INTERNATIONAL REPORTS

Responses to 2.02. Deaths attributed to Covid-19 among people who use and provide Long-Term Care


Hong Kong

As of December 2020, there have been 20 care homes with outbreaks. This has resulted in 124 residents and 29 staff members testing positive for COVID-19. Of these 124 residents, 32 have died, accounting for 19% of all COVID-19 related deaths in Hong Kong.

It is estimated that there are 73,231 care home residents in Hong Kong. Therefore, the number of deaths of care home residents linked to COVID-19 would represent 0.04% of this population (Source: https://www.swd.gov.hk/storage/asset/section/632/en/15.Number_of_Homes_Providing_Residential_Care_Services_for_the_Elderly_(By_district)(30.6.20).pdf; https://www.swd.gov.hk/storage/asset/section/632/en/3.Provision_of_RCHEs_(Subsidised_versus_Non-subsidised_Places)(30.6.20).pdf; https://www.statistics.gov.hk/pub/B72002FA2020XXXXB0100.pdf).

Last updated: August 4th, 2021


Ireland

Ireland has a centralised system to collect epidemiological information in relation to cases of COVID-19 infections (Source: https://ltccovid.org/wp-content/uploads/2020/04/Ireland-COVID-LTC-report-updated-28-April-2020.pdf). All deaths, in all care settings and dwellings, related to COVID-19 that are notified to the Health Prevention Surveillance Centre are included in the official count of deaths. While the number of outbreaks in nursing homes is published regularly, the number of notified deaths in care homes is only made publicly sporadically.

A report by the Department of Health and the Health Prevention Surveillance Centre published in December 2020, estimated that up to December 13, 2020, there had been 1,112 deaths linked to COVID-19 in nursing homes. On that date, there had been 2,110 deaths attributed to COVID-19 in Ireland. Therefore, deaths of nursing home residents represented 51% of all deaths linked to COVID-19, but this figure has changed during the pandemic, suggesting lessons from the first wave may have improved the capacity of nursing homes to fight the pandemic. Based on the data in the same report, during what was the first wave in Ireland (up to early August 2020), the proportion of COVID-19 deaths attributed to nursing home residents was 54%, but in the second wave (August to October 2020) it was 38%, and between November and mid-December the share was 34%. There are an estimated 30,000 people living in nursing homes. Therefore, 3.71% of all nursing home care residents would have died because of COVID-19 as of December 13, 2020.

Last updated: August 3rd, 2021


Lithuania

As of March 27, 2021, there have been 3,552 COVID-19 related deaths, of which 382 were care home residents (11%) (Source: https://socmin.lrv.lt/lt/veiklos-sritys/socialine-integracija/socialines-paslaugos/globos-istaigu-sarasai/covid-19-atvejai-socialines-globos-istaigose). There are 12,700 care home beds in Lithuania. Therefore, the total number of COVID-19 related deaths in care homes represents 3.02% of all care home beds.

Last updated: August 2nd, 2021


Slovenia

As of March 14, 2021, there have been 4,220 deaths in total, and 2,057 among the care home population, representing 56% of all deaths (Source: https://www.nijz.si/sites/www.nijz.si/files/uploaded/gumb_4-_smrti_v_povezavi_s_covid-19_20210315.pdf). In 2017, there were 22,904 people living in long-term care institutions in Slovenia. Therefore, the share of residents who would have died linked to COVID-19 would be 8.98% (Source: https://www.stat.si/StatWeb/en/News/Index/8579).

Last updated: August 2nd, 2021


Switzerland

Data on COVID-19-related mortality among people living in care homes is only available for a few cantons. In the canton of Geneva where these data are published regularly, and as of January 27, 2021, there have been 674 COVID- related deaths, of which 511 (76%) were care home residents, and 110 of people who received domiciliary care. An estimated 46% (310) of all COVID-19 related deaths happened in care homes, suggesting that 39% of all care home residents who died from COVID-19 did so in hospital. There are an estimated 4,125 care home beds in Geneva. Therefore, the number of COVID-19 related deaths in care homes represents 12.4% of this population (Source: https://www.bfs.admin.ch/bfs/fr/home/statistiques/sante/etat-sante/personnes-agees.assetdetail.15724050.html).

Last updated: August 4th, 2021


Australia

There have been 2,051 cases of COVID-19 and 685 COVID-19 related deaths in Australian Government–subsidised residential aged care facilities. The majority of cases occurred during the first wave, with Victoria accounting for over 90% of the cases and deaths in residential aged care (Source: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#cases-in-aged-care-services).

