Many of the UK’s care homes have been hard hit by the pandemic, with research showing that larger and fuller care homes with fewer staff have higher rates of COVID-19. We speak to researcher Dr Laura Shallcross and Charlotte Oppong-Agyare, communications director of Four Seasons Health Care about why working together and sharing data are crucial to protecting care homes over the months ahead.
It might shock you to learn that although there are around 400,000 people living in 20,000 care homes in the UK, we don’t know much about who they are, their health, or how the pandemic has affected them at a national level.
“The data that exists on care homes nationally is really poor,” explains Dr Laura Shallcross, a Health Data Research UK (HDR UK) Associated Researcher at UCL and leader of the national Vivaldi study looking at COVID-19 infections across 179 UK care homes run by Four Seasons Health Care. “We don’t even know who is living in care homes in the UK, because there is no dataset that tells us that.”
The first results from their collaboration with Four Seasons Health Care, published as a preprint in July 2020, showed that care homes with a larger proportion of their beds filled and a higher ratio of residents to staff had more cases of COVID-19.
Another study of 189 care homes in Scotland by HDR UK Associated Researcher Professor Bruce Guthrie and his team showed that outbreaks were 20 times more likely in larger facilities. And a report from Public Health England revealed that temporary staff moving between care homes played a role in spreading the virus.
Along with reports of deaths in care homes, the headlines have led to media criticism of the care home sector, particularly for commercial care organisations like Four Seasons. However, Laura feels that without the bravery and transparency of Four Seasons in sharing their data – which many other companies in the sector refused to do – things would be far worse.
“If we don’t have this information, we don’t know what’s going on in care homes, and we can’t do anything to stop infections,” she says, pointing out that we need care homes to be able to share their data without criticism if we want to have any hope of improving the situation.
Looking for clues in care home data
Unlike many other care home providers, Four Seasons collated daily electronic datasets for its residents right from the start of the pandemic, which meant that it was easier for the research team to extract the necessary data.
This system enabled them to record the number of suspected and confirmed COVID-19 infections across all homes and track the spread of the disease early in the pandemic, providing incredibly valuable data on the progression of the pandemic before testing was widely available.
The data collected by Four Seasons was vital for the Vivaldi team’s analysis, which showed the scale of the problem of COVID across their homes and highlighted which factors made infections more likely, including high occupancy.
Four Seasons communications director Charlotte Oppong-Agyare says that they are glad they took part in the study, despite the criticism they have received. Importantly, the results have helped shape the company’s response to the pandemic, along with government and local guidelines. But she believes it is essential to see the study in the context of the real life experiences of care home staff and residents.
“Care home residents are some of the most vulnerable people in society, as many are well over the age of 80 and have underlying health conditions. In that sense, it is understandable that the number of excess deaths increased early in the pandemic, but it was still very upsetting. It reminds us of the need to continue to go above and beyond to look after our residents, and to identify more innovative ways of preventing infection,” says Charlotte, who adds that death rates at their homes have now fallen to below normal levels.
Undeterred, Four Seasons Health Care is now collaborating with Laura and her colleagues on a second study looking at the proportion of residents and staff that have developed antibodies against COVID-19. The findings will be used to understand how many people living and working in care homes have been infected, and to discover whether people can become immune to COVID-19 and how long this immunity lasts.
“The goal is to understand how many people have antibodies for the disease, whether they now have immunity, why some care homes get infections, and others don’t, and what we can do to prevent the spread of infection moving forward,” says Laura.
The early results so far show that in some homes nearly everyone has antibodies, while in others, nobody has them. But in general, antibody levels in care homes are higher than in the general population. This result didn’t come as a surprise.
“The environment of care homes, with staff and new residents coming in all the time and people coming back in from hospital means it’s comparatively easy for infection to get in,” Laura explains.
Laura hopes that her work will bring attention to how inadequate our data collection systems are in care homes in the UK, with some homes still keeping all their records on paper.
“We really need good data from care homes to identify problems, improve investment and increase the quality of care in homes, and this needs to be embedded across the whole sector as standard,” she says. “We’ve got excellent data from hospitals, but we need the equivalent systems for data from care homes,” she says.
Charlotte hopes that taking part in studies like Vivaldi will not only encourage other care providers to share and analyse their health data, but will also help the public to see care homes and their staff for what they truly are.
“These are places run and staffed by people who bring improved quality of life to our vulnerable relatives in roles that are hugely demanding,” she says. “This has only become more challenging in the context of COVID-19, and we want to do everything we can to protect our residents and support our team members over the months ahead.”
- Covid-19 outbreaks up to 20 times more likely in large care homes, study finds – The Guardian
- Fuller care homes with fewer staff had more Covid cases, study finds – The Guardian
- Covid-19 infection and attributable mortality in UK Long Term Care Facilities: Cohort study using active surveillance and electronic records (March-June 2020) – MedRxiv
- Covid-19 and lack of linked datasets for care homes – The BMJ
- Identifying who lives in a care home—a challenge to be conquered – Age and Ageing
- The Vivaldi study – UCL