Older people living in care homes in 2021 and changes since 2011

• There were 278,946 people aged 65 years and over living in a care home in England and Wales, accounting for 82.1% of all care home residents.

• The proportion of the usual resident population aged 65 years and over living in a care home decreased from 3.2% in 2011 to 2.5% in 2021.

• Within the 65 years and over care home population, 56.4% of residents were aged 85 years and over; this is a decrease from 2011, where 59.2% of residents were aged 85 years and over.

• Female care home residents aged 65 years and over outnumber men, with 23 female residents to every 10 male residents; this is a decrease from 2011, when there were 28 female residents to every 10 male residents.  

• Since 2011, the proportion of care home residents living in homes with nursing has increased, while the proportion of those living in homes without nursing has decreased.

• In 2021, the proportions of care home residents aged 65 years and over in very good, good, or fair health were higher than in 2011, while the proportions in very bad health or bad health were lower.

• While most care home residents identified within the "White" ethnic group in 2021, the ethnic diversity of care home residents has increased slightly since 2011.

• Higher proportions of the usual resident populations aged 65 years and over in the North East (2.9%) and North West (2.8%) were care home residents than in any other regions.

When interpreting the data, it is important to keep in mind that Census 2021 was conducted during the coronavirus (COVID-19) pandemic, which may have affected the number of residents in care homes at that time.

In 2021, there were 278,946 people aged 65 years and over living in care homes in England and Wales, accounting for 82.1% of all care home residents (excluding staff and family members).

Care home residents as a proportion of the population

Between 2011 and 2021, there was a 4.0% decline in the number of care home residents aged 65 years and over, while the total usual resident population in this age group rose by 20.0% over the same period. This means that the proportion of the older population residing in care homes has decreased over time, from 3.2% of the 65 years and over usual resident population in 2011 to 2.5% in 2021.

The biggest decrease in the proportion of the older population residing in care homes was among people aged 85 years and over, down from 13.7% in 2011 to 10.8% in 2021.

The proportion of the older population residing in care homes increases with age for both women and men. A slightly higher proportion of men aged 65 to 69 years and aged 70 to 74 years reside in care homes compared with the proportions of women in these age groups. In age groups from 75 years, higher proportions of women reside in care homes compared with men, with the differential increasing with age.

Figure 1: Women aged 65 years and over were more likely to reside in care homes than men in this age group

Percentage of usual resident population in each five-year age group from age 65 years residing in care homes in 2021 and 2011, by sex, in England and Wales

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Age and sex profile of care home residents

The median age of the care home population aged 65 years and over has decreased slightly since 2011, from 86 years and 10 months to 86 years and 5 months in 2021.

In 2021, almost three-quarters of the older care home population (74.0%) were aged 80 years and over and more than half (56.4%) were aged 85 years and over. This represents a decrease in the proportions of care home residents at the oldest ages since 2011, when 78.6% of residents were aged 80 years and over and 59.2% were aged 85 years and over.

Male care home residents have a younger age profile than female residents, with higher proportions of men in age groups below 85 years and higher proportions of women than men in age groups 85 years and over. In 2021, the median age of female care home residents aged 65 years and over was 87 years and 10 months old compared with 82 years and 8 months old for males.

Figure 2: In 2021, most of the female care home population were aged 85 years and over, while most of the male care home population were aged 84 years and under

Age structure of care home resident population aged 65 years and over, by sex, 2021 and 2011, in England and Wales

Notes:

1. Bases are total female and male usual residents aged 65 years and over living in care homes.

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Sex ratios

Female care home residents aged 65 years and over outnumber men, with 23 female residents to every 10 male residents. This represents a decrease in the sex ratio from 2011, when there were 28 female residents to every 10 male residents.   

In 2021, among residents aged 65 to 74 years, there were more male residents than female residents. However, this reverses from age 75 years, with more female residents than male with the gap increasing with age. This is a slight change from 2011, when there were higher proportions of females in all age groups except those aged 65 to 69 years old. At age 90 years and over, there were over four times as many female residents as male. This was a slight decrease from 2011, when there were five times as many female residents compared with males.

