Summary by Will Byrd (Care Policy and Evaluation Centre, LSE)

Over the past year and a half, Vilans, the National Centre for Expertise for long-term care in the Netherland, been mapping the measures taken by the governments of eight countries (Belgium, Denmark, France, Germany, the Netherlands, Norway, Sweden, and the United Kingdom) in response to the Covid-19 pandemic in the long-term care sector. Their aim was to learn from the measures introduced in these countries to better deal with Covid-19 and its consequences, in particular to inform clients, and formal and informal carers in long-term care (LTC). On June 29, 2021, they released their fourth overview, which highlights the measures that have been taken since March 2021. This mainly focuses on vaccination status and strategies, current testing policies, the impact on visitor arrangements, financial compensation, and preparations for a possible ‘fourth wave’. Timelines are presented at the end of the overview, illustrating how measures have been deployed in the eight countries over time. 

In addition, there is a section setting out some final reflections and lessons that can be drawn from the series of overviews that they have published, which touches upon resource availability and distribution, service integration, policy implementation, regulation and oversight, and ethical dilemmas. 

These overviews have been commissioned by the Ministry of Health, Welfare, and Sports in the Netherlands. Data was collected by reviewing key publications and websites in the various countries, and by reviewing publications on international forums, such as the LTCcovid platform of the International Long-term Care Policy Network. Numerous experts in the eight countries assisted in collecting additional information and providing insights for a deeper understanding. The takeaways from each section are briefly described below. 

Vaccination strategy 

In all participating countries, although the vaccination strategies differed slightly, all of them prioritised the oldest and most frail. These policies have been effective in reducing the number of casualties from Covid-19. Citizens are free to refuse to be vaccinated, and this is true for staff of health and LTC services. Furthermore, because of privacy reasons, employers are unable to enquire about the vaccination status of employees. Therefore, those who refuse to be vaccinated cannot be dismissed from employment. In some countries, there is debate about mandatory vaccination for certain staff groups.

Testing policy 

There are significant differences in testing policies between the countries as a precondition for visiting individuals in LTC. No tests are required in some countries, whereas in others, visitors must be tested with rapid tests on the day of the visit. Generally, where there is no requirement for testing before visiting, there are fewer requirements for staff to be tested. In other countries, staff must follow a regular testing cycle. At the time of the publication of the report, with the decline in infections and increase in vaccines administered, there had been discussions in some countries about dropping some of these visiting and staff testing policies. In the case of the discovery of a Covid-19 infection, all countries follow a strict protocol of testing. 

Visiting arrangements

There are significant differences in visiting policies between the countries. At the time of the publication of the report, with few exceptions, none of the countries are back to the ‘old’ normal with respect to visiting arrangements. There are few limits on the number of visitors in some countries, whereas, in others, a specific number of named visitors are allowed. In decentralised countries, these restrictions may vary between municipalities and nursing homes. In many cases, social distancing guidelines must still be followed, and in a minority of these, masks must still be worn. 

Financial compensation by the government 

Compensation to organisations for the loss of revenue and additional expenses during the Covid-19 crisis differs between countries. Financial support packages have been created in some countries to provide additional funding to meet pressures on public services such as health and social care. Bonuses have been awarded in some countries to staff who work in health and LTC services to recognise the contribution that they have made during the pandemic.

The fourth wave 

At the time of the publication of the report, in general, the infection and death rates had been decreasing in all of the countries studied, and it was expected that most restrictions could be lifted during or after the summer. Increases in infection are expected to take place during the autumn and winter because of seasonal influences on the spread of the virus. However, it is anticipated that health and LTC services will be capable of handling these. New unprecedented situations may occur, and all of the countries studied are aware of the risks of the Delta variant and are following it’s spread. In addition, it is unclear how long the vaccines will provide protection and how many of the population in the end will be vaccinated. Booster programmes have been planned in some countries. 

Preparations are being made in case of outbreaks, and even if LTC residents or frail people are vaccinated, there is no guarantee of restrictions not being imposed once more. However, infection prevention in LTC is now much more common, with care providers being better prepared to prevent and react to future outbreaks. 

The full report is available here: https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf?_ga=2.149290806.1272526668.1625667671-185404347.1625667671