Fiona Grimm*, Karen Hodgson, Richard Brine, Sarah R Deeny (The Health Foundation, London, UK)

The Health Foundation have published a preprint on the first comprehensive national analysis of hospital use by care home residents during the first wave of the COVID-19 pandemic, compared to the year before. 

Efforts to understand the impact of the pandemic on residents’ health needs have been hampered by the lack of a central register of care home residents and the challenge to identify residents in national, routinely collected healthcare data. This study is based on a large linked dataset and uses validated address-based data linkage methodology to identify residents of residential and nursing homes in routinely collected hospital data, while maintaining individual residents’ privacy. It captures all hospital admissions for 252,432 care home residents in England during the COVID-19 outbreak, up until 28 June 2020.

The authors found that emergency hospital admissions from care homes for conditions other than COVID-19 decreased by 36% between March and May 2020, indicating that significantly fewer care home residents received potentially lifesaving treatment during the first phase of the pandemic. Routine elective admissions for care home residents – which includes care such as cataract surgery, some cancer treatment and hip replacements – fell by 63%. This is compared to a 56% reduction in routine admissions for the general population, which suggests that those living in care homes who often have complex health needs and require high levels of hospital care – were particularly hard hit by the reduction in services.

The findings appear to substantiate concerns that care home residents (including those in nursing homes and residential care) may have faced barriers to accessing hospital treatment as the NHS rapidly reorganised to free up hospital capacity to care for critically ill COVID-19 patients. Some hospital admissions may have been avoided through increased provision of NHS care in the community, and the perceived risk of infection in hospitals may also have led to changes in patient and carer preferences for hospital admission.

With the NHS under ongoing pressure from COVID-19, the scale of the reduction in hospital admissions will mean that many care home residents will still be waiting for care and many are likely to be sicker as a result.  The level of unmet need within care homes will now be placing additional strain on the NHS alongside ongoing pressures from COVID-19.

Please note that this article is currently under review with a journal and may be subject to change. The full paper is available here:

https://www.preprints.org/manuscript/202102.0593/v1

The abstract is reproduced below:

Preprint: Hospital Admissions from Care Homes in England During the COVID-19 Pandemic: A Retrospective, Cross-Sectional Analysis Using Linked Administrative Data

Fiona Grimm*¹, Karen Hodgson¹, Richard Brine¹, Sarah R Deeny¹

¹The Health Foundation, London, UK

Abstract

Background: Care home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. 

Objective: To examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak. 

Methods: Retrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England between 20 January 2020 and 28 June 2020, compared to the corresponding period in 2019. Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May and primary admissions reasons for this period were compared across years. 

Results: Hospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents. Emergency admissions for acute coronary syndromes fell by 42% and 28% and emergency admissions for stroke fell by 16% and 24% for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents. 

Conclusions: This is the first study showing that care home residents’ hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.