Report by Walter D. Dawson, Elizabeth C. Ashcroft, Klara Lorenz-Dant and Adelina Comas-Herrera, last updated 19th May 2019

Mortality associated with COVID-19 in care homes: international evidence

Comas-Herrera A, Zalakaín J, Lemmon E, Henderson D, Litwin C, Hsu AT, Schmidt AE, Arling G, Kruse F and Fernández J-L (2021) Mortality associated with COVID-19 in care homes: international evidence. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 1st February 2021.

The full report is available here:

Key findings:

• Not all countries publish data on the numbers of deaths among care home residents linked to COVID-19 and international comparisons of the data available are difficult due to differences in testing capabilities and policies (particularly in the earlier part of the pandemic), different approaches to recording deaths, and differing definitions of what constitutes a “care home”.
• There are three main approaches to quantifying deaths in relation to COVID-19: deaths of people who test positive (before or after their death), deaths of people suspected to have COVID-19 (based on symptoms or epidemiologically linked), and excess deaths (comparing total number of deaths with those in the same weeks in previous years). Another important distinction is whether the data covers deaths of care home residents or only deaths in the care home (as there are variations in the share of care home residents who are admitted to hospital and may die there).
• Despite the difficulties arising from differences in definitions, in almost all countries where there have been deaths linked to COVID-19, a substantial proportion of those deaths were among care home residents.
• Based on the data gathered for this report, up to the 26th January, the current average of the share of all COVID-19 deaths that were care home residents is 41% (based on 22 countries), this is lower than in previous phases in the pandemic.
• Adding up all the deaths of care home residents counted in the data available for the 22 countries covered in this report amounts to just over 325,000 deaths of care home residents attributed to COVID-19 since the beginning of the pandemic, this would be equivalent to the entire population of Thessaloniki (Greece) or Cordoba (Spain).
• To compare the relative impact of COVID-19 on care home residents in different countries it is useful to focus on the share of all care home residents whose deaths have been linked to COVID-19. For the countries where data is available, the share of all care home residents who have died (linked to COVID-19) ranges from 0.02% in Singapore and 0.04% in New Zealand to over 5% (which would mean that over one in 20 care home residents have died linked to COVID-19) in Belgium, France, the Netherlands, Slovenia, Spain, Sweden, the UK and the USA.
• The share of all care home residents who have died (linked to COVID-19) is highly correlated to the total number of COVID-19 deaths in the population who live outside care homes.
• It is also worth noting that whilst the focus of this report is on care homes, many older people receive care in the community. Currently, there is limited evidence from anywhere in the world on how those individuals have been directly or indirectly affected by COVID-19.
• Although the rollout of COVID-19 vaccinations has started in many countries covered in this report, the data up to 26th January 2021 is unlikely to capture the impact of vaccination programmes on the care home resident population. At this stage it is also difficult to monitor the potential impact of vaccinations, given the difficulties associated with obtaining disaggregated data on vaccines this early on in the rollout. Attempts to gather international data on vaccinations in care homes and among care home residents are underway.

Comparison of COVID-19 mortality in care homes in the UK

Previous versions of the international report:

Report by Annette Bauer and Josie Dixon, last updated 9th June 2020

Summary:

• Palliative care has a vital role to play in the response to COVID-19, for relieving pain and other symptoms associated with the condition, particularly breathlessness; for providing emotional and spiritual support; and to ensure dignity in dying.
• There is evidence from media reports that some older people, who died in care homes during the pandemic, did so without adequate basic care, including palliative care. However, the proportion of people of those who died, or continue to die, in care homes with insufficient palliative care is unknown.
• In this paper, we summarise some of the challenges experienced in North America, Europe and Australia during the COVID-19 pandemic with regards to palliative care provision in care homes. We consider these in the context of long-standing challenges with systems of palliative care provision and care home services, highlighting opportunities for change.
• Most countries have focused measures in care homes on the prevention or control of Covid-19 infection rather than on the provision of palliative care, with most care homes poorly-prepared and positioned to provide effective palliative care to their residents.
• Most countries have developed various guidance documents for health and social care staff on palliative care. However, in many countries, guidance is not setting-specific. It is also often patchy in its coverage or inconsistent, and details about how to operationalise recommendations is commonly lacking.
• Lack of personal protective equipment for staff and visitors and shortages of palliative care medications have been major barriers to ensuring effective palliative care and a good quality of death for care home residents.
• The COVID-19 crisis has exposed the weaknesses of many health and social care systems, including the underfunding and understaffing of care homes and palliative care provision. There were already calls in most countries, prior to the current crisis, to scale measures that ensure high quality palliative care in care home settings. Once the acute phase of this crisis has passed, countries should revisit these recommendations, which include training curricula for care home staff that include palliative care; quality standards for palliative care in care homes; national monitoring of quality standards and indicators; national minimum data sets that include palliative care in care homes; and clear contractual arrangements between specialist palliative care providers and care homes.