Figure 3: At older age groups, female care home residents make up a larger proportion of the care home population than at younger age groups

Sex-ratio within care home population aged 65 years and over in 2021 and 2011, England and Wales

Notes:

1. Base is usual residents in each age group living in care homes.

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In 2021, similar proportions of care home residents aged 65 years and over lived in care homes with nursing (49.4%) and in care homes without nursing (50.6%). Since 2011, the proportion of care residents in homes with nursing has increased, while the proportion living in care homes without nursing has decreased. This pattern is apparent across 10-year older age groups. However, care home residents aged 85 years and over are still more likely to reside in care homes without nursing.

Figure 4: Since 2011, there has been an increase in the proportion of care home residents in homes with nursing and a decrease in those in homes without nursing

Proportion of care home population residing in care homes with and without nursing by 10-year age group, 2021 and 2011, England and Wales

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The proportion of residents in care homes with nursing has increased within both female and male care home populations between 2011 and 2021, with male care home residents now being more likely to reside in care homes with nursing than without.

In 2021, 47.9% of the female care home population resided in homes with nursing, an increase of 7.0 percentage points from 2011, with the remaining 52.1% residing in homes without nursing. The male care home population in homes with nursing increased by 6.5 percentage points in 2021, with 52.9% in homes with nursing, and 47.1% in care homes without nursing.

In 2021, in England and Wales, 18.7% of care home residents aged 65 years and over were in good or very good general health, 49.4% in fair health, and 31.8% in bad or very bad health. There was little difference in the patterns of health status of female and male care home residents.

Care home residents across older five-year age groups from age 65 years to 90 years and over were less likely to be in very good or good general health and more likely to be in fair, bad, or very bad health than the general population in these age groups.

Across all older age groups, care home residents in care homes with nursing were less likely to be in very good, good, or fair health than residents in care homes without nursing and more likely to be in bad or very bad health.

Figure 5: Care home residents in homes with and without nursing were more likely to report good or very good health within younger age groups

General health of care home populations aged 65 years and over with nursing and without nursing, by five-year age groups, 2021, England and Wales

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The general health of the older care home population has improved over time. In 2021, the proportions of care home residents aged 65 years to 74 years, 75 years to 84 years and 85 years and over in good, or fair health were higher than in 2011. Meanwhile, the proportions in very bad health or bad health were lower compared with 2011. There was little change in proportion of residents in very good health across all age groups.

Figure 6: The general health of the care home population aged 65 years and over has improved since 2011

General health status of care home population aged 65 years and over, 2021 and 2011, England and Wales

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For the definition of disabled, see Section 10: Glossary.

Of the care home population aged 65 years and over in 2021:

• 70.9% were disabled with day-to-day activities limited a lot

• 18.4% disabled with day-to-day activities limited a little

• 0.91% were non-disabled with a non-limiting condition

• 9.7% were non-disabled with no condition

Older care home residents across five-year age groups from age 65 years to 90 years and over were more likely to be disabled with day-to-day activities limited a lot compared with the general population in these age groups. This pattern holds for those disabled with day-to-day activities limited a little up to age 74 years. From age 75 years and over, the pattern reverses and the general population are more likely to be disabled: limited a little compared with the care home population.

Figure 7: Care home residents in homes with nursing are more likely to be disabled with day-to-day activities limited a lot compared with those in homes without nursing

Disability status of care home resident populations with and without nursing by five-year age groups, 2021, England and Wales

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Here, we focus on the five high-level ethnic groups people identified, as set out in our Ethnic group by age and sex, England and Wales: Census 2021 article.

Please note that numbers of older people resident in care homes were too low to allow for meaningful analysis at the lower level 19 category classification of ethnic group.

The overall proportion of usual residents aged 65 years and over living in care homes in England and Wales has decreased since 2011. This was the case in all high-level ethnic groups except for the proportion who identified as "Mixed or Multiple ethnic groups", which increased slightly in 2021.

In 2021 across all high-level ethnic groups, people aged 85 years and over were the most likely to be care home residents. Among the 85 years and over population those who identified as "Asian, Asian British or Asian Welsh" were the least likely of all the high-level ethnic groups to live in a care home.

