LTCcovid Country Profiles

Responses to 3.00. Overview of the pandemic response in the Long-Term Care system

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It was compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project moderated the entries and edited as needed. It was updated regularly until the end of 2022.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors.  (2022) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science.

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.


The Royal Commission into Aged Care Quality and Safety’s special report on COVID-19 identified the following factors in terms of the ability of the aged care sector to respond (Royal Commission, 2020):

Factors linked to preparedness

In the residential facilities that have suffered the largest number of infections and deaths that have been the subject of inquiry (e.g Newmarch, St Basils) or used as case studies in reports (Epping Garden Gardens) the follow conclusions/points were made about their preparation or lack of preparedness (Royal Commission, 2020):

  • – Insufficient PPE provided residential care and home care providers
  • – Staff were excluded from the vaccination rollout.
  • – Lack of understanding that workers bring the infection into the homes as well as taking it out and infecting family members.
  • – Individual homes expecting to transfer large numbers of residents to hospital at short notice
  • – There was no National COVID Plan for Aged care. The National Covid plan was adapted.
Structural problems in the LTC system
  • – The effective casualisation of the workforce resulting in some personal care workers working across several facilities.
  • – Chronic understaffing
  • – The lack of clinical skills with the declining ratio of nursing qualified staff
  • – The outsourcing of support services such as such as cleaning  and food preparation with workers working across several sites
  • – Contested lines of responsibility between state and Commonwealth department

Academics, aged care peak bodies and unions agreed that the casualisation of the workforce, and outsourcing of some services (e.g. cleaning) resulting in a number of workers moving between aged care sties was considered to exacerbate the spread of the virus (Senate, Oct 2021 section 4.14).


Royal Commission into Aged Care Quality and Safety (2020) Aged care and COVID-19: a special report. Commonwealth of Australia. 

The Senate (2021) Select Committee on Job Security. Commonwealth of Australia.

Last updated: January 17th, 2022   Contributors: Lee-Fay Low  |  

In the LTCcovid report for Sweden published in July 2020, Szebehely emphasises that, despite Swedish authorities stressing the importance of protecting older people, there was no specific attention to care home residents or people who use care at home. As in many countries, the focus was on limiting the spread of infections in the community and protecting capacity in the health care sector (Szebehely, 2020).

The lack of prioritisation of the LTC sector in the initial part of the pandemic meant that it had very limited access to Personal Protection Equipment (PPE), testing, poor capacity to implement Infection and Prevention and Control measures, and that particularly people living in care homes did not have enough access to medical care (Szebehely, 2020).

There was scarcity of Personal Protection Equipment (PPE), which affected the LTC sector in particular. The Public Health Authority mentioned the use of masks and shields in LTC for the first time on the 7th May, however a proper recommendation to use shields and masks in personal care of people with confirmed or suspected COVID was not made until the 25th of June 2020.


Szebehely M (2020) The impact of COVID-19 on long-term care in Sweden., Long-Term Care Policy Network, CPEC-LSE, 22 July 2020.

Last updated: February 13th, 2022

Following the declaration of a nationwide curfew in Thailand on 25 March 2020, in  April 2020, the Department of Older Persons issued a  manual of control and prevention of COVID-19 for all government care homes to ensure social distancing, which has been in place at least until February 2021.

The manual of control and prevention of COVID-19 in care homes includes the following measures (Srifuengfung et al., 2021):

Activities are to be organised in open spaces that are at least 2 metres apart

Beds and personal items must be at least 1 to 2 metres apart

There must be a one-way entry and exit system

Residents must maintain physical distancing as always be at least 1-2 metres apart, they must have their body temperature measured every day, their cutlery must be separate, was their hands regularly and wear a face mask, refrain from going in and out of the centre.

Visitors and people from outside organisations are not permitted to visit or organise activities.


Srifuengfung, M., Thana-Udom, K., Ratta-Apha, W., Chulakadabba, S., Sanguanpanich, N., & Viravan, N. (2021). Impact of the COVID-19 pandemic on older adults living in long-term care centers in Thailand, and risk factors for post-traumatic stress, depression, and anxiety. Journal of Affective Disorders, 295, 353–365.

Last updated: January 14th, 2022

As there is no information on people who use or provide LTC specifically, the following information pertains to measures adopted to minimize the impact of the COVID-19 pandemic on elderly people; the group most likely to use LTC (albeit often from their families).

Aside from additional support provided by the Government / Ministry of Health (see section 2.05), various socio-political organisations have played an important role in caring for and supporting vulnerable people (including elderly people and in particular, lonely elderly people) throughout the pandemic. For example, The Fatherland Fund established charity funds to help with the containment of COVID-19, and Youth Union has provided free food to vulnerable older people. The private sector has also played a role – for example, private donors set up ‘rice ATMs’ to distribute free rice to vulnerable people in some of the rural areas (Tung, 2020)..


Tung, L. T. (2020). Social Responses for Older People in COVID-19 Pandemic: Experience from Vietnam. Journal of Gerontological Social Work, 63, 682–687.

Last updated: December 30th, 2021   Contributors: Daisy Pharoah  |  

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica BreuerJorge Browne Salas, Jenni Burton, William Byrd, Sara CharlesworthAdelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin HämelNina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’DonovanCamille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. SchmidtAgnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.