LTCcovid Country Profile – Printable Version

COVID-19 and the Long-Term Care system in Denmark

Structural characteristics of the LTC system, impact of the pandemic, measures adopted and new reforms

This is a section of the LTCcovid International Living Report on COVID-19 Long-Term Care that brings together information on the experience of the long-term care sector (focussing on people who use and provide care) during the COVID-19 pandemic in Denmark, as well as description of the system and of new reforms. This report is updated and expanded over time, as experts on long-term care add new contributions.

Authors:

Tine Roostgard and Maggie Langins

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Please use this citation and add the date in which the document was downloaded:

Roostgard, T. and Langins, M.  COVID-19 and the Long-Term Care system in Denmark. In: Comas-Herrera A., Marczak J., Byrd W., Lorenz-Dant K., Pharoah D. (editors) LTCcovid International Living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy and Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6

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Acknowledgement and disclaimer

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.

Copyright: LTCCovid and Care Policy and Evaluation Centre, LSE

Update for: Denmark   Last updated: January 6th, 2022


1.00. Brief overview of the Long-Term Care system

The Long-Term Care (LTC) system in Denmark is a universal and primarily public system. Access to LTC services is at no cost for home-based care, or with a means-tested co-payment. The LTC system has strong public and political support. It is a highly decentralized system, organised, financed and provided at the municipal level. There is a strong emphasis on community-based care, re-ablement and professionalisation of care staff (WHO, 2019).

The main law regulating social service provision and, implicitly, LTC provision is the Social Services Act, which passed in 1998. The Social Services Act emphasizes the users’ right to influence social service provision and enshrines the highly decentralized nature of the system, putting municipalities in a key position to shape long-term care.

In recent years there has been a decrease in the number of people who receive home care services, which resulted in more burden placed on unpaid carers (WHO, 2019; Rostgaard, 2020).

References:

Rostgaard T. (2020), The COVID-19 Long-Term Care situation in Denmark. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 25 May 2020.

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019.

Update for: Denmark   Last updated: February 3rd, 2022


1.01. Population size and ageing context

In 2021 Denmark had a population of just under 6 million; 19.4% of the population were over 65,  with 4.1% over 80 and 1.9% over 85 (source: https://www.dst.dk/en/Statistik). These numbers are expected to rise significantly, and according to calculations from Statistics Denmark, by 2053, 10% of the population will be over 80 (source: https://www.sst.dk/da/viden/aeldre).

Update for: Denmark   Last updated: February 1st, 2022


1.02. Long-Term Care system governance

Although national legislation sets a broad framework for service provision, municipalities maintain responsibilities for long-term care policies. These include establishing eligibility and entitlement criteria and the level and content of service delivery, regulating services’ delivery and organizing the public provision of services.

In 2007 the number of municipalities was reduced from 275 to 98, creating larger administrative units. This change was accompanied by municipalities also taking charge of the rehabilitation of people who are being discharged from hospital, with municipalities taking a stronger role in prevention and health-oriented interventions (Rostgaard, 2020).

In 2015, the responsibility for regulating services and support for older people was transferred from the Ministry of Social Affairs and the Interior to the Ministry of Health. This transfer of responsibilities for regulation and oversight of care for older people was a clear move towards integrating central and strategic decision making for health and social services (WHO, 2019).

References:

Rostgaard T. (2020), The COVID-19 Long-Term Care situation in Denmark. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 25 May 2020.

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 3rd, 2022


1.03. Long-term care financing arrangements and coverage

Public sending on Long-Term Care as % of Gross Domestic Product (GDP):

In 2016 Denmark spent 2.5% of GDP on publicly funded LTC which was almost twice of the EU average (WHO, 2019).

Approach to public funding for LTC and eligibility:

Municipalities are responsible for allocating resources; they obtain funding from the national government, local taxes and equalization money from other municipalities. There are no co-payments for home-based care services  such as cleaning and personal care, although individuals who use private providers can buy additional services. Eligibility for LTC is based purely on needs assessment carried out by the municipalities, principle of free and equal access applies, regardless of income, wealth, age or household situation. There are no thresholds or minimum dependence required for in-kind or cash benefits. Needs assessment is multidimensional and captures a wide range of aspects related to a person’s situation and well-being (WHO, 2019).

It has been estimated that 16% of the total population provided unpaid care at least once a week in 2016 (WHO, 2019). The availability, or not, of informal care is not considered as a criterion for assessing needs and entitlements. Unpaid carers experience less burden and are less likely to report difficulties in reconciling work and caregiving compared with the rest of the EU (Rodrigues at al., 2013).

