LTCcovid Country Profiles

Responses to 3.02. Governance of the Long-Term Care sector's pandemic response

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 Health Protection Principal Committee (AHPPC), made up of the Chief Health Officers from each state and territory, the Chief Medical Officer, and representatives from key departments coordinates the pandemic response. The Australian government is the main funder and regulator of aged care services. Therefore, it has a key role in coordinating a response to COVID-19 in aged care services. State and territory governments also have responsibility for acute care and managing health emergencies within their jurisdictions. Responsibility was fragmented between the federal and state governments. Within the states, while funded by the Commonwealth and having to comply with Commonwealth standards, there are some nursing homes run by state governments  (eg Victoria runs 178 nursing homes) and some home care is provided by local government (eg in Victoria). (Charlesworth and Low, 2020).

The federal, state, and territory governments established a COVID-19 health sector response plan but this plan has been criticized for not specifically addressing the aged care sector. There is a need for a national COVID-19 aged care advisory body to establish protocols between the national and state governments (sources: Royal Commission, 2020; Charlesworth and Low, 2020).

Fragmentation between the Australian Government, state, and territory governments led to confusing and inconsistent messaging. It was not clear to providers and recipients who was in charge and what communication to follow. The Commission into Aged Care Quality and Safety recommended a specific aged care advisory body for COVID-19. The Australian Health Protection Principal Committee is responsible for responding to health emergencies. While they released a response plan in early in the pandemic, none of the committee’s members are aged care specialists.

Public health is a shared responsibility between the Commonwealth and the states. In respect of COVID the Commonwealth oversees whole of government (Commonwealth & state) coordination measures and the COVID national communication plan. In aged care the key COVID-19 Commonwealth roles are:

  • upskilling and supporting aged care providers to practice robust infection control—for example, stand-by infection control teams to be deployed if an aged care facility requires assistance with managing an COVID-19 outbreak
  • easing contractual restrictions on funding for services delivered in the community—for example, having the flexibility to cease group activities
  • increased funding for aged care providers—for example, additional funding to services that provide meals to people in the community
  • temporary delay in introducing new reforms and programs—for example, the introduction of payment administration changes for home care packages has been delayed
  • cross-portfolio arrangement to ease international student visa working arrangements within aged care, so they can work additional hours
  • coordinating with state and territory governments in the event of an outbreak
  • developing and making available communication material and resources for older people—for example, Coronavirus (COVID-19) advice for older people
  • funding grants—for example, the Commonwealth Home Support Programme (CHSP)—emergency support for COVID-19 and
  • introducing telephone options to support older people—for example, establishing a dedicated telephone line.

However, the states have the key responsibility for declaring and responding to emergencies, including public health emergencies such as COVID-19. “At the State level, each State has its own public health legislation to deal with a pandemic. It also has emergency legislation to deal with emergencies, including a pandemic. The States have exercised their powers to impose lockdowns, prohibit mass gatherings, limit the movement of people, close down non-essential businesses, and close schools, libraries and public facilities.” See

While cooperation during COVID between the Federal and state governments has been seen to be generally successful at a broad constitutional level, one major area of failure has been the lack of coordination between LTC run by the Commonwealth and the public hospital system run by the states: thus not “preventing the spread of coronavirus in aged care facilities… when nursing homes became infected with COVID-19, questions arose as to whether residents should be moved to hospitals, or treated in the nursing home, and who was responsible. After a number of crises in nursing homes, particularly during the second wave of the pandemic in Victoria, the Commonwealth and the State established the ‘Victorian Aged Care Response Centre’, which includes representatives from Commonwealth and State health departments, the aged care regulator, State and Commonwealth emergency management bodies and the defence force.”  See However this body has not been emulated in other states and is set to only exist until June 2022.

Other areas of state/federal jurisdictional tension in LTC have been in respect of the supply of PPE, the slow pace of the vaccine role out (and now booster role out) by the Commonwealth including of staff in LTC, adequate testing and tracing measures.


Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020 (click here)

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

Last updated: January 17th, 2022

Provincial Health Officer Dr Bonnie Henry and Minister of Health Adrian Dix had a “united and consistent presence in providing key messages to the public which may have led to greater adherence and compliance to public health recommendations. Each regional health authority mobilized an Emergency Operations Centre (EOC), which included the medical health officer (MHO). MHO has authority under the Public Health Act to manage the public health response and outbreak in their region. EOC was useful and effective in coordinating responses in health authority owned and operated (public) LTC facilities but not privately owned or affiliate facilities (Source:

There was a lack of coordination between health and social care. Healthcare is monitored more by the national government, although jurisdiction is under the provincial government. Social care is almost exclusively provided and monitored by regional health authorities within the provinces. While the same five health authorities oversee both health and social care, the creation of emergency committees and new medical health officer roles within these authorities created confusion regarding decision making power and authority.

