British nursing homes in crisis as deaths mount in coronavirus pandemic


UNDERSTANDING COVID-19

British nursing homes in crisis as deaths mount

More than 43,000 people have suffered deaths linked to COVID-19 across the United Kingdom, underlining the country’s status as the worst-hit in Europe.

At least 13,500 deaths linked to the novel coronavirus — nearly 1 in 3 — have occurred in British nursing and residential homes, known as care homes in the United Kingdom. Care homes are places where elderly or vulnerable people live for short or long periods of time and can receive nursing care.

But that is only a part of the pandemic’s tragic impact inside care homes across the United Kingdom. Deaths attributed to other causes have also risen sharply over the same period — so much so that the homes have 26,000 more deaths than is typical, a concept known as “excess deaths.”

Hot spots
Excess deaths in nursing homes per 100 beds, by local authority, for the weeks ending March 13 to May 15

0

20 excess deaths per 100 care home beds

County Durham has the most excess care home deaths with 408 fatalities.

0

ENGLAND

Birmingham has the most care home beds with 7,545.

GREATER LONDON

Hackney

Tower Hamlets

Islington

Newham

Hammersmith

and Fulham

Southwark

The local authorities reporting largest number of care home deaths per 100 beds were all located in Greater London except the London commuter town Broxbourne.

The highest weekly death counts among them was 26 fatalities in Islington.

30

20

10

0

Hammersmith

and Fulham

Tower

Hamlets

Broxbourne

Newham

Islington

Southwark

Hackney

Average weekly deaths in care homes for the first 10 weeks of 2020

0

20 excess deaths per 100 care home beds

County Durham has the most excess care home deaths with 408 fatalities.

ENGLAND

GREATER LONDON

Birmingham has the most care home beds with 7,545.

Hackney

Tower Hamlets

Islington

Newham

Hammersmith

and Fulham

Southwark

The local authorities reporting largest number of care home deaths per 100 beds were all located in Greater London except the London commuter town Broxbourne. The highest weekly death counts among them was 26 fatalities in Islington.

30

20

10

0

Hammersmith

and Fulham

Tower

Hamlets

Broxbourne

Newham

Islington

Southwark

Hackney

Average weekly deaths in care homes for the first 10 weeks of 2020

0

20 excess deaths per 100 care home beds

County Durham has the most excess care home deaths with 408 fatalities.

0

ENGLAND

Birmingham has the most care home beds with 7,545.

GREATER LONDON

Hackney

Tower Hamlets

Islington

Newham

Hammersmith

and Fulham

Southwark

The local authorities reporting largest number of care home deaths per 100 beds were all located in Greater London except the London commuter town Broxbourne.

The highest weekly death counts among them was 26 fatalities in Islington.

0

10

20

30

Hammersmith

and Fulham

Tower

Hamlets

Broxbourne

Newham

Islington

Southwark

Hackney

Average weekly deaths in care homes for the first 10 weeks of 2020

0

20 excess deaths per 100 care home beds

County Durham has the most excess care home deaths with 408 fatalities.

ENGLAND

Birmingham has the most care home beds with 7,545.

GREATER LONDON

Hackney

Tower Hamlets

Islington

Newham

Hammersmith

and Fulham

The local authorities reporting largest number of care home deaths per 100 beds were all located in Greater London except the London commuter town Broxbourne. The highest weekly death counts among them was 26 fatalities in Islington.

Southwark

30

20

Average weekly deaths in care homes for the first 10 weeks of 2020

10

0

Hammersmith

and Fulham

Tower

Hamlets

Broxbourne

Newham

Islington

Southwark

Hackney

Comparable data not available for Scotland, Wales and Northern Ireland. Does not include Isles of Scilly which had 2 deaths in care homes with a total of 14 beds. Data for the weeks ending March 13 to May 15

Not much is known about these deaths, as regulators have declined to divulge any details — not even the number of deaths— for individual homes, citing privacy concerns. Yet a Reuters analysis of past and current fatality data shows people are dying at much higher rates in care homes in some areas than others.

Patient advocates have called for more transparency from the Care Quality Commission (CQC), which oversees the sector, saying that residents and their families are being kept in the dark.

What are excess deaths?

