Research into Practice

Jill Manthorpe looks at the implications for
supply and demand of the growth of monopolies in the care home
market.

At local level many social workers may have
noticed the growth of large commercial companies in the residential
and nursing home market. New research¹ shows that a
concentration of long-term care by large companies, some of them
international, is occurring throughout the country. Some of this
process is through merger, some through take-overs. It is taking
place in nursing homes particularly. The concentration of places in
homes run by large companies is accompanied by closure of homes
with small numbers of places that are finding it difficult to
operate profitably for a variety of reasons.

Holden
sets out the context for such changes and notes that although there
may be pressures on the residential sector as a whole it is the
larger companies that are better placed to survive. They may have
greater financial flexibility and can benefit from economies of
scale. In contrast, smaller homes may be finding it difficult to
meet new standards. The closure of some of these homes may lead to
further concentration among larger companies. Holden predicts that
surplus capacity of beds can turn to under-supply quickly. This may
also result in near monopolies in some areas and possibly increased
fees.

In
addition to regulation changes, the drive to concentration of
ownership in long-term care is also being prompted by labour market
factors. Holden identifies the national minimum wage as having an
impact, particularly in the north of England where wages are lower.
The European working time directive has also led to increases in
employment costs and benefits such as holidays.

What
do these changes mean for social workers and service users? First,
increased movement between providers of long-term care may mean a
lack of staff continuity and problems with morale. Both impact on
residents. Their lives can be further disrupted by changes in the
home’s practices and systems. Some homes may not seem worth running
and can close.

Second, there may be increasing
standardisation across homes leading to reduced choices for
residents. Homes run by one company generally have to conform to
its ways of doing things. Staff may have less
flexibility.

Third,
Holden raises the possibility of a decline in quality of care.
Concentration or monopoly provision can mean systems rely on
regulation to ensure standards, but this may be undertaken at a
low-level and thus miss important elements.

The
author concludes by setting out the difficulty of running a social
care market when there seems to be a powerful move to concentration
of providers. A “hands-off” approach may lead to monopolies but
there are problems in managing the market, particularly if
providers are becoming less tied to areas.

In
light of these changes, Woolham’s article² outlining
good practice when a residential home closes may be useful. It
draws together some of the elements which appear to help residents
at this difficult time. Some of the advice is derived from
international sources for there is little research from the UK.
Some of the lessons are drawn from hospital closures
studies.

Nonetheless, the article offers a
series of constructive suggestions for reducing stress among
residents and staff. Preparation is important, if there is time,
and this needs to include talking to residents and staff. Moving to
a new home needs to be handled sensitively; it needs planning and
knowledge of individual residents’ abilities and needs. Residents
and staff may benefit from help during the adjustment
process.

¹C Holden, “British government
policy and the concentration of ownership in long-term care
provision”, Ageing and Society 22 (1),
2002

²JWoolham,”Good practice in the
involuntary relocation of people living in residential care”,
Practice 13 (4), 2002

Jill Manthorpe is reader in
community care at the University of Hull.