Supply and demand

Overall care home market in Staffordshire

• There are 254 care homes with 8,101 beds in Staffordshire (as of May 2022). The numbers of homes and beds has increased in recent years. Since May 2019, there has been a net increase to the care home market of 7 care homes and 462 care home beds.

• Currently (October 2022) occupancy levels for residential homes are 81% and for nursing homes at 84%.

• Care Homes when registering with CQC can detail their specialism of the type of client they support. Table 3 shows how many homes in Staffordshire have a client type specialism within their CQC registration. It is important to note that a care home can be registered for more than one specialism.

Table 3: Staffordshire care homes by client type

Quality

There are 175 residential homes in Staffordshire with the following CQC ratings (April 2022):

• Outstanding: 7
• Good: 113
• Requires improvement: 24
• Inadequate: 2
• The remainder have not yet been inspected.

There are 79 nursing homes in Staffordshire with the following CQC ratings (April 2022):

• Outstanding: 1
• Good: 48
• Requires improvement: 22
• Inadequate: 1
• The remainder have not yet been inspected.

Current admissions and placements funded by social care in Staffordshire

Residential and Nursing care homes

• The Council funds just under 3,000 care home placements at any point of time; just over 1,700 in residential homes and under 1,100 in nursing homes, and around 80% within Staffordshire. The remaining beds in county are commissioned by the NHS, other local authorities, or occupied by self-funders. A breakdown of Council funded placements by client group and location is shown in Table 4.

Table 4: Council funded care home placements (March 2022)

The Countys care home population over the past 12 months for all adults is 612 per 100,000. When looking at those aged 65+ only, Staffordshire’s care home population increases to 1923 per 100,000 people. In comparison, for the West Midlands this figure for their 65+ population is 2097 per 100,000 and for England the rate is 2005 per 100,000.

Residential and nursing care for older people

This section relates to care homes providing the following categories of care: Residential Older People, Residential Older People (with Dementia Care), Nursing Older People or Nursing Older People (with Dementia Care).

• New Council care home placements for older people now seem to be returning to pre-pandemic levels, that were just over 100 placements per month, with just under 100 per month currently.
• It is anticipated that the number of Council placements for older people will rise over the next ten years to 3,900 by 2031
• Supply of care home placements is also rising, with a 5% increase in capacity since September 2020

Accessibility and sufficiency

In nursing and specialist nursing with dementia there is a shortage of staff to meet demand. We expect to see an increasing demand for higher level, complex care (often linked to dementia) in both residential and nursing care homes. The average age of people entering into care homes is 83 – on average, people are increasingly older and frailer when they access care home services.

Whilst there is capacity in the market for nursing home placements, these placements can be difficult to source (across key criteria such as quality, cost effectiveness and timeliness of access) especially in certain areas of the county such as South Staffordshire, Cannock, Lichfield and Tamworth.

Care homes in the county are currently (April 2022) averaging around a 20% vacancy rate.

Residential and nursing care for people with learning disabilities, autism, mental health, physical or sensory impairments

This section relates to care homes providing the following categories of care: Residential care for physical disability/ sensory impairment; residential care for learning disability or autism; residential care for mental health; nursing care for physical disability/sensory impairment, nursing care for learning disability or autism; nursing care for mental health.

Accessibility and sufficiency

Learning disability and autism

It is anticipated that the overall number of people with a disability in Staffordshire will increase by around 1.3% in the next 3 years. The greatest increases are projected to be in those over the age of 55, as people with learning disabilities and/or autism continue to live longer, and also the age groups 0–18 and 25-34. Data suggests that the number of people with a learning disability in receipt of long-term services funded by the Council will remain relatively consistent over the next 10 - 15 years. However, as per national trends, the complexity of need is likely to increase as people live longer with associated health conditions. In response to this, we are currently exploring how to best meet the combined needs of individuals (including for example, those with both dementia and a Learning Disability).

Nursing provision is currently focused around Lichfield, Staffordshire Moorlands and South Staffordshire. Conversely, South Staffordshire, Lichfield and Tamworth have the lowest numbers of residential care homes currently for these groups and East Staffordshire, the greatest concentration.

There are people currently under the age of 18 (mainly in educational residential establishments) who are likely in future to need accommodation and care and support solutions in either residential or community support settings. The number of young people supported to prepare for adulthood is shown to have increased over the last few years as shown in Table 5, this is due to the advent of the ‘preparing for adulthood pathway’ however not all these young people will go on to receive adult social care services. The County Council is currently reviewing its Preparing for Adulthood pathway, further work is needed to understand the proportion of young adults within the preparing for adulthood pathway likely to require long term services.

Table 5: Number of young people ‘preparing for adulthood’

Mental health

There is currently a relatively high usage of residential and nursing care for people with mental health needs – these placements currently make up 78% of the overall mental health placement spend. The availability of step-down supported living care for individuals with a Learning Disability, Autism and/ or mental health condition with challenging behaviour and/or complex needs, including forensic needs is increasing pressure on care home beds currently. This is a gap we are looking to address through the recommissioning of supported living services. It is our aim to work with our key partners and the independent and voluntary sector to rebalance the current service support far more towards recovery focused, short term interventions and an increase in support within people’s local communities. This is likely to reduce the number of residential and nursing care required in the longer term.

There are occasions where the complexity of need of the person requiring a placement means that the number of care homes which could meet the need are relatively few, and the requirement is often time sensitive. A lack of placement offers within the necessary timescale can lead to placements being sourced in an emergency in care homes unnecessarily far from family and friends, which can then lead to a requirement for a second move, or unnecessary and overly restrictive use of one-to-one staffing.

Physical Disability

Just over 42,000 people aged 18-64 in Staffordshire are estimated to have a moderate physical disability and 12,700 a serious physical disability (All Age Disability report, October 2017). Prevalence increases with age for both moderate and serious physical disabilities

It is our aim to support working age individuals with a physical disability to remain living independently for as long as possible whilst maximising the use of technology to support them. The Council aims to explore all other options for a working age individual to remain living independently, before considering a long-term care home placement to manage social care needs. The average Council placement length for a working age physical disability placement is 83 weeks (April 2022).