LTCcovid Country Profiles

Responses to 3.03. Monitoring Covid-19 impacts in the Long-Term Care sector: data and information systems

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. https://doi.org/10.21953/lse.mlre15e0u6s6

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

 

The Department of Health publishes weekly traffic light reports of the COVID-19 situation across Australia, which includes details about cases, testing, and capacity nationwide and in individual states. Specific systems have been developed in individual states. For example, the Victorian Aged Care Response Centre brings together Commonwealth and Victorian state government agencies in a coordinated effort to manage the impact of the COVID-19 pandemic in aged care facilities.

Last updated: December 22nd, 2021

Limitations in accessing basic LTC and assisted living sector data, including human resources and expense data, created challenges in implementing COVID-19 policy and operational support initiatives (Source: https://news.gov.bc.ca/files/1.25.2021_LTC_COVID-19_Response_Review.pdf). LTC operators reported “spending hundreds of extra hours to respond to requests for reporting and additional inspections over the course of the pandemic” and many providers found these requests to be overwhelming. But the government saw this information as essential to evaluate how LTC sector was doing throughout COVID-19 and what further assistance/support was needed.

Last updated: November 6th, 2021

From April 2020 Statens Serum Institut has started gathering data on infections  at the nursing homes. The close monitoring of infection rates by Statens Serum Institut as well as the Danish Patiens safety Authority is considered to be a decisive tool in the management of the pandemic. Weekly data on LTC and COVID-19 is published online by Statens Serum Institute (Source: https://covid19.ssi.dk/overvagningsdata/ugentlige-opgorelser-med-overvaagningsdata).

Once a week, Danish Regions publish statistics on the stocks of masks, disinfectants and gloves (Source: https://www.regioner.dk/sundhed/coronaviruscovid-19).

Last updated: May 25th, 2023

Finland has very good data through its health and social care registers, both in terms of data and coverage. However, during the pandemic up-to-date data on, for example, deaths in care homes and among home care clients was not available. This is in part because, in order to guarantee the quality of the data, the registers take a substantial amount of time to be updated. Statistics Finland stepped in to publish preliminary data on deaths.

Source:

Forma L, Aaltonen M, Pulkki J (2020) COVID-19 and clients of long-term care in Finland – impact and measures to control the virus. LTCcovid, International Long-Term Care Policy Network, CPEC-LSE, 12 June 2020.

Last updated: November 9th, 2021

The first operational system for documenting the situation in care homes was made available only near the end of March 2020, and publicly available on April 2. Regional structures (ARS) were largely left to their own devices at the beginning of the pandemic. The Health Ministry’s infectious diseases risk register was not adapted to the recording of care home deaths. The Direction Générale de la Cohésion Sociale [General Directorate of Social Cohesion] developed an emergency oversight system on March 28, which was dependent on departments submitting information from LTCFs on observed events (e.g. probable cases, confirmed cases, deaths), recording alerts based on symptoms. This contrasted to SiVIC, the national hospital database, which collected useful personal information. The Senate criticised the system as the ARS regions had to adapt the systems they had developed to a poorer system which wasn’t as useful and required significant resources to extract and convert brute information into something useful (Source: https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf)

Last updated: September 9th, 2021

The Robert Koch-Institute (RKI) is the federal institute responsible for disease detection and health reporting. It collects data on diseases nationwide (Source: https://drive.google.com/file/d/1-RDnqErydbuGGNXlM8WaFB2oSTRKStTc/view). Laboratories and medical doctors are required to inform the local health authority about COVID-19 and selected other infections. The local health authorities then transfer the aggregate data to the health authority responsible for the federal state. This main health authority then transfers the information to the RKI. The RKI works closely with the Federal Ministry of Health, other Federal authorities, and public health authorities in each of the 16 Federal states. The RKI also maintains interaction with international bodies, such as the World Health Organisation and European Centre for Disease Prevention and Control. The information routes are outlined by law (Source: https://www.gmkonline.de/documents/pandemieplan_teil-i_1510042222_1585228735.pdf).

