Care homes and estimating the self-funding population, England: 2022 to 2023

• From 1 March 2022 to 28 February 2023, there was a statistically significant 3.1% increase in the number of care home residents (372,035); of these, 37.0% (137,480) were self-funders, which is not a significant change since last year.

• The South East remained the region with the highest proportion of self-funders in care homes (47.5%), which is statistically significantly higher than the North East, which had the lowest proportion of self-funders (26.4%).

• Care homes providing care for older people remained the care homes with the highest proportion of self-funders (48.9%), which was statistically significantly higher than all other care home types; care homes for younger adults remained the lowest (2.0%).

• Smaller care homes, with 1 to 19 beds, remained the care homes with the lowest proportion of self-funders (12.0%), which is statistically significantly lower than all other care home sizes.

• Of care homes with ratings, care homes rated outstanding remained the care homes with the highest proportion of self-funders (50.9%), which was statistically significantly higher than care homes rated inadequate, which remained the lowest (24.0%).

• The coverage of the care home population improved in this release (75.4%) compared with the previous release (68.6%).

We previously developed a new experimental method to understand the size of the self-funding population in care homes in England, as shown in our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology. We have used the same experimental method to produce estimates for the period 1 March 2022 to 28 February 2023 (inclusive). This article contains data from the adult social care provider information returns (PIR) for residential services (care homes with or without nursing), which are collected by the Care Quality Commission (CQC).

The data have been weighted up to an annual estimate for England because of incomplete coverage of the care home population (75.4% after data cleaning); this coverage is an improvement compared with our previous article, Care homes and estimating the self-funding population, England: 2021 to 2022 (68.6%). For our definition of "self-funder" see Section 9: Glossary. We will make comparisons with the previous year of PIR data collection (1 March 2021 to 28 February 2022) where relevant.

Additional breakdowns (lower and upper tier local authorities, rural versus urban areas, Index of Multiple Deprivation, provider size, and nursing care provision) and confidence intervals for all estimates can be found in our accompanying dataset.

There were an estimated 372,035 care home residents from 1 March 2022 to 28 February 2023, a 3.1% increase from last year (360,792), which was statistically significant. Care home occupancy was 80.5% of Care Quality Commission (CQC) registered beds, which is a statistically significant increase from last year (77.8%). The number of CQC registered care home beds (461,958) has decreased since last year (463,765).

Approximately, 137,480 (37.0%) of care home residents were classified as self-funders, compared with approximately 234,555 (63.0%) state-funded residents (Figure 1). This is a 9.2% increase in self-funders from last year (125,954), which was not statistically significant, and the proportion of self-funding residents was also not statistically significantly different from last year (34.9%).

Most care homes (9,016, 59.7%) had a mix of self- and state-funded residents. Most care homes that had at least one self-funded resident had between 20.0% and 29.0% self-funders (1,376, 14.9%) as shown in Figure 2.

Over a third of care homes (5,891, 39.0% of all care homes) had no self-funded residents, but these accounted for just 13.6% of CQC registered care home beds (62,596). In contrast, 1.3% (197) of care homes had all self-funded residents, accounting for 1.6% of care home beds (7,460). For more information about the relationship between care home size and self-funding, see Figure 5 in Section 5: Comparing the proportion of self-funders by care home characteristics.

The South East remained the region with the highest proportion of self-funders (47.5%), and the North East remained the lowest (26.4%), a statistically significant difference (Figure 3). The proportion of self-funders increased in every region compared with last year, but none of these differences were statistically significant and the overall regional pattern remained the same.

The proportion of self-funders in care homes providing care for younger adults was 2.0%, which was statistically significantly lower than all other care home types (Figure 4). Care homes providing care for older people (aged 65 years and over) had a statistically significantly higher proportion of self-funders (48.9%) compared with the proportion of self-funders in all other care home types, the same pattern as last year.

Care homes with 1 to 19 beds had the smallest proportion of self-funders (12.0%; Figure 5). This was statistically significantly lower compared with all other care home sizes. Unlike last year, care homes with 60 or more beds had a statistically significantly higher proportion of self-funders (45.0%) than all other care home sizes. However, the differences between the same categories this year and last year are not statistically significant.

In terms of care homes with ratings, care homes rated outstanding had the highest proportion of self-funders (50.9%), which is statistically significantly higher than all other ratings (Figure 6). Care homes rated inadequate had the lowest proportion of self-funders (24.0%), which was statistically significantly lower than all other ratings, except for requires improvement (30.1%). The proportion of self-funders in the care home decreased as quality rating decreased.

A subset of variables was analysed for only care homes that provide care for older people, individuals with dementia or both, based on care home type rather than age of residents. For more information on care home type, see Section 4 of our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology and for the full breakdown of variables, see our accompanying dataset.

The overall pattern of findings is similar to the whole sample, with the exception of care home size and nursing provision. For care home size, there was a higher proportion of self-funders in smaller care homes (1 to 19 beds) in the older people and dementia sub-sample (33.9%) compared with the whole sample (12.0%). Unlike in the whole sample, this proportion was not statistically significantly different than the 40 to 59 beds category (36.9%).

