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)
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
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%
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
Table 1 provides a summary of the annual number, percentage, median monthly and maximum monthly number of people who died by care home “cared for” group presented for 3 age groups (all ages, under 85 years, and 85 years and older) for 2019 to 2022.
This data is displayed in 4 sub-tables:
lived and died in a care home
lived elsewhere and died in a care home
lived in a care home and died elsewhere
all care home “cared for” groups
Table 1: Summary of people who died in care home “cared for” groups by age group and place of death: England 2019 to 2022
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 64,916 | 12.1 | 5,307.5 | 6,235 |
2021 | 66,805 | 12.2 | 5,195.5 | 9,504 |
2020 | 87,245 | 15.4 | 6,026.0 | 18,685 |
2019 | 70,494 | 14.3 | 5,731.5 | 7,211 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 18,569 | 5.7 | 1,540.5 | 1,795 |
2021 | 18,982 | 5.7 | 1,470.0 | 2,602 |
2020 | 25,562 | 7.5 | 1,658.5 | 5,971 |
2019 | 19,903 | 6.7 | 1,608.0 | 1,995 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 46,347 | 21.7 | 3,767.0 | 4,456 |
2021 | 47,823 | 22.6 | 3,687.5 | 6,902 |
2020 | 61,683 | 27.1 | 4,367.5 | 12,714 |
2019 | 50,591 | 25.6 | 4,123.5 | 5,216 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 45,543 | 8.5 | 3,829.5 | 4,179 |
2021 | 43,741 | 8.0 | 3,603.0 | 4,678 |
2020 | 47,333 | 8.3 | 3,435.5 | 8,179 |
2019 | 40,685 | 8.2 | 3,365.0 | 4,010 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 17,846 | 5.5 | 1,495.0 | 1,594 |
2021 | 17,349 | 5.2 | 1,437.5 | 1,788 |
2020 | 19,294 | 5.7 | 1,391.0 | 3,404 |
2019 | 17,173 | 5.8 | 1,426.0 | 1,695 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 27,697 | 12.9 | 2,294.0 | 2,594 |
2021 | 26,392 | 12.5 | 2,154.5 | 2,890 |
2020 | 28,039 | 12.3 | 2,047.0 | 4,775 |
2019 | 23,512 | 11.9 | 1,959.0 | 2,315 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 16,186 | 3.0 | 1,318.5 | 1,652 |
2021 | 16,797 | 3.1 | 1,249.5 | 2,847 |
2020 | 20,959 | 3.7 | 1,619.5 | 4,168 |
2019 | 20,030 | 4.0 | 1,679.5 | 2,225 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 6,576 | 2.0 | 543.5 | 667 |
2021 | 6,821 | 2.0 | 503.5 | 1,170 |
2020 | 8,739 | 2.6 | 633.5 | 1,977 |
2019 | 7,440 | 2.5 | 632.0 | 843 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 9,610 | 4.5 | 775.0 | 985 |
2021 | 9,976 | 4.7 | 734.5 | 1,677 |
2020 | 12,220 | 5.4 | 1,000.0 | 2,191 |
2019 | 12,590 | 6.4 | 1,061.0 | 1,382 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 126,645 | 23.6 | 10,455.5 | 12,033 |
2021 | 127,343 | 23.3 | 10,014.5 | 17,029 |
2020 | 155,537 | 27.4 | 11,000.0 | 31,032 |
2019 | 131,209 | 26.5 | 10,801.5 | 13,446 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 42,991 | 13.2 | 3,616.5 | 4,047 |
2021 | 43,152 | 12.9 | 3,383.5 | 5,560 |
2020 | 53,595 | 15.8 | 3,668.0 | 11,352 |
2019 | 44,516 | 15.0 | 3,638.5 | 4,533 |
Year | Number of deaths | Percentage of all deaths | Median monthly deaths | Maximum monthly deaths |
---|---|---|---|---|
2022 | 83,654 | 39.1 | 6,839.0 | 7,986 |
2021 | 84,191 | 39.8 | 6,599.5 | 11,469 |
2020 | 101,942 | 44.8 | 7,380.0 | 19,680 |
2019 | 86,693 | 43.9 | 7,163.0 | 8,913 |
Figure 4 shows by week (A) the number of people who died in a care home from COVID-19, and (B) of all people who died from COVID-19, the percentage who died in a care home.