RKI publishes a daily Situation Report on the pandemic, which includes limited information on COVID-19 morbidity and mortality in residents of care homes and clients of home care services as well as for staff of these services. Details of how this information is gathered and presented have changed over time. More fine-grained information is not generally available. Information on persons who receive only informal care in their own home is not included. Impacts on the LTC system in general, e.g. availability and usage of services, are not routinely monitored and therefore not easily available.

Last updated: September 9th, 2021

Nursing homes in Ireland have to report any ‘outbreak of COVID-19’ to the Chief Inspector of Social Services in the Health Information and Quality Authority (Source: https://ltccovid.org/wp-content/uploads/2020/05/Ireland-COVID-LTC-report-updated-13-May-2020.pdf).

Last updated: September 9th, 2021

COVID-19 is being tracked by the Israel Ministry of Health’s Data Dashboard. The Ministry has introduced a smartphone app, HaMagen (“The Shield”), for their track and trace programme. The Ministry’s Center for Disease Control also publishes a broader surveillance of respiratory viruses each week. Israel has an extensive and highly digitized online medical system. This made the creation of appointment smartphone apps to set up automatic scheduling and appointment reminders for vaccination relatively easy (Video:14:10). Nonetheless, the Dashboard does not post data concerning LTCFs. Daily reports of the monitoring and operations of the national task force were published on the task force’s website daily until February 2021 [in Hebrew].

Last updated: December 5th, 2021   Contributors: Shoshana Lauter  |  LIAT AYALON  |  

Absence of data and figures of what happened during Covid-19 in LTC sector has been acknowledged as one of the main critical issues for the sector and for the impact of the pandemic by the newly established commissions on the post-covid reforms that have been enacted in the last months (2021). At the national level, the Istituto Superiore di Sanità was the only actor collecting comparable and robust figures on what was happening in nursing homes. This was done through a voluntary national survey submitted to nursing homes providers in three rounds: April 2020, June 2020 (for an international report on this data see Lombardo et al.). Regions enacted some ex-post data collection with limited relevance and poor continuity of data. During 2021 the same institute promoted a new survey on the surveillance of vaccination and spread of Covid-19 in nursing homes, covering the period October 2020-September 2021.

Sources:

Lombardo, F. L., Salvi, E., Lacorte, E., Piscopo, P., Mayer, F., Ancidoni, A., … & Nursing Home Study Group. (2020). Adverse events in Italian nursing homes during the COVID-19 epidemic: a national survey. Frontiers in psychiatry, 11.

Last updated: December 4th, 2021   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  

It is unclear what measures have been put in place for data and information sharing within LTC during the COVID-19 pandemic. Japan has not adopted electronic record sharing on a large scale and most records remain paper-based and mostly shared by fax (Source: https://www.healthaffairs.org/do/10.1377/hblog20200721.404992/full/).

Some of the supplementary budget provided by the government in response to the COVID-19 pandemic was for the construction of a ‘data-sharing system among hospitals, municipalities and national ministries’ to support the government with monitoring the number of people with COVID-19 infections (Source: https://ltccovid.org/wp-content/uploads/2021/03/ltccovid-Country-Report-Japan_Final-27-February-2021.pdf).

Last updated: September 9th, 2021

The association of geriatric doctors, Verenso, initiated a registration system to improve data collection from nursing homes on incidence and mortality (Source: https://drive.google.com/file/d/1Ji-iDCjC-8EbBpV0dW_xlz780uvU7F–/view). Two electronic healthcare systems (i.e. Ysis and ONS) have collected the number of COVID-19 cases in nursing homes. These electronic healthcare systems cover the majority of nursing homes in the Netherlands (Source: https://ltccovid.org/wp-content/uploads/2020/05/International-measures-to-prevent-and-manage-COVID19-infections-in-care-homes-11-May-2.pdf).