References:

Rodrigues, R., Schulmann, K., Schmidt, A., Kalavrezou, N. & Matsaganis, M. (2013). The indirect costs of long-term care. European Centre for Social Welfare Policy: Research Note.

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 15th, 2022


1.04. Approach to care provision, including sector of ownership

Free choice of provider was introduced in 2003, which banned public monopolies in service provision.  Municipal councils are required by law to ensure private providers exist in each municipality. In 2017, Denmark had 320 private for-profit home care agencies (WHO, 2019).

Municipalities usually use competition with fixed prices for tendering home care. Competition takes place on quality by, for example, ensuring continuity of workforce. Municipalities are obliged to contract with any private-for-profit provider that meets the requirements on quality standards and the price. Public and for-profit providers co-exist and the latter are not permitted to refuse to provide care for any individual. Legislation allows private home care providers to compete on price in the privately-paid for sector and, although municipalities are no longer obliged to contract with all bidders who meet minimum tender specifications, they must contract with at least two such providers (Marczak and Wistow, 2015).

References:

Marczak, J., Wistow, G. (2015). ‘Commissioning long-term care services’, in Gori C, Fernandez JL, Wittenberg R (eds) Long-Term Care Reforms in OECD Countries: Successes and Failures, Policy Press, Bristol. Accessed at Commissioning long-term care services

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 3rd, 2022


1.05. Quality and regulation in Long-term care

Quality standards for LTC apply to public and private providers. The municipalities are responsible for service and quality assurance, however they need to comply with standards set by national framework legislation.  The municipalities must ensure full transparency and clear separation between their function as providers and as the authority supervising quality. The municipal quality standards describe in detail the services available locally and are intended to be objective and transparent to allow individuals to evaluate the performance of the provider themselves. There are 23 impact and background indicators For general monitoring of providers, most indicators are monitored through administrative data and through user surveys (WHO, 2019).

References:

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 1st, 2022


1.06. Care coordination

Coherence and coordination in service delivery is a stated goal of the Danish Health Act of 2005 and one of the key drivers behind the major reform of local government of 2007. In reducing the number of municipalities and administrative regions, the reform effectively represented a large step towards centralizing health and social services and has actively pursued the coordination between the administrative regions and municipalities in providing care. The Danish Health Authority has also established chronic disease management strategies that bring together efforts by the administrative regions and the municipalities under a single model.

There is a good level of integration of care across providers, people who need long-term care following hospital discharge, the hospital discharge management team  works closely with the general practitioner and local home services. The administrative regions are responsible for coordinating after-hours care. After-hours clinics tend to be associated with hospital emergency department  (WHO, 2019).

References:

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 1st, 2022


1.07. Information and monitoring systems 

The sundhed.dk portal was launched in 2003 as a partnership between the Ministry of Health, five administrative regions and municipalities. The platform gathers information from 85 sources to enable individuals to access their medical records such as laboratory results, prescription information and scheduled visits, individuals can also enter or complement data on patient-reported outcomes. Hospitals share various information including discharge summaries and outpatient notes, and medical results with other hospitals, general practitioners and other specialists (WHO, 2019).

References:

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

 

Update for: Denmark   Last updated: February 1st, 2022


1.08. Care home infrastructure

In Denmark’s 98 municipalities, there are around 930 nursing homes with over 40,000 residents  (source: https://covid19.ssi.dk/overvagningsdata/ugentlige-opgorelser-med-overvaagningsdata).

The number of people in residential facilities and receiving home care has declined in both absolute and relative numbers in this decade.  In 2018, in absolute numbers there were 65,573 beneficiaries of long-term residential care services aged 65 years or older which equals to 5.8% of the population (source: https://www.dst.dk/en). In particular the proportion of people age 90 and over living in residential care facilities has fallen drastically, as 41.7 percent  lived in LTC facilities and senior housing in 2010 while the number fell to 33.1 percent in 2019 (source: https://www.dst.dk/da/Statistik/nyt/NytHtml?cid=30746#)

In 1984 it was made illegal to build any multiple bed residential services, therefore currently all nursing homes are private rooms with personal space, kitchenette and living space. Denmark is the only country in the EU in which the construction of traditional old-age and nursing institutions has been legally banned. There are five types of residential care facilities: nursing homes; sheltered housing; housing for older people; general homes for older people;  private care accommodation. The choice of specific type of accommodation depends on individuals’ preferences and needs, those choosing to live with their spouse or partner must be offered a facility suitable for two people (WHO, 2019).