Figure 4: Total number of people who died from COVID-19 in a care home: England 21 March 2020 to 08 December 2023
Figure 5 uses box plots to show the variation between UTLAs in each region of England. The box plots show the percentage of people who died with dementia and died in a care home out of (A) all people who died in care homes and (B) all people who died with dementia.
On both charts the percentage for England is indicated by the blue horizontal line.
Figure 5: Percentage of people who died with dementia in a care home out of (A) all people who died in a care home and (B) all people who died with dementia: England 2022
The number of care home beds relative to the local population aged 75 and older is shown in Figure 6. Data is presented by (A) care home type (nursing home and residential home) and (B) care home resident group (people with dementia and older people). The box plots describe the variation across England in UTLA bed rates.
Figure 6: Care home bed rates per 100 people aged 75 years and older: England 2023
Item | Data source |
---|---|
Figures 1-3, 5, Table 1 |
Office for National Statistics (ONS) annual mortality extracts (up to
2022) UK Health Security Agency held Mortality & Births Information System data (2023 provisional) |
Figure 4 |
ONS
death registrations and occurrences by local authority and health board
dataset Latest data: lahbfileweek482023.xlsx |
Figure 6 |
Numerator: Care
Quality Commission’s care directory from 01 December 2023 Denominator: ONS mid-year population estimates for 2021 |
the Mortality & Births Information System (MBIS) provisional data used for 2023 was deduplicated using MBISID as a unique person identifier
throughout this factsheet the month or week a death is reported is determined by the date of registration, there can be a delay between the date a death occurred and the date a death was registered. This is explained by the Office for National Statistics (ONS) in Impact of registration delays on mortality statistics
individual deaths are assigned to a UTLA according to the postcode of the deceased’s place of residence
the reported UTLA is not necessarily the UTLA where a death occurred, particularly for the categories where place of death was different to place of residence as in “lived elsewhere and died in a care home” and “lived in a care home and died elsewhere”
place of death, and place of residence are recorded in the mortality data. For further information on the methods used for all place of death indicators as classified by ONS death certificate data, please see Public Health England’s National End of Life Care Intelligence Network publication: Classification of Place of Death: A technical bulletin
people dying with dementia were identified as those for whom their underlying cause of death or contributory causes of death included any of the ICD-10 codes for dementia and Alzheimer’s disease (F00, F01, F03, G30, G318, G310)
the denominators for care home bed rates in Figure 6 were calculated using ONS mid-year population estimates for 2021
information on how to interpret the box plots in this factsheet is shown in Figure 7
Figure 7: Interpretation of box plots
Commissioners and service providers should review the data presented in this factsheet alongside several other data and intelligence tools and reports. They should also consider using locally produced data on specialist palliative care and social care services. We have provided information on the main supporting resources in this section.
More detailed information is available in the UTLA care home factsheets.
Local indicators on care homes can be found in the care home and community topic section on the Palliative and End of Life Care Profiles. These include care home and nursing home beds per 100 people aged 75 years and older and temporary care home residents who die in a care home. These profiles also include indicators describing the percentage of people who died in a care home by different age groups in the place of death topic section. The data for all these indicators are shown for multiple geographies.
The Place of Death Factsheet provides the most recent data available on trends in place of death at ICS level during the COVID-19 pandemic and compares this with the pattern seen in 2019 as a baseline. Number and percentage of deaths in hospitals, at home, in care homes, in hospices (not community) and ‘other places’ are presented.
Additional data sources on social care and care homes include:
There are also several tools designed to support policy and planning decisions in the context of the COVID-19 pandemic. These include:
Office for Health Improvement and Disparities – Excess mortality in England
Office for Health Improvement and Disparities – Wider Impacts of COVID-19 on Health monitoring tool
Information and resources for health and social care professionals can be found on the National End of Life Care Intelligence Network’s Palliative and End of Life Care Resources and Publications page. This includes a comprehensive catalogue of condition and setting-specific data, intelligence tools, policy and guidance.
Data used to produce this factsheet is available as a spreadsheet.
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