OOPS #7: The Business of Growing Old
Welcome to OOPS, my occasional reflections on the business of getting older — what catches me by surprise, what makes me think, and what seems to matter more with each passing year.
This may feel like a less personal reflection but the whole ‘business’ of growing old has been very much on my mind this week because of an excellent (and depressing) article in The Guardian (https://www.theguardian.com/society/2026/mar/28/the-great-care-home-cash-grab-how-private-equity-turned-vulnerable-elderly-people-into-human-atms). I’ve found myself reflecting on the increasing role of investors in the care home sector, and what it means when care for people in their later life is shaped less by their needs and more by the logic of markets and investment. How on earth did we allow a system like this to develop?
There was an article in The Guardian this week about the care home “market” — a market attracting increasing amounts of private investment
Investors have spotted two simple facts. People are living well into their 80s and 90s. And more than half of them own homes that have risen significantly in value. Put those together, and care homes start to look like a recession-proof investment: a growing “market” of older people who can fund expensive residential care by selling their homes.
When I started working in social care 50 years ago, most residential care was small-scale and often family-run. Over time, regulatory and financial pressures led many of these homes to be bought up by larger companies. Today, nearly a third of all UK care home beds are owned by just 26 providers. Around 83% of the sector is now for-profit, and private equity investors have a particularly strong influence over the largest chains.
Now, all investors expect a return. That in itself is not the issue. Profit does not automatically mean poor care.
The problem lies with a particular model of investment. Private equity firms often use what is called a leveraged buyout. In simple terms, they buy a company using a small amount of their own money and a large amount of borrowed money — and then place that debt onto the company itself. The company, in effect, goes into debt to pay for its own purchase.
That debt has to be repaid. And it is repaid through the fees paid by the people living there.
So those fees are not just funding care. They are also servicing debt and generating returns for investors. The pressure this creates is predictable: cut costs, wherever possible. That often means fewer staff, lower pay, and less time for care. And that, inevitably, affects quality.
This isn’t just anecdotal. A 2022 study published by Oxford Academic found that for-profit providers backed by private equity had, on average, fewer staff hours per resident and poorer indicators of care quality.
So far, so dry. But the human consequences are anything but.
In 2025, WIGO carried out a survey of people’s experiences of care. Many spoke warmly about the people supporting them — but also recognised those staff were being run ragged. And some stories were deeply troubling.
I still remember one told by a social worker about her former GP, now living in a care home. She went to visit her and found her sitting in her own urine. She had been ringing for help to get to the toilet. No one had time to come.
We also heard good stories — particularly about smaller, locally run homes where people felt known and cared for. So this is not a simple argument that private is bad and voluntary is good.
It is something more fundamental than that.
It is about what happens when we start to treat older people as a market — as assets, as income streams, as commodities. People who have worked, saved, bought homes, and are now expected to sell those homes to pay for care that is, too often, not good enough — however attractive the building may be.
Under the Care Act, local authorities have a responsibility to help people — regardless of their financial situation — make informed choices about their care and support. Too often, that amounts to little more than a printed list of local providers, with no real guidance on how to choose well, and no exploration of alternatives.
People paying for their own care deserve better advice than that.
Some will choose residential care. But many, if they understood the options, might choose something very different.
As my colleague Angela puts it:
“If I have to pay £2,000 a week for care, just think of the many different kinds of help I could buy — if I knew about them.”
