Non-covid deaths in care homes rise sharply

Residents of care homes in England and Wales have been dying at a much higher rate than normal since the start of lockdown, according to shocking new figures published by the Office of National Statistics.  

Between 14 March, two days before lockdown began, and 11 September the number of deaths due to common (non-coronavirus related) causes was up 7.9% for men in care homes in England and 8.3% in Wales, and has risen even more steeply by 26.5% for women in care homes in England and Wales. This adds up to a total of 5,618 deaths. 

The sharp increase in deaths seems to be largely driven by increased fatalities due to dementia and Alzheimer’s among women. From 14 March to 11 September the number of women dying of these causes in care homes rose by 32% in England, and 28.6% in Wales. 

Experts have long been raising the alarm about the impact of the pandemic on non-covid conditions, and in particular on care home residents suffering from dementia. They have been concerned that restrictions on relatives and friends visiting in the name of infection control could have the unfortunate side-effect of contributing to the worsening of dementia sufferers’ condition.  

An investigation by the Alzheimer’s Society published 30 July found that 82% of those with dementia had seen their condition deteriorate since lockdown began. The Alzheimer’s Society has also raised concerns about the sharp drop in the number of people being diagnosed with the disease – further worsening the crisis by depriving sufferers of the support they need. 

There seems little prospect for respite as local lockdowns spread across the country. The official government guidelines which apply to English care homes insist that in “local areas with a high local COVID alert level (high risk or very high risk), visiting should be limited to exceptional circumstances only such as end of life.” Currently, some 28 million people – over half of England – live in areas currently classified as high or very high risk. 

Still, care homes seem trapped on this issue. Dementia is a dangerous but so is coronavirus which tore through care homes earlier this year. An ONS report published in July identified 19,934 deaths in care homes tied to coronavirus in the period 28 December 2019 to 12 June 2020. 

Care home managers I spoke to were keen to increase visiting but also at pains to ensure it could take place safely. Indeed, the Scottish government’s more relaxed approach to care home visiting – last week relaxing restrictions to allow four-hour visits and physical contact – have also caused alarm. 

Robert Kilgour, Executive Chairman of Renaissance Care Homes, was pleased by earlier relaxations which allowed him to bring hairdressers into his homes – something he saw as a welcome fillip to resident’s morale – but he criticised last week’s changes. 

He said: “Care homes are not islands. They are part of the local community and if Covid-19 is rife in the community then it is much more difficult to keep it out of local care homes.” He added: “I am keen to have relatives back in our care homes asap, but this latest visiting guidelines change is too much too soon while we are busy fighting the second wave.”  

Indeed, the number of coronavirus outbreaks in care homes is on the rise again. In the week up to 11 October there were 214 outbreaks of coronavirus in care homes, up from 116 the week before. Care homes insist they are better prepared than before, and the government has offered additional support, but difficulties remain. 

PPE is one area of concern, with many care home operators not fully trusting government promises to ensure adequate supplies. Indeed, according to Tim Buckley, Chief Operating Officer of Agincare, the weekly PPE deliveries provided by the government aren’t quite enough to cover all their care homes needs. They plan to dip into the stockpile they built up over summer to cover the shortfall. Other care homes might not be quite so prepared. 

Testing remains another area of concern. While care home staff are receiving weekly tests the government seems to still be struggling to meet its initial promises that all tests would have results in seventy-two hours – despite a quick turnaround on results being vital for infection control. 

More generally the pandemic has highlighted many of the weaknesses of a sector long under strain. In the Care Quality Commission’s State of Care report published at the end of last week.  

Even before the crisis the system “was fragile as a result of the lack of a long-term funding solution, and in need of investment and workforce planning”, according to the report. The pandemic not only exposed but exacerbated existing problems: “The sector, already fragile, faced significant challenges around timely access to PPE, testing and staffing – and coordinated support was less readily available than it was for the NHS.”  

The report further called for urgent reform – a chorus joined by key voices in the care sector, even as they criticised the report for failing to provide specifics in this regard. In his very first speech as prime minister Boris Johnson promised to “fix the crisis in social care once and for all.” We are still waiting.