Last updated: July 30th, 2021


Australia

The Australian Department of Health first published deaths linked to COVID-19 in care homes and among users of home care services on April 15, 2020. As of April 8, 2021, there have been 2,051 confirmed cases of COVID-19 among government-subsidized residents in aged care facilities, 97% of which were in the state of Victoria. There have been 685 deaths among residents, 95% of which were in the state of Victoria, suggesting that 75% of all COVID-19 deaths in Australia have been among care home residents. These figures are based on people who have tested positive for COVID-19 and are for the place of residence, not place of death, so may include residents who died in hospital. Among people who use government-subsidized home care, there have been 81 confirmed cases of COVID-19 and 8 deaths. In 2020, there were approximately 208,500 people living in aged care residential accommodation in Australia. Therefore, the numbers of care home COVID-19 deaths would amount to 0.33% of this population (Source: https://www.aihw.gov.au/reports/australias-welfare/aged-care).

A weekly report includes data on the number of outbreaks and staff infected in care homes. As of April 1, 2021, there have been no active cases of COVID-19 among people living in care homes since October 28, 2020. In total, there have been 2,238 staff with COVID-19 infections.

Last updated: August 3rd, 2021


Austria

During the earlier part of the pandemic, Austria was among those countries that had reported fewer deaths in care homes. During the second wave of the COVID-19 pandemic, Austria experienced very high rates of infections, reflected in a steep rise in infections and deaths due to COVID-19 in care homes (Source: https://ltccovid.org/2020/11/27/the-second-wave-has-hit-austria-harder-also-in-care-homes/). As of January 2021, infection growth rates are decreasing again, as are the number of COVID-19 cases in care homes.

As of January 24, 2021, 18,080 residents in care homes (including all ages) have tested positive for COVID-19, and of these, 3,243 have died. Compared to the 7,328 total deaths linked to COVID-19 in Austria on the same date, deaths of care home residents would represent 44% of all deaths. There have been 10,180 cases among staff in care homes, of which 1 was fatal.

According to data from September 17, 2020, only 0.4% of care home residents had died after the first wave. By January 2021, this number has risen to 4.7%. This is based on there being 69,730 residents in care homes in Austria (BM für Arbeit, Soziales, Gesundheit und Konsumentenschutz (2019) Pflegevorsorgebericht 2018. Vienna, BMASGK).

Last updated: August 2nd, 2021


Belgium

Belgium first reported official estimates of the number of deaths in care homes on April 11, 2020. The data is collected by Sciensano, a public research institution, which publishes very detailed epidemiological daily reports on COVID-19, which include data on the number of deaths in care homes (“maisons de repos”). As of April 15, 2020, reports have also included the number of tests done within care homes. For deaths outside hospitals, Belgium reports both “confirmed” cases (through a test or, since April 1, a chest scan), and “suspected” cases where the patient had not been tested but a doctor confirmed that their symptoms were consistent with COVID-19.

As of March 24, 2021, there have been 22,763 deaths linked to COVID-19 in Belgium, and of these, 12,597 people lived in care homes (55%). This number also includes suspected cases, particularly during the earlier part of the pandemic. Of the 12,597 deaths of care home residents, 9,404 happened in care homes (75%) and the rest (3,193) in hospital (Source: https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_Weekly_Pub_NH_FR_2021_03_24.pdf). Belgium has an estimated 125,000 people aged 65 and over living in care homes. The number of care home residents whose deaths are linked to COVID-19 so far would represent 10.08% of this population (Source: https://kce.fgov.be/fr/les-maisons-de-repos-ne-se-pr%C3%A9parent-pas-un-avenir-de-tout-repos).

Last updated: August 4th, 2021


Brazil

There is no official data on the number of cases and mortality related to COVID-19 in Brazilian care homes. A report published in September 2020, found that there had been over 4,015 confirmed cases and 937 deaths in Brazilian care homes, which represents a case fatality rate of 23.33%. This was based on data collated informally by the researchers.

Last updated: August 3rd, 2021


Canada (British Columbia)

As of February 8, 2021, there have been 235 COVID-19 related deaths from current outbreaks in long-term care in British Columbia. There was no data available for total number of deaths in long-term care for the duration of the pandemic (Source: http://www.bccdc.ca/Health-Info-Site/Documents/COVID_sitrep/LTC_AL_COVID-19_Outbreak_Report_0204_2021.pdf).

Last updated: July 29th, 2021


Canada

On March 5, 2020, the first outbreak in a Canadian long-term care home was reported in the province of British Columbia, where a staff member at the Lynn Valley Care Centre in Vancouver had tested positive for COVID-19 (Source: https://www.theglobeandmail.com/canada/article-how-the-coronavirus-took-north-vancouvers-lynn-valley-care-centre/). On March 8, a resident at the home became the first Canadian to die from COVID-19. The Public Health Agency of Canada have reported that, as of March 13, 2021, 12,337 out of 22,438 (55%) COVID-19 deaths in Canada were from these settings. According to the 2016 Census, 425,755 Canadians lived in long-term care or retirement homes as well as assisted living facilities. Therefore, the number of COVID-19 deaths in these settings would represent 2.90% of this population.