References:

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 3rd, 2022


1.09. Community-based care infrastructure

The number of people receiving home care has declined over the last decade. Municipalities provide social services for older people and overall, older people can access a wide range of social services that enable them to remain in their homes even if they are chronically or terminally ill. These services include day care services, extensive home help and nursing care.

In January 2015, a new legislation came mandated all municipalities to consider first whether a person applying for home support could instead receive reablement services. Reablement is often offered in the form of a 12-week exercise training course, provided by multidisciplinary teams with an involvement of physiotherapists, in which the older person together with the care worker identifies and works towards achieving one or more goals such as, showering alone or cleaning home. Individuals receive home support only after the reablement failed to help. Municipalities offer services in the individual’s home or in rehabilitation centres. Rehabilitation services are included in the mandatory healthcare agreements between the administrative regions and the municipalities, and they ensure cooperation between the various service providers.

Individuals discharged from hospitals can receive follow-up home visits from general practitioners or nurses, which takes place a week after discharge and may be repeated at three and eight weeks after discharge if additional support is needed (WHO, 2019).

References: 

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at:  https://www.euro.who.int/en/health-topics/Life-stages/healthy-ageing/publications/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019

Update for: Denmark   Last updated: February 1st, 2022


1.10. Workforce conditions: pay, employment conditions, qualification levels, shortages

Social and health helpers and assistants represent most of the long-term care workforce. Physiotherapists and occupational therapists have increased in numbers during the past decade, particularly after the reablement programme was implemented. While the number of personnel has stagnated or sometimes declined in most residential settings, while there has been an increase by almost 10% of staff in employed in home help. Moreover, between 2005-2015 the number of staff working part time increased. There has also been a greater professionalization of the workforce: in 2016, 46% of the staff in residential care facilities had relevant qualifications that required training of more than two years as compared to 33% in 2005. As care needs of residents have increased, nursing home staff also experienced an increase in health, and nursing-related tasks. LTC workforce also reported higher work intensity (WHO, 2019).

The Danish Health Authority provides accreditation and licensing services for practitioners, including physicians, nurses, social and health care assistants, physiotherapists (Olejaz, 2012). Social and health helpers can become accredited after 1.5 years of training, including a basic course of 20 weeks and a period of alternating practical and theoretical courses. Social and health helpers can perform tasks related to support with personal care and hygiene as well as household chores. A further module of 32 weeks of theoretical training and 48 weeks of practice leads to the next level as social and health assistants. These can carry out nursing functions, including planning of activities. Social and health assistants may choose the traditional nursing education that encompasses 3.5 years for a university bachelor’s degree (Raholm et al. 2010). Modular training for personal carers is under development  for those seeking to access managerial roles or for nurse aides wanting to become nurses (OECD, 2020).

References:

OECD (2020) Who Cares? Attracting and Retaining Care Workers for the Elderly

Olejaz, M.,  Nielsen, A., Rudkjøbing, A., Okkels Birk, H., Krasnik, A., Hernández-Quevedo, C. (2012) Denmark: Health System Review. WHO European Observatory

Raholm, M., Birte Larsen HedegaardAnna LofmarkAshild Slettebo (2010).  Nursing education in Denmark, Finland, Norway and Sweden – from Bachelor’s degree to PhDJournal of Advanced Nursing

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 3rd, 2022


1.11. Role of unpaid carers and policies to support them

It has been estimated that 16% of the total population provided unpaid care at least once a week in 2016. Family members may apply to the municipality to be formally recognised as informal carers. If they are found to be eligible, the carer is employed by the municipality, up to six months with a pre-specified salary based on the national yearly income. Additional services for caregivers include training and education, often focused on improving knowledge and ability to provide support and on improving coping skills (WHO, 2019).

References: 

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 16th, 2022


1.12. Personalisation, user voice, choice and satisfaction

Municipalities partner with voluntary organizations to roll out community programmes to engage and reach out to older people (Olejaz et al. 2012).

Non-profit actors play mainly a role in advocacy rather than in providing services, although some provide nursing home care (Danish Deaconess Foundation and OK Foundation) while others organize self-support and peer-support activities (DaneAge Association and Danish Alzheimer Association). The DaneAge Association, a voluntary organisation with more than 825 000 members, has the most prominent role among civil society organizations and is involved in advocating the rights and well-being of older people, whilst many volunteers are themselves 65 years or older. The Elders Help Elders network, a partnership among six organizations, is one of the most visible initiatives organizing volunteers with a focus on visiting services, mobility support, shopping, practical assistance in the home, sharing meals and exercise. Non-profit organizations also play an important role in organizing volunteers in nursing homes, hospices and hospitals (WHO, 2019).