When government statistical agencies describe COVID-19 deaths, they’re counting people whose primary or contributing causes of death are the coronavirus. But the death certificates that record those causes are imperfect. For example, if a patient dies of pneumonia caused by the coronavirus but the doctor does not list the virus as a contributing cause, then that patient’s death would not count in the official COVID-19 statistics.

Measuring excess deaths — those that exceed the normal number of fatalities for a given period — can account for some of that imperfect recordkeeping, providing a more complete picture of the pandemic’s death toll. The number of excess deaths is the difference between how many people are dying now and how many died on average during the same period in previous years. Because it accounts for all deaths — not just those that make it into the government’s official coronavirus death toll — it helps track the true effects of COVID-19.

Since the week ending March 13, more than 157,239 people have died in England and Wales.

 

From 2015 to 2019, about 103,386 deaths were typically registered during the same period.

Each figure represents 100 deaths

An additional 12,748 deaths do not mention coronavirus on the death certificate.

41,105 fatalities list coronavirus as the main cause of death. That means there have been 53,853 deaths in total over the historical average.

Since the week ending March 13, more than 157,239 people have died in England and Wales.

 

From 2015 to 2019, about 103,386 deaths were typically registered during the same period.

Each figure represents 100 deaths

An additional 12,748 deaths do not mention coronavirus on the death certificate.

41,105 fatalities list coronavirus as the main cause of death. That means there have been 53,853 deaths in total over the historical average.

Since the week ending March 13, more than 157,239 people have died in England and Wales.

 

From 2015 to 2019, about 103,386 deaths were typically registered during the same period.

Each figure represents 100 deaths

An additional 12,748 deaths do not mention coronavirus on the death certificate.

41,105 fatalities list coronavirus as the main cause of death. That means there have been 53,853 deaths in total over the historical average.

More than 24,000 excess deaths have occurred in care homes in England and Wales, compared to 16,000 in hospitals. The historic spike in care homes deaths was so high that during the week ending May 1, more people died in care homes than in hospitals.

Excess deaths by place of death
Number of deaths registered weekly in England and Wales that exceed a 5-year average for the same period, by place of occurrence

Care homes reported an excess of 5,656 deaths for the week ending April 24.

Hospitals recorded 614 excess deaths for the week ending May 15. The week before saw fewer deaths than the average.

6,000

During the coronavirus pandemic, there were 12,843 excess deaths at home.

4,000

2,000

0

March

April

May

Care homes reported an excess of 5,656 deaths for the week ending April 24.

Hospitals recorded 614 excess deaths for the week ending May 15. The week before saw fewer deaths than the average.

6,000

During the coronavirus pandemic, there were 12,843 excess deaths at home.

4,000

2,000

0

March

April

May

Care homes reported an excess of 5,656 deaths for the week ending April 24.

6,000

4,000

2,000

0

March

April

May

Hospitals recorded 614 excess deaths for the week ending May 15. The week before saw fewer deaths than the average.

4,000

2,000

0

March

April

May

During the coronavirus pandemic, there were 12,843 excess deaths at home.

2,000

0

March

April

May

Care homes reported an excess of 5,656 deaths for the week ending April 24.

Hospitals recorded 614 excess deaths for the week ending May 15. The week before saw fewer deaths than the average.

6,000

During the coronavirus pandemic, there were 12,843 excess deaths at home.

4,000

Other includes deaths in hospices and communal establishments.

2,000

0

March

April

May

Care homes reported an excess of 5,656 deaths for the week ending April 24.

Hospitals recorded 614 excess deaths for the week ending May 15. The week before saw fewer deaths than the average.

6,000

During the coronavirus pandemic, there were 12,843 excess deaths at home.

4,000

Other includes deaths in hospices and communal establishments.

2,000

0

March

April

May

Most recent data for the week ending May 15

Ideally, an analysis of excess deaths would use a five-year average of deaths for each week and area to account for year-to-year spikes. But the Office for National Statistics (ONS) has not yet released such data at the local level, so Reuters used weekly death statistics the agency published for this year. Using the first 10 weeks of the year as a baseline — the period before the first coronavirus death was recorded — Reuters estimated the number of care home deaths that would have happened in each area if that rate of mortality had extended through May 15. Typically, the winter weeks at the beginning of the calendar year have higher mortality, so this method likely undercounts excess deaths.

Reuters then calculated the rate of excess deaths per 100 care home beds in each area.

