Care homes – the elephant is out the room

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We can take as the roughest of approximations that the numbers dying in care or at home is about half of the number in hospitals.


That would mean that the number who have died outside hospital by now  (April 19) is about half of those reported dead in hospital – about 7,500 people.

Bearing in mind the immediacy of hospital reporting, the  National Care Forum’s estimate that around 4,000 have died in care  sounds plausible.

These numbers are probably a few days behind and exclude those who died at home. The BBC quote a separate and later study by Candesic, for the Financial Times, which suggested the number of deaths due to the epidemic in UK care homes was at least 6,000.

It doesn’t seem that many people who have advanced symptoms of  infection are making it onto wards and ICU and there are reports of some isolated deaths , where people never made it to hospital and died where they were living. There are also the homeless sick.

These numbers are expected , they have been predicted and the issue is what should be done for carers. If you want to see how actuaries come to a view on the real numbers of those in care, you can read about it here (the elephant in the care home).

Last week calls were made for those nursing the elderly and frail in residential care homes, to be given the same PPE as those nursing those in ICUs. Ros Altmann has been to the fore in this. Writing in the Daily Mail she states

In all my decades of campaigning for the dignity of the elderly, there has been no clearer snapshot of how they are being abandoned like lambs to the slaughter. They are being left to die because we don’t value their lives as highly as the young.


and continues

There are no winners here, but when hospitals do not take in the elderly they face a horrible death, at home or in care homes, without ventilators or oxygen nor even the palliative care that any civilised society should be able to provide.

Once again, the elderly are being hung out to dry by this country’s failure to eliminate the artificial distinction between ‘health’ and ‘care’.

Questions of capacity?

Last week saw the FT reporting on a score-card used to allocate ICU to patients. Put simply, patients needing ICU scoring above 7 were seen as unsuitable for intensive care . The thought is that the majority of those in Care Homes wouldn’t get ICU and would be no better off on wards than staying in homes.

The argument for this system of triage is based on the capacity of the frailest to benefit from ICU, sceptics argue that the issue is more to do with ICU capacity.

I don’t have to put  words in Ros Altmann’s mouth, she sees the treatment of the elderly in this pandemic as a societal failing

A millionaire with cancer would normally be treated by the NHS with state of the art equipment and expensive drugs. But an old person with coronavirus or other illnesses may be abandoned in their care home, all the while using their life savings or family home to cover enormous fees.

And for those who work in care homes?

The risks run from treating a dying patient in a care home or a hospital seem similar – and obvious.

Front line carers are more than likely to treat Covid-19 patients, based on the reports from our continental neighbours. While latest estimates suggest 1 in four London nursing homes have infected residents, in Belgium, where testing is much higher – the number is 90%). If it is possible to keep numbers of infections in our homes down, we may do better than 90% but if carers themselves become spreaders then the prognosis is not good.

The cost to carers of the elderly at home has been little talked about. I wrote last week about the phone-in run by Petrie Hosken, which gave this group a voice. 

The Elephant exiting the room

The elephant that is now exiting the room brings bad news for Britain and indeed for other European countries with high numbers of  infected patients in hospital. The Washington based Institute for Health  Metrics  Evaluation (IHME) has revised upwards the expected numbers of deaths in Europe and Britain now leads the way

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these changes are primarily driven by the major improvements to the IHME death model. In addition, for some EEA countries, data updates (i.e., incorporating updated time series of COVID-19 deaths by location, some of which experienced large lags in reporting or did not fully account for deaths occurring in nursing homes and the inclusion of the number of reported cases as a leading predictor in the death model.

Complacency , complicity or both?

The IHME are now predicting deaths in the UK at more than twice the 20,000 target mentioned by Government earlier this month.

If the 20,000 target was solely based on hospital deaths then this is not that much of an overshoot (around 12,000 of those predicted deaths may be from deaths out of hospital).

But a death is a death- it is every bit as grievous to die in a care home as in an ICU. To use the Prime Minister’s phrase – we want Government to level with us. Focus will inevitably be on our league table performance (where we seem to be only rivalled by the USA for getting it wrong).

But by excluding deaths in care homes from our daily published numbers we do two things

  1. We give undue credit to our national performance in combating the Coronavirus
  2. We risk abandoning those in care to secondary statistical status – and we know that what is not measured is not governed.

Right now I think that the exclusion of predicted numbers for those dying in care homes and at home is leading to some complacency – most worryingly about the need to support carers with PPE.

Government should level with us on total deaths

The argument that we need to report on a like for like basis with other countries is looking increasingly fragile. Increasingly other countries are reporting on an all-deaths basis (and certainly that’s what IHME is doing).

The management of this sensitive information is now required. If you let the elephant out of the room and people , as a result of sudden changes in data-reporting – lose confidence in the Government’s management of the situation, things will get worse and not better.

So it is time that the Government found a way of getting proper information on what is going on in our care homes (and at home) and making it public. And it’s time we started treating those managing infection in Care Homes with the same the same respect and with the same PPE as those nurses in hospital.

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About henry tapper

Founder of the Pension PlayPen,, partner of Stella, father of Olly . I am the Pension Plowman
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