Individuals can complain to their municipality if they are not satisfied with the quality of local LTC offer and the services they receive. When a complaint is made,  the municipality must review the decision and if the decision is not changed, their complaint must be sent by municipality to a National Board of Complaints (European Commission, 2021).

References:

European Commission (2021)  2021 Long-Term Care Report Trends, challenges and opportunities in an ageing society. Luxembourg: Publications Office of the European Union,

Olejaz, M.,  Nielsen, A., Rudkjøbing, A., Okkels Birk, H., Krasnik, A., Hernández-Quevedo, C. (2012) Denmark: Health System Review. WHO European Observatory

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

 

Update for: Denmark   Last updated: February 11th, 2022


1.13. Equity and Long-Term Care

Denmark is one of the European countries with the lowest income inequality and high coverage of social and health services. The rate of poverty or social exclusion for older people  was 8.7% in 2015, about half the EU average (WHO, 2019).

References:

WHO (2019), ‘Denmark: Country case study on the integrated delivery of long-term care’. Accessed at: https://www.euro.who.int/2019/denmark-country-case-study-on-the-integrated-delivery-of-long-term-care-2019).

Update for: Denmark   Last updated: February 11th, 2022


1.14. Pandemic preparedness of the Long-term care sector

The health sector was prioritized during the first wave of the pandemic, and therefore there were challenges early on with preventing infections and securing resources to protect care homes. Conversely, adequate measures in LTC facilities have been implemented later on (Rostgaard, 2020).

References: 

Rostgaard T. (2020), The COVID-19 Long-Term Care situation in Denmark. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 25 May 2020.

Update for: Denmark   Last updated: February 11th, 2022


2.01. Impact of the COVID-19 pandemic on the country (total population)

As of February 8, 2021, there have been 202,051 confirmed cases of COVID-19 in Denmark, and 2,216 deaths, according to the Danish Health Authority, corresponding to 38.5 attributed deaths per 100,000 population.

Update for: Denmark   Last updated: December 4th, 2021


2.02. Deaths attributed to COVID-19 among people using long-term care

The data on cases and deaths within nursing homes are published weekly every Tuesday by the Statans Serum Insititut under the Danish Department of Health. Deaths among confirmed residents are defined as deaths among residents who died within 30 days of a positive covid-19 PCR test (from the data first tested).

As of April 19, 2022, there have been 6,019 deaths from COVID-19 in the whole population. There have been 2,204 deaths of care home residents. Therefore, the share of confirmed deaths among nursing home residents was 40% (Source: https://covid19.ssi.dk/overvagningsdata/ugentlige-opgorelser-med-overvaagningsdata).

There were just over 40,000 nursing home residents in Denmark, which suggests that 4.69% of this population have died from confirmed COVID-19.

 

Update for: Denmark   Last updated: May 3rd, 2022   Contributors: William Byrd  |  Disha Patel  |  


On September 15, 2020, the Danish Health Authorities announced that they have established a special committee responsible for developing national guidelines to health services and health professionals regarding the handling of long-term COVID-19 complications. There is no data yet on long-term COVID-19 in the LTC sector.

Update for: Denmark   Last updated: November 30th, 2021


2.05. Impacts of the pandemic on the health and wellbeing of people who use Long-Term Care

report on mental health from the nursing home sector indicated that the quality of life actually increased for the majority of residents. Nursing home managers reported that residents slept better, medication was reduced, there were fewer conflicts with residents suffering from dementia, more time for individual residents and the sickness rates among staff was lower. This was attributed to fewer common for all residents, instead members of staff make activities in smaller groups of residents or engage with them one by one. Staff reported a more relaxed atmosphere, one reason being that they did not have to engage with family members who at times are considered overly critical (Rostgaard, 2020).

However, there were also concerns that the Danish government’s response to the pandemic (e.g. care home visiting ban) was inflexible and not tailored to individuals circumstances (rather, it was based on ‘one size fits all’ rules). Combined with the late ease of restrictions, it had a negative long-term impact on older people’s mental and physical health and concerns were raised that the government should have done more to respect basic individuals’ freedoms (Source: https://www.djoef.dk/presse).

Reference:

Rostgaard T (2020) The COVID-19 Long-Term Care situation in Denmark. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 25 May 2020.