Due to variation in reporting we are unable to determine whether the location of death was in a care home. It is important to note that, in Canada, many official sources have been reporting total counts of deaths in care homes, whether COVID-19 was determined to be a contributing or underlying cause of death or not. This may have inflated the estimates of the proportion of deaths due to COVID-19. Unfortunately, given the low rates of testing early in the pandemic, and the subsequent lack of post-mortem testing, some residents who died remain suspected rather than confirmed cases.

Last updated: August 3rd, 2021


Chile

There are no official publicly available estimates of the total number of people who use care who have died with COVID-19 infections. The lack of data on the impact of the pandemic is particularly problematic in the unregulated sector (Source: https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Chile-24-July-2020-3.pdf).

Last updated: August 2nd, 2021


Denmark

As of April 6, 2021, there have been confirmed COVID-19 infections in 42.6% of Danish nursing homes (405 out of 937). There have been 3,690 residents in nursing homes which have tested positive for COVID-19 and 924 of these have died. In the total population, 2,432 COVID-19 related deaths were confirmed. Therefore, the share of confirmed deaths among nursing home residents was 38% (Source: https://covid19.ssi.dk/overvagningsdata/ugentlige-opgorelser-med-overvaagningsdata).

There were just over 40,000 nursing home residents in Denmark, which suggests that 2.30% of this population have died from confirmed COVID-19.

Last updated: July 29th, 2021


England (UK)

The Office for National Statistics provide weekly updates of deaths registered in England, which include any death where COVID-19 was mentioned (by a doctor) on death certificates.

Between December 28, 2019, and November 6, 2020, an estimated 15,659 people died linked to COVID-19 in care homes (Source: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales).

As of March 12, 2021, there have been 127,911 COVID-19 related deaths, with 39,196 of these occurring in care homes (23%) (Source: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/weeklyprovisionalfiguresondeathsregisteredinenglandandwales). In terms of deaths of care home residents in England, that is, those care home residents who died from COVID-19 but did not necessarily die in a care home, the Office for National Statistics publish data on weekly deaths of care home residents that are registered in England and Wales. As of March 12, 2021, there have been 41,107 COVID-19 related deaths of care home residents in England and Wales. Subtracting the total number of care home resident deaths in Wales (1,911 deaths) gives a total of 39,196 care home resident deaths in England up until March 12, 20201. Therefore, care home residents accounted for 31% of all COVID-19 related deaths in England. There are 425,408 care home residents in England. Therefore, the number of COVID-19 related deaths of care home residents represents 9.21% of this population.

There is relatively little data on the impact of COVID-19 on people who use long-term care and reside in private households. Using data from the Care Quality Commission, The Health Foundation estimated that, between March 23 and June 19, 2020, there were an additional 4,500 deaths among people using domiciliary care from providers registered with the Care Quality Commission, compared to the previous three years during the same period (an increase of 225%). The deaths of 819 service users had been notified and published as involving COVID-19 during this period.

The Care Quality Commission published a one-off analysis of 386 death notifications of adults with intellectual disabilities using community-based social care or living in residential care from April 10 to May 15, 2020, compared to 165 death notifications for the same period in 2019. Of the 386 deaths in 2020, 206 were confirmed/suspected COVID-19 deaths and 180 were deaths notified as not COVID-19 related. An analysis of 163 people with learning disabilities who died with COVID-19 reported that 35% of these people were living in residential care, a further 19% were living in nursing care, 25% were living in supported living accommodation, and 18% were living on their own or with their family.

Half (49.5%) of all COVID-19 related deaths in care homes in England and Wales between March and June 2020, were in people living with dementia (Source: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/deathsinvolvingcovid19inthecaresectorenglandandwales/deathsoccurringupto12june2020andregisteredupto20june2020provisional?WT.mc_id=f5e0eb1233c5d2a1a4a1b591e46fecbd&hootPostID=1376c0e546f27d0e33d8ce1e242a810f).

The largest number of excess deaths (compared to the last five years during the same period) between March 20 and October 30, 2020, happened in private homes (25,634, of which only 2,571, 10%, were registered as COVID-19), followed by deaths in care homes (22,948, of which 15,415, 60%, were registered as COVID-19). In contrast, there were 2,724 fewer deaths than expected in hospices during that period. These figures do not include all deaths of care home residents, as some will have died in hospital (Source: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest).

In July 2021, the Care Quality Commission published care home level data on deaths notifications involving COVID-19 for the period from April 10, 2020, to March 31, 2021. In total, the Care Quality Commission had been notified of 39,017 deaths in that period that took place in 6,765 care homes.