Last updated: March 3rd, 2022

A published paper critically reviews Canada’s response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the country.


Allin, S., Fitzpatrick, T., Marchildon, G., & Quesnel-Valleé, A. (2021). The federal government and Canada’s COVID-19 Responses: From “we’re ready, we’re prepared” to “fires are burning.” Health Economics, Policy and Law.

Last updated: November 30th, 2021   Contributors: William Byrd  |  

The Ministry of Health, the National Service for Older People (Servicio Nacional de Personas Mayores, SENAMA), and the Chilean Geriatrics and Gerontology Society (SGGCh) developed a set of prevention and management measures. Additionally, SENAMA implemented a mitigation strategy that included face to face technical support, supply of PPE, testing, and temporary transfer of residents who had tested positive to other health settings (Browne et al., 2021).


Browne, J., Palacios, J., Madero-Cabib, I., Dintrans, P.V., Quilodrán, R., Ceriani, A. and Meza, D., 2021. Enablers and Barriers to Implement COVID-19 Measures in Long-Term Care Facilities: A Mixed Methods Implementation Science Assessment in Chile. Journal of Long-Term Care, (2021), pp.114–123. DOI:

Last updated: December 22nd, 2021

Overall, the Danish governance approach to governance of the pandemic has relied on general agreement within political parties and among the public about the necessity of fast-tracking and wide-ranging emergency Epidemic laws, and introducing lock-downs and restrictions. Support for such measures was high, in particular in the first phases of the pandemic. The approach in Denmark (and Finland) in terms of the government response to the pandemic, been characterised as being politics-lead and using authoritative regulatory instruments. In comparison, Sweden and to some degree Iceland used expert-based management and less invasive regulatory instruments and Norway took a middle ground by balancing politics and expert-lead management with regulatory instruments based on the treasurer (Christensen et al, 2022).

In the first phase, the government seemed to have engaged selectively with expertise.  In Feb 2021, a cross-disciplinary ‘Epidemic Commission’ of experts was set up in order to serve as an advisory board for the government and the cross-party Epidemic council. The council executes the parliamentary control of policy-making in the various ministries. Ministries can only decide on a new regulation if the commission has suggested it and the council has approved it. Also, The Danish Health Authority is chairing a number of COVID-19 related working groups, focusing on health and vaccination.

Overall, it seems that given the high level of integration of the health and social sectors and their communication structures with municipalities, the pandemic response was able to efficiently focus on the wide range of LTC services during the pandemic.

The municipalities set up working groups in the first phase, in charge of governance implementation of the new measures in the LTC sector. Central regulation included lockdowns, recommendation on hygiene, cleaning, testing, visit and isolation strategies and later on vaccination. For instance, the Danish Health Authority was in charge of communicating central guidelines to short and local instructions to be used by managers and staff. Hotlines and Q&A sessions were set up where managers could pose questions. Often specific members of staff were designated in charge of Covid-19 cleaning and work schedules were changed so that staff limited the number of residents they cared for (Danish Health Authority, n.d).

VIVE, the national welfare research center, has conducted an evaluation focusing at the de-central level and based on interviews with managers in the LTC sector (Topholm and Kjellberg, 2022). One learning is that there were insufficient hygiene measures set up. As a result, many municipalities established cross-facility organizations for promoting better hygiene and employed nurses specialized in hygiene who could be in charge of upskilling staff (Topholm and Kjellberg, 2022).

Often central regulation was to be implemented within short time and without particular knowledge of the sector and the skills-level of the staff working there. One example is that the communication should have been quicker, more direct and hands-on. Due to the shortage of PPE, the health sector was prioritized over the LTC sector and staff, management and users were concerned about the lack of PPE and the varied use of this. There is generally high support for the extensive testing strategy, although it seems to have come too late, and it seems desirable that the responsibility for testing should be at a decentral level. The roll-out of the vaccination strategy was initially demanding but over time became more manageable (Topholm and Kjellberg, 2022).


Christensen, J.G., Askim, J., Gyrd-Hansen, D. and Østergaard, L (2021) Håndteringen af covid-19 i foråret 2020 Rapport afgivet af den af Folketingets Udvalg for Forretningsordenen nedsatte udredningsgruppe vedr. håndteringen af covid-19 (Copenhagen: Folketinget).

