Future profiles - District / Borough level. Older people’s residential & nursing care

Adur has an estimated 16 residential and nursing care homes with a fairly even spread of residential, nursing, and dual-residential provision. This is the second lowest number of overall care home beds in the County and the lowest number of dementia specialist beds. However, Adur also has the lowest proportion of older people (7%) in West Sussex and the lowest number of older people in receipt of public funded bed spaces. Approximately 68% of residents in care and nursing homes currently in Adur are privately funded.

Only 38% of people living in Adur and in receipt of Council funded bed-based care remain in Adur once they move into residential services. A large proportion of people move into Worthing for this type of service. However, there are reportedly around 9.4% of unoccupied beds in Adur which does not indicate a need that is not currently meeting demand. It is possible there will be an increased need for provision which meets needs of older people with dementia where there is expected to be an increase of almost 30% of people with dementia from the current 17,000 estimated numbers.

Bearing in mind an anticipated increase in demand for the population of 200 more older people with high needs by 2035, the available beds currently, and the intention to develop between 120 – 150 units of extra care in Adur in the coming 10 years, it is anticipated that there is not likely to be a need for net growth in provision of residential care services in Adur over the next 10 years. This is of course dependent on a range of factors and could be subject to change.

Projected supply
It is projected that in 10 years there will not be a need for additional residential and nursing care in Adur based on current supply, future needs and demand and strategic direction with greater use of Extra Care Housing.

Suggested strategy

• No net growth of residential and nursing care.
• An increased focus on dementia provision.
• Reduce standard residential provision or redevelop for more complex care.
• Grow alternative options as planned for Extra Care Housing.

Arun has 56 care homes with more residential homes than nursing and dual -registered homes. Arun has one of the highest proportions of care homes in the County and the highest nursing dementia bed capacity together with Worthing. Arun has the highest older person population of all West Sussex districts at 23% and the highest number of older people in receipt of WSCC public funded bed-based care at 27%. The number of self-funders is the second lowest in the County. Most people stay in Arun for their residential and nursing care and this area also gains the most residents from other areas within West Sussex, mainly from Chichester and Worthing Districts, but also from Adur and out of county. The future growth of the older people population is projected to be highest in Arun.

There are reportedly around 14% of unoccupied beds in Arun which indicates that current supply is meeting demand. It is possible there will be an increased need for provision which meets needs of older people with dementia where there is expected to be an increase of almost 30% of people with dementia from the current 17,000 estimated numbers. The prevalence of dementia projections for 2035 are highest in Arun. Other factors are likely to influence the demand, including for example an intention to develop between 300-350 units of extra care in Arun in the coming 10 years.

Projected supply
It is projected that in 10 years there will be an oversupply of residential and nursing care in Arun based on current supply, projected needs and demand and strategic direction with the growth of Extra Care Housing.

Suggested strategy

• Some diversifications of existing residential supply to cater for complexity due to high proportion of residential care beds.
• Dementia and nursing care beds are important to develop in Arun.
• Develop the planned Extra Care Housing units in Arun.

Chichester has 38 care homes with more residential homes than nursing and dual-registered homes. Chichester has the third lowest capacity of nursing dementia beds. It has 16% of the West Sussex older people population, 12% of older people in receipt of a WSCC public funded placement and estimated to have the highest number of self-funders in the County. Although people from Chichester tend to remain in Chichester for their residential care, the rate for nursing customers is much lower. Most people moving from Chichester tend to move to the Arun area for both residential and nursing care. Very small percentages move to Chichester from other areas.

There are reportedly around 11% of unoccupied beds in Chichester which indicates that the current supply is meeting current need. It is possible there will be an increased need for provision which meets needs of older people with dementia where there is expected to be an increase of almost 30% of people with dementia from the current 17,000 estimated numbers. The prevalence of dementia projections for 2035 are second highest in Chichester.

Current provision is 1,431 beds with an 11% vacancy rate. Other factors are likely to influence the demand, including for example an intention to develop between 220-270 units of extra care in Chichester in the coming 10 years.

Projected supply
It is projected that in 10 years there will be an oversupply of residential and nursing care in Chichester based on current supply, projected needs and demand and strategic direction with the growth of Extra Care Housing.

Suggested strategy

• No net growth required in Chichester for Council commissioned provision.
• Small/limited net growth may be required over course of 10 years for the self-funder market.
• To diversify standard residential bed-base as there is capacity / vacancies in this market.
• Maintain specialist beds as dementia prevalence is predicted to be higher here than other areas and there is lower nursing dementia capacity here currently.

Crawley has only 7 care homes, the majority of which are residential care. It only has one nursing dementia care home. Crawley has one of the lowest older people populations and one of the lowest numbers of older people in receipt of a WSCC public funded placement. It has the lowest percentage of self-funders in the County and people tend to move to either Mid-Sussex or Horsham and some out of county for their care.

There are reportedly around 13% of unoccupied beds in Crawley which even given its small bed base does not indicate a need that is not currently meeting demand. It is possible there will be an increased need for provision which meets needs of older people with dementia where there is expected to be an increase of almost 30% of people with dementia from the current 17,000 estimated numbers. Crawley’s dementia prevalence in 2035 is predicted to be much lower than in other areas as is medium to high need dependency levels.

Work is required to understand accessibility of service provision and whether residential and nursing care is meeting the needs of people with protected characteristics – particularly for people from an ethnic minority, the numbers of which are high in the Crawley population.

Current provision is 277 beds with a 13% vacancy rate. Other factors are likely to influence the demand, including for example an intention to develop between 45-75 units of Extra Care Housing in Crawley in the coming 10 years.

