2025/05/01 by Anders Bach‐Mortensen, Benjamin Goodair, Michelle Degli Esposti +1 · 1 voice
Health Professions · Social Sciences · #Geriatric Care and Nursing Homes #Healthcare innovation and challenges #Intergenerational Family Dynamics and Caregiving
paper · doi:10.1093/ageing/afaf100
openalex publication_date 2025/05/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/23
BACKGROUND: Adult social care in England operates in a two-tier system of self-funded and state-funded residents. It is unclear, however, whether resident funding source impacts care home quality. METHODS: We conducted a nationwide retrospective observational analysis of care homes in England (n = 28 239 Provider Information Return entries for 14 444 care homes, representing ~367 653 residents), 2021-23, to examine the relationship between resident funding (self- or state-funded) and care home quality (inspection ratings by the industry regulator). We linked data from the Care Quality Commission's Provider Information Return to inspection ratings, area deprivation, and care home and resident characteristics. We modelled a series of logistic regressions, incorporating interaction terms to investigate the interrelationships between ownership (for-profit, third sector, public) and area deprivation. FINDINGS: Care homes with more self-funded residents were more likely to have better inspection ratings [odds ratio for each percentage of self-funded residents: 1.01, 95% confidence interval (CI) 1.008-1.012, P < .001]. The effect of self-funded residents on care quality was largest amongst for-profit homes and not statistically significant for third sector and public homes. For homes without self-funders, third sector and public providers were 14.0 (95% CI: 10.1-17.8, P < .001) and 6.9 (95% CI: 4.1-9.7, P < .001) percentage points more likely to be rated higher than for-profit homes. CONCLUSIONS: The quality of for-profit care homes is strongly influenced by the proportion of self-funded residents, whilst third and public sector homes provide consistent care regardless of resident funding source. This strongly impacts care equity for residents nationwide, as the concentration of self-funders is largely determined by area wealth.