Last updated: September 9th, 2021

To track the movements of people with COVID-19 infections, the government used Global Positioning System (GPS) records from cellular phone or credit card records to generate a movement map. Once the movement map was made, the map was displayed on the Web or notifications were sent to inhabitants in the relevant neighbourhoods so they could take additional precautions. To monitor people under quarantine, applications on smartphones using GPS data were introduced (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160162/).

Last updated: September 9th, 2021

On December 2, 2020, the Territorial Council of Social Services and the System for Autonomy and Dependency Care, agreed to prepare and publish weekly statistics and reports regarding the situation of residential centres during the Covid-19 pandemic.

The report is published on the Institute for the Elderly and Social Services (IMSERSO) website, and is prepared with each autonomous communities aggregate data concerning the situation of residential centres in their territory. The report includes information on residential centres for the elderly (R1), residential centres for people with disabilities (R2) and other permanent social services accommodation for both elderly and disabled people (R3).

The collection and systematization of statistics is conducted by IMSERSO, the Ministry of Health’s Coordination Centre for Health Alerts and Emergencies (CCAES) and the Ministry of Science and Innovation’s Institute of Health Carlos III (ISCIII). Data is submitted by ISCIII for weekly updates which can be found at https://covid19-country-overviews.ecdc.europa.eu/.

The data is always provisional and is updated weekly by the Autonomous Communities, and consequently, the structure of the report may vary. The report can be found on the IMSERSO website, and it is also possible to download the data that forms each weekly report.

The reports’ meet the parameters of the European Centre for Disease Prevention and Control’s (ECDC) protocol for epidemiological surveillance of residential centres in EU / EEA countries. The ECDC’s metadata has been implemented into the European Surveillance system (TESSy) since January 2021.

 

Last updated: July 4th, 2022   Contributors: Sara Ulla Díez  |  

A lack of linked datasets for care homes slowed down the pandemic response in care homes.  The number of different bodies that are collecting information, and the absence of standardisation and cross sector cooperation in how data are collated, shared, and used have prevented rapid and effective responses (Hanratty et al. 2020). 

References:

Hanratty B. et al. (2020) Covid-19 and lack of linked datasets for care homes. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2463

Last updated: March 24th, 2022

In August 2020, the Scottish Government commissioned the use of a new web-based tool- The Turas Care Management Tool or Safety Huddle tool – to help monitor the risk of COVID-19 within Scotland’s care homes. The tool provides a central location for all Scottish care homes to record information on infection rates, demand on services and staff testing. The purpose of the tool was to provide early warning signs of emerging trends to allow homes to intervene early.

Last updated: March 24th, 2022   Contributors: Jenni Burton  |  David Henderson  |  David Bell  |  Elizabeth Lemmon  |  

There are multiple on-going studies and information systems tracking the impact of the pandemic on LTC users. The official government data system for tracking COVID-19 in nursing facilities and other LTCFs is through the Center for Disease Control’s (CDC) National Healthcare Safety Network (Source: https://www.cdc.gov/nhsn/ltc/covid19/index.html). In coordination with the federal agency for health insurance programs, the Center for Medicare and Medicaid Services (CMS), this Network has produced a Nursing Home COVID-19 Public File to which over 15,000 certified nursing facilities nationwide are expected to report related data weekly. The CMS can impose financial penalties if facilities do not report, and compliance has thus been nearly 100% (Sources: https://ltccovid.org/wp-content/uploads/2021/02/LTC_COVID_19_international_report_January-1-February-1-1.pdf; https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/). Other, independent information systems tracking the impact of the pandemic in LTCFs include the Kaiser Family Foundation (KFF) and The Atlantic Magazine’s COVID Tracking Project (CTP) (Source: https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/#long-term-care-cases-deaths; https://covidtracking.com/).

Last updated: September 9th, 2021

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica Breuer, Jorge Browne Salas, Jenni Burton, William Byrd, Sara Charlesworth, Adelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin Hämel, Nina 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’Donovan, Camille 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. Schmidt, Agnieszka 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.