Care Homes And Covid

The impact of Covid-19 on care homes in the UK.

Worldwide, COVID-19 has had a devastating impact on care home residents. In the time between mid-March and mid-June, coronavirus affected care homes drastically.

There were 19,286 deaths of residents where the virus was issued on the death certificate. This accounted for a sobering 40% of all Covid deaths that were registered during this time.

There has been an increase in measures to prevent and manage the factors affecting care hones, however, there are still underlying issues that remain. The figures submitted will likely way underestimate the true scale of the impact COVID-19 has had on care home residents.

So, what has the impact of Covid-19 had on care homes? What does the future look like? What issues led to a soar in cases and deaths?

What Happened To Care Homes During The First Wave?

Before the pandemic swept across the globe, the care sector and NHS were struggling. Staff shortages, lack of equipment and financial troubles were among the many issues that faced the sector. Add in a global pandemic and it was a disaster waiting to happen.

In the early stages of the pandemic, these faults were there for everyone to see. An incredibly slow response saw massive delays in PPE supplies reaching care staff, along with many patients being discharged without being tested to clear hospital beds in the first weeks.

This initial impact of Covid on those receiving home care is still largely unmeasured.

What Happened To Care Homes During The Second Wave?

With faster testing and a more reliable supply of PPE, the preparations were better for the second wave. A pledge to supply the sector with PPE free of charge and an extension of the infection control fund added to the fight against the pandemic.

However, there were still challenges to overcome. With delayed testing, as well as restrictions on care come visits added to the trauma for residents and families, creating a balancing act of risks for care home managers.

Although there was a soar in Covid-19 deaths among care home residents in this second wave, so far, the numbers haven’t reached the scale we experienced in the first wave. In the period from 31 October until 5 February, 26% of all Covid-related deaths were from the virus among care home residents.

Overall Coronavirus Impact On Care Homes

UK care homes were especially vulnerable to contracting coronavirus, later dying from the illness. Those most vulnerable may have unknowingly contracted COVID-19 from new residents admitted directly from the hospital without being tested.

With a lack of testing and employees moving between different care homes, there are many unanswered questions. A study by the University of Stirling found that 31% (17,127) of all COVID-registered deaths in the UK, had occurred within care homes.

Furthermore, 47% of deaths attributed to COVID-19 in Scotland had occurred in care homes. In comparison, 28% in Wales, 30% in England, and 42% in Northern Ireland.

This study reported Scotland had the highest proportion of care homes affected by COVID-19, however, it had a lower proportion of excess deaths in these facilities compared with England and Wales.

What Factors Caused Care Homes To Be Impacted So Badly?

Some of the reasons why care homes were amongst the most affected during the pandemic include:

The stress placed on staff	Even before the pandemic, staff shortages were a problem. With many staff members off sick due to the virus, as well as those shielding added more stress to support residents. The number of residents that died will have been incredibly difficult for anyone connected with the home such as staff, residents and loved ones.
Vulnerable residents	Those in care homes and nursing homes are usually the elderly, living in their 80s or 90s. Often, dementia and underlying health conditions are common amongst those residents. These factors, added with other illnesses make care home residents at high risk of catching the virus and becoming seriously ill.
How the virus spread	As we know, coronavirus spreads in small droplets such as from sneezing and coughing. This is more common in shared living areas, such as care homes. Also, symptoms in older peoplewere a lot easier for care home staff to miss due to many showing no symptoms at all.
Poor testing	Especially during the first wave, testing was slow and poorly managed. Care homes struggled to get enough coronavirus tests for residents and staff. Many will have been infected without knowing. Patients with COVID-19 were discharged from the hospital due to policy. Many of these left without first being tested, bringing coronavirus into care homes for the first time.
Not enough support	In addition to poor testing, care homes had massive issues receiving personal protective equipment (PPE). To meet the NHS demand, many care homes reported that supplies had been diverted.

What About Mental Health And Wellbeing In Care Homes?

Before the pandemic engulfed the nation, there had been concerns for a long time about the mental health of residents. Many patients suffer losses and don’t have the ability to communicate with the outside world independently.

A report showed that prior to COVID-19, rates of depression and suicidal behaviour in care home residents was higher in comparison to matched age groups in the community.

In the UK alone, the Mental Health Foundation estimates that one-in-five older people who are living in the community experience depression or poor mental health. However, for those living in care homes, this number soars to two-in-five.

However, care home residents were often allowed to take part in activities aimed at maintaining their wellbeing before the pandemic. This would include visits from family and friends.

Due to the pandemic, these activities were frozen as infection-control measures were put in place to protect residents’ health. Loved ones were advised to stay away, with many residents having to stay in their rooms, limiting contact with others.

Residents only form of contact was from members of staff carrying out essential tasks such as personal care, meals and medication. Furthermore, many residents have lost friends and loved ones, banned from attending funerals.

With long periods spent alone in their rooms, as you can imagine, many residents would often display signs of distress, as well as suffering negative emotions due to boredom.

What About Carte Homes Abroad?

It wasn’t just the UK that was facing the monumental task of fighting the coronavirus pandemic. Different countries used various methods to change their care practices, such as restricting visits to care homes and increasing infection control measures.

In The Netherlands, a study reported high levels of loneliness and depression. Especially during the lockdown, behavioural problems worsened among care home residents and those lacking cognitive impairment being affected significantly.

Studies from the United States reported that during the isolation period, volunteer students providing telephone calls with residents found they experienced restlessness and anxiety.

There was a population-based study in Ontario that reported a soar in psychotropic medication use for care home residents, continuing through September 2020.

What Impact Did Visiting Restrictions Have?

The restriction of visitors attending care home residents had detrimental impacts on the wellbeing and mental health of residents. Both the Alzheimer’s Society and John’s Campaign have signified how important it is for family members to continue supporting people with dementia in care homes.

There have been some care homes that have granted access for family members to organise window visits. Here, family and friends can visit residents, seeing each other through closed windows to prevent passing on the virus.

Other ideas, such as drive-by visits have allowed residents to safely see their loved ones by the roadside. Video calls have been essential during this unprecedented time, however, due to poor or limited internet connections in care homes, this has been hampered.

Some staff have advised it can be difficult for residents to use this form of communication, especially those with poor eyesight, hearing problems or cognitive impairment.

More recently, the UK government has provided new guidance that acknowledges visiting as a crucial part of care home life. With lockdown restrictions easing up, from 8th March 2021, face-to-face visits from a single named visitor were permitted.

What About The Impact On The Workforce?

Compared to the general population, social care workers are more than twice as likely to die from COVID-19 when adjusted for sex and age. This is with no significant raised risk of death in those working in the health care sector.

Unfortunately, similar to the points made earlier, many deaths are still under review, with some of the statistics yet to be measured. Death rates for both social and health care workers are likely to change.

What Is Next For Care Homes And Coronavirus?

Rates of deaths from COVID-19 in care homes are slowly starting to decline, however, with new variants, as well as vaccination uptake rates, slowing, there is an evident need to better understand how the virus is transmitted in both care home workers and residents.

There is a clear lack of information on the number of cases and tests in care homes, especially the impact the virus is having on those receiving social care in the community and those with learning disabilities.

The UK government announced a £600m package for infection control in care homes. We mentioned earlier the lack of PPE for staff in care homes, as well as issues with testing.