Changes in the Older Resident Care Home Population between 2001 and 2011

• The care home resident population for those aged 65 and over has remained almost stable since 2001 with an increase of 0.3%, despite growth of 11.0% in the overall population at this age

• Fewer women but more men aged 65 and over, were living as residents of care homes in 2011 compared to 2001; the population of women fell by around 9,000 (-4.2%) while the population of men increased by around 10,000 (15.2%)

• The gender gap in the older resident care home population has, therefore, narrowed since 2001. In 2011 there were around 2.8 women for each man aged 65 and over compared to a ratio of 3.3 women for each man in 2001

• The resident care home population is ageing: in 2011, people aged 85 and over represented 59.2% of the older care home population compared to 56.5% in 2001

As health almost inevitably declines during the later stages of life, one area of particular importance is the provision of care for the elderly. Care can take a number of forms from hospital treatment for acute medical conditions through to residential care homes and unpaid care by relatives and/or friends. The provision of unpaid care has been the focus of a number of ONS census analyses.

This analysis focuses on the changes in the over 65 resident care home population of England and Wales. This age group represents most of the care home population: 82.5% in 2011. Analysis of the characteristics of older people, based on census data, has been the focus of two recent reports:

• What does the census tell us about older people?

• What does the census tell us about the oldest old living in England and Wales?

Improvements in population health, for example, increasing disability-free life expectancy, could contribute to the increasing age of the population in England and Wales. However, the increasing age of the population means that in the future, more people will require some form of care during their lives. It is also important to note, that the level of required care could become more intensive, since the oldest old (those aged 85 and over) are more vulnerable to conditions requiring high levels of support.

Information relating to residents of care homes was captured by the communal establishment questionnaire; census form CE1 in 2011 and 2001. This is an example of the first question from the CE1 questionnaire 1.

Census form CE1 in 2011 and 2001.

This analysis focuses on residents of care homes, excluding staff and their families, combining the categories of care homes with and without nursing in 2011 and ‘Nursing Home’ and ‘Residential Care Home’ in 2001. Because of the differences in terminology used in 2011 Census and 2001 Census, a degree of caution should be applied when drawing conclusions based on direct comparisons of these data.

In 2011, more than a quarter of a million (291,000) people aged 65 and over were living in care homes in England and Wales, representing 3.2% of the total population at this age. This number has remained almost stable since 2001 when 290,000 people were living in care homes, representing a slightly higher proportion, 3.5% of the population aged 65 and over at that time. Increases in the usual resident population of England and Wales have outstripped changes in the resident care home population. At age 65 and over, the resident care home population grew by just 0.3% between 2001 and 2011 compared to an overall increase of 11.0% in the usual resident population; see table 1.

Dividing the age 65 and over group into narrower categories reveals further detail:

• The resident care home population for ages 65 to 74 and 85 years and over both increased by 5.1%: around 1,500 more people aged 65 to 74 and around 8,300 more people aged 85 and over.

• For those aged 75 to 84 there has been a decline in the resident care home population of 9.2%, or around 8,900 fewer residents in 2011 compared to 2001.

Figure 1: Proportions of the resident care home population aged 65 and over by age in England and Wales, 2011

The resident care home population is ageing: in 2011, people aged 85 and over represented 59.2% of the older care home population compared to 56.5% in 2001. Whilst, three in ten (30.3%) were aged 75 to 84 and one in ten (10.5%) aged 65 to 74 in 2011.

Women and men living in care homes, 2001 and 2011

The picture for women, in terms of changes in the resident care home population between 2001 and 2011, contrasts with that of men. For example, the fall in care home residents aged 75 to 84 was driven by a decline of 15.1% for women, while for men there was an increase of 6.3% at this age; see tables 2 and 3.

The number of women residing in care homes aged 65 and over declined by 4.2 per cent to 214 thousand between 2001 and 2011. This is in contrast to an increase of 6.4% of the usual resident population at this age. There was also a decline in the proportions of women living in care homes at ages 65 to 74 (4.5%) and notably at age 75 to 84 (15.1%). For the oldest old, there was a small increase of 1.6% against a backdrop of a 15.8% increase in the population at this age.

For men aged 65 and over there was an overall increase of 15.2% in the resident care home population, close to the overall increase of 17.2% in the total usual resident population. Looking at the different age groups over 65, the picture of change for men living in care homes shows that:

• For ages 65 to 74, the increase in the care home population (17.7%) outstripped the increase in the general population (14.0%).

• For the oldest old the resident care home population increased substantially, by more than a fifth (22.7%), but this represents only half the increase in the usual resident population at this age (45.1%).

The contrasting changes of men and women living in care homes between 2001 and 2011 have resulted in a shift in their relative proportions. In 2001, there were around 3.3 women for each man aged 65 and over living in care homes; in 2011 this ratio fell to 2.8. There were still many more women than men living in care homes, but the gap had narrowed.

Figure 2a: Proportions of women aged 65 and over living in care homes by age in England and Wales, 2011

Source: Census - Office for National Statistics

Notes:

1. Data from 2011 Census, DC4210EWla: Communal establishment management and type by sex by age.
2. The figures may not sum due to rounding.

Figure 2b: Proportions of men aged 65 and over living in care homes by age in England and Wales, 2011

Source: Census - Office for National Statistics

Notes:

1. Data from 2011 Census, DC4210EWla: Communal establishment management and type by sex by age.
2. The figures may not sum due to rounding.

In 2011, more than half (56.3%) of the 65 and over male resident care home population was aged between 65 and 84. For women aged 65 and over, however, almost two-thirds (64.7%) of the resident care home population was 85 or over.

While the usual resident population aged over 65 in England and Wales has grown by 11.0%, the number and proportion of people at this age living in care homes has remained relatively stable at close to 300 thousand people; 3.5% of the total usual resident population in 2001 and 3.2% in 2011. One explanation for this stability in the face of an increasingly aged population is the improvement in the health of the population between 2001 and 2011 and this may also explain why the care home population of those aged 85 and over has increased.

A major contribution to the stability of the aged care home population is likely to be due to the increase in unpaid carers; there were an additional 600,000 unpaid carers in 2011 compared to 2001. Given that unpaid care is likely to be provided by a spouse or family member, the increased longevity of men in particular, could be behind the fall in the numbers of women entering care homes. However, as the provision of unpaid care seems to have negative consequences for the health of the carer, there is an increased likelihood that these people will themselves require care in later life.

A further potential explanation is that relatives and/or friends may be more inclined to provide unpaid care to relieve the financial burden of care home costs. The Health Survey 2011, suggested “that a substantial proportion of older people receiving formal care are funding this themselves”. As a result, people in need of social care may be encouraged to reside in their own homes, receiving unpaid care or domiciliary care (care provided at home by a carer) rather than move into a care facility, for as long as possible. This could help contribute to a much older care home population. Care in the community may also encourage people to stay at home for longer as it ensures people who are in need of long-term care are able to live at home and receive care, as implemented by the National Health Service and Community Care Act of 1990. This act evolved so that people could have services provided at home and as a respite service for carers.

Recent government policy ‘Providing housing support for older and vulnerable people’ may have an impact upon future numbers of people receiving support in a care home setting as it aims to help older and disabled people to live at home for longer.