Last updated: September 6th, 2021


Finland

Deaths from COVID-19 have fallen disproportionately amongst the elderly; the median age of the deceased is 84. Of the deceased, 19% were in specialised medical care, 34% in primary health care units, 45% in 24-hour social welfare units (residential LTC homes) and 2% at home or elsewhere (Source (p. 17): https://drive.google.com/file/d/19z_e5j7bcPxUYh2qLBa6VwrVDVnWilv7/view).

Last updated: July 30th, 2021


Finland

As of April 8, 2021, 80,842 people have tested positive for COVID-19 and 866 people have died. Of those, 29% (approximately 251) died in social care 24-hour units (Source: https://thl.fi/en/web/infectious-diseases-and-vaccinations/what-s-new/coronavirus-covid-19-latest-updates/situation-update-on-coronavirus#Coronavirus_situation). In 2018, there were 50,298 residents in social care 24-hour units (Source: https://thl.fi/fi/tilastot-ja-data/tilastot-aiheittain/ikaantyneet/sosiaalihuollon-laitos-ja-asumispalvelut). Therefore, the number of COVID-19 related deaths in these units represents 0.50% of this population.

Last updated: August 2nd, 2021


France

As of Feb 12, 2021, there have been 181,965 confirmed cases in LTCFs and 23,671 confirmed deaths (Source: https://www.gouvernement.fr/info-coronavirus/carte-et-donnees). Between March 1 and Nov 22, 2020, there were 96,059 cases among residents of care homes, with significant regional variation. There were 21,644 excess deaths (COVID-19 was over 14,000 of these) of the total 50,237 from March 1 and July 7, 2020. A total of 47,428 cases were recorded among social care workers, of which at least 17 died (Source: https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf). It’s unclear how many excess deaths occurred at home, and among domiciliary care users. Excess deaths at home between March 1 and April 30, 2020, are estimated to have increased by 32% compared to the previous year, with the highest increase among older people. Some provisional data from Inserm, which contains biases and delays, estimated that between March 1 and May 31, 2020, at least 1,800 deaths at home were due to COVID-19 (Source: http://www.senat.fr/rap/r20-199-1/r20-199-11.pdf).

Last updated: August 4th, 2021


France

France first published official death estimates for people in care homes on March 31, 2020. Deaths linked to COVID-19 among care home residents had been stable from the end of July until the week ending September 20, when they started to increase again.

The most recent numbers published by the Ministry of Health on April 1, 2021, reported a total of 95,264 COVID-19 related deaths, of which 36,889 (39%) were residents in care homes. Of these, 26,044 (71%) died in the care homes and, particularly in the earlier part of the pandemic, were mostly “probable cases” (people who were not tested but a doctor confirmed that the symptoms were associated with COVID-19). The remaining 10,845 died in hospital and were confirmed through testing. As of April 1, 2021, there have been 201,766 confirmed infections among care home residents, and 105,980 among care home staff. Deaths among care home staff are not reported in the bulletin. There are an estimated 605,061 care home beds in France. Therefore, the number of deaths of care home residents linked to COVID-19 would represent 6.10% of all the available beds (Source: https://www.insee.fr/fr/statistiques/3676717?sommaire=3696937).

Between March 1 and November 22, 2020, there were 96,059 cases among residents of care homes, with significant regional variation. There were a total number of 50,237 deaths between March 1 and July 7, 2020, of which 21,644 were excess deaths (over 14,000 of these were COVID-19 related) (Source: https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf).

Last updated: August 4th, 2021


Germany

According to a survey conducted in April/May 2020, 50% of COVID-19 related deaths occurred in residential care settings and 12% among people receiving domiciliary care services, while the overall share of people infected in care homes only amounts to 8.5%. It also showed that LTC workers (particularly those working in residential settings) have a higher risk of infection. The survey showed that LTC providers reported in April/May 2020 that almost every third client who tested positive for COVID-19 died. The average share among clients of domiciliary services who died is considerably smaller than among people living in residential care settings (Source: https://www.socium.uni-bremen.de/uploads/Ergebnisbericht_Coronabefragung_Uni-Bremen_24062020.pdf).

On February 24, 2021, the Robert Koch Institute reported that among people living in residential care settings (including asylums for refugees, homeless people, prisons), there had been 113,111 cases. Out of these, 19,760 people (17%) have died from COVID-19. For a total of 64,041 cases, the Robert Koch Institute provides detailed information. Among these, 58,986 cases were recorded in residential care settings. Out of these 11,201 people died of COVID-19. The data also contains 531 cases among people receiving domiciliary care. Out of this group, 79 people died.

Last updated: August 3rd, 2021


Germany

Germany’s Robert Koch-Institute published the first official number of infections and deaths in different care settings on April 22, 2020. People in care and nursing homes are covered under §36 of the Protection Against Infection Law (IfSG). §36 also includes people living in facilities for those with disabilities or other care needs, homeless shelters, community facilities for asylum-seekers, repatriates, and refugees, and so the data is not directly comparable with the data on care homes presented for the other countries.

