COVID-19 mortality and long-term care: a UK comparison

Abstract

The impact of the COVID-19 pandemic on the oldest old, especially those within care home settings, has been devastating in many countries. The UK was no exception. This article reviews the path of the COVID-19 pandemic across the UK long-term care (LTC) sector, indicating how it evolved in each of the four home nations. It prefaces this with a description of LTC across the UK, its history and the difficulties encountered in establishing a satisfactory policy for the care of frail older people across the home nations. The paper makes several contributions. First, it provides an up to date estimate of the size of the adult care home sector across the UK – previous work has been bedevilled by inaccurate estimates of the number of care home places available. It also assembles the limited information that is available on delayed transfers of care and testing of care home residents, both of which played a role in the evolution and consequences of the pandemic. Its most important contributions are estimates of the number and share (the P-Score) of "excess deaths" in care homes in each of the home nations. The P-Scores provide measures that allow comparisons across care home populations of different size. Not only do we discuss the number of individuals affected, we also compare the proportions of care homes in each of the home nations that experienced a COVID-19 infection. The paper also discusses deaths of care home residents outside care homes, largely in hospitals. It reviews the sparse information on deaths at home of people who were receiving social care. Throughout our narrative, it will become clear that there have been major deficiencies in both the amount and the consistency of data available to clinicians, care sector staff and researchers trying to understand and to alleviate what has happened in care homes. Thus, the final section makes some recommendations about the scope and timeliness of relevant data. Collection of such data would seem to be a necessary condition to inform best practice and thus avoid a repeat of the troubling effects of the pandemic on people who use formal care between March and June 2020.