Christensen, T., Dagnis Jensen, M., Kluth, M. F., Kristinsson, G. H., Lynggaard, K., Lægreid, P., Niemikari, R., Pierre, J., & Raunio, T. (2022). The Nordic governments’ responses to the Covid-19 pandemic: A comparative study of variation in governance arrangements and regulatory instruments. Regulation & Governance.

Danish Health Authority (n.d.)

Topholm, E.H-E. and Kjellberg, P.K. (2022) Decentrale beretninger fra hjemmeplejen og plejecentre under covid-19-epidemien. Delrapport 4. København: VIVE.

Last updated: May 25th, 2023

Finland announced a state of emergency on March 16, 2020, after reaching its pandemic threshold of 156 cases on March 15 (Source (p. 15)). The Ministry of Social Affairs and Health (MSAH) is responsible for the planning of the national pandemic response with the help of The Finnish Institute for Health and Welfare (THL), an independent national health research institute. Any national directive (i.e. care measures for infected LTC home residents) is then implemented by local municipalities (Source:

Decision-making has primarily fallen on the shoulders of the Finnish Health and Welfare research institute (THL), employed by the Ministry of Social Affairs and Health. Expertise at the municipality level is slightly unclear, although agents at the local level are clearly instrumental in bridging the gap between local need/services and nationwide policies/standards (Source:

On the other hand, municipalities appear to have a large degree of freedom in decision making around LTC. National operators have developed guidelines for residential and domiciliary care. These guidelines were updated over time. However, most guidelines provided at the national level (including LTC guidance) were not binding for municipalities. This led to a situation that in some municipalities visiting bans were introduced ahead of the Government guideline, while others did not follow this. Other municipalities, on the other hand had implemented additional measures, such as support with shopping for older people. Regional variation of the spread of COVID-19 could have been another reason for the different application of guidelines (Source:

Last updated: September 8th, 2021

An expert scientific group was set up on March 12, 2020, and a first lockdown was announced on March 14 (Source: The French Senate and National Assembly reports on the management of the pandemic were highly critical of the delayed response and support in the social care sector, especially in domiciliary care. Similarly, counting of deaths in care homes was not required until the March 28, and published before the April 2 (Sources:; On March 6, the Health Ministry required the activation of ‘blueprints’, a necessary document needed by care homes and other social/health services to prepare against health crises, in the wake of the high death levels which followed the 2003 heatwave.

Last updated: December 3rd, 2021   Contributors: Camille Oung  |  

On February 27, 2020, the Federal Minister of Health and the Minister of the Interior established a crisis plan as outlined in Germany’s pandemic plan. It is, however, unclear whether the crisis team specifically focused on LTC (Source:

While the Federal Government seeks expert advice on the pandemic response, it is not disclosing names or credentials of the experts involved. It is therefore impossible to know which, if any, expertise on long-term care was sought.

Last updated: September 8th, 2021

Before the Covid-19 outbreak, even though Iceland had systems for the healthcare sector and emergency preparedness, it was missing specific procedures for the LTC sector. For this reason, Iceland quickly advanced new LTC-specific measures which included written recommendations, webpages, and rapid response teams. For example, if a Covid-19 outbreak took place in LTC facilities, the health workers were quarantined and replaced by one of the rapid response teams. Thanks to these preventive measures, as of October 2021, LTC Covid-19 death rates in LTC facilities remained very low.


Rocard, E., P. Sillitti and A. Llena-Nozal (2021), “COVID-19 in long-term care: Impact, policy responses and challenges”, OECD Health Working Papers, No. 131, OECD Publishing, Paris,

Last updated: December 12th, 2021   Contributors: Elisa Aguzzoli  |  

By the end of March 2020, concerns were expressed regarding the lack of attention that was paid to nursing homes. A meeting between Nursing Homes Ireland, ‘representatives working within nursing homes’, the Minister for Health, and the Secretary General of the Department of Health took place. At the same time, the Health Service Executive provided an updated guidance document for residential care facilities.

This was followed by a request by the Minister of Health for the National Public Health Emergency Team to examine the situation of nursing homes. This led to a number of measures for nursing homes, such as supporting homes with supplies, staff and, the establishment of a national and regional outbreak team (Source:

Last updated: September 8th, 2021

LTC facilities in Israel are supervised by the Ministry of Health and/or the Ministry of Welfare and Social Affairs. At the same time, the National Insurance carries responsibility for LTC services in the community.