Data recorded here only includes confirmed cases following a laboratory diagnosis independent of clinical assessment. In addition, the Robert Koch Institute advises that information on care setting is missing in 37% of cases, which means that the number of people affected represents the minimum number of cases in specific care settings. A report estimated that, based on a survey of care homes, the share of deaths of care home residents attributed to COVID-19 by May 2020 was 49% of all COVID-19 deaths, which is higher than the rate that would result from the Robert Koch Institute data at the time (36%).

According to a survey conducted in April/May 2020, 50% of COVID-19 related deaths occurred in residential care settings and 12% among people receiving domiciliary care services, while the overall share of people infected in care homes only amounted to 8.5%. It also showed that long-term care workers (particularly those working in residential settings) had a higher risk of infection. Additionally, the survey showed that long-term care providers reported in April/May 2020 that almost every third client who tested positive for COVID-19 died (Sources: https://www.socium.uni-bremen.de/uploads/Ergebnisbericht_Coronabefragung_Uni-Bremen_24062020.pdf).

Based on Robert Koch Institute data, as of March 24, 2021, 120,763 people living in communal settings and 58,736 people working in these settings (as defined by §36 IfSG) had been infected with COVID-19. Out of these, 21,372 residents as well as 163 staff have died. The total number of COVID-19 related deaths in Germany on the same date was 75,212. Therefore, deaths in communal settings represent 28% of all deaths. The total number of people living in care and nursing homes in Germany in 2017 was 818,000, and assuming that there were a similar number in 2020 and that all the deaths in communal establishment had been care home residents, 2.61% of all care home residents would have died due to COVID-19 (Source: https://de.statista.com/statistik/daten/studie/36438/umfrage/anzahl-der-zu-hause-sowie-in-heimen-versorgten-pflegebeduerftigen-seit-1999/).

Last updated: August 3rd, 2021


Hungary

As of August 27, 2020, there have been 142 COVID-19 related deaths in care homes, accounting for 23% of all deaths (142 of 614). These COVID-19 related deaths only account for people who have tested positive and died (Source: https://koronavirus.gov.hu/cikkek/idosotthonok-142-koronavirussal-fertozott-gondozott-hunyt-el-kozuluk-55-en-pesti-uton).

Because less than 3% of the population aged over 65 lives in care homes in Hungary, it is expected that the share of deaths in care homes in Hungary will be lower than in other countries. In 2018, the total number of residents of care homes was 55,170, of which 50,589 were aged 65 or more. Assuming the number of residents hasn’t changed, then the share of care home residents who have died as of August 27, 2020, would be 0.3%.

Last updated: August 2nd, 2021


Israel

The first outbreak in a long-term care facility in Israel began in mid-March 2020, sixteen days after the first patient was diagnosed in Israel. Only a month after the initial outbreak, and following massive public criticism and a call for help from the managers of long-term care facilities, the Israeli government appointed a national-level team to manage the COVID-19 outbreaks in long-term care facilities (Source: https://ltccovid.org/2020/04/30/the-impact-of-covid-19-on-people-using-and-providing-long-term-care-in-israel/). As of October 12, 2020, there have been 704 COVID-19 related deaths in long-term care facilities, which accounts for 39% of the total deaths in the population. There were 45,000 people in long-term care facilities in Israel. Therefore, the number of COVID-19 related deaths in these facilities represents 1.56% of this population (https://brookdale.jdc.org.il/publication/statistical-abstract-elderly-israel-2020/). Furthermore, according to a survey, 50% of all COVID-19 related deaths occurred in residential care settings, while the overall share of people infected in care homes only amounts to 8.5%.

Last updated: August 3rd, 2021


Italy

The only data available on the COVID-19 outbreak in nursing homes is from the results of a survey carried out by the National Health Institute (Istituto Superiore di Sanità), which was sent to 3,276 nursing homes out of the 4,629 operating in the national territory. On June 17, 2020, the National Health Institute published the results of the survey. As of May 5, 2020, 1,356 nursing homes responded. The total mortality rate during that time frame was 9.1% (considering all deaths). The COVID-19 related mortality rate (tests and suspected) was 3.1%.

Last updated: August 3rd, 2021


Japan

There is no publicly available official data on the numbers of people who use or provide care who have had COVID-19 infections or whose deaths are attributed to COVID-19. It was reported that 14% of all COVID-19 was the result of infections in care homes in early May 2020.

Last updated: August 3rd, 2021


Netherlands

During the first wave, the National Institute for Public Health and the Environment (RIVM) estimated that about 40% of nursing homes had experienced outbreaks. By May 15, 2020, about 7% of residents in nursing homes had been infected and 2% had died. A report published in November 2020 noted that approximately 50% of all COVID-19 related deaths during the second wave were residents of nursing homes.

