Declining demands or constraining supply? Explaining the trend of care home entry in England 2001–2021

OBJECTIVES: Despite population aging, care home residency in England has declined over time. However, little is known about the drivers of this decline, particularly the role of supply-side factors. Guided by the Andersen Behavioral Model, this study examines how predisposing, enabling, need, and supply-side contextual factors are associated with care home entry and identifies the mechanisms underlying the decline in institutional care use over time. METHODS: Using newly linked data from the ONS Longitudinal Study 2001-2021 and the Care Quality Commission care directory (n = 89,122), we estimated logistic regression models to identify key predictors of care home entry. We then applied a nonlinear decomposition to quantify the contributions of compositional changes and changing associations to the declining trends over time. RESULTS: The rates of people aged 65 years and older moving from private households to care homes declined from 5.5% in 2001-2011 to 4.0% in 2011-2021. Poor health remained the strongest predictor of care home entry in both periods, while homeownership, being married, and lower local care home bed supply were associated with reduced likelihood of admission. Decomposition results showed that 85.3% of the decline was explained by compositional changes, primarily improvements in population health, alongside reduced supply of care home beds and shifting ethnic composition. DISCUSSION: The findings indicate that promoting healthy aging remains central to delaying institutionalization, while declining institutional capacity raises concerns about future access and equity in long-term care provision. This study also offers insights for care home projections and effective resource allocation.