A subset of variables was analysed for care homes that only provide care for younger adults (aged 18 to 64 years), based on care home type rather than age of residents. For these data, see our accompanying datasets and for more information on care home type, see Section 4 of our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology. Note that for care home size and rating, certain categories were collapsed because of small sample sizes.

Care home resident

An individual who receives care in a place where personal care and accommodation is provided together. In this publication a care home refers to care homes with or without nursing care, however specialist college services are not included in this definition. For more information see Section 4 of our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology.

Self-funded care home residents ("Self-funders")

The provider information return (PIR) defines a self-funder as an individual who pays for their own care privately. They can receive this in a number of ways.

Organised by themselves or through the local authority

• This is where an individual is over the savings or income threshold and therefore organises their care themselves or requests the local authority to arrange the care for them, but the individual still funds the full cost.

Organised by a charity

• Individuals who receive charity funding (for example, in a charity-run care home) are also defined as self-funders if they do not meet the eligibility criteria for state funding.

NHS-funded nursing care

• If an individual is in receipt of NHS-funded nursing care in a care home, they will have an amount paid for by the NHS, deemed to be the cost of the nursing care they receive. However, the rest of the cost could be self-funding, depending on their financial situation, and therefore they have been included in this definition.

• It is important to note that not all individuals in receipt of NHS-funded nursing care will be self-funding, they could also be in receipt of local authority support. NHS-funded nursing care should not be used to directly measure the size of the self-funding population.

State-funded care home resident

The PIR defines a state-funded care home resident as an individual whose care is funded in full or in part by the local authority and/or the NHS. This includes the following.

Paying user charges when funded by local authority

• This is where the local authority has assessed an individual as having care and support needs and the individual has savings or income below the upper savings or income threshold and is funded by a local authority. However, the individual may pay additional costs to the local authority (a user charge).

NHS continuing healthcare

• This is where an individual's needs have primarily been deemed as health-based, as per the decision support tool, and therefore care is fully funded by the NHS (state).

Personal budget

• This is where an individual has been assessed through the local authority as having care and support needs and has savings or income below the threshold, so is given a budget to arrange care themselves, for example through a personal assistant; however, care is still funded through the local authority.

Third-party top up

• This is where an individual has been assessed through the local authority as having care and support needs and has savings or income below the threshold, therefore is state-funded. However, their care may be more expensive than the local authority is willing to pay, so a third party pays an additional cost (this is not categorised as a self-funder, as this cannot be paid for by the individual).

Care home types

Care homes have been categorised into four different groups based on the users that they provide care for. Users are derived by the service user band variables in the Care Quality Commission Care directory, which a care home is required to specify when registering as a provider. For more information, see Derivation of care home type in Section 4 of our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology. The groups are defined as:

• dementia (all ages)

• older person (aged 65 years and over)

• younger adults (aged 18 to 64 years)

• other

A variable that combines the "older people" and "dementia" care home type categories has also been created. This contains an estimate of the proportion of self-funders in care homes that provide care to older people, care homes that provide dementia care, and care homes that provide both. These breakdowns are available in our accompanying dataset.

Statistical significance

The term "significant" refers to statistically significant changes or differences. Significance has been determined using the 95% confidence intervals, where instances of non-overlapping confidence intervals between estimates indicate the difference is unlikely to have arisen from random fluctuation. For more information, see Section 6: Statistical significance in our Uncertainty and how we measure it for our surveys page.

For a full description of our methods, see our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology.

Completion and submission of provider information returns (PIRs) has been mandatory since 1 July 2021. Our analysis includes data from PIRs submitted between 1 March 2022 and 28 February 2023. Care homes were not sent a PIR if they:

• have been registered for fewer than 10 months and have not yet been inspected

• are dormant

Please note up to July 2022, care homes deemed to be under pressure were not sent a PIR. After this, this criterion was no longer applied; however, if a service was under pressure, they could request to delay the submission until a later time, after being invited in their original scheduled month.

There were 13,827 care homes which were sent a link to an online PIR form. Of these, 12,958 care homes responded (93.7%). Care Quality Commission (CQC) removed 853 responses affected by system errors, for a sample of 12,105 (87.5%). There were 12,058 responses from care homes that were still active two months after they submitted the PIR, and therefore could be linked to the CQC Care directory with registered beds, producing a final response rate of 87.2%. After validating, cleaning, and editing the data, the final sample was 11,391 care homes, which is 75.4% of all care homes that were registered with CQC in the relevant time period (15,104 care homes).

Unlike previous years, we did not reassign care homes without a rating in the Care directory (see Care homes without a rating in Section 7 of our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology), following discussions with CQC, as care homes without a rating may still be sent a PIR. Table 1 shows the differences between the distributions in cleaned and all other care homes in the Care directory.

Notes:
1. Percentages may not add to 100% because of rounding.
2. The region variable was derived from the May 2023 National Statistics Postcode Lookup File (NSPL) which is linked to the Care directory.
3. Care home rating, size (number of beds) and types are derived using the Care directory. For more information see our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology.
4. For more information on cleaning and potential bias in the sample, please refer to our Care homes and estimating the self-funding population, England: 2019 to 2020 - methodology.