As of March 6, 2021, there have been 8,446 COVID-19 related deaths of care home residents (Source: https://coronadashboard.rijksoverheid.nl/landelijk/verpleeghuiszorg). This accounts for 51% of the total COVID-19 deaths in the Netherlands and 7.04% of all nursing home residents. These numbers are an underestimation of the actual COVID-19 deaths because not all those who died due to COVID-19 will have been tested (especially at the beginning of the pandemic). Only people over 70 years of age are included in these statistics.

Statistics Netherlands (CBS), a governmental organisation, provides weekly updates on observed mortality. They distinguish the mortality figures by long-term care users and age. They also provide expected figures based on the previous 5 years to estimate excess mortality. These figures show that there was 13% excess mortality (observed-expected/expected) among long-term care users in 2020 compared to 7% excess mortality among the wider population (outside long-term care).

Last updated: August 3rd, 2021


New Zealand

As of March 25, 2021, there have been 16 COVID-19 related deaths in Aged Residential Care facilities, accounting for 57% of all COVID-19 related fatalities (Source: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-current-situation/covid-19-current-cases#summary). The Aged Residential Care sector comprises 38,000 beds in over 650 facilities throughout the country. Therefore, the number of deaths in aged care facilities represents 0.04% of all beds.

Last updated: August 2nd, 2021


Northern Ireland (UK)

The Northern Ireland Statistics and Research Agency publish data on deaths, including those where COVID-19 (suspected or confirmed) is mentioned on the death certificate. According to this data, as of March 5, 2021, there have been 2,839 COVID-19 related deaths, with 762 of these occurring in care homes (27%). Furthermore, there have been 997 COVID-19 related deaths of care home residents. Therefore, care home residents accounted for 35% of all COVID-19 related deaths in Northern Ireland. There are 14,935 care home residents in Northern Ireland. Therefore, the number of COVID-19 related deaths of care home residents represents 6.68% of this population.

Last updated: August 3rd, 2021


Portugal

Although no official reports have been published, the Government of Portugal released the number of deaths in nursing homes to the media. According to data published in the media, as of January 10, 2021, 2,254 people have died in nursing homes, corresponding to 2.27% of all the 99,000 residents in legal care homes in Portugal. On the same date, 7,803 deaths attributed to COVID-19 had been reported in Portugal. Therefore, the deaths of care home residents as a share of total deaths would be 28.9% (Source: https://covid19.min-saude.pt/wp-content/uploads/2021/01/314_DGS_boletim_20210110.pdf).

Last updated: August 3rd, 2021


Republic of Korea

Based on data provided by the Ministry of Health and Welfare and the Korea Disease Control and Prevention Agency, as of September 7, 2020, there have been 27 COVID-19 related deaths of nursing home residents, which accounts for 8% of the total number of COVID-19 related deaths. Another 76 occurred in long-term care hospitals. Deaths of residents in both types of settings would amount to 31% of total deaths. However, there were no deaths in care homes, because all residents with potential COVID-19 infections were transferred to hospitals.

In 2018, there were 177,318 beds in nursing homes (Source: https://stats.oecd.org/Index.aspx). Therefore, 0.02% of this population have died from COVID-19. There were 483,433 patients hospitalized in the 1,560 long-term care hospitals in 2018. Therefore, 0.02% of this population have died from COVID-19 (Source: https://ltccovid.org/wp-content/uploads/2020/05/The-Long-Term-Care-COVID19-situation-in-South-Korea-7-May-2020.pdf).

As of December 31, 2020, there had been 316 deaths among nursing home and long-term care hospital residents (Source: https://www.reuters.com/article/us-health-coronavirus-southkorea/south-korea-moves-coronavirus-patients-out-of-nursing-homes-as-deaths-mount-idUSKBN2950JR). The number of deaths among social care staff is unknown.

Last updated: July 30th, 2021


Scotland (UK)

National Records of Scotland (NRS) publish a weekly analysis of death registrations that mention COVID-19 on the death certificate. According to this, as of March 21, 2021, there have been 9,897 COVID-19 related deaths, with 3,283 of these occurring in care homes (33%). Since May 25, 2020, the Care Inspectorate Scotland (CIS) has reported weekly data on notifications of deaths of care home residents, which has showed that up to March 21, 2021, there have been 1,813 COVID-19 related deaths of care home residents. Prior to this, NRS published data up until May 17, 2020, which showed there had been 1,777 COVID-19 related registered deaths of care home residents. Including those deaths that occurred within a care home during the week between May 17 and May 23, 2020, (124 deaths), in total there were at least 3,714 care home resident deaths due to COVID-19. This represents 38% of the total COVID-19 related deaths. There are 35,989 care home residents in Scotland. Therefore, the number of COVID-19 related deaths of care home residents represents 10.32% of this population.