Figure 8: Usual residents aged 65 years and over who identified as “Asian, Asian British or Asian Welsh” were least likely to be living in care homes in 2021, particularly at older age groups

Percentage of the usual resident population aged 65 years and over in each high-level ethnic group living in care homes, by 10-year age groups in 2021 and 2011, England and Wales

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Within the care home population aged 65 years and over living in England and Wales in 2021:

• 97.5% identified in the "White" ethnic group

• 0.95% identified in the "Asian, Asian British, Asian Welsh" ethnic group

• 0.96% identified in the "Black, Black British, Black Welsh, Caribbean or African" ethnic group

• 0.43% identified in "Mixed or Multiple ethnic groups"

• 0.20% identified in "Other ethnic groups"

The percentage of the care home population aged 65 years and over identifying as "White" decreased from 98.3% in 2011 to 97.5% in 2021. The percentage identifying in all other high level ethnic groups increased, with the largest increase seen in the "Asian, Asian British, Asian Welsh" ethnic group, up from 0.62% in 2011 to 0.95% in 2021.

There was more ethnic diversity among residents aged 65 years and over in care homes with nursing than without. In 2021, there were slightly higher proportions of residents identifying within the "White" ethnic group in care homes without nursing compared with in care homes with nursing. The proportions of residents identifying in all other high-level ethnic groups were slightly higher in care homes with nursing compared with in care homes without nursing.

Figure 9: Ethnic diversity was slightly higher in care homes with nursing compared with care homes without nursing

Percentage of the care home population aged 65 years and over in care homes with and without nursing by high-level ethnic group, 2021, England and Wales

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In 2021, there was slightly higher ethnic diversity among the male care home population compared with the female. A lower proportion of male care home residents identified in the high-level “White” ethnic group and slightly higher proportions of male care home residents identified in all other high-level ethnic groups compared with females. This was a similar pattern to 2011.

Figure 10: In 2021, there was a slightly higher ethnic diversity among the male care home population compared with the female care home population

Proportion of care home residents by sex within high-level ethnic groups, 2021 and 2011, England and Wales

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In 2021 in England and Wales, 98.6% of the care home population aged 65 years and over reported their main language to be "English" or "English or Welsh" if in Wales. For the remaining 1.4%, nearly half reported their main language as a European language.

Within the care home population aged 65 years and over whose main language was not "English" or "English or Welsh" if in Wales:

• 0.33% could speak English very well

• 0.42% could speak English well

• 0.47% could not speak English well

• 0.22% could not speak English

More detail on the languages spoken by older residents in care homes in 2021 may be found in the accompanying reference table.

In 2021, London had the lowest proportion of usual residents aged 65 years and over living in care homes (1.9%). This was also the case for the population aged 85 years and over (7.3%). Significantly higher proportions of the usual resident populations aged 65 years and over in the North East (2.9%) and North West (2.8%) were care home residents than in any other regions. This was also the case for the populations aged 85 years and over, with 12.5% residing in care homes in the North East and 12.0% in the North West.

Figure 11: Higher proportions of usual residents aged 65 years and over in the North East and North West were living in a care home than in other regions

Proportion of 65 years and over and 85 years and over usual resident population living in care homes by region and care home type, 2021 and 2011, England and Wales

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The proportion of the usual resident population aged 65 years and over living in care homes has decreased between 2011 and 2021 across all regions in England and Wales. This is also the case for the population aged 85 years and over living in care homes.

The South East had the biggest decrease in the proportion of the 65 years and over population living in care homes, decreasing by 0.83 percentage points between 2011 and 2021. Meanwhile, the West Midlands had the smallest decrease, at 0.47 percentage points. Within the 85 years and over population, the East Midlands had the largest decrease with a drop of 3.40 percentage points in the older population living in care homes, while the East of England had the smallest decrease, at 2.41 percentage points.

The proportion of the care home population aged 65 years and over residing in homes with and without nursing varies across the different regions in England and Wales.