Update for: Denmark   Last updated: February 3rd, 2022


2.09. Impact of the pandemic on workforce shortages in the Long-Term Care sector

According to The Federation of European Social Employers (February 2022 report), Denmark has reported an increase of between 1 – 10% in staff shortages since 2021. The sub-sector most critically affected by staff shortages across the countries surveyed for this report were services for older persons. The job position most affected was nursing, but care assistants and homecare / social care workers also face real shortages. The most common reasons given for staff leaving the social care sector for another include low wages, and mental and physical exhaustion relating to the pandemic.

Update for: Denmark   Last updated: February 5th, 2022   Contributors: Daisy Pharoah  |  


3.02. Governance of the Long-Term Care sector's pandemic response

The Danish Health Authority is chairing a “COVID-19 Intensive Task Force”, with representatives from national authorities and the Danish regions. The task force is responsible for coordinating the regional capacity of intensive care units and staff. The Danish Health Authority has published a status document with assessment of the need for ICU and ventilator capacity (Source: https://www.sst.dk/-/media/Nyheder/2020/ITA_COVID_19_220320.ashx?la=da&hash=633349284353F4D8559B231CDA64169D327F1227). Once a week, Danish Regions publish statistics on the stocks of masks, disinfectants and gloves (Source: https://www.regioner.dk/sundhed/coronaviruscovid-19).

Lessons learned

Given the high level of integration of the health and social sectors and their clear communication structures with municipalities, the pandemic response was able to efficiently focus on the wide range of LTC services during the pandemic (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Update for: Denmark   Last updated: September 8th, 2021


3.02.01. National or equivalent Covid-19 Long-Term Care taskforce 

There is no task force specifically identified for LTC, but there is a Danish COVID-19 Taskforce referred to as the COVID-19 Intensive Task Force (Source: https://www.covid19healthsystem.org/countries/denmark/livinghit.aspx?Section=5.%20Governance&Type=Chapter).

Update for: Denmark   Last updated: September 8th, 2021


3.02.02. Measures to improve coordination between Health and Social Care in response to the pandemic

The Board for Patient Safety enforced that the municipalities introduced restrictions preventing visitors in nursing homes. This included visits inside the institutions, and in common areas, as well as apartments or rooms. It could also include outdoor areas if necessary but this was a decision to be taken by the Municipal Board (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

On April 8, 2020, an extensive guideline was issued by the Board of Health, outlined how nursing homes and other institutions could prevent the spread of COVID-19, in the wake of the so-called controlled re-opening of the country which was planned to take place after Easter (April 14). It was intended to supplement the procedures that the municipalities had already put in place, and provided guidelines on how to organise this. It specifically addressed the handling of the disease as a responsibility of the management. The managers were encouraged to plan the daily activities so that residents gathered in smaller groups than normally, preferably no more than two (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Update for: Denmark   Last updated: September 9th, 2021


3.03. Monitoring Covid-19 impacts in the Long-Term Care sector: data and information systems

Weekly data on LTC and COVID-19 is published online.

Update for: Denmark   Last updated: September 9th, 2021


3.04. Financial measures to support users and providers of Long-Term Care

Employers will be reimbursed for any sick pay they have had to pay out due to COVID-19, an employee’s illness, unavailability due to quarantine responsibilities, or if a person has had to stay at home because they or their relatives are in a risk group. This has been extended to July 31, 2021 (source: https://www.aeldresagen.dk/viden-og-raadgivning/penge-og-pension/arbejdsliv/gode-raad/corona-nye-regler-for-udvidet-sygedagpenge).

More funds have been given to municipalities as well as to the NGO’s to provide information and individual advice to debilitated older people, including those with dementia and their relatives, on how to deal with the consequences of COVID-19. Funds have also been allocated for telephone counselling which targets older isolated people (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

Update for: Denmark   Last updated: September 16th, 2021


3.05. Long-Term Care oversight and regulation functions during the pandemic

On May 12, 2020, an extensive publication providing new guidelines on how to organize visits in nursing homes was published by the Board of Health. From the introduction, it was made clear that the Board of Health did not have the authority over who could visit, as this was the responsibility of the Board for Patient Safety, and thus underlining the general confusion over which authority was in charge (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Update for: Denmark   Last updated: September 10th, 2021


3.06. Support for care sector staff and measures to ensure workforce availability 

There is ongoing work to try to collect statistics on the number of nursing home staff infected with COVID-19. In the meantime, the number of care staff reporting the disease as a work-related injury gives an indication of the situation. On April 24, 2020, a new guideline was published that underlined that COVID-19 would be regarded as a work-related injury if the person had been exposed to the disease and was tested positive. This gives the person an entitlement to claim for workers’ compensation. As of May 21, 242 people had reported COVID-19 as a work-related injury, and of these 42 people were employed in a nursing home. The majority of all cases relate specifically to the disease, while 9% relate to skin diseases caused by wearing Personal Protection Equipment (PPE) (Source: https://www.aes.dk/da/Temaer/COVID-19.aspx).