Early in the pandemic the vulnerability of people with LTC needs was recognized which led to the establishment of the ‘Fathers and Mothers Shield task force’. This taskforce was made up of representatives of all relevant government ministries, the Israeli army, Israeli intelligence organizations, and public sector organizations. Measures implemented by the task force include an increase in testing among residents and staff in residential LTC settings, setting up Corona Wards in geriatric hospitals and LTC facilities, and regulation around visiting. The authors of a paper assessing the management of COVID-19 in the long-term care sector concluded that the centralized management implemented in response to the pandemic ‘had led to a welcome change in LTC policy in Israel’.  At the decline of the 4th wave of the pandemic in Israel, it is hard to say that the centralized management of the pandemic in LTCFs will impact broader and long-term changes regarding the organization of the LTC system in Israel (Tsadok-Rosenbluth, 2021).


Tsadok-Rosenbluth, S., Hovav, B., Horowitz, G. and Brammli-Greenberg, S., 2021. Centralized Management of the Covid-19 Pandemic in Long-Term Care Facilities in Israel. Journal of Long-Term Care, (2021), pp.92–99. DOI:

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

In Italy, as in other countries, measures to mitigate the impact of COVID-19 in care homes were adopted later than in the national health services. A detailed study attributes this delay (as well as the lack of timely resources to support the implementation of measures) to policy legacies resulting in nursing homes lacking recognition and visibility and being seen as a marginal part of the Long-Term Care system.

This is also connected with the governance of LTC sector, allocating to Regions the responsibility of regulating elderly sector. This led to differences in the regional approaches, also following the spread of Covid-19 across the country.

However, the national level kept a significant role in allocating resources (such as PPE and personnel) during the first phases of the pandemic. I.e. in early April, 2020, The Ministry of Health published the operational guidelines for a “rational”  use of Personal Protection Equipment (PPE) in healthcare and LTC settings. The guidelines list the basic principle to ensure personal protection and recommends that regional authorities guarantee adequate provision of PPE and engage in training activities for care workers. Also, Ministry of Health published the first guidelines for COVID-19 management in nursing homes, requiring providers to ensure training of care workers and suggesting extensive testing.

Much of the legislation was then promoted from the Regions, since they represent the institutional level in charge of defining the operating rules and guidelines for the LTC sector. During the pandemic, Regions (and local health authorities) gave directions, regulations and instructions to the health institutions for older people, for the management of COVID-19 cases and their containment and prevention. The spread of the virus in the sector was very vast as witnessed by previously exposed data: it had a significant impact on all settings providing care to a population particularly at risk. The combination of these two factors has led to the need to define emergency and risk management plans which had to be differentiated between the LTC sector and the “rest of the world”, precisely to take into account these specificities and, in some cases, guarantee additional protection to the older population. The healthcare sector managers, for their part, have activated internal risk management strategies, aimed at protecting their structures and ensuring the maximum quality of assistance. At the same time, however, common regional instructions were also needed to coordinate action in the LTC domain, also guaranteeing homogeneous treatment consistent with the simultaneous “pure health” policies that were implemented. (Berloto et al. 2020)


León, M., Arlotti, M., Palomera, D., & Ranci, C. (2021). Trapped in a Blind Spot: The Covid-19 Crisis in Nursing Homes in Italy and Spain. Social Policy and Society, 1-20. doi:10.1017/S147474642100066X

Berloto, Longo, Notarnicola, Perobelli, Rotolo (2020), Il settore sociosanitario per gli anziani a un bivio dopo l’emergenza Covid-19: criticità consolidate e prospettive di cambiamento, Rapporto OASI 2020, Egea Milano

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

Japan responded more immediately to the threat of COVID-19 in LTCFs in comparison with Western countries. This has been attributed to cultural respect for older adults, and existing high standards of hygiene and infection control as a result of frequent TB outbreaks (Source: On January 29, 2020, LTCFs were contacted by the national ministry in charge and told to put in place infection control measures. On February 13, they were contacted again. On February 24, measures stepped up with restricted visits and more stringent infection control (at this point, there were only 141 confirmed cases in Japan). National lockdown started on March 14, but, by then, LTCFs had been in lockdown for 3 weeks already. (Source: There are hierarchically organised government agencies whose sole missions are elderly care (at the top of the hierarchy is the Bureau of Health and Welfare for the Elderly in the MHLW). Local governments have specific departments that liaise with this Bureau. Well-established channels of communication within the sector may also have been beneficial (Source:

Last updated: September 8th, 2021

As per the national pandemic action plan, crisis response is delegated to many organisations at all system levels. However, as the crisis deepened the National Institute for Public Health and the Environment (RIVM) was made coordinator of the response and an outbreak management team was created to advise the government (Source:–/view).

