Short-notice care home closures

Continuity of care

Providers and commissioners should ensure that the health and the wellbeing of residents in care homes are maintained regardless of threatened or actual closure of their care home and, ideally, wherever possible, by staff who know them.

We're dealing with some very vulnerable people here and they need to know that we're going to look after them well during the whole process - it's scary and unsettling

Care Manager

Where there are safeguarding issues these need to take precedence and locally agreed safeguarding vulnerable adults procedures/policies should be followed.

The content which follows is focused on addressing potential market failure.

• Avoiding closuresOpen

  • The risk of market failure can be reduced through good commissioning policy and practice (see 'Intelligence and information sharing' section).
  • Local authorities (and partners) should take steps to prevent potential home closures occurring by putting in place quality control and monitoring systems.
  • Local authority commissioners can help to maintain continuity of care in a home threatened by market failure in a number of ways, for example by:
    • issuing a new contract to the care home at a different price
    • retaining the existing contract, but providing financial assistance in the form of a grant or a loan
    • seconding council staff to the care home on a temporary basis.
  • There is no automatic right for a local authority to put its own staff into a home; only if this is by agreement or already in the terms of the contract.
    See examples and tips for more information.

• Reducing risk for all residentsOpen

  • If a home closure is unavoidable, the care home managers, local authority and health commissioners must try to manage the pace of the closure in order to reduce the risk to the wellbeing of residents.
  • Local authorities are required to safeguard the needs and welfare of all residents in care homes in their area, regardless of whether they are self or publicly funded and regardless of which local authority has placed them there.
  • Involving existing staff as far as possible under the presenting circumstances will do much to allay anxiety in residents. See examples and tips for more information.

• When closure is unavoidableOpen

  • The closure process needs to be handled sensitively in order to allay anxieties and protect the welfare of residents to ensure that good quality care is continued during the days and weeks of negotiations.
  • Where possible, residents should not be separated from long-term friends and/or staff.
  • Staff should be aware of residents' reactions to change and listen to their fears, wishes and needs throughout the process. In turn, those arranging transfer to new homes should heed the experience of existing staff.
  • Residents should not be promised anything that cannot be delivered.
  • Care home closure should be managed as a multi-agency project so that all organisations offering some level of care or support to residents and staff can work towards the common aim of effecting best outcomes and continuity of care.
  • Key players (regulators, receivers/administrators, commissioners, NHS, residents' representatives, professional associations etc.) must therefore be engaged at the earliest possible stage.
  • Closure processes should be informed by a clear purpose with values and principles that guide how the desired outcomes are to be achieved.
  • Commissioning staff should identify a range of alternative services which are available and can be matched to the needs of the residents being relocated.
  • Good record keeping is important to promote effective communication between staff and organisations, and to enable the transfer of information to the new home.
  • Be clear about who will manage staff and who will be paying salaries and other costs.
  • Support staff in the aftermath of any announcements about the future of the home.  
  • Staff need to be kept informed and advised of their employment rights. See examples and tips for more information.
    

• Reassessment and care plan development (see 'Assessment and choice' section for further information)Open

  Good quality assessment and care planning is essential to ensure that the best interests of each individual resident are met, and that, wherever possible, residents are helped to make as informed a choice as they can over where they will next live.

  • reassessment and care planning must be undertaken with all publicly supported residents who are going to be moved (and must be offered as well to self-funders). 
  • Every resident should have an initial one-to-one meeting with a senior member of the care staff.
  • A key worker should be identified for each resident for the duration of the closure and transfer process.
  • Personal histories, likes and dislikes (e.g. names) should form part of the information transferred.
  • Families and carers should be involved throughout the process or an independent advocate where the person is without a family who can help.
  • Particular attention needs to be paid to more vulnerable residents (e.g. those with dementia or with medical conditions requiring health care interventions and/or equipment). Their individual care plans will need to be more comprehensive. 
  • Where the person's needs are complex, communication with other health professionals, including district nurses and GPs, will be important.
  • Staff should look out for any residents who become withdrawn, depressed or anxious about the move. 
  • Every person should have a list of equipment and medication prepared in advance and then checked so that all items are ready to go with them.
  • Contact details of GPs and relatives should be secured at an early stage.
  • The requirements of the Mental Capacity Act must be fulfilled.
  • Keeping friendship groups together is very important. Awareness of alternative vacancies in other establishments that would accommodate friendships is essential.
  • Care staff should be encouraged to support residents at their new home for an initial settling-in period if possible as this promotes familiarity and continuity of care.
  • People's new care arrangements should be reviewed three weeks, three months and six months after the point of transfer.

