Deaths in care homes: what do the numbers tell us?

Covid-19 has had a particularly hard impact on care homes. With deaths in the sector now being reported daily, Nigel Edwards and Natasha Curry analyse what the numbers tell us about this vulnerable group. Social care has long been in crisis – could Covid-19 prove to be a significant turning point for it?

Blog post

Published: 01/05/2020

Updated: 04/05/20

The Chief Scientific Adviser reportedly warned the government in January that the care homes sector in the UK was particularly vulnerable to Covid-19 – and that has unfortunately proved to be the case. With care home deaths now being reported daily, what do the numbers tell us about this group? Have care home residents been disproportionately affected? And is there a chance the crisis could belatedly mark the start of better times for a sector in danger of collapse?

What the numbers tell us

England and Wales have not been alone in their difficulties with care home cases during the pandemic. Other European countries have also had high numbers of deaths in care homes – with WHO Europe last week reporting that up to 50% of Covid-19 deaths across the region were in care homes. The USA, Canada and other countries further afield have also been affected – with coronavirus-related deaths in Canadian care homes corresponding to 72% of all Covid-19 deaths in the country.

Over the last five years in England and Wales, around 21-23% of deaths took place in care homes – an average of 2,238 a week with some seasonal variation. There are around 400,000 care home beds in England and Wales.[1] Assuming 85% occupancy, this gives an average of 6.5 deaths per 1,000 residents per week.

The ONS have been routinely reporting weekly data on place of deaths this year since week 11 (ending March 13th). Up to March 27th, the number of deaths was in line with previous years, but from that point on there has been a very marked uptick. The table below shows care home deaths over recent weeks, which have been increasing so that by the week of April 17th there were 5,162 more deaths than the five-year average (so-called ‘excess deaths’). This is equivalent to a weekly mortality rate of around 21.4 per 1,000 residents (again assuming 85% occupancy).

Week

All care home deaths (England & Wales)

Covid-19 deaths

Excess over 5-year average

% over 5-year average

13-Mar

2,471

0

28

1%

20-Mar

2,335

2

4

0%

27-Mar

2,489

20

209

9%

03-Apr

3,769

195

1,557

70%

10-Apr

4,927

826

2,747

126%

17-Apr

7,316

2,050

5,162

240%

Source: ONS

The rate in care homes might be somewhat inflated if fewer care home residents were taken to hospital but, given that usually there are only 450 admissions to hospitals that result in death from care homes each week, the effect of any change in policy about sending patients to hospital is likely to be relatively small.

Since the beginning of the year, care homes have accounted for 16% of all Covid-19 deaths. But, as the table shows, Covid-19 was only mentioned in 2,050 of cases. The reluctance to record the contribution of Covid-19 in the absence of a test may explain some of this, and therefore it is likely that a significant proportion of the remaining 5,162 additional deaths can be directly or indirectly attributed to it. This probably makes 16% a sizeable underestimate.

That these figures are broadly in line with international trends will be no consolation to those affected. Getting a full understanding of the picture will have to wait, but it is likely that systemic issues within the care sector have played a part.

Covid-19 response: social care the poor relation again?

With the focus on the NHS, social care entered the daily Covid-19 discourse relatively late.

There was almost a full month after schools had closed before an action plan for social care was published, and well before then care homes had to rapidly establish supply chains and often pay a high price for PPE. As the NHS worked to free up hospital beds for Covid-19 patients, care homes had to manage how to receive people newly discharged from hospital (some having tested positive for Covid-19 and some awaiting test results) who required strict isolation.

Many homes struggled to source enough PPE and field enough staff, with pre-existing shortages exacerbated by sickness and self-isolation. High use of agency staff who may work across multiple homes has been identified as a key factor in rapid spread between homes in the USA, and may also have played a part in the UK.

It is still too early to say what the overall impact has been on the sector but, even if the immediate response had been better, social care entered this crisis ill prepared.

Chronically underfunded, with an increasingly fragile provider market and a myriad of workforce issues, the sector was already struggling to meet the growing needs of the population. Before the crisis, 75% of councils were reporting providers closing down or handing back contracts due to dwindling fees, with little slack in the system to respond to increased pressure.

Although £1.3 billion was provided to councils for short-term care packages for those discharged from hospital, and a further £1.6 billion to support all council services (social care among them), there are concerns that the money, if it reaches providers, is not sufficient to fund existing care packages as well as new ones.  

Provider failure or a silver lining?

There is a tangible risk that the growing pressures from lost income, the costs of sourcing PPE and the extra staff required to put in place containment measures in the event of an outbreak will lead to widespread failure of the market.  

What we have observed when studying the reforms to care systems in Germany and Japan is that support for change had been building among the public over time, but it took a major political or economic event to force eventual change. In Germany, reunification; in Japan, the stock market crash of the early 1990s.

Whether the Covid-19 crisis proves to be a watershed moment for social care in the UK remains to be seen, but we owe it to those lives lost to this tragedy and to their families to see a positive legacy emerge from it.

 

[1] W. Laing of Laing Buisson Ltd (personal communication)

*This blog refers to the latest data at the time of writing (1 May). For updated international figures (3 May) on mortality associated with Covid-19 outbreaks in care homes, please click here.

Suggested citation

Edwards N and Curry N (2020) “Deaths in care homes: what do the numbers tell us?”, Nuffield Trust comment.

Updated 04/05/2020

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