Over time, the proportion of those living in care homes with nursing has increased across all regions in England and Wales. In contrast, the proportion of care home residents in homes without nursing has decreased across all regions except Yorkshire and the Humber, which saw a 0.88 percentage point decrease in the proportion of the care home population living in homes with nursing. This was also the case in the population aged 85 years and over. London had the biggest change in the proportion of care home population in homes with nursing, increasing by 12.5 percentage points in 2021 for the 65 years and over population, and 14.8 percentage points within the population aged 85 years and over.

In 2021 across local authorities (LAs) in England and Wales, Worthing had the highest number of care home residents aged 65 years and over per 1,000 of the usual resident population in that age group (47) and the fifth highest number of care home residents aged 85 years and over per 1,000 in that age group (165). Reigate and Banstead had the highest number of care home residents aged 85 years and over per 1,000 usual residents of that age (179). 

Four out of the five LAs with the lowest proportions of both their resident population aged 65 years and over and 85 years and over living in care homes were in London. Westminster had both the lowest number of care home residents aged 65 years and over per 1,000 of the usual resident population in that age group (2) and the lowest number of residents aged 85 years and over per 1,000 usual residents of that age (9).

Use the interactive map to explore the patterns in your local area.

Figure 12: Westminster had the lowest number of older care home residents per 1,000 of the usual resident population

The number of usual residents aged 65 years and over and aged 85 years and over living in care homes, per 1,000 population in those age groups by local authority in 2021, England and Wales

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Usual resident

A usual resident is anyone who, on Census Day, 21 March 2021, was in the UK and had stayed or intended to stay in the UK for a period of 12 months or more or had a permanent UK address and was outside the UK and intended to be outside the UK for less than 12 months.

For a full glossary of terms, please see our Census 2021 dictionary.

Communal establishment

A managed communal establishment is a place that provides managed full-time or part-time supervision of residential accommodation.

Examples include:

• university halls of residence and boarding schools

• care homes, hospitals, hospices, and maternity units

• hotels, guest houses, hostels and bed and breakfasts, all with residential accommodation for seven or more guests

• prisons and other secure facilities

• Single Living Accommodation (SLA) in military bases

• staff accommodation

• religious establishments

It does not include sheltered accommodation, serviced apartments, nurses' accommodation, and houses rented to students by private landlords. These are households.

Care home resident

A usual resident of a care home is either:

• someone who lives there

• someone who works and lives there

• someone who is a family member of staff that works there and lives there

This analysis includes only usual residents who live in the care home and are not staff or family members of staff. For a detailed explanation of usual residents, see our Measurements used in Census 2021 data webpage.

Care home type

In this analysis, the ce_management_type variable has been used to define a care home. A care home with nursing includes ce_management_type categories:

• "Medical and care establishment: Local Authority: Care home with nursing"

• "Medical and care establishment: Other: Care home with nursing"

A care home without nursing includes ce_management_type categories:

• "Medical and care establishment: Local Authority: Care home without nursing"

• "Medical and care establishment: Other: Care home without nursing"

Ethnic group and high-level ethnic group

The ethnic group that the person completing the census feels they belong to. This could be based on their culture, family background, identity, or physical appearance.

Respondents could choose 1 out of 19 tick-box response categories, including write-in response options. High-level ethnic group refers to the first stage of the two-stage ethnic group question. In the first stage, the respondent identifies as one of the following options:

• Asian, Asian British, Asian Welsh

• Black, Black British, Black Welsh, Caribbean or African

• Mixed or Multiple ethnic groups

• White

• Other ethnic group

Sex

This is the sex recorded by the person completing the census. The options were "Female" and "Male".

Census Day

Census 2021 was conducted on 21 March. At this time, coronavirus (COVID-19) lockdown restrictions were still in place in England and Wales. The coronavirus pandemic may have affected estimates of disability prevalence and general health because of changes in people's perceptions and increased death rates during this period (see our Updated estimates of coronavirus (COVID-19) related deaths by disability status article).

General health

A person's assessment of the general state of their health from very good to very bad. This assessment is not based on a person's health over any specified period of time.

