Palliative and end of life care factsheet: Recent trends of deaths in care homes and provision of care

England

January 2024


Introduction


This factsheet provides the most recent data available to support the planning of palliative and end of life care (PEoLC) service provision in care homes. Trends in people who died in a care home are shown and compared with the pattern seen in 2019 as a baseline. The most recently published care home bed rates by care home type and care home resident group are also presented.

Care homes (residential and nursing homes combined) look after some of the most vulnerable in society. Older people are more likely to live and die in this setting. It is therefore important that commissioners and planners consider the provision of PEoLC in care homes. This factsheet describes people who were in care homes at or near the end of their life, split into three “cared for” groups:

  • lived and died in a care home, permanent care home residents who died in a care home

  • lived elsewhere and died in a care home, people usually living in their own home (temporary care home residents)

  • lived in a care home and died elsewhere, permanent care home residents who died elsewhere (most commonly in hospital)


Summary of data


Headlines


Number of people cared for near the end of their life in care homes

In the 12 months from October 2022 to September 2023:

  • in England, 129,468 people were cared for near the end of their life in a care home (compared with 131,209 in 2019; 155,537 in 2020); this comprised 23.9% of all people who died (26.5% in 2019; 27.4% in 2020)

  • for upper tier local authorities (UTLAs), of all people who died, the percentage who were cared for in a care home ranged from 6.7% to 34.3%. The middle half of UTLAs had percentages between 19.7% and 26.2%

  • 112,757 people died in a care home (compared with 111,179 in 2019; 134,578 in 2020), and of them 41.5% did not normally live in a care home (36.6% in 2019; 35.2% in 2020)

  • for UTLAs, of all people who died, the percentage who died in a care home and lived elsewhere ranged from 22.3% to 77.2%. The middle half of UTLAs had percentages between 36.9% and 47.7%

  • 82,687 care home residents died (compared with 90,524 in 2019; 108,204 in 2020), and of them 79.8% died in a care home (77.9% in 2019; 80.6% in 2020)

  • for UTLAs, of permanent care home residents who died, the percentage who died in a care home ranged from 51.8% to 90.9%. The middle half of UTLAs had percentages between 73.2% and 82.2%

Age of people cared for near the end of their life in care homes: 2021

  • in England, 39.7% (84,191) of all people who died aged 85 years and older and 12.9% (43,152) aged under 85 years were cared for in a care home

  • for UTLAs, of all people who died aged 85 years and older, the percentage who were cared for in a care home ranged from 12.8% to 51.6%. The middle half of UTLAs had percentages between 32.2% and 43.0%

  • for UTLAs, of all people who died aged under 85 years, the percentage who were cared for in a care home ranged from 3.4% to 21.4%. The middle half of UTLAs had percentages between 9.7% and 14.4%

People who died from COVID-19 in care homes

In the most recent 52 weeks, 03 December 2022 up to 08 December 2023:

  • in England, of the 113,941 people who died in a care home, 2,206 (1.9%) died of COVID-19; this was 13.4% of all people who died from COVID-19

  • across UTLAs in England, of people who died in a care home, the percentage who died from COVID-19 ranged from 0.0% to 5.4%. The middle half of UTLAs had percentages between 1.1% and 2.3%

In the first 52 weeks of the COVID-19 pandemic, 21 March 2020 up to 12 March 2021

  • of the 137,727 people who died in a care home, 29,737 (21.6%) died of COVID-19; this was 23.5% of all people who died from COVID-19

People who died with dementia in care homes: 2022

  • 46.6% (51,450 of 110,459) of people who died in a care home died with dementia

  • for UTLAs, of people who died in a care home, the percentage who died with dementia ranged from 36.2% to 60.8%. The middle half of UTLAs had percentages between 44.3% and 50.5%

  • care home was the place of death for 55.1% (51,450 of 93,366) of all people who died with dementia

  • for UTLAs, of all people who died with dementia, the percentage who died in a care home ranged from 22.2% to 73.3%. The middle half of UTLAs had percentages between 46.4% and 59.9%

Care home bed rates: 01 December 2023

  • in England, the care home bed rate was 9.3 beds per 100 people aged 75 years and older. 48.6% of beds were in nursing homes and 51.4% in residential homes

  • for UTLAs, the care home bed rate ranged from 3.5% to 16.8%. The middle half of UTLAs had percentages between 7.9% and 10.6%

  • for UTLAs, the percentage of care home beds in nursing homes ranged from 17.5% to 90.3%. The middle half of UTLAs had percentages between 41.9% and 59.5%


Trends in deaths of care home residents


Figure 1 shows (A) the number of people who were cared for in a care home at or near the end of their life and (B) those same numbers as a percentage of all people who died. The first 2 groups on each chart present data for those people who died in a care home. These were either residents who lived and died in a care home or people who lived elsewhere and died in a care home (usually temporary care home residents). The third group is care home residents who died elsewhere (most commonly in hospital). The monthly data for each of the 3 groups are presented for years 2019 to 2023.


Figure 1: Number of people who died by care home “cared for” group: England 2019 to 2023


Figure 2 shows the number of all people who died in any of the three care home “cared for” groups as a percentage of all people who died in England. The box plots show the variation in this percentage between the UTLAs for each region of England.

Further information on interpreting box plots is provided in the methodology section.


Figure 2: Variation in the percentage of people who died who were in one of three care home “cared for” groups: England October 2022 to September 2023


Figure 3 shows the percentage of people who died in each of the care home “cared for” groups. Percentages on both charts are shown separately for males and females. The bars show for each age group the percentage of people who died out of all people who died in 2022 irrespective of place of death across (A) all age groups and (B) all people who died for that age group.


Figure 3: Age and sex distribution of people who died by care home “cared for” group: England 2022