Survey of private nursing homes in seven English counties

BMJ 1994; 309 doi: (Published 30 July 1994) Cite this as: BMJ 1994;309:314
  1. J M Henry,
  2. I A MacPherson,
  3. S C Donald
  1. Department of Public Health, University of Aberdeen, Aberdeen AB9 2ZD
  1. Correspondence to: Dr J Henry, Priority Services Research Team, Department of General Practice, Foresterhill Health Centre, Aberdeen AB9 2AY.
  • Accepted 22 February 1994

On behalf of the Association of County Councils of England and Wales we undertook a survey of private nursing homes in England.1 Our results challenge the view that the NHS has become a dumping ground for increasingly dependent residents of nursing homes.

Methods and results

Three hundred and six nursing homes across seven English counties were surveyed by postal questionnaire; replies were received from 230 (75%) homes. Data were gathered on the home, all current residents, and all residents who had been discharged (which included those who had died) during 1989-91.

Questions were analysed with respect to numbers responding to that question, so denominators vary. The analysis is in terms of discharged residents, and 95% confidence intervals apply to the difference in proportions between 1989 and 1991.

Forty three per cent (4314/10 032) of discharged residents were aged 85 or more, and 46% (4587/9972) were classed solely as being frail. Seventy six per cent (7474/9834) of all residents had lived in the home for one year or less. Forty one per cent (4077/9944) of the discharged residents had come from the community and 43% (4192/9749) from a hospital.

Fifty nine per cent (5446/9230) of the discharged residents died in the nursing home (table). The proportion of residents dying in the home decreased significantly from 62% (1550/2500) in 1989 to 56% (2009/3587) in 1991 (2.7% to 7.7%). Seventy per cent (2993/4276) of the residents admitted from a hospital subsequently died; this was significantly higher than the 45% (1862/4138) of residents admitted from the community who died (23% to 27%).

Numbers (percentages) of discharged residents of 230 private nursing homes 1989-91

View this table:

Twenty six per cent (2344/9015) left the home to live in the community. The proportion of residents doing so increased significantly from 23% (585/2543) in 1989 to 29% (1020/3517) in 1991 (3.3% to 7.7%). Although 95% (2331/2454) of residents who left to live in the community did so within six months, many of them may have entered the home for respite care.

Five per cent (462/9240) of residents who left were admitted to hospital, most to acute hospitals. The proportion of those who came to the home from hospital and were discharged back to hospital did not change significantly over the three years, remaining at about 6%.


The proportion of residents who were admitted to hospital from their nursing home remained low, regardless of whether the residents had been living in the community or been in hospital. This suggests that hospitals are not being used as dumping grounds by nursing homes unable or unwilling to continue to care for residents. It is noticeable that about three quarters of those who enter a nursing home from hospital and then return to hospital do so within six months - is this an acceptable rate of return?

Our results predate the implementation of the NHS and Community Care Act in April 1993. What effect, if any, this will have on discharge patterns from nursing homes remains to be seen. Assessment for state funded residents of nursing homes is now in the hands of the social services, whose criteria may alter the pattern of admissions and, in consequence, discharges. Ironically, given the current policy of rationalising long stay beds within the NHS, if any change were to lower death rates this might increase the discharge rate to acute hospitals.

We thank the owners and staff of the nursing homes who gave their time freely to the survey. We also thank the officers of the participating counties and the Association of County Councils of England and Wales for their administrative support and enthusiasm, especially Graeme Lythe for all his help.


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