Disability

In Census 2021, people who assessed their day-to-day activities as limited by long-term physical or mental health conditions or illnesses were considered disabled.

This definition of a disabled person meets the Government Statistical Service harmonised standard for measuring disability and is in line with the Equality Act (2010). This requires that a person has a physical or mental impairment, and that the impairment has a substantial and long-term adverse effect on a person's ability to carry out day-to-day activities.

Therefore, those reporting conditions that limited their day-to-day activities a little or a lot were classified as disabled. People who had no long-term physical or mental health conditions, or who had conditions that did not limit their day-to-day activities, were classified as non-disabled. For details on changes to questions between 2011 and 2021, see Section 10 of our Unpaid care and protected characteristics, England and Wales: Census 2021 article.

For more information on the disability variable, see our Disability variable: Census 2021 web page.

English language proficiency

How well people whose main language is not English (English or Welsh in Wales) speak English.

Main language

A person's first or preferred language.

Local authority

The general term for a body administering local government services.

In England, local government is administered by either single tier or two-tier local authorities. The single tier authorities comprise unitary authorities, metropolitan districts, and London boroughs, though some services, such as transport planning, are carried out by the Greater London Authority. The two-tier authorities elsewhere comprise counties and non-metropolitan districts. In Wales, there are single tier unitary authorities.

Reference date

The census provides estimates of the characteristics of all people and households in England and Wales on Census Day, 21 March 2021. It is carried out every 10 years and provides the most accurate estimate of all the people and households in England and Wales.

We are responsible for carrying out the census in England and Wales but will also release outputs for the UK in partnership with the Welsh Government, the National Records of Scotland (NRS), and the Northern Ireland Statistics and Research Agency (NISRA). The census in Northern Ireland was also conducted on 21 March 2021, whereas Scotland's census was moved to 20 March 2022. All UK census offices are working closely together to understand how this difference in reference dates will affect the UK-wide population and housing statistics in terms of both timing and scope.

Response rate

The person response rate is the number of usual residents for whom individual details were provided on a returned questionnaire, divided by the estimated usual resident population.

The person response rate for Census 2021 was 97% of the usual resident population of England and Wales and over 88% in all local authorities. Most returns (89%) were received online. The response rate exceeded our target of 94% overall and 80% in all local authorities.

Read more about question-specific response rates at local authority level in Section 4 of our Measures showing the quality of Census 2021 estimates methodology.

Ethnic group question

To see the ethnic group question on the household, individual, and Welsh questionnaires, visit our Census 2021 paper questionnaires page.

Ethnic groups in the detailed ethnic group classification

An ethnic group will be shown in the detailed classification if the number of people who identified with the group within a write-in response option are large enough to disaggregate from other ethnic groups. For this reason, some ethnic groups appear in multiple high-level categories. Where the number of people identifying with an ethnic group is small enough for individuals to be identified, an ethnic group will be aggregated with other ethnic groups in the same write-in response option.

Quality

The census provides the most detailed picture of the entire population, with the same core questions asked to everybody across England and Wales. Census results can be more reliable than survey results based on a sample of the population, because the whole population is included. The UK Statistics Authority has assigned National Statistics status to Census 2021 outputs, providing assurance that these statistics are of the highest quality and value to users.   

Census 2021 achieved a very high response rate of 97%. We ensure the census results reflect the whole population by using statistical methods to estimate the number and characteristics of people who were not recorded on a census response. This means that the census statistics are estimates, rather than simple counts of responses, so they have some statistical uncertainty associated with them. We take steps to minimise possible sources of error. 

Additionally, we apply statistical disclosure control to protect the confidentiality of census respondents. Differences in the methods used for statistical disclosure control may result in minor differences in data totals between census products. 

Quality considerations, along with the strengths and limitations of Census 2021 more generally, are provided in our Quality and methodology information (QMI) for Census 2021.

We also have specific methodologies for Demography and migration quality information, Ethnic group, national identity, language, and religion quality information, Health, disability and unpaid care quality information, and Sexual orientation and gender identity quality information.

Further information on our quality assurance processes is provided in our Maximising the quality of Census 2021 population estimates report.