The COVID-19 pandemic led to a high number of deaths in care homes in the UK and other countries. One of the suggested causes for this was the transfer of infected patients from hospitals who had not been tested. A study across care homes in Wales has found that hospital discharges contributed only a small amount to the number of cases in care homes.

The challenge

Care homes typically have very vulnerable people living in close proximity, making them particularly susceptible to infectious diseases. During the first wave of the COVID-19 pandemic, several care homes saw significant outbreaks that led to many deaths despite being in protective bubbles that prevented visitors from entering.

One of the prominent factors blamed for this in the media was the discharging of hospital patients into care homes without being tested for COVID-19. However, there is little evidence for the causes of these outbreaks. Without testing at the time, it is difficult to look back and quantify the impact that hospital discharges had.

The solution

To overcome this, researchers analysed national-level data to identify over 180,000 hospital discharges between March and July 2020 in Wales. These included people who were released into 923 care homes with over 15,000 residents. By looking for links between discharges, outbreaks and other factors, the team aimed to understand what influenced the number of cases in care homes.

Impact and outcomes

The results, published in the journal Age and Ageing,  showed that there was no link between hospital discharge and subsequent increases in care home case numbers, after adjusting for care home size. The main risk factors that were identified included care home size, care home resident density and provision of nursing care. This suggests that most care home outbreaks were related to community infection, potentially entering the homes through visitors, visiting professionals or staff.

Given the high infection rate in hospitals at the time, this suggests that efforts to mitigate the risk were mostly successful, whether through decisions on individual discharges or the management of patients once transferred into the care home.

However, hospital discharge did slightly increase the intensity of cases, that is, leading to a larger outbreak in the care home, although this had a smaller impact than the size of the home.

Impact committee

The Impact committee highlighted this research because of its excellent quality. In addition, the small team behind the work have identified a surprising finding that has a great potential for impact in an under-studied group of people.