Regarding measures to increase or maintain the availability of health workers, emergency child care facilities are provided (Source: https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).  Denmark also provided financial help to LTC facilities to recruit unemployed or former LTC workers, as well as providing financial help to LTC facilities to recruit LTC students (Source: OECD paper).

Update for: Denmark   Last updated: January 26th, 2022   Contributors: Joanna Marczak  |  


3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, support and implementation

There is a dedicated page on how to manage COVID-19 among older populations on the Danish Health Authority website. These are updated on a bi-weekly basis, or more frequently, if needed. On May 12th an extensive publication providing new guidelines on how to organize visits in nursing homes was published by the Board of Health.

Update for: Denmark   Last updated: November 30th, 2021


3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes

Guidance

On April 8, 2020, an extensive guideline was issued by the Board of Health, outlined how nursing homes and other institutions could prevent the spreading of COVID-19, in the wake of the so-called controlled re-opening of the country which was planned to take place after Easter (April 14th 2020). It was intended to supplement the procedures that the municipalities had already put in place, and provided guidelines on how to organize this. It specifically addressed the handling of the disease as a responsibility of the management. The managers were encouraged to plan the daily activities so that residents gathered in smaller groups than normally, preferably no more than two (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Update for: Denmark   Last updated: January 12th, 2022


3.07.03. Visiting and unpaid carer policies in care homes

Measures were first introduced by the March 17, 2020, guidelines issued by the Board of Health, ’Håndtering af COVID-19: Besøg på institutioner hvor personer fra risikogrupper bor eller har langvarigt ophold’. These recommended that family members and friends should not visit nursing homes (or hospitals) unless strictly necessary, for instance if the person was terminally ill (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Individual institutions were asked to ensure that the visit could be conducted in a safe manner, for instance by ensuring that it was only a brief visit, that visitors did not sit in common areas and that they did not have physical contact or use common facilities. Institutions were required to inform visitors about the risk of spreading the disease and encouraging them to avoid visiting, through posters (for example a poster with the message ‘You best protect your loved ones by not visiting them’) and personal instruction. If family members had symptoms, they were not allowed to visit. Instead, it was recommended to stay in contact over the telephone, video or mail.

A formal ban of visiting was introduced temporarily on April 6, 2020, ‘Besøgsrestriktioner på plejehjem m.v. og sygehuse’. The guidelines also outlined that the manager should ensure that members of staff stayed at home if they showed signs of being infected, even with mild symptoms, and only returned after 48 hours of being symptom free. If a member of staff was suffering from respiratory diseases or the like they could be referred by the manager to take a COVID-19 test. Also, staff who had been in close contact with persons infected with COVID-19 were to be tested (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

On May 12, 2020, an extensive publication providing new guidelines on how to organize visits in nursing homes was published by the Board of Health. From the introduction, it was made clear that the Board of Health did not have the authority over who could visit, as this was the responsibility of the Board for Patient Safety, and thus underlining the general confusion over which authority was in charge (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/). It was recommended to limit the number of residents that each member of staff had access to and to avoid staff involvement in activities spread across the institution. Staff should receive instruction in the use of PPE and there should be a strong focus on hygiene and behaviour in all common rooms. It was acknowledged that residents were entitled to leave the institution but the manager and staff were encouraged to inform them about the increased risk and they should be supported in how to disinfect their hands upon returning. Staff were instructed in wearing work clothes and maintaining distance (1-2 m), regardless of whether the resident had any symptoms. Which centres have what kind of restrictions is posted here (https://stps.dk/~/media/07F68A96CC9C44B08BBDF33E1DF81C1C.ashx).

