Resident funding and care home quality: a retrospective observational analysis of the impact of the two-tier care system in England

Anders Bach-Mortensen, Benjamin Goodair, Michelle Degli Esposti and Christine Corlet Walker
Age and Ageing, Vol 54/5 | May 2025

Summary

England’s adult social care system operates on a two-tier basis, where some residents pay privately (self-funders) and others are funded by the state. However, it has remained unclear whether the source of a resident’s funding affects the quality of care they receive. To explore this, researchers at Oxford University and CUSP conducted a nationwide analysis of more than 14,000 care homes between 2021 and 2023, examining links between funding type and official care quality ratings. The study used inspection data from the Care Quality Commission alongside information about care home and resident characteristics, local deprivation levels, and provider ownership models.

The findings reveal a clear pattern: private care homes with self-funded residents tend to receive higher inspection ratings. This link was especially strong in for-profit care homes where quality appears closely tied to the number of residents paying privately. In contrast, not-for-profit and public sector homes showed little to no variation in quality based on funding source, and consistently outperformed for-profit homes when no self-funders were present.

These results raise serious questions about equity in the care system. Because self-funded residents are more concentrated in wealthier areas, the study suggests that quality of care may depend not just on where someone lives, but on how their care is financed—highlighting systemic inequalities in access to high-quality residential care.

Further Reading