Last updated: August 3rd, 2021


Singapore

As of January 24, 2021, there had been 59,308 cases of COVID-19 infection (the majority, 54,508, in dormitories of migrant workers) and 29 deaths (Source: https://www.moh.gov.sg/covid-19/situation-report). As of January 24, 2021, there have been 4 COVID-19 related deaths in nursing homes, which represents 12% of all deaths. There are 16,059 nursing home beds in Singapore. Therefore, the number of COVID-19 related deaths in nursing homes would represent 0.02% of all beds (Source: https://ltccovid.org/wp-content/uploads/2020/08/The-COVID-19-Long-Term-Care-situation-in-Singapore-27July-2020.pdf).

Last updated: August 2nd, 2021


Spain

Data on COVID-19 related mortality in care homes is reported on Spanish national television, which needs to be treated with caution because the methods and definitions used to gather the data from the regional governments are not homogeneous. According to this source, as of January 22, 2021, there have been 26,328 COVID-19 related deaths in care homes, which includes both the deaths of people who have been diagnosed with COVID-19 and the deaths of those with symptoms but who have not been diagnosed. Estimating the share of all COVID-19 deaths that the deaths of care home residents represent in Spain is complicated because the national estimates of COVID-19 deaths only include deaths of people with a confirmed diagnostic test, missing the deaths of people that were not tested at the beginning of the pandemic. The national estimate for (confirmed) COVID-19 deaths on January 22, 2021 was 56,563 (Source: https://cnecovid.isciii.es/covid19/#documentaci%C3%B3n-y-datos).

The Spanish National Institute of Older People and Social Services (IMSERSO) reported that, in the first part of the pandemic (up to July 2020), there had been 20,268 deaths of care home residents in care homes, of which 9,904 were of people who had not been tested. That report highlighted that the national estimate for total deaths linked to COVID-19 does not include people who have not been tested and recommended adding the number of suspected deaths in care homes to the current total of confirmed deaths nationally. Using a similar approach would bring the total of confirmed and suspected deaths in the whole population to 66,467 by January 22, 2021. This would suggest that 40% of all deaths linked to COVID-19 in Spain have been among care home residents. This figure is lower than the estimate of 47% produced by the Spanish National Institute of Older People and Social Services up to June 23, 2020. This suggests that, proportionally, care home residents have not been as badly impacted as the rest of the population, compared to the initial part of the pandemic. The most recent estimate suggests that there are 333,920 care home residents (Source: http://envejecimientoenred.es/nivel-de-ocupacion-en-residencias-de-personas-mayores/). Therefore, the total number of COVID-19 related care home deaths would represent 7.88% of this population.

The Spanish National Institute of Older People and Social Services also publishes a monthly report on the excess mortality for people registered with the Spanish public long-term care system. Between March and November 2020, there have been 45,665 excess deaths among those who had applied for (and or received) care benefits. This was 31.8% higher than expected. The highest number of deaths were among people receiving benefits for institutional care (22,718, representing 9.12% of all recipients of this benefit). About 72.6% of care home residents are estimated to be in receipt of care benefits, and these are expected to be those who are most frail (Source: https://www.imserso.es/InterPresent2/groups/imserso/documents/binario/gtcovid_residencias_vf.pdf). Among people receiving benefits for care at home, there were 17,612 excess deaths, amounting to 2.02% of recipients (the share was a bit lower for people receiving cash payments for family care, 1.41%, compared to people receiving benefits in kind, 2.62%).

Last updated: August 4th, 2021


Sweden

On January 6, 2021, there had been 8,556 deaths in Sweden where COVID-19 was mentioned on the death certificate, of which 4,051 (47%) were among care home residents, and 2,276 among people who use care services in their own home (45%). Of the deaths of care home residents, 3,739 happened in the care home (92%). On October 31, 2019, there were 82,217 care home residents in Sweden, and using that as the denominator for total number of residents, 4.93% of care home residents would have died from COVID-19. The regional differences have been strong in Sweden. In the Stockholm region, 7% of the care home residents have died while there have been hardly any COVID-19 deaths in care homes in several other regions (Sources: https://aldrecentrum.se/wp-content/uploads/2021/02/Johansson-L.-Sch%C3%B6n-P.-2021.-Governmental-response-to-the-COVID-19-pandemic-in-Long-Term-Care-residences.pdf; https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Sweden-22-July-2020-1.pdf).

Last updated: July 30th, 2021


Sweden

As of April 5, 2021, there have been 12,598 deaths in Sweden where COVID-19 was mentioned on the death certificate, of which 5,446 (43%) were among care home residents, and 3,277 among people who use care services in their own home (26%) (Source: https://www.socialstyrelsen.se/statistik-och-data/statistik/statistik-om-covid-19/statistik-over-antal-avlidna-i-covid-19/). Of the deaths of care home residents, 4,887 happened in the care home (90%) (Source: https://www.socialstyrelsen.se/statistik-och-data/statistik/statistik-om-covid-19/statistik-om-covid-19-bland-aldre-efter-boendeform/).