The Board for Patient Safety enforced that the municipalities introduced restrictions preventing visitors in the nursing homes. This included visits inside the institution, and in common areas as well as the apartments or rooms. It could also include outdoor areas, if necessary, but this was a decision to be taken by the Municipal Board (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

In June 2021 at most nursing homes things have returned to normal. There is again open access for relatives, volunteers and activities. Where there is an outbreak of COVID-19 at a nursing home or there is  comprehensive outbreak of COVID-19 in a municipality, the agency for patient security has the authority to issue a directive restricting access to nursing homes. In the following situations visits cannot be restricted: visits from close relatives to a critically ill person; close relatives visiting a grown adult with learning disabilities, to the degree that the person doesn’t have the ability to understand and accept the purpose of the restrictions, and by that reason has a special need to be visited; visits from the person’s guardian, personal representative or lawyer (https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

Update for: Denmark   Last updated: September 8th, 2021


3.08. Access to testing and contact tracing for people who use and provide Long-Term Care

The general strategies for testing have changed a number of times in Denmark, leading to some criticism for lack of transparency or evidence-based practice (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

The initial test strategy, introduced in early March, was aimed at preventing the disease from spreading, a so-called confinement strategy. This took place by testing persons who might have been exposed to the disease, even if they did not have symptoms. These were typically persons who were exposed during travelling (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

As of March 15th, the strategy changed to a mitigation strategy, targeting test measures to alleviate the consequences of the disease. Now only persons with symptoms were tested and following a referral from the GP. This led to concerns being raised such as from the WHO, which generally advised a more aggressive testing strategy. Nationally it sparked a debate that the new test strategy was a pragmatic and not a health-based decision, mainly due to a lack of testing equipment (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Since 27 April 2020, residents and staff without symptoms could also be tested if there was an outbreak in the nursing home. Testing must take place at the nursing home and not in the regional test centres, which are set up in tents (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

On May 12th, a new and more aggressive testing strategy was introduced, where persons without symptoms were also tested. The capacity was set to 20,000 persons on a daily basis and the ambition was to increase this number over time. This would make Denmark a country with one of the highest number of tests per inhabitants. There were two tracks in the new strategy:

– A health track, which includes testing of persons with symptoms, as well as employees of hospitals and nursing homes and patients admitted to hospital, even if they do not have symptoms. The test took place at regional hospitals. The capacity for this track was 10,000 daily tests.

– A societal track, which included testing of persons without symptoms. Testing took place in 16 specially set-up tents around the country, some of them with a drive-in facility. The capacity was for an additional 10,000 daily tests. Initially, only those aged 18- 25 years old could asked to be tested. This included around 600,000 persons and 4,500 persons were tested during the first day. During the first week, other age groups were included and, as of 25th May, there were no age limitations. (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Staff, working in the health and elder sector and some parts of the social sector, should be tested twice a week if they are not fully vaccinated. It is essential to implement a systematic, regular solution, which is easily accessible for the staff to secure comprehensive support from the personnel. Fully vaccinated staff can refrain from being tested regularly. This also applies to staff working in nursing homes, assisted living facilities, respite care, and social institutions, and in hospitals and the home care sector. Unvaccinated staff should still be tested regularly (https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

In case of a discovery of a COVID-19 infection among a resident or an employee, all residents, if possible, should be tested within a day after contact with someone infected with COVID-19. The test is then repeated for the residents who are not fully vaccinated, every 7 days, until there are no more instances of COVID-19 at the institution. Personnel, including temporary staff and cleaning staff have to get tested even if they have no knowledge of being in contact with the person concerned and are fully vaccinated. The test must be taken as quickly as possible. Preferably within a day after they have received information, they must get tested. The test must be repeated every days for the personnel who are not fully vaccinated until there are no more outbreaks at the institution. It is a case of extra testing on the basis of caution, and the test does not require self-isolation for the staff member/s who can work while they wait on their test results (https://www.vilans.nl/vilans/media/documents/publicaties/covid-19-in-long-term-care-until-june-2021.pdf).

Update for: Denmark   Last updated: September 8th, 2021


3.09. Access to Personal Protection Equipment (PPE) in the Long-Term Care sector

The shortage of PPE (and a decision to prioritize PPE for the hospitals) has influenced the recommendations for how to handle the disease in the nursing homes. Initially, physical distance was considered sufficient but later (when the supply of PPE seemed sufficient), wearing PPE was considered essential and regardless of whether there were symptoms of the disease. The reason for the shortage of PPE in the municipalities was that early in the outbreak (March 10th), the Danish Medicines Agency approached the providers of PPE and asked them to prioritize delivery to the regions and therefore for hospitals. The municipalities therefore needed to find other providers and this led to a shortage of PPE in the municipalities (https://ltccovid.org/2020/05/28/new-country-report-the-covid-19-long-term-care-situation-in-denmark/).

Update for: Denmark   Last updated: November 9th, 2021


3.10. Use of technology to compensate for difficulties accessing in-person care and support

The National Association for Older People organizes supports for using technology to access friends, social networks and health services (https://www.aeldresagen.dk/om-aeldresagen/lige-nu/corona/faa-gode-raad/saadan-ser-du-den-du-taler-med?scrollto=start).