Last updated: September 8th, 2021

The decentralization of authority has had negative consequences for pandemic response (particularly during the first wave of the pandemic), with local authorities responsible for social welfare homes, and the split between healthcare and social sector had a negative impact on responding to the threat quickly and comprehensively. In case of social welfare homes, the management of the crisis depended on the ability of the local authorities and managers to mobilize the resources and led to geographical differences in pandemic response (sources:  Responding to the Covid19 in residential long-term care in Poland ; ESPN Flash Report 2020/43).

Last updated: November 24th, 2021   Contributors: Joanna Marczak  |  

The Government raised the infectious disease alert level to “highest” on February 23, 2020. On January 29 they introduced a monitoring system to check social welfare facilities’ compliance with the guidelines, and from February 9, the central headquarters conducted daily monitoring on, for example, isolation of care workers. Constructive relationships with key institutions such as the president’s office, the Ministry of Health, and the Korean Centers for Disease Control and Prevention enabled a decisive response (Source: The Korean National Health Insurance Services developed and published guidance for all welfare and LTC facilities on February 20, 2020. This set out containment measures within Korean LTCFs including site monitoring, resident quarantining, identification of high risk staff and visitors, targeted screening, and stringent personal hygiene measures for staff and residents. They also published a a response plan for COVID-19 to effectively react to suspected and confirmed cases of the virus within the service boundaries of each institution (e.g. suspected/affected care recipients, suspected/affected care providers) (Source:

Last updated: September 8th, 2021

The long-term care sector in Singapore was first advised on January 23, 2020, against traveling to Wuhan (China) (

Last updated: September 8th, 2021

In Spain, in principle, 4 different ministries were tasked with responding to the pandemic, but in practice the Ministry of Health had the most visible role (this was also the case at regional level. The governance of the pandemic in relation to the Long-Term Care system has varied by region and in the different phases of the pandemic. Local governments were also involved, specifically with regards to logistical support and in rural areas. There was also support from the army, civil protection volunteers, police, the fire service, and NGOs. A report on the organisation and governance of the pandemic response in care homes concluded that being better prepared would have reduced the reaction time, which has been identified as a key factor in the impact of the pandemic on the Spanish care home population. There was also a lack of clarity over responsibility, where 45% of the population thought that responsibility of the pandemic response in care homes was with the regional governments, 24% with the central government, and 28% with both (Del Pino et al, 2021).

The delay in adopting (and having enough resources to implement) preventative measures in care homes, compared to in health care services has been attributed to policy legacies resulting in nursing homes lacking recognition and visibility and being seen as a marginal part of the Long-Term Care system (Leon et al, 2021)


Del Pino, E., Moreno Fuentes, F. J., Cruz-Martínez, G., Hernández-Moreno, J., Moreno, L., Pereira-Puga, M. and Perna, R. (2021), ‘Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Spain’, MC COVID-19 working paper 13/2021.

León, M., Arlotti, M., Palomera, D., & Ranci, C. (2021). Trapped in a Blind Spot: The Covid-19 Crisis in Nursing Homes in Italy and Spain. Social Policy and Society, 1-20. doi:10.1017/S147474642100066X

Last updated: November 23rd, 2021

Although the importance of protecting older people was stressed from the beginning of the pandemic, no specific attention/measures were taken to protect homecare users. The focus was to limit the spread of the infection in the community through wider population measures such as basic hygiene, social distancing, limiting non-essential travel, and social gatherings (Source:

The responsibility to restrict disease spreading in care homes and other forms of social care services rests with the municipalities together with the regional infection control units (Smittskydd). During the 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 (Source:

Last updated: September 8th, 2021

Guidance on infection prevention and control for care homes was updated numerous times during the pandemic. Some of the relevant guidance was issued in policy documents from the Department of Health and Social Care, and some from Public Health England. Initial guidance on February 25, 2020, advised that it was unlikely that people receiving care would be infected (at the time there had been no known transmission within the UK). It was not until April that the guidance documents in England took into account the possibility of pre-symptomatic or asymptomatic transmission both with regards to testing and isolation policies.