International report (last updated 19 August): https://ltccovid.org/2020/08/19/impact-and-mortality-of-covid-19-on-people-living-with-dementia-cross-country-report/

India: https://ltccovid.org/2020/04/06/report-the-impact-of-the-covid-19-pandemic-on-people-with-dementia-in-india/

Spain (last updated 10 August 2020): https://ltccovid.org/2020/08/10/updated-report-impact-and-mortality-of-the-first-wave-of-covid-19-on-people-living-with-dementia-in-spain/

United Kingdom: https://ltccovid.org/2020/05/03/report-the-impact-of-the-covid-19-pandemic-on-people-living-with-dementia-in-uk/

Supporting people living with Dementia in Low and Middle Income countries: https://ltccovid.org/2020/04/10/supporting-people-living-with-dementia-and-their-carers-in-low-and-middle-income-countries-during-covid-19/

Mapping of evidence on interventions and policy measures to prevent and mitigate Covid-19:

PREPRINT: What long-term care interventions and policy measures have been studied during the Covid-19 pandemic? Findings from a rapid mapping review of the scientific evidence published during 2020

Lessons learnt from care homes in Spain:

What went wrong and what could be learned from the institutional and organizational Management of Care Homes during the Covid-19 pandemic in Spain

Report summarizing international examples of measures to prevent and manage COVID-19 outbreaks in residential care and nursing home settings, by Adelina Comas-Herrera, Elizabeth C. Ashcroft and Klara Lorenz-Dant, last updated 11th May 2020.

A briefing note summarising the increasing evidence of pre-symptomatic transmission of COVID-19, recent evidence on the extent of asymptomatic positive cases of COVID-19 and discussing the implications of this evidence for reducing the spread of infections in care homes.

International overview of care home visiting practices in 23 countries, July/August 2021:

Current situation in relation to “visiting” in care homes and outings for residents. LTCcovid international overviews of long-term care policies and practices in relation to Covid-19 (Issue 2, August 2021)

In-depth report on Safe Visiting at care homes during COVID-19 published in January 2021:

https://ltccovid.org/wp-content/uploads/2021/01/Care-home-visiting-policies-international-report-19-January-2021-1.pdf

Safe visiting at care homes during COVID-19: A review of international guidelines and emerging practices during the COVID-19 pandemic

Rapid review on the Impacts of COVID-19 on unpaid carers and Measures to address these impacts, covering literature published up to November 2020:

The impacts of COVID-19 on unpaid carers of adults with long-term care needs and measures to address these impacts: a rapid review of evidence up to November 2020

Report summarizing international examples of measures to support unpaid carers during the COVID-19 pandemic, compiled from the LTCcovid country reports by Klara Lorenz Dant (last updated 17th June 2020).

Key Findings:

• The responsibility of many unpaid carers has increased during the COVID-19 as their usual support networks (e.g. day care, respite care, home care, other unpaid carers) are no longer available or can only provide support at reduced capacity
• Voluntary sector is providing tangible support across countries
• Most countries report virtual support interventions for unpaid carers
• Many countries provide unpaid carers with guidance and resource documents
• Existing financial support mechanisms continue in a number of countries, but there is limited evidence of  new or additional financial support measures being put in place to support unpaid carers during the COVID-19 pandemic
• Lack of recognition that unpaid carers need to get goods for people with care needs and support with navigating other restrictions to be able to provide care
• There is limited recognition that unpaid carers need support with contingency planning
• There is limited recognition that unpaid carers need access to testing and PPE

International Overview on national discussions on mandatory vaccinations for long-term care staff, May 2021:

National discussions on mandatory vaccination for long-term care staff in 24 countries. LTCcovid international overviews of long-term care policies and practices in relation to Covid-19 (No. 1, May 2021)

International “living” report: Long-Term Care and COVID-19 vaccination, prioritization and data, 26th January 2021 update

https://ltccovid.org/wp-content/uploads/2021/01/COVID-19-vaccine-and-LTC-prioritization-and-data-18-January-update.pdf

https://ltccovid.org/2021/01/19/new-international-living-report-long-term-care-and-covid-19-vaccination-prioritization-and-data/