Despite warnings of the potentially devastating impact of Covid-19 on care homes, the first wave of the pandemic saw an extraordinary number of excess deaths among residents. The scale of mortality in care homes laid bare long-standing problems with care home provision, as well as shortcomings in the response to the pandemic, which we discuss in our accompanying blog.
Nearly a year on, as the second wave of the pandemic passes its peak, we look in detail at new data on the mortality of care home residents, covering residents who died in hospital as well as those who died in the care home. Our analysis takes account of all deaths registered, compared to the average number of deaths, after first looking at deaths involving Covid-19.
This analysis covers deaths registered up to 5 February across all care homes in England and Wales.
Deaths of care home residents from the coronavirus
Deaths where Covid-19 was mentioned on the death certificate rose sharply last April, and between mid-March and mid-June there were 19,286 care home resident deaths where the coronavirus was mentioned.
But deaths where Covid-19 was not mentioned also rose. With hindsight, it is likely that many of these deaths were also from Covid, but were not identified as such at the time. There was limited testing available in care homes, and the novelty of the virus combined with the different symptoms often shown by older people made identifying the disease difficult.
Looking at the second wave, Covid death registrations began to increase in November, rising sharply in the first weeks of 2021. Between 31 October and 5 February, there were 16,355 Covid deaths registered among people in care homes.
Comparing the scale of coronavirus cases and deaths between the two waves is challenging, because there was so little testing in the early months. However, the burden of the virus fell much more severely on care homes (relative to the population generally) in the first wave. Of the 48,213 Covid deaths registered between mid-March and mid-June, 40% were care home residents – compared with 26% of the 62,250 deaths registered from 31 October to 5 February.
Excess deaths in care home residents
Excess deaths, which are the number of deaths above the ‘expected number’ and which are obtained by comparing the number of deaths from all causes with the average number of deaths over five years, gives a clearer understanding of the overall impact of the pandemic on care home residents.
There were 35,067 excess deaths in the first two months of the pandemic, with 6,331 in the week ending 24 April alone. Between mid-June and November, the number of deaths of residents was at or below the average for 2015-19, and it is only since mid-December that death registrations have consistently exceeded the average.
One difference since last spring is that deaths of care home residents usually increase by 75% or more per week during the winter. This winter there has been very little flu, due to a combination of social distancing and lockdown measures, along with record levels of flu vaccination. Fewer deaths from other causes have been registered in the second wave.
One unknown to bear in mind when comparing excess deaths over time is that the number of occupants of care homes is reported to have dropped. This might also contribute to lower excess deaths – simply that there are fewer people living in care homes to start with – but would not account for the scale of difference between the two waves.
Where are care home residents dying?
Until this year, weekly reporting of deaths by place of occurrence only included residents’ deaths if they occurred in the care home.
Since the start of the pandemic, 86% of deaths of care home residents have occurred in the care home, compared with 84% over the same period for 2015-19.
Residents whose deaths involved Covid were more likely to die away from the care home – only 75% of this group died in the care home, compared to 90% of patients without the virus. In other words, three in four care home residents who died of Covid did so in a care home – the remaining residents were likely to have died in hospital.
Deaths from other causes include a high proportion of deaths from dementia or Alzheimer’s disease. The lower proportion of these residents who died in the care home reflects the limited benefits of hospital treatment at the end of life.
Place of occurrence of deaths of care home residents (deaths registered 14 March 2020 to 5 February 2021)
|Deaths of care home residents||Deaths occurring in care homes||% resident deaths occurring in care homes|
The second wave of the pandemic has seen significant excess deaths and deaths from Covid-19 across the country. Although care home residents have not been protected from this, we have not seen the disproportionate toll of excess deaths among care home residents that occurred during the first wave.
Weekly data on deaths of care home residents will enable more complete monitoring of the impact of the virus on the care home sector, but there are still important gaps in available information. The number of residents in care homes is not known: information on the number and age of care home residents is urgently needed to monitor mortality, as well as to understand the capacity of the sector.
And while care homes have become more effective at limiting the impact of Covid-19, in the face of high rates of community transmission, we can only guess at the impact on people receiving home care services, or those who rely on support from unpaid carers.
Scobie S (2021) “Covid-19 and the deaths of care home residents”, Nuffield Trust comment.