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 providing 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

A summary of international data on the number of COVID-related deaths among care home residents. This document is regularly updated and improved as new information and data become available.

Key findings (21st May):

  • Official data on the numbers of deaths among care home residents linked to COVID-19 is not available in many countries but an increasing number of countries are publishing data
  • Due to differences in testing availabilities and policies, and to different approaches to recording deaths, international comparisons are difficult
  • 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), 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).
  • Trusted data from 19 countries suggests that the share of care home residents whose deaths are linked to COVID-19 tends to be lower in countries where there have been fewer deaths in total, although as the number of deaths grows the share seems to reach a plateau, for now.
  • There have been no infections or deaths in care homes in Hong Kong (only 4 deaths in total and 1,056 cases of infections in the total population).
  • In the other countries where there have been at least 100 deaths in total and we have official data, the % of COVID-related deaths among care home residents ranges from 24% in Hungary to 82% in Canada)
  • Data from England illustrates well the importance of paying attention to differences in definitions and methods used to estimate these percentages: the share of all probable COVID-19 deaths in care homes is 27%, whereas the share of probable deaths of care home residents is 38%. The share of excess deaths in care homes during the pandemic has been 44% and the share of deaths of care home residents is 52% of all excess deaths. Also, in France, deaths in care homes are 34% of all COVID-19 deaths, whereas deaths of care home residents are 51%.
  • Data on the share of all care home residents whose deaths can be linked to COVID-19 may be a better indicator of the impact of COVID-19 on care home residents. We have been able to compile this for a few countries. The shares range from 0 in Hong Kong, 0.3% in Austria, 0.4% in Germany and 0.9% in Canada, to 2% in Sweden, 2.4% in France and 3.7% in Belgium. In the UK, if only deaths in care homes registered as linked to COVID-19, the figure would be 2.8, whereas if excess deaths of care home residents is used, it would be 6.7%[1].

[1] This does not include deaths of Scottish care home residents in hospitals or deaths in care homes in Northern Ireland, so the share may be higher

Previous versions of this report:

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

Report by Annette Bauer, Josie Dixon and Adelina Comas-Herrera, last updated 1st May 2020

Key Findings:

  • Up to half of COVID-19 deaths occur in care homes; all people dying of COVID-19 should have access to palliative care.
  • Palliative care has an important role to play in the response to COVID-19, in order to ensure that people dying as a result of COVID-19 – including care home residents – do so with dignity, with emotional support available and free of pain.
  • Countries have primarily focused measures in care homes on the prevention or control of the infection rather than on palliative care. Most care homes are unprepared for the pandemic and not all are well-positioned to provide palliative care to their residents in this context.
  • Whilst most countries have developed national or local guidance for health and social care staff on palliative care, in many countries this is not setting-specific or is contradictory and inconsistent; lack of personal protective equipment for staff and/or visitors and palliative care medication have been major barriers to ensuring a good quality of death for care home residents; financial measures to support palliative care providers have also varied between countries (leaving some providers potentially unable to support care homes in a timely way).
  • The COVID-19 crisis has exposed the weaknesses of many health and social care systems, including the under-staffing and under-funding of care homes and palliative care.
  • We have not found publicly available data for any of the COVID-19 outbreak countries on how many people received adequate palliative care at end of life. This kind of information will be essential in order to understand the performance of health and social care systems in terms of whether equitable care was provided for those reaching the end of life during the COVID-19 pandemic.
Policy and practice measures to prevent and manage 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 cuntry reports by Klara Lorenz Dant (last updated 20th May 2020).