Is small beautiful if it isn't viable? The case of nursing homes

The optimal size of nursing home is examined in the light of overseas and Australian research evidence. The economic optimal size nursing home was found to be in the range of 45-55 beds for a sample of proprietary New South Wales homes in 1978-9 where average weekly expenditure per bed was minimised. However, this did not take into account a number of other important social and environmental factors as well as costs of travel and the quality of care provided or the characteristics of patients. When these factors are considered, evidence suggests that larger than average homes have the economic advantage. Smaller adapted residences, or those incorporating group living design, may be more homelike for residents but at slightly higher cost. Thus there is unlikely to be one single optimal size of home but rather a range. The final selection of scale is therefore a matter of striking a compromise between these and other factors in each situation.