Pandemic Governance: Perceptions of Care Home Managers

Authors of a study published in February 2021 interviewed 10 managers of care homes in the East Midlands of England, asking them about their experiences of the pandemic from a structured organisational perspective. Results highlighted that the care sector was placed in considerable jeopardy by the organised responses to the pandemic, in part because those responsible for pandemic response were insufficiently expert in the way that care is delivered in care homes. For example, when central and local government increased the formal reporting requirements placed on care homes (albeit to better understand their needs), efforts were duplicated for staff who were already overstretched – which risked compromised care for residents. Control over pandemic response was also taken away from care home managers – who were normally quite competent at managing the supply chain – when PPE supplies were centralised. Overall, participants in the study felt that care homes were not adequately considered by those making and delivering policy (Marshall et al., 2021).

Pandemic Governance: Experiences of Care Home Staff

Care home-specific guidance was scant during the early stages of the pandemic. This was highlighted in a study by Spilsbury et al. (2021), who analysed the contents of a WhatsApp group to capture the nature of uncertainties and organisational questions expressed by members. The self-formed WhatsApp group was comprised of 250 care home staff in the early stages of the pandemic to facilitate peer-support and information-sharing. Results of the study reveal that staff faced a range of uncertainties; in particular, uncertainties around symptoms and treatment, prevention and control, maintaining an effective workforce, and maintaining effective care. Importantly, just under a third of these (28%) were fact-based and could have been easily resolved through unambiguous and efficient signposting to guidance. The study illustrates that the basic information needs of care home staff were not satisfied in the early stages of the pandemic . This sits in contrast to the proliferation of – sometimes conflicting – guidance during the later stages of the pandemic (Hinsliff-Smith et al., 2020).

Pandemic Governance: Impact on Mental Health

Nyashanu et al. (2020) collected data through interviews with forty frontline healthcare workers from nursing homes (n = 20) and domiciliary care agencies (n = 20) in the English Midlands in the early phase of the pandemic to explore triggers of mental health problems. One of the key anxiety-inducing triggers that they found was a lack of guidance from central government. Participants felt that improved guidance was crucial, especially given the ever-changing information that was coming out about the virus.


Hinsliff-Smith, K., Gordon, A., Devi, R., & Goodman, C. (2020). The COVID-19 Pandemic in UK Care Homes – Revealing the Cracks in the System. The Journal of Nursing Home Research, 6, 58–60.

Marshall, F., Gordon, A., Gladman, J. R. F., & Bishop, S. (2021). Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study. BMC Geriatrics, 21(1).

Nyashanu, M., Pfende, F., & Ekpenyong, M. S. (2020). Triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic in private care homes and domiciliary care agencies: Lived experiences of care workers in the Midlands region, UK. Health & Social Care in the Community.

Spilsbury, K., Devi, R., Griffiths, A., Akrill, C., Astle, A., Goodman, C., Gordon, A., Hanratty, B., Hodkinson, P., Marshall, F., Meyer, J., & Thompson, C. (2021). SEeking AnsweRs for Care Homes during the COVID-19 pandemic (COVID SEARCH). Age and Ageing, 50(2), 335–340.

Last updated: March 24th, 2022   Contributors: Daisy Pharoah  |  

Health Protection Scotland (HPS) has published specific guidance for infection prevention and control in social or community care and residential settings for frail people and those with complex needs. In addition the Chief Medical Officer has published specific advice about visitors and admissions to care homes (Sources: GOV.SCOT;;


Last updated: March 29th, 2022   Contributors: Jenni Burton  |  Elizabeth Lemmon  |  David Henderson  |  David Bell  |  

Governance: impact on mental health

Respondents across the UK of a survey in early 2020 by The Queen’s Nursing Institute (2020) reported feeling worse (42%) or much worse (15%) in terms in terms of their mental and physical health as a result of working in conditions instigated by the pandemic. A key contributing factor to this was a lack of government support or guidance.


Queen’s Nursing Institute. (2020). The Experience of Care Home Staff During Covid-19. A Survey Report by The QNI International Community Nursing Observatory. July. [accessed 11/10/2020]

Last updated: March 24th, 2022   Contributors: Daisy Pharoah  |  

The United States, according to the Global Health Security Index, was considered to be the country most prepared in the world for a pandemic, and studies as to why its failures were so extreme are underway. President Trump declared COVID-19 a public health emergency on February 3, 2021. Jurisdiction regarding stay-at-home orders, travel quarantines, and sheltering in place is given to the individual states, which led to what is a considered a highly-politicized divide in local and regional responses and mandates (Source:

Last updated: September 8th, 2021

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.