When the wealth a service creates is steadily taken out of it, the service decays. The writer Cory Doctorow has a blunt word for this: enshittification.
In care, it is simple. The quality of care falls because the money that should sustain it has gone somewhere else. Is it happening?
In parts of the sector, yes, and under more than one ownership model.
The good news: independent homes are the best placed in the sector to get ahead of it.
Where did the word come from?
Doctorow coined the term in 2022 to describe why big platforms such as Facebook, Amazon and Google all seemed to get worse in the same way.
His argument runs in three stages. First, a platform is genuinely good to its users, because it needs them.
Then, once users are locked in, it shifts the value to its business customers, such as advertisers and sellers paying for access to those users.
Finally, once everyone is locked in, it claws back value for itself and its shareholders, and the whole thing curdles. The service still exists. It just quietly stops being for you.
And it stopped being an internet word some time ago. The clearest example in Britain right now is water.
Decades of dividends flowed out while the infrastructure quietly degraded, and the public noticed the difference between what they pay and what they get.
When wealth leaves a service faster than it’s reinvested, people eventually feel it, and they stop believing the brochure.
Once you’ve seen the pattern, you see it everywhere. So let’s be honest about our own sector.
Is it actually happening in care?
Here’s the fair answer: care is not a platform, and most of the people in it, including most owners, are motivated by something money can’t fully explain.
But three layers around care show the pattern clearly enough that every operator should recognise it.
The middle layer between you and families. The big care directories began as a genuinely useful thing: one place for families to search.
Today, directories also sell paid tiers to care homes. Check your own directory’s price list, and see what each tier promises about where you appear.
That’s not a scandal. It’s a business model, and the tools can be useful.
Where a tier affects position, the order a worried daughter scrolls through is partly a ranking of subscription.
That visibility is rented, not earned. That is textbook stage two.
The ownership layer. A University of Manchester study of 10,803 English care homes, published in Age and Ageing, found that in January 2020, private-equity-backed chains were 6.6 percentage points more likely to be rated “Requires Improvement” or “Inadequate” than not-for-profit providers, with the gaps showing up in safety, effectiveness and responsiveness.
That is a statistical pattern, not a verdict on any individual home, and there are excellent corporate homes and struggling independents.
But when a home’s surplus is being pulled upward to service debt and investor returns rather than reinvested in the floor, residents and staff feel it first. That is what taking money out of care looks like.
Two things need saying plainly here. This is no argument against profit, and investment firms are only part of the story.
First: margin is not the enemy. Margin is why a care home can exist at all.
It funds the pay rise, the refurbishment, the extra activities coordinator, the owner’s own livelihood after years of risk and 6am phone calls.
Operators are entitled to do well from doing good work. That’s the deal, and we’d defend it.
Second: extraction is a behaviour, not an ownership structure. It doesn’t need a fund in another country; it can happen quietly in a family-owned group too.
If the rewards of the business are visibly growing while carers’ pay hasn’t moved in five years and the building hasn’t seen investment in as long, staff and families do that maths. The perception, fair or not, lands in the same place as it does for the investment firm.
The question that matters is simple, and it has nothing to do with who owns the home.
Does enough of the wealth this home creates find its way back into the care? When the answer is yes, profit and quality can rise together, and everyone, including the owner, is better off.
The marketing layer. Private fees keep rising while, from a family’s point of view, homes can be hard to tell apart.
Every website promises “person-centred care” in a “homely environment”, and AI tools are now flooding the sector with content that sounds plausible and says nothing.
Families respond the way we all respond to empty words, with scepticism.
Prices up, distinctiveness down, trust down. That’s the curdling.
Here’s the pattern side by side:
Doctorow’s stage
What it looks like in tech
What it can look like in care
1. Good to users
Free, useful, honest platform
A directory that simply helps families find homes
2. Squeeze users for business customers
Feeds filled with ads and paid placement
Rankings and prominence sold to homes as subscriptions
3. Squeeze everyone for the owner
Fees up, quality down, everyone locked in
Value extracted upward while fees rise and quality is squeezed
The caring itself is hard to squeeze. The layers around it are easier.
What are the warning signs for your home?
You can’t fix the whole sector from one home. You can absolutely spot when the pattern is creeping into your own corner of it:
More of your enquiries arrive through intermediaries who charge you for access to them, and the charge rises each year.
Your position in a directory changes with your subscription tier, not with your CQC rating or your reviews.
A search for your home’s own name shows portals above your own website.
Your marketing looks and sounds like everyone else’s, because it was generated the same way.
A supplier or agency keeps your website, photography, data or contacts when the contract ends, so leaving means starting again.
And one to check in the mirror, gently: if the business is visibly rewarding its owners more than it did five years ago while pay and the building look much as they did then, that’s the same pattern seen from the inside, and your team will have noticed before you have.
If two or more of those feel familiar, the pattern has found you.
Why is it happening?
Because the conditions that used to prevent it have weakened.
Doctorow argues platforms decay when four constraints fail: competition, regulation, the ability to switch, and the power of the people doing the work. Care has its own version.
Most homes have rooms to fill. In mid-August 2026, 86.8% of care home beds were occupied, on government figures.
That leaves homes ready to pay for anything that promises enquiries. Families in crisis rarely have time to compare carefully.
And the sector’s marketing has consolidated around a handful of intermediaries that everyone feels obliged to pay. Extraction thrives exactly where dependence lives.
How do good care homes resist it?
This is where independent homes hold the better cards.
There’s no investment committee between you and the decision to put this year’s surplus into the team, the building or the family experience. You can decide that tomorrow morning.
Being able to show you are on the right side of that line is also something the biggest operators may find hard to copy.
Beyond that, resisting comes down to refusing to be dependent. This pattern only works on people who can’t leave.
Own your route to families. Your website, your Google Business Profile, your reviews, your photography, your enquiry data.
If it’s paid for, it should be yours. If a supplier keeps it when you go, that tells you whose asset it really was.
Many families start their search on Google, so being found directly can reduce what you pay in rent. (Our page on care home SEO, which means being found on Google, covers where to start.)
Treat directories as a channel, never the channel. They’re useful. Dependence on them is the trap. Measure what each one actually sends you and pay for what performs. Our care home marketing budget calculator can help you see what that spend should look like.
A home that owns its assets, answers families honestly and measures where its enquiries come from is hard to squeeze.
If you’d like to know how much your enquiries depend on rented ground, our Free Enquiry Review can help. There’s no obligation, and you keep the findings.
(That’s rather the point.)
Barry Jobson, founder
25 years in brand, digital and marketing, six of them only in care. Barry writes the Quick Wins email every week and still answers the phone.
