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The role of care homes in end of life care

Briefing 1 - Care home bed provision and potential end of life care need in people aged 75 or older in England

This is the first of two briefings produced by the National End of Life Care Intelligence Network to describe the actual and potential role of care homes in provision of end of life care for people aged 75 years or over.

Care homes are becoming an increasingly important place for end of life care (EoLC) as the population ages because the weeks, months, and sometimes years before death are marked, for many, by physical and mental decline, frailty and increasing need for support and care. It is also recognised that for many people the acute hospital setting may not be the best place to provide end of life care.

In 2015, 493,498 people died in England of whom 111,738 (23%) died in a care home. The number of deaths in care homes has increased from 87,751 (20%) in 2011. Care homes are a major provider of end of life care.

105,099 permanent care home residents (all ages) died in 2015, 71% (74,634) of these died in a care home and 29% (30,465) died elsewhere, predominantly in hospital.

One third of people who died in care homes normally lived in their own home but were transferred to a care home, often via an acute admission to hospital, for their final care. In this briefing they are referred to as temporary residents.

Adding together deaths in care homes with permanent residents who die elsewhere, there are at least 142,203 people (29% of all deaths) in 2015 who were cared for in a care home shortly before death. This underestimates the end of life care role of care homes as there are temporary residents of care homes who died in hospital and are not included in this total.

This briefing focuses on people aged 75 or older because the majority of all deaths (69% in 2015) occur in this age group. The vast majority of people who die in a care home 102,953 (92%) were aged 75 or older. Of all those aged 75 or older at death 30% died in a care home and 38% have been cared for in a care home before death.

This briefing describes the variation in potential need for care home places and in particular for end of life care across England by Clinical Commissioning Groups (CCGs) and explores variation in capacity. It also highlights changes in care home bed capacity over recent years.