ArticleBMJ public health2024
Does outsourcing enable the survival of good care homes? A longitudinal analysis of all care homes in England, 2011-2023.
Article in BMJ public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Trends and Factors in Nursing Home Closures.JAMA health forum · 2026Article
- Resident funding and care home quality: a retrospective observational analysis of the impact of the two-tier care system in England.Age and ageing · 2025Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
Abstract
Background: It is unclear whether outsourcing has enabled the growth and survival of the best care homes, as intended. We aimed to test whether ownership (for-profit, public and third sector (non-profit)) influences determinants of closure among all care homes in England, 2011-2023. Methods: We created a dataset of all care homes from 2011 to 2023 (29 548 care homes and 8346 closures) and Care Quality Commission inspections from 2014 to 2023 (n=65 726). Using logistic regression, we investigated determinants of care home closures including care home characteristics (eg, number of beds), service registrations (eg, dementia and nursing), quality (inspection ratings) and area deprivation. We then tested for interaction effects; specifically exploring (1) whether the determinants of closure vary by ownership and (2) whether quality differences between active and closed for-profit and third sector/public homes vary by area deprivation. Results: The prevalence of for-profit care homes increased from 2011 to 2023. Ownership was a key determinant of care home closure; public and third sector care homes were almost twice as likely to close than for-profit providers (OR 1.8; 95% CI 1.44 to 2.24, p<0.001 and OR 1.6; 95% CI 1.37 to 1.76, p<0.001, respectively). Although care quality was also a significant determinant of closure, this association varied by care home ownership. For example, public and third sector homes rated 'good' were 7.6 percentage points (p<0.001) and 5.9 percentage points (p<0.001) more likely to close than for-profit homes with the same rating. Lastly, the quality of for-profit homes is heavily influenced by area deprivation, and the best active homes in deprived areas are operated by public and third sector providers. Conclusion: Our findings suggest that outsourcing of care services has not promoted the survival of the best care homes and may have adverse effects on the equity and accessibility of care. This calls for a reassessment of current policies to ensure that vulnerable populations have continued access to adequate quality of care.
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Registered trials
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