International reports on COVID-19 and Long-Term Care

These cross-cutting reports aim to document the impact of COVID-19 on people who use and provide Long-Term Care and the measures adopted internationally to contain and mitigate the impact of the virus. They are updated regularly as new information becomes available. If you’d like to contribute to a report please email a.comas@lse.ac.uk

Community-based care: measures to support care provision during COVID-19 and prevent infection

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

Deaths of care home residents and staff linked to the COVID-19 pandemic

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

Adelina Comas-Herrera, Joseba Zalakaín, Elizabeth Lemmon, David Henderson, Charles Litwin, Amy T. Hsu, Andrea E. Schmidt, Greg Arling and Jose-Luis Fernández, last updated 14th October 2020

The full report is available here:

Key findings:

  • Official publicly available data on the numbers of deaths among care home residents linked to COVID-19 is not available in many countries.
  • International comparisons are difficult due to differences in testing capabilities and policies, 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, the current average of the share of all COVID-19 deaths that were care home residents is 46% (based on 21 countries).
  • To compare the relative impact of COVID-19 on care home residents in different countries it may be more useful to focus on the share of all care home residents whose deaths have been linked to COVID-19. We found that that, for the countries where this data is available, the share of all care home residents who have died (linked to COVID-19) ranges from 0.01% in South Korea to over 4% (which would mean that over one in 25 care home residents have died linked to COVID-19) in Belgium, Ireland, Spain, the UK and the US. This share 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.

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

Previous versions of the international report:

End-of-life support for people in care homes in the context of COVID-19

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.
Preventing and managing COVID-19 outbreaks in care homes

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.

Unpaid carers: impact of the pandemic and measures to support them

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