Projected supply

• It is anticipated that Crawley will require a small growth of provision for services that can be accessed by Council funded customers.
• There is a need for more specialist residential and nursing care in this area so that people can stay locally for this type of care.

Suggested strategy

• Explore accessibility issues for ethnic minority individuals and communities to older people bed-based services in Crawley and learn from this to expand to other areas.
• Maintain beds due to smaller supply of beds and the risks this small supply brings and because older people projected population growth is large comparative to size of district.
• Support a small net increase in bed numbers for Council funded customers.
• Increase specialist dementia care – nursing and residential and diversity of provision and clients using bed-based care.

Horsham has 25 care homes with the largest proportion being dual-registered followed by nursing care. Horsham has the highest capacity for nursing dementia care in the County and the highest bed-based occupancy in the County. Significant proportions of nursing customers move to Horsham from Crawley and out of county, and smaller percentages from Chichester and Mid Sussex. Horsham currently has 16% of the older people population and future growth of the older people population is projected to be second highest in Horsham. Self- funders are estimated to comprise 62.6% of Horsham’s care home customers.

There are reportedly only around 6% of unoccupied beds in Horsham. It is possible there will be an increased need for provision which meets needs of older people with dementia where there is expected to be an increase of almost 30% of people with dementia from the current 17,000 estimated numbers. The prevalence of dementia projections for 2035 are third highest in Horsham and medium to high need dependency levels are also third highest in the County. Other factors are likely to influence the demand, including for example an intention to develop between 120 – 150 units of Extra Care Housing in Horsham in the coming 10 years.

Projected supply

• It is anticipated that Horsham is the only area that will have an undersupply of residential and nursing care by 2035, especially dementia care if occupancy rates stay high. This is with Extra Care Housing units factored into projections.

Suggested strategy

• To maintain the suitable number of dual-purpose homes and to maintain good supply of nursing care and specialist dementia care as medium and high dependency figures and dementia prevalence are projected to be higher than other areas.
• Diversify standard residential beds.
• Support slow growth in additional provision catering for high complex needs, including and particularly focused on dementia if the demand continues to be projected to be high.

Mid Sussex has 35 care homes with a very even balance between residential, nursing, and dual-registered homes. Of these, over half the beds cater for specialist dementia care. Mid Sussex has the highest supply of nursing and nursing dementia beds in the County and relatively low vacancy rates. Mid Sussex has 15% of the older people population. People from Mid-Sussex tend to stay in Mid Sussex for their bed-based care at 68% for both residential and nursing care. It is estimated that 56% of customers in Mid-Sussex are self-funders.

There are reportedly around 10% of unoccupied beds in Mid Sussex which indicates that current demand is met by current supply. It is possible there will be an increased need for provision which meets needs of older people with dementia where there is expected to be an increase of almost 30% of people with dementia from the current 17,000 estimated numbers. Projected dementia prevalence in Mid Sussex is not as high as other areas and projected medium and high dependency is mid-point in the County compared to other districts.

Current provision is 1,365 beds. Factors are likely to influence the demand, including for example an intention to develop between 140 – 190 units of extra care in Mid-Sussex in the coming 10 years. Therefore, it is anticipated that Mid Sussex will have an oversupply of residential and nursing care by 2035.

Projected supply

• It is anticipated that Mid Sussex will have a small oversupply for Council funded and self-funded demand by 2035 but not significant numbers.

Suggested Strategy

• To maintain the level and balance of provision as there is a good level of provision of nursing and dementia care, good occupancy, people tend to stay in district and people come into Mid-Sussex for bed-based care.
• Need for a mixture of provision to cater for the self-funding market.
• Small growth maybe required by 2035 for the self-funder market.

Worthing has 51 care homes with a good balance between residential and nursing homes but few dual registered homes. 40% of these beds can cater for specialist dementia care. Along with Arun, Worthing has the highest capacity for nursing dementia care within West Sussex. Worthing has 12% of West Sussex's older people population and 17% of the older people bed-based WSCC public funded customers. A significant proportion of the older people population stay in Worthing for their bed-based care and a sizeable proportion of customers for both nursing and residential care relocate to Worthing from Adur and from out of county for residential care. It is estimated that Worthing has the 2nd lowest percentage of self-funded care home customers.

There are reportedly around 10% of unoccupied beds in Worthing which does not indicate a need that is not currently meeting demand. It is possible there will be an increased need for provision which meets needs of older people with dementia where there is expected to be an increase of almost 30% of people with dementia from the current 17,000 estimated numbers. Projected dementia prevalence in Worthing is mid-point among districts as are predictions for medium to high dependency.

Other factors are likely to influence the demand, including for example an intention to develop between 120 – 150 units of extra care in Worthing in the coming 10 years.

Projected supply

• It is anticipated that Worthing will have a small but very limited oversupply of residential and nursing care by 2035 for Council and self-funded customers.

Suggested strategy

• Limited net growth in residential in Worthing.
• To diversify from a focus on residential to other forms of bed-based care such as nursing dementia which has a good supply in Worthing.

This Market Position Statement is heavily influenced by a variety of factors that are inter-dependent and reliant on future projections which are estimates. We will continue to review the position and will now develop an action plan to drive forward towards this vision with providers, partners, service users and families. Relationships with District and Borough Councils are critical in delivering this MPS and other associated MPSs and this will be a key area of focus in terms of joining up on planning applications for care homes and strategically planning together for future provision. WSCC will redesign its commissioning model for older people’s bed-based care taking into account the market position outlined and other interdependencies such as its directly provided service provision, the ongoing Shaw contract and the growth of Extra Care Housing and Care at Home.