The wealthy London borough of Hammersmith and Fulham had about 17 excess deaths per 100 care home beds, the highest in England, Reuters found. On the other side of London, in the capital’s East End, the much poorer Tower Hamlets borough had a relatively high rate of 13 excess deaths per 100 care home beds. A number of other London areas, such as Islington, Southwark, Enfield and Hackney also had among the highest rates in England.

In Hammersmith and Fulham, council officials said they recognized the potential for outbreaks in care homes and undertook a local effort to test all care home residents for coronavirus and did so by April 24. Council officials there and in Tower Hamlets said they had relatively few care homes and some are larger, so outbreaks quickly increase their excess death rates.

“It is clear that without rapid testing of more than 300 residents and all staff in the homes, the outbreaks would not have been brought under control,” said Dr. Nicola Lang, Hammersmith and Fulham’s director of public health

In terms of total numbers, County Durham, Leeds and Birmingham each recorded 300 or more excess deaths in care homes during the past three months, Reuters found. For each, the death toll was at least double the baseline.

It’s unclear why the disparities exist and difficult to pinpoint their source without better information about care homes that have become hotspots for COVID-19. The Care Quality Commission that regulates the sector has declined to divulge death counts about individual care homes, citing issues such as privacy, disruption of the social care market and the risk of complicating the government’s ability to respond to the pandemic.

Why are care homes shouldering the burden?

By the week ending April 17, excess deaths in care homes were higher than those in hospitals. During the last two weeks of published statistics, hospital deaths have substantially decreased --- and the week ending May 8 was below the five-year average. The following week had 614 excess deaths in hospitals, but still far fewer than a high of 4,416 during the pandemic.

The novel coronavirus and excess mortality
Weekly registered mortality in England and Wales compared to the 5-year average for the corresponding time period

There has been a surge of deaths at home, but only 5% of these fatalities are officially due to the coronavirus.

In care homes the coronavirus accounted for nearly 50% of excessive deaths above the historical average.

In hospitals deaths not related to the coronavirus are far below the 2015-2019 weekly average.

10,000

8,000

6,000

Deaths due to the coronavirus

4,000

Deaths not related to the coronavirus

2,000

2015-2019 average weekly mortality

0

March

April

May

In care homes the coronavirus accounted for nearly 50% of excessive deaths above the historical average.

In hospitals deaths not related to the coronavirus are far below the 2015-2019 weekly average.

There has been a surge of deaths at home, but only 5% of these fatalities are officially due to the coronavirus.

10,000

8,000

6,000

Deaths due to the coronavirus

4,000

Deaths not related to the coronavirus

2,000

2015-2019 average weekly mortality

0

March

April

May

In care homes the coronavirus accounted for nearly 50% of excessive deaths above the historical average.

8,000

11,636 deaths due to the coronavirus

6,000

4,000

34,700 deaths not related to the coronavirus

2,000

2015-2019 average weekly mortality

0

March

April

May

In hospitals deaths not related to the coronavirus are far below the 2015-2019 weekly average.

10,000

8,000

26,730 deaths due to the coronavirus

6,000

4,000

2015-2019 average weekly mortality

2,000

38,536 deaths not related to the coronavirus

0

There has been a surge of deaths at home, but only 5% of these fatalities are officially due to the coronavirus.

6,000

1,860 deaths due to the coronavirus

4,000

34,990 not related to the coronavirus

2,000

2015-2019 average weekly mortality

0

In hospitals deaths not related to the coronavirus are far below the 2015-2019 weekly average.

There has been a surge of deaths at home, but only 5% of these fatalities are officially due to the coronavirus.

In care homes the coronavirus accounted for nearly 50% of excessive deaths above the historical average.

10,000

8,000

6,000

Deaths due to the coronavirus

4,000

Deaths not related to the coronavirus

2,000

2015-2019 average weekly mortality

0

March

April

May

In hospitals deaths not related to the coronavirus are far below the 2015-2019 weekly average.

There has been a surge of deaths at home, but only 5% of these fatalities are officially due to the coronavirus.

In care homes the coronavirus accounted for nearly 50% of excessive deaths above the historical average.

