LTCcovid Country Profiles

Responses to 3.05. Long-Term Care oversight and regulation functions during the pandemic

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 Australian Government’s Aged Care Quality and Safety Commission is responsible for providing COVID-19 information and recommendations to aged care providers and facilities. However, state and territory health agencies also have the ability to implement policies in the aged care sector. With both the federal, state, and territorial governments having some oversight over aged care providers, there is a fragmentation of power leading to ineffective and often confusing protocols (source: Aged Care and COVID-19 report).

Last updated: December 22nd, 2021

Health authority owned LTC facilities were found to have had better oversight, management, and support during the pandemic. Provincial health officer orders could be interpreted differently in each health authority, for example leading to different visitor guidelines/policies. The ministry established a clinical reference group as part of the Health Emergency Management British Columbia (HEMBC) to develop clinical policy responses to COVID-19. However, it is unclear how the HEMBC differs from the Provincial Health Services Authority (Source:

Last updated: March 3rd, 2022

On May 12, 2020, an extensive publication providing new guidelines on how to organize visits in nursing homes was published by the Board of Health. From the introduction, it was made clear that the Board of Health did not have the authority over who could visit, as this was the responsibility of the Board for Patient Safety, and thus underlining the general confusion over which authority was in charge (Source:

Last updated: September 10th, 2021

LTC quality checks and necessary patient to staff ratios were temporarily suspended in March 2020 but supposed to resume in October 2020 (source: Due to increased infection risk this date was finally pushed to March 2021 (Source:  Quality checks were only undertaken if there was reason to suspect that quality of care was not maintained.

In March 2020, the German Government allowed care providers to divert from contractual obligations around staffing to avoid gaps. LTC insurance was also given some freedom to avoid gaps in domiciliary care (Source:

Last updated: February 12th, 2022   Contributors: Klara Lorenz-Dant  |  Thomas Fischer  |  Kerstin Hämel  |  

Regulation guidelines in LTCFs during COVID-19 that overrode regular protocols were issued by the national taskforce, The Shield of the Fathers and Mothers. Three of the major policy measures that had particularly important impacts were: the increased testing in LTCFs; the re-evaluation of family visitation policies; and the opening of specialized COVID-19 wards within LTCFs (to reduce the burden on general hospitals and stop the spread of infection from LTCFs to local communities). A study has been published outlining the adaptation and level of success.

Last updated: September 10th, 2021

LTC oversight and regulation is part of regional functions and did not changed during the pandemic. No specific intervention has been implemented during 2020 or 2021 and the governance model remained unchanged.

Last updated: December 3rd, 2021   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  

New legislation has been brought in nationally to manage the pandemic, but when it was released, LTCFs had already responded using well-established infection control protocols (Source:

Last updated: September 10th, 2021

Nationwide monitoring and inspection of LTC hospitals was conducted to ensure the ‘exclusion’ of workers with a recent travel history to affected regions or countries, or those with symptoms.

Last updated: September 10th, 2021

There has been little oversight, at most reviews of written documents, which care home managers have found to be very onerous (Source:

Last updated: September 10th, 2021

The responsibility to restrict the spread of any disease in care homes and other forms of social care services rests with the municipalities together with the regional infection control units (Smittskydd). During the entire pandemic, this local/regional responsibility has been stressed by the Public Health Agency and the National Board of Health and Welfare. The latter has mainly acted by providing recommendations and check-lists, and by presenting good examples. In April 2020 the Government appointed the Health and Social Care Inspectorate (IVO) to conduct a large-scale inspection in care homes and other care units for older and disabled people to investigate the consequences of COVID-19 for quality and safety in the care services (Source: The regions are responsible for COVID-19 testing conducted under the Health and Medical Services Act and the Communicable Diseases Act. Under the Work Environment Act the regions also have responsibility for the health and safety of their own staff (Source:

Last updated: November 30th, 2021

The Coronavirus Act (March 25 and renewed on September 30, 2020) included provision to relax the responsibilities of local authorities under the Care Act 2014 to streamline their services in case of workforce shortages or increased demand. The Act also enabled rapid discharge of patients from hospital by allowing assessments to be delayed. There was concern that the Care Act Easements included in the Coronavirus Act would be widely used to reduce care packages but only a small number of councils utilised them. As of November 2020, the Care Quality Commission (CQC) reported that no local authorities were currently using Care Act Easements.

The CQC interrupted routine inspections on March 16, 2020. In May 2020, the CQC began to implement an Emergency Support Framework setting out its approach to regulation during COVID-19. This involved suspending routine inspections of services and instead using and sharing information to target support where it’s needed and taking action to keep people safe and protect their human rights. The CQC are now starting to resume some inspections in 300 random homes in relation to management of the pandemic, examining four key areas; safe care and treatment; staffing arrangements; protection from abuse; assurance processes monitoring and risk management. Much will be conducted remotely and in person inspections will take place under exceptional circumstances only.

Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. During this period, the CQC will continue to apply a risk-based approach to inspection, using information from a range of sources, including from people using services and their families, to shape their inspection activity. Additionally, they will ensure that all inspections of care providers consider how well services are managing infection prevention and control, taking swift regulatory action where provider-level performance requires rapid improvement. This will include monitoring compliance with vaccinations as a condition of deployment within its inspection activity.

Additional Sources:

Dunn, P. et al. (2020). Adult social care and COVID-19: Assessing the policy response in England so far. Health Foundation briefing

Eight councils have triggered Care Act duty moratorium in month since emergency law came into force – Community Care

Joint statement on our regulatory approach during the coronavirus pandemic | Care Quality Commission (

Routine inspections suspended in response to coronavirus outbreak | Care Quality Commission (

Last updated: March 15th, 2022   Contributors: William Byrd  |  

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.