  See examples and tips for more information.

• Enable choice and controlOpen

  • While continuity is hugely important, once the closure of one home and the move to another becomes inevitable, residents need to be provided with sufficient information to exercise choice and control over where they will next live and how their support is delivered.
  • Families will require reassurance about continuity of care and this should be the responsibility of the key worker appointed to work with the resident.
  • Commissioners should identify a range of alternative ways of securing individuals' outcomes (including other care home placements, home care packages, higher cost placements, split packages with the NHS, extending direct payments to relatives, family placement schemes or the procurement of 'extra care' capacity).

  See examples and tips for more information.

• Supporting staffOpen

  • The existing staff in a care home have a central role in ensuring continuity of care and it is therefore important to work with and involve them in the closure process.
  • Staff should receive particular support in the immediate aftermath of any announcement. They need to be provided with timely and credible communication which enables them to make sense of what is happening and their options for the future.
  • Be clear about who will manage paying salaries to retained or replacement staff.
  • Managers will need to be aware of the potential for difficulties around equal opportunities when people's futures are under threat.
  • The effect of administration and receivership on staff needs to be considered carefully.

  See examples and tips for more information.

Examples and tips

Examples of what others are doing plus materials they have developed and useful tips.

Continuity of care - examples and tips sections

Tools and checklists

Continuity of care - Tools and checklists section

Key points from policy and research

• It is possible to manage the process of relocation into another care arrangement in ways that are least damaging for the residents involved. Although relocation is undesirable, there is nothing in the research which indicates that increased mortality rates are inevitable (Woolham, 2001).
  
  
• Relocation stress can be avoided in a number of ways (Woolham, 2001), including consultation and discussion to improve people’s sense of autonomy with an emphasis on potentially positive outcomes; allowing plenty of time to choose a new home and opportunities for visits before transfer; collecting relevant and detailed data about individuals and ensuring its transfer with residents; and paying particular attention to support on the day of transfer itself.
  
  
• Good practice should include:
  • placing service users’ needs and wishes at the heart of care plans and consulting properly with service users and their families/carers
  • maintaining continuity of care and relationships with staff wherever possible
  • paying particular attention to the needs of people with cognitive impairments.
  • providing adequate support for care managers (who may experience complex and stressful demands)
  • the importance of training and support to enable care staff to work in different ways in future services.
  (Le Mesurier and Littlechild, 2007)
  
  
• involving staff and securing their organisational commitment can help to maintain standards in the home. A before and after study of hospital employees during a reorganisation involving closures, reduced budgets and a hiring freeze showed that employees with higher levels of organisational commitment were better able to withstand the effects of increased pressure during this period (Begley and Czajka, 1993)
  
  
• Older people need to be allowed ‘voice’ and given as much control over events as possible. They need to be given proper opportunities to articulate their feelings about their situation and make sense of what is happening (Scourfield, 2004).
  
  
• Residents and relatives voice similar good practice elements - adequate notice of closure, consideration of the needs of people with cognitive impairments, impartial advice and information and opportunities to visit the proposed new homes - which are central to delivering continuity of care (Williams and Netten, 2003).
  
  
• There has been extensive concern about the over-use of anti-psychotic medication among care home residents with dementia (Bannerjee, 2009). The inappropriate prescribing of antipsychotic medication can be reduced by person centred approaches focused on an individually tailored care plan and a stimulating social environment (e.g. Fossey et al, 2006), and by a supportive home culture and structures (Testad et al, 2010).

  If a care home is being closed where these measures have been employed, special care is required to ensure that residents do not suffer the unnecessary prescription of anti-psychotic medication in their new care setting.

This is especially important in the context that care home closure has been shown to increase the restlessness of residents (Hallewell et al, 1994).

What the regulator says

In the event of threatened or imminent emergency closure, commissioners should make contact with the Care Quality Commission (CQC) at the earliest opportunity. CQC will provide information under its information-sharing protocols indicating any action which it is taking