10,000

8,000

26,730 deaths due to the coronavirus

11,636 deaths due to the coronavirus

6,000

1,860 deaths due to the coronavirus

4,000

34,700 deaths not related to the coronavirus

2015-2019 average weekly mortality

34,990 not related to the coronavirus

2,000

2015-2019 average weekly mortality

38,536 deaths not related to the coronavirus

2015-2019 average weekly mortality

0

March

April

May

Most recent data for the week ending May 15

A Reuters investigation published May 5 detailed how the government’s focus on shielding hospitals, part of an effort to prevent them from being overwhelmed, left care home residents and staff exposed to COVID-19. To free up hospital beds, some patients were discharged into homes for the elderly and vulnerable, often without being tested for the coronavirus that causes the disease.

At least 5,876 care homes — about 1 in 3 — in England have suffered COVID-19 outbreaks, Public Health England data show.

An outbreak is defined as two or more people experiencing a similar illness, which appears to be linked to a particular setting. In London, some boroughs such as Camden, Hammersmith and Fulham, Kensington and Chelsea, and Tower Hamlets have had outbreaks in nearly every care home.

Outbreaks in care homes
Number of English care homes reporting a suspected or confirmed outbreak of COVID-19 to Public Health England

1,010 care homes, or 6.5% of all English care homes, reported COVID-19 outbreaks during the week commencing April 6.

1,000

800

600

400

200

0

March

April

May

1,010 care homes, or 6.5% of all English care homes, reported COVID-19 outbreaks during the week commencing April 6.

1,000

800

600

400

200

0

March

April

May

Any individual care home is only included in the dataset once. Data are for the weeks commencing March 9 to May 11.

Care homes are susceptible to infectious disease transmission. Once a virus like COVID-19 enters the home, it can become difficult to control — even with infection control measures and proper equipment. The Reuters investigation detailed how some care home staff said they did not have sufficient protective equipment. Also, many residents are elderly and suffer other conditions that make them susceptible to more severe infections and death.

At the start of the pandemic more care home residents were dying of COVID-19 symptoms in hospitals than in nursing homes. But on April 1 that trend reversed with 5,595 more care home residents dying of coronavirus-related symptoms in care homes than in hospitals from March 2 to May 1.

“This could mean that people who would normally be dying in hospital are dying in care homes, or that some cases of COVID-19 are not being reported or documented as such,” said a CQC spokesperson.

Not making it to hospital
Number of deaths of care home residents involving COVID-19 by place and day death occurred

On April 1 there were more care home residents dying of coronavirus in care homes than in hospitals.

400

Within care homes there were 9,039 care home resident deaths involving coronavirus.

200

0

In hospitals there were 3,444 deaths.

200

March

April

On April 1 there were more care home residents dying of coronavirus in care homes than in hospitals.

400

Within care homes there were 9,039 care home resident deaths involving coronavirus.

200

0

In hospitals there were 3,444 deaths.

200

March

April

On April 1 there were more care home residents dying of coronavirus in care homes than in hospitals.

Within care homes

400

200

0

In hospitals

200

March

April

Deaths from March 2 to May 1 registered up to May 9, England and Wales; Does not include the 43 care home residents who died elsewhere

The same is true for other causes of death. Among the historical leading causes of death for care home residents, fewer are dying in hospital. For example, 20 percent of the care home deaths attributed to coronary heart disease occurred in hospital during 2019. In 2020, it fell to less than 9 percent.

Not dying in hospitals
Percentage of care home residents dying in hospitals has decreased for leading causes of death during the coronavirus pandemic.

Coronary heart diseases

2020

2019

Cerebrovascular diseases

Dementia and Alzheimers

0

10

20

30%

Coronary heart diseases

2020

2019

Cerebrovascular diseases

Dementia and Alzheimers

0

10

20

30%

Coronary heart diseases

2020

2019

0

10

20

30%

Cerebrovascular diseases

0

10

20

30%

Dementia and Alzheimers

0

10

20

30%

England and Wales, 2 March 2020 to 1 May 2020, registered up to 9 May 2020

During questioning by senior members of parliament on Wednesday, Prime Minister Boris Johnson said a “huge effort was made to protect care homes” during the pandemic. He said the number of care homes deaths had “come down dramatically” because of the success of his efforts his government implemented earlier this month.

“I’m not going to pretend this has been anything other than a tragedy, an absolute tragedy what has happened in care homes,” he said.


Graphics by Michael Ovaska

Edited by Jon McClure, Janet Roberts and Janet McBride

Sources: Office for National Statistics, National Records of Scotland, Public Health England, Care Quality Commission