Key Messages 

• training for heart failure is often designed for acute settings rather than care homes 
• care home staff navigate complex clinical decision-making with limited tailored guidance 
• communication with residents and families is a central part of managing heart failure care 
• staff described both barriers and facilitators to delivering appropriate care 
• role clarity and access to support influenced confidence in practice. 

Policy implications

• training for long-term health conditions should be adapted to care home contexts 
• clearer pathways between health services and care homes could improve care continuity 
• communication skills training may support discussions with residents and families. 

Gaps

• findings are based on qualitative accounts 
• recruitment through an independent network may limit representativeness 
• the study focuses on heart failure and may not transfer to other conditions 
• limited insight into organisational and system-level variation. 

Commentary 

• This study provides insight into the everyday realities of delivering heart failure care in care homes. It shows that staff are required to make complex judgements in settings that differ significantly from the acute environments where most clinical training is focused. 
• Participants described the challenge of adapting condition-specific knowledge to residents with multiple needs, alongside the emotional labour of communicating with families about changing health and care requirements. These responsibilities often sit outside formal role definitions or training expectations. 
• From a care equity standpoint, the findings highlight how gaps in training and support can lead to uneven care experiences for residents. Where staff lack access to appropriate education or specialist input, residents with heart failure may receive variable levels of care depending on the confidence and experience of individual workers or teams. These inconsistencies reflect broader inequities in how clinical expertise is distributed across care settings. 
• Overall, the study underscores the importance of recognising care homes as complex clinical environments. Supporting the workforce with tailored training and clearer integration with health services is essential for delivering equitable, high-quality care to residents living with long-term conditions such as heart failure. 

Key messages 

• care home provision in Wales included 25,607 residential and nursing beds across 1,069 sites in March 2020 

• the average care home had around 24 places, although many homes were small and over a quarter had six or fewer places 

• only around 9% of care home places were provided by local authorities, with most delivered by independent providers 

• there were on average 53.3 care home places for every 1,000 people aged 70 or over, but this varied widely between areas 

• cities and densely populated areas had more care homes, but they also had higher demand for places 

• where people live strongly affects access to care homes, with some communities having far fewer nearby options 

• simple measures of care home supply can hide local inequalities, especially in rural areas 

Policy implications 

• use detailed mapping of care homes and population need to identify areas with limited access to residential care 

• improve coordination between neighbouring local authorities when planning care home provision 

• target investment in areas where demand for care is increasing but local provision is limited 

• include population ageing, deprivation and health needs in long-term care planning 

• monitor how financial pressures and changes following COVID-19 affect the stability of care home services 

Gaps 

• demand was estimated using the number of people aged 70 or over, which does not fully reflect health needs or disability 

• the study did not include data on how many beds were already occupied, meaning real availability may differ from total capacity 

• financial barriers to accessing care homes were not included in the analysis 

• the study did not consider differences in care home quality, fees or specialist services such as dementia care 

• travel assumptions were based on driving distances and may not reflect access for people without a car 

Commentary 
This study looks at how access to care homes varies across Wales depending on where people live. The researchers mapped the location of care homes and compared this with the distribution of older people who may need residential care. This helps show whether some areas have better access to care home places than others. 

The results show that care homes are not evenly distributed. More homes tend to be located in urban areas and the post-industrial valleys of south-east Wales. However, these areas also have larger older populations, which means demand for care home places is higher. As a result, the actual availability of places may not be as high as the number of homes suggests. 

Some rural areas appear to have a better balance between the number of places and the number of older residents. However, people in these areas may still face challenges because care homes are further apart and travel distances can be longer. This can make it harder for families to visit relatives and for people to remain close to their communities when they move into residential care. 

The study also highlights how the organisation of the care sector affects access. In Wales, most care homes are run by independent providers rather than local authorities. This means the location of homes is partly shaped by market conditions and business decisions, not just local need. Areas that are less profitable or harder to operate in may therefore have fewer services. 

These patterns matter for care equity. If some communities have fewer nearby care homes, people living there may have fewer choices or may need to move further away from their families and support networks. This can affect wellbeing and continuity of care. 

Overall, the study shows that looking at where services are located, and where people live, can help policymakers understand where gaps in care provision exist. This kind of analysis can support better planning of care home services and help ensure that access to residential care is more evenly distributed across regions.