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Margaret Butterworth Care Home Forum

What does the research say about care home managers?

A scoping review about managers of care homes for adults

by Katharine Orellana, King's College London

Orellana, K. (2014) 'Care home managers: a scoping review of evidence', London: NIHR School for Social Care Research. Published December 2014.

Katharine discusses her review on our blog.

Rationale for the review

There are almost 18,000 care homes with over 450,000 places in England. A small proportion of homes are owned and managed by the same person while a significant proportion of beds are in care homes that are part of large, or multi-national, chains. In the majority, a manager is appointed by the home owner. Following several recent high profile failings of care, quality and safety in care homes are becoming an increasingly important concern for the adult social care sector and for other stakeholders such as policy makers, the media, family carers and the general public.

Research around care homes has mainly focused on the organisational culture within which, it has been argued, impacts on organisational systems and processes, and the responsiveness or flexibility of the home and, therefore, on staff and residents. It has been suggested that the running of care homes depends crucially on the skills and leadership attributes of their managers amongst whom there is an average turnover rate of 12%. However, little is known about care home managers, their careers, training and the supervision and support they receive from home owners or regional managers.


Although a broader range of demographic data on the social care workforce is becoming available, most attention has been paid to care workers or the care home workforce as a whole and we know very little about the practice, experiences, skills of care home managers and challenges they face. This review aims to identify and summarise the evidence available on managers of care homes for adults in England. It is timely in that the Care Quality Commission’s proposals for changes to the way it inspects include replacing 16 outcomes and 28 regulations with five key domains, one of which is well-led which is important for positive outcomes in the remaining four: safe, effective, caring and responsive.

As well as identifying areas for further research, it provides valuable evidence for care home providers, managers and practitioners, commissioners, policymakers, researchers, and for people using services and carers.


The review primarily covers evidence from England since the passing of the Care Standards Act 2000. Other UK and international literature is included where findings are relevant to English regulatory frameworks. It covers managers of care homes with and without nursing and ‘other’ residential homes for adults of all ages with or without mental health problems/illness. Adult placement homes, extra care/sheltered housing, supported living services and children’s homes are excluded.


Katharine spoke about the review at the Margaret Butterworth Care Home Forum, 14 May 2014.

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