Why Small is Beautiful

Dr Nick Bruce is the founder and non-executive chairman of Nightingale Retirement Care Ltd, and holds a Doctorate in Business Administration from the University of Liverpool.

Whilst most care facilities have continued to grow in size, we have remained small, and not just because it seems the intuitively right thing to do. Academic research proves it, and the CQC agree (Ref. 3).

In a landscape where care facilities often expand to accommodate all client needs, regardless of their compatibility, we consciously choose to remain small, a decision rooted in more than intuition. Rigorous academic research supports this approach, highlighting a direct correlation between smaller care environments and heightened client satisfaction (Ref. 1, 9) and wellbeing (Ref. 4, 8, 9, 10).

At the heart of our philosophy is the understanding that those in need of care thrive in a setting where they can form meaningful relationships with a familiar group of caregivers (Ref. 8). This is a stark contrast to the often impersonal nature of larger facilities where a frequently rotating staff group, who are often sourced from overseas or through agencies, struggle to build genuine connections with clients (Ref. 5, 11). Our model, being founder-employee-owned, results in a low staff turnover. Our caregivers are deeply familiar with each client, creating a sense of community and belonging that is rare in larger institutions.

This intimate approach to care is more than comforting; it’s beneficial for the health and wellbeing of our clients (Ref. 4, 8, 9, 10). Larger facilities, while boasting of the ability to cater to diverse needs, often create a soulless and stressful atmosphere by doing so (Ref. 7, 11). The looming possibility of being moved to accommodate changing needs is distressing for clients, potentially exacerbating their conditions and becoming a self-fulfilling prophecy (Ref. 2, 5, 7). We prioritise stability, offering a lifelong home with specialised care as needed, thus minimising the disruptive and often detrimental transfers seen in larger settings.

Our focus on creating a boutique environment for our private clients further differentiates us. Our facilities are designed to be unobtrusive, offering a supportive system that blends seamlessly into a homely setting (Ref. 8, 10). This approach often contrasts with the clinical, hospital-like atmosphere of larger facilities, which not only constantly remind clients of their vulnerabilities but also proved to be more susceptible to challenges like the infection outbreaks during the COVID pandemic (Ref. 6) .

In essence, our belief in “small is beautiful” translates into a deeply caring and effective approach to meeting the needs of our clients. They quickly become familiar with our dedicated team, who are not just caregivers but part-owners, ensuring a level of care and commitment that resonates deeply with our clients and their families, as evidenced by our numerous positive reviews.

This model isn’t just a choice; it’s a commitment to providing the best possible environment for those in our care.

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References

1. Bhattacharyya et al (2022) – Self-reported satisfaction of older adult residents in nursing homes: Development of a conceptual framework.
2. Holder et al (2012) – Forced relocation between nursing homes: residents’ health outcomes and potential moderators.
3. CQC (2017) – The state of adult social care 2014-2017- Findings from CQC’s initial programme of comprehensive inspections in adult social care.
4. Kane et al (2007) – Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial Green House program.
5. Keller et al (2012) – Does the perception that stress affects health matter? The association with health and mortality.
6. Rosenberg (2021) – More nursing home staff linked to more COVID-19 cases.
7. Shields et al (2023) – Why is subjective stress severity a stronger predictor of health than stressor exposure? A preregistered two-study test of two hypotheses.
8. Slavich et al (2020) – Social Safety Theory: A biologically based evolutionary perspective on life stress, health, and behaviour.
9. Spangler et al (2019) – Small is beautiful? Explaining resident satisfaction in Swedish nursing home care.
10. Verderber et al (2023) – Residential environments for older persons: A comprehensive literature review (2005–2022).
11. Vermeerbergen et al (2017) – A compairson of working in small-scale and large-scale nursing homes: A systematic review of quantitative and qualitative evidence.