil to nearly 50%, and “the highest rate occurred in relation to a sudden relocation with no preparation”. So there is some evidence of a connection between care home closures and residents’ health – and a suggestion this can be mitigated by proper planning.

In a blog at the time of the Old Village School home closure, Andrea Sutcliffe, chief inspector of adult social care at the CQC, said: “None of us want to put people through this upheaval and disruption – an urgent closure will always be a shock for the residents and their relatives and I understand their angry reactions.”

Speaking this week, she reiterated: “We don’t take these decisions lightly. We are very, very mindful of the impact on people who are using the service, their families and their carers.”

One of the problems, says Sutcliffe, is the CQC is limited in the actions it can take when faced with a failing service. It can either issue a notice of proposal to de-register a service, which can take between four and six months, or, if there is immediate risk to residents, it can seek an urgent closure of the service. This means the CQC applies to the local magistrate’s court to cancel the registration of the service, which takes around 24 hours. Sutcliffe recognises this isn’t ideal, and says: “One of the things I am keen to explore is whether we can come up with an alternative ... and this would have to be a legislative change, which gives us a bit more scope to do something ... over a week, let’s say.”

With more care home closures expected, the challenge for local authorities, CCGs and the CQC is to manage closure in an organised way. The Birmingham research produced advice on important elements of successful closures, such as having a clear strategy, keeping service users together and providing support after the move. For sudden closures based on urgent financial or quality reasons there may not be the luxury of time. But efforts can be made to make the closure as smooth as possible, and to try to avoid situations like Greg Jeffreys and his aunt found themselves in last year.