On October 31, 2019, there were 82,217 care home residents in Sweden. Therefore, the total number of COVID-19 related deaths in care homes represents 6.62% of this population. The regional differences have been strong in Sweden. In the Stockholm region, 7 % of care home residents have died, while there have been hardly any COVID-19 deaths in care homes in several other regions (Sources: https://aldrecentrum.se/wp-content/uploads/2021/02/Johansson-L.-Sch%C3%B6n-P.-2021.-Governmental-response-to-the-COVID-19-pandemic-in-Long-Term-Care-residences.pdf; https://ltccovid.org/wp-content/uploads/2020/07/The-COVID-19-Long-Term-Care-situation-in-Sweden-22-July-2020-1.pdf).

Last updated: August 2nd, 2021


Turkey

On September 30, 2020, the Minister of Heath announced that the official figures of COVID-19 refer to the number of COVID-19 ‘patients’ (who have received treatment), whereas COVID-19 ‘cases’ (who tested positive but do not show any symptoms) have not been included in the published data since July 29, 2020. As of October 2, 2020, the total number of patients was 321,512 and 8,325 COVID-19 related deaths have been recorded (Source: https://covid19.saglik.gov.tr/?_Dil=2).

No recent official data on deaths of care home residents has been released by the Ministry. Based on public statements of government officials provided on different platforms, as of May 7, 2020, there have been 1,030 diagnosed COVID-19 cases in care institutions where the resident had been admitted to a hospital and 150 deaths of care home patients. The deaths in nursing homes accounted for 4% of all COVID-19 deaths in Turkey (Source: https://ltccovid.org/wp-content/uploads/2020/06/The-COVID-19-Long-Term-Care-situation-in-Turkey.pdf).

Last updated: August 3rd, 2021


United States

There has been approximately 1.2 million identified cases of COVID-19 amongst residents and staff of US nursing (care) homes, resulting in the deaths of 128,285 residents and 1,591 staff. The highest death rates have occurred in the most populous states, namely California, New York, and Texas. There was a spike in cases and slight increase in death rates in December 2020-January 2021, but the vaccination campaign has led to a significant drop in nursing home cases. All of the data submitted by nursing homes to the Center for Disease Control’s National Healthcare Safety Network is available.

Last updated: August 3rd, 2021


United States

This covers cumulative deaths in US care homes (nursing facilities, assisted living facilities, and other long-term care facilities) from January 1, 2020, through to March 29, 2021. Information about deaths in care homes comes from three sources: the Center for Medicare and Medicaid Services (CMS), the Kaiser Family Foundation (KFF), and the COVID Tracking Project (CTP) produced by The Atlantic Magazine. As of March 7, 2021, COVID Tracking Project has stopped collecting data. We derived COVID-19 mortality estimates by starting with state-level figures, which were reported directly by each of the sources (Sources: https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/; https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/#long-term-care-cases-deaths; https://covidtracking.com/). We started with state-level figures to address inconsistencies between the three data systems in the number of recorded COVID-19 deaths. Because the sources draw from different sources, their state totals differ. By starting at the state level, we were able to pick the ‘best’ estimate of care home COVID-19 deaths from each state from among the three data systems. To obtain the ‘best’ estimate of care home COVID-19 deaths, we selected the highest number of deaths recorded for each state from among the three sources. The ‘best’ estimate was a cumulative number of 185,269 COVID-19 related deaths in care homes. Based on this data, care home COVID-19 related deaths account for 34% of all COVID-19 related deaths.

The number of residents in care homes was approximated by adding the residents in nursing facilities from the Center for Medicare and Medicaid Services data and the number of residents in assisted living facilities taken from a report by the National Center for Assisted Living, to get 1,937,345. Therefore, the total number of COVID-19 related deaths in care homes represents 9.56% of this population.

Last updated: August 2nd, 2021


Wales (UK)

Data published by the Office of National Statistics shows that as of March 12, 2021, there have been 7,717 COVID-19 related deaths, with 1,650 of these occurring in care homes (21%). Care inspectorate Wales (CIW) publish weekly data on notifications of deaths of care home residents by date of notification and cause. As of March 12, 2021, there have been 1,911 COVID-19 related deaths of care home residents. Therefore, care home residents accounted for 25% of all COVID-19 related deaths in Wales (Source: https://gov.wales/notifications-care-inspectorate-wales-related-covid-19-adult-care-homes-1-march-2020-12-march-2021-html). There are 23,766 care home residents in Wales. Therefore, the number of COVID-19 related deaths of care home residents represents 8.04% of this population.

Last updated: August 3rd, 2021