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. 2022 Nov;30(6):2218-2229.
doi: 10.1111/hsc.13770. Epub 2022 Feb 25.

Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches

Gary Higgs  1 , Mitchel Langford  1 , Mark Llewellyn  2
Affiliations

Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches

Gary Higgs et al. Health Soc Care Community. 2022 Nov.

Abstract

Suggestions of the existence of so-called 'social care deserts' in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. In this paper, we draw attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, we illustrate the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. We conclude by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.

Keywords: COVID-19; Wales; accessibility; residential and nursing beds; social care; spatial inequalities.

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Conflict of interest statement

No potential conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Capacities of care homes in Wales (as of March 2020)
FIGURE 2
FIGURE 2
Distribution of care home provision (a) All Wales (b) South‐east Wales
FIGURE 3
FIGURE 3
Distribution of potential demand, and example of local supply‐demand complexity (a) South‐east Wales (b) South Wales valleys
FIGURE 4
FIGURE 4
Density measure of accessibility in local authorities and MSOAs. MSOA, middle layer super output area
FIGURE 5
FIGURE 5
Proximity‐based analyses of care home accessibility (a) Nearest supplier (b) Minimal choice
FIGURE 6
FIGURE 6
A proximity rule‐based classification of care home accessibility
FIGURE 7
FIGURE 7
Care home accessibility E2SFCA scores mapped at output area level.
See this image and copyright information in PMC

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