Update for: Denmark   Last updated: September 8th, 2021


3.11. Vaccination policies for people using and providing Long-Term Care

Denmark was one of the first countries to reach near full-vaccination of people living in care homes, concluding the first round of vaccinations by mid-February 2021, and by mid-March for older people who receive long-term care.

In November 2020 new legislation was proposed which would give the Danish Health Authority the power to “define groups of people who must be vaccinated in order to contain and eliminate a dangerous disease”. The proposal applied to diseases posing threats to public health; diseases which the global community are seeking to eradicate; diseases with a high mortality rate; or in instances where a person is deemed to be a danger to themselves or others. In January 2021 the proposed legislation was not passed due to concerns about the use of coercion and physical detainment to control the disease. Any proposed future interventions will instead be on a case by case basis, requiring a parliamentary vote. The Health Minister noted: “we believe that information and openness are better for the vaccination case than threats and force”.

In early September 2021 the vaccination rate among care home residents was 96% and it was announced that all care home residents will be offered a third those, following an increase in infections in care home during August 2021. Among those receiving home care, the rate is 97.9% and 98.4% among staff working in LTC.

The fast rollout of the booster soon proved effective as the incidence rates in nursing homes started falling. By week 37 only 11 nursing homes experienced new incidences of the disease and only 22 double vaccinated residents were infected.  By September 21st (week 38), 46.5% of residents had received the booster vaccination. From this week to the following, the incidence rate increased in the general population from 43 to 52 new cases per 100.000 inhabitants, while the number fell from 18 to 4 in nursing homes, a fall of 78% just within a week.

In early November, the number of incidences among residents started increasing again and had within two weeks tripled from 36 to 87 persons infected. In the same period, the number of incidences among nursing home staff increased from 272 to 738 persons. Only 49.2% of staff had received the booster vaccination at that time. In comparison, 60.4% of hospital staff had received the booster. The Danish Patient Safety Authority reported that they were aware of nursing homes where staff needed to go to work even though they were infected, as there was a shortage of staff.

There is currently no policy for prioritizing offering the booster to staff in hospitals and nursing homes. With the new Omicron variant (first reported in Denmark Nov 28th), the general roll-out of the booster vaccination was speeded up and regardless of timing of the second vaccination, every person over 40 years is currently (Dec 21st) offered the booster. The age group 18-39 year old is offered the booster 5.5. months after the second vaccination. In the whole population, 80.9% have received their first vaccination and 76.9% their second, while 34.7% have received the booster.

Data sources:

https://files.ssi.dk/covid19/brancher/vaccinationstilslutning/vaccinationstilslutning-brancher-covid19-uge50-2021-fg45  https://covid19.ssi.dk/overvagningsdata/vaccinationstilslutning

Update for: Denmark   Last updated: January 4th, 2022   Contributors: Tine Rostgaard  |  


3.12. Measures to support unpaid carers

There is a dedicated page on Danish Health Authority website  on how to manage COVID-19 among older populations in the home (https://www.sst.dk/da/corona/Information-til-fagpersoner/Sundheds–og-plejesektoren).

Overall, the informal carers have not been supported systematically; there are some cash benefits for carers, but by far the majority of LTC offers are directed at the claimants and not their relatives. However, there are offers of respite care (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

Update for: Denmark   Last updated: September 16th, 2021


4.05. Reforms to address Long-Term Care workforce recruitment, training, pay and conditions

There have been attempts to attract and retain workers to the formal care sector following the action plan ‘More hands in the older person and health sector’ of the Association of Municipalities from 2018. These have not least attempted to get more young people to start training as home and health care assistants or helpers. The measures span information campaigns, higher wages, and better collaboration between relevant partners to attract, educate and retain more workers (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

Update for: Denmark   Last updated: September 16th, 2021


4.11. Reforms to improve the pandemic and emergency preparedness of the Long-Term Care sector

Prior to the World Health Organization declaring a pandemic on 11 March,  Danish politicians quickly amended the national Epidemic Act, which had not been updated since the 1970s. Consequently, the decision-making authority which previously was in the hand of local epidemic commissions is now centralized within the government. The newly centralised authority is primarily comprised of Danish prime minister and various Ministry representatives and experts from the Danish Health Authority, the Danish Patient Safety Authority, and virologists at Statens Serum Institut (SSI). This authority alone now has the power to make evidence-based decisions regarding public health and safety in relation to pandemic (source: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission (europa.eu).

Update for: Denmark   Last updated: November 23rd, 2021