The Lancet: An extra 71000 care home places will be needed by 2025 in England as care needs increase, study predicts.
As life expectancy increases, so too have the number of years that older adults spend with substantial care needs, now reaching an average of 3.0 years for women and 2.4 years for men aged over 65 according to a new analysis of care needs in 2011 compared to 1991, published in The Lancet.
While care is increasingly provided in the community placing a significant burden on families, the study warns that at current rates of provision, an additional 71000 care home places will be needed by 2025 in the UK.
The study compares levels of dependency in adults aged 65 years and over in England in 1991 and 2011 – 15000 adults in total. Adults were classed as high dependency if they required 24 hour care, medium dependency if they required care at regular times each day, low dependency if they required care less than daily, or independent .
Between 1991 and 2011, life expectancy increased for both men (from 77.9 to 82.6) and women (from 81.5 to 85.6). Over this time, the proportion of years that an adult aged 65 could expect to live independently declined from 73.6% to 63.5% for men, and from 58.0% to 47.3% for women. By contrast, the proportion of years living with low, medium or high dependency increased.
In 2011, average life expectancy for men aged 65 was 17.6 years. Of this, an average of 11.2 years was spent independent, 4 with low dependency, 1.1 with medium dependency and 1.3 with high dependency. For women, average life expectancy at age 65 was 20.6 years in 2011. Of this, an average of 9.7 years was spent independent, 7.8 with low dependency, 1.1 with medium dependency and 1.9 with high dependency.
For adults aged over 65, the number of years spent with substantial care needs (medium or high dependency) has nearly doubled between 1991 and 2011 – increasing from 1.1 years to 2.4 years for men, and from 1.6 years to 3.0 years for women.
“The past 20 years have seen continued gains in life expectancy, but not all of these years have been healthy years. Our study suggests that older people today are spending more of their remaining life with care needs. Though most of the extra years are spent with low dependency – including help with activities such as washing, shopping or doing household tasks – older men and women are spending around one year more requiring 24h care. This finding, along with the increasing number of older adults with higher rates of illness and disability is contributing the current social care crisis,” says Professor Carol Jagger, lead author from Newcastle University, Newcastle, UK. 
The researchers also analysed whether or not people lived in care homes or the community. They found that older people with substantial care needs were less likely to be living in a care home in 2011 than in 1991. For instance, in 1991, three quarters (73.5%) of adults aged 85 years who required 24h care were living in a care home, compared to about half (51.8%) in 2011.
The authors estimate that if rates of dependency remain constant, there will be an additional 190000 older people with medium dependency, and 163000 with high dependency by 2025 compared to 2015 (reaching 883000 for medium and 813000 for high dependency in 2025). While approximately half of these people will live in the community, at current rates of provision, this means an extra 71215 care home spaces will be needed by 2025.
Additionally, the study projects an increase of 885000 in the number of people with low dependency (generally looked after in the community), reaching 4.44 million by 2025.
“Our study estimates that by 2025, there will be an additional 353000 older people with complex care needs that require sustained input from family carers or community health and social care teams to support independent living. While many of these people will live in the community, at current rates of provision, this will mean a shortfall of over 71000 care home places by 2025.” Professor Jagger adds. 
The authors highlight the burden on family and friends who often provide unpaid care in the community, and warn of the implications for health and social care services of the increase in care needs. They highlight the need for adequately trained professionals to care for older adults with complex needs. Early interventions for people with low dependency, such as structured exercise, rehabilitation or assistive technology, could potentially slow down the decline and ensure fewer years are spent with higher dependency.
The study is the first to analyse the extent to which the current care crisis is due to greater levels of dependency than in previous generations, rather than simply greater numbers of older people. It compared data on cognitive function and ageing in people aged 65 or over from three areas in England (Cambridgeshire, Newcastle and Nottingham). 7635 people were included in the study in 1991 and 7796 in 2011. Levels of dependency were assessed via interviews in their place of residence, i.e., their own home or a care home.
The authors note that there was little ethnic diversity in the two studies and therefore the results may not be generalisable to non-white populations in the UK.
Writing in a linked Comment, Andrew Dilnot, University of Oxford, Oxford, UK, says: “Expenditure on the care of older people will need to increase substantially and quickly. It will be important to ensure that this expenditure is managed efficiently, and in particular that the boundary between health care and social care is well handled. In England, for example, there is substantial difficulty in so-called delayed discharges, where patients remain in (more expensive) hospital care, despite being fit to leave, because it has not been possible to arrange social care for them, which is less expensive and also more appropriate. Although the overall amount of care needed will increase substantially, this increase does not mean that every individual will need large amounts of care. On average, as Kingston and colleagues showed in their study, high dependency will last for only about a year. But for a minority it will last for much longer, and the fear of that is a powerful one.”
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In response to The Lancet, Neil Tester, Deputy Director of Healthwatch England said:
“For those who work in health and care these new figures will not come as a shock, but for everyone else they paint a picture of the stark reality we all now face.
“At Healthwatch we know from what people tell us every day that the care sector is already in a fragile state, and it is clear these daunting challenges aren’t going away. As a country we have some really big questions to face about how we plan and fund care.
“But finding solutions to the lack of space, appropriate care, and the best use of resources, requires far more than simply increasing the number of care home places. To deliver the right sort of care we must listen carefully to people living in care homes right now as well as the rest of us who may need care in the future.
“As our recent report “What’s it like to live in a care home?” published last week highlighted, it is vital that homes value and use people’s feedback to ensure they are helping their residents to live their lives to the fullest.”
Rob Burley, Director of Policy at Alzheimer’s Society said:
“By 2025 there will be more than one million people living with dementia. They are the biggest users of the social care system and need a high level of support as the condition progresses. Yet we hear daily about how the system is unable to meet the needs of people with dementia – from being turned down by a care home, to facing extortionate costs for inadequate care. A social care system that is unable to fully meet the needs of people with dementia also places strain on the wider health system, with things such as delayed discharges from hospitals creating costs for the NHS as well as being detrimental to the health of a person with dementia.
“The Government and sector as a whole must act now to ensure we have future-proof plans to accommodate the enormous rise in demand. A new approach that recognises the needs of people with dementia is desperately needed.”
Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said:
“This analysis reinforces the urgent need to reform adult social care and deliver a long-term sustainable solution.
“While it is great news that life expectancy is increasing, the Lancet study confirms our warnings that this will heap even more pressures on social care and the demand for services, which are already under huge strain.
“While the £2 billion announced in the Spring Budget for social care was a step in the right direction, it is only one-off funding and social care services still face an annual £2.3 billion funding gap by 2020.
“It is absolutely critical that the Government brings forward its consultation for social care announced in the Queen’s Speech, and that it works with local government leaders in delivering a long-term sustainable solution for social care.
“This must address the issue of long-term funding, but it must also create the conditions necessary to ensure the development of the right kind of care and support services, that can meet the demand of an increasing number of adults with care needs.”