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

A summary of international data on the number of COVID-related deaths among care home residents

Adelina Comas-Herrera, Joseba Zalakaín, Charles Litwin, Amy T. Hsu, Elizabeth Lemmon, David Henderson and Jose-Luis Fernández, last updated 26th June 2020

This document is regularly updated and improved as new information and data become available.

Key findings (26th June):

  • 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
  • International comparisons are difficult due to differences in testing availabilities 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)
  • This updated report contains data from a larger number of countries and this shows that earlier suggestions (when data were available for fewer countries) that the share of all COVID-19 deaths who were care residents increases with the total number of deaths may not be a robust finding, as New Zealand and Slovenia, despite having had relatively small numbers of total COVID deaths, have had a large share of those deaths among care home residents (72 and 81% respectively).
  • The impact of COVID-19 on care home residents has been very different internationally, with some countries reporting no deaths (or infections) in care homes, such as Hong Kong, Jordan and Malta, and two countries reporting that over 80% of COVID-19 deaths were of care home residents. Without including the three countries with zero deaths, and with the caveat that the definitions used vary, on average the share of all COVID-19 deaths that were care home residents is 47% (based on 26 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 18 countries for which have these data, the share of all care home residents who have died (linked to COVID-19) ranges from 0 to 6.1%. This is share is highly correlated to the total number of COVID-19 deaths in the whole population.
  • 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.

Previous versions of this 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