What has been the impact of COVID-19 on care homes and the social care workforce? COVID-19 chart series

What does the latest data tell us about deaths in care home?

Deaths in hospitals have declined from a peak of 9,434 in the week ending 17 April, to 6,397 in the week ending 1 May. However, the outbreak has continued to spread in care homes. As the above chart shows, there were 6,409 deaths in care homes in the week ending 1 May, exceeding the number of deaths in hospitals (6,397) for the first time since the start of the outbreak.

However, this is likely to be an underestimate of the scale of the impact of COVID-19 on care home residents. Data published on 15 May show that a total of 45,899 care home residents have died since the start of the pandemic, 12,526 from COVID-19. This includes 3,444 care home residents dying in hospital. The large increase in the number of deaths from all causes since the outbreak began is likely to be a more accurate indication of the scale of the direct and indirect impacts of the pandemic on those living in care homes. 

What’s the impact on the social care workforce?

When adjusted for age and sex, social care workers are more than twice as likely to die from COVID-19 compared to the general population. In contrast, staff working in the health care sector do not appear to have a statistically significant raised risk of death compared to the general population.

However, there are some important limitations that need to be explored further. Some deaths may not have been registered as they are still under review by the coroner. Our analysis only includes deaths registered up until 20 April, so death rates for both social and health care workers are likely to change considering the sustained high number of deaths. Workers aged 65 and over were also excluded from the analysis. While any of these factors alone are unlikely to explain the total raised mortality rate seen in social care workers, they may change the relative difference seen between health care and social care workers.

Caution is also required when comparing death rates for social and health care workers without considering that averages may hide significant differences between different types of workers within each industry. And for all staff, there are likely to be significant other adverse impacts, including from burnout and mental health issues.

Why might those receiving and working in social care be more at risk?

The high death rates sustained over the pandemic demonstrate the stark impact of COVID-19 on care home residents and social care workers. 

Infection control and isolation in care homes and private homes is much more difficult than in the controlled, clinical environment of a hospital. People receiving social care often have underlying conditions that make them more at risk of infection and death from COVID-19. Some people require physical help with aspects of daily living such as washing or eating, making complete isolation very difficult.

Social care workers are often poorly paid and on insecure contracts. The sector is also hugely fragmented with thousands of organisations providing care, with concerns being raised about adequate provision of personal and protective equipment (PPE) for staff in care homes. Social care workers often need to have very close physical contact with those they care for, and in care homes many people live in the same building or facility. This makes transmission of the virus among staff and patients more likely.  

What is needed?

Weekly deaths from COVID-19 in care homes are starting to decline slowly, but the virus is still circulating in hospitals, care homes and the community. To prevent a resurgence in cases, there is a clear need to better understand the causes of transmission in both care home workers and residents. 

Since 29 April, deaths in care homes are being reported daily, but there is still a lack of information on the numbers of cases and tests in care homes. Outside of care homes, we now know that between 10 April and 8 May 2020, there were 3,161 deaths of recipients of domiciliary care in England. This is over twice as high as the three-year average (1,171 deaths) for the same period. However, there is no published and timely information on COVID-19 cases, hospital admissions or deaths for this group of people. Additionally, we don’t fully understand the impact on those receiving social care in the community, or people with unmet need for care, including those with learning disabilities.

The government has announced a package of £600m available for infection control in care homes. This is welcome as there have also been reports of a lack of PPE for staff, along with testing issues in care homes, which has restricted the effectiveness of the response. It is vital that they make sure this reaches front line providers and that the huge practical challenges of PPE and testing logistics are resolved.