This week we hear that numbers in England and Wales dying in care homes is exceeding those in hospital. In March Government told these homes the risk of death in homes was “most unlikely”. How did it come to this?

It seems only when Government can show that COVID-19 has done its worst, are we allowed to know its impact on our most senior citizens. The figures suggest the impact of the virus in care homes is finally reducing. Is this supposed to give us comfort?

The grim reality of the last seven weeks for those in residential care homes is becoming clear. The numbers told us it was happening and so did the presence of morticians parked outside care homes.

Academics at the London School of Economics found that data on deaths in care homes directly attributed to the virus published by the Office for National Statistics significantly underestimated the impact of the pandemic on care home residents and accounted for only about four out of 10 of the excess deaths in care settings recorded in recent weeks in England and Wales.

ONS statisticians said on Tuesday that 8,314 people had died from confirmed or suspected Covid-19 in English care homes up to 8 May.  They are based on reports filed directly from care home operators to the regulator, the Care Quality Commission. Care Inspectorate Wales has said Covid was confirmed or suspected in a further 504 cases in homes up to the 8 May in Wales.

Graph showing how care home deaths (though falling) are moving ahead of hospital deaths

But academics at the care policy and evaluation centre at the LSE found that when excess deaths of other care residents and the deaths of care home residents from Covid-19 in hospitals are taken into account, the toll that can be directly and indirectly linked to the virus pandemic is likely to be more than double the current official count.

Why the ONS numbers don’t tell the story

Adelina Comas-Herrera and Jose-Luis Fernandez who wrote the LSE report tell us that

“Data on deaths in care homes directly attributed to Covid-19 underestimate the impact of the pandemic on care home residents, as they do not take account of indirect mortality effects of the pandemic and/or because of problems with the identification of the disease as the cause of death,”

“Data on registered Covid-19 deaths in care homes in England and Wales only accounts for an estimated 41.6% of all excess deaths in care homes. Not all care home residents die in care homes … Calculating total excess mortality in care homes since 28 December and adjusting this by the assumption that 15% of care home residents die in hospital, suggests that by 1 May there had been in excess of 22,000 deaths of care home residents during the Covid-19 pandemic – 54% of all excess mortality – in England and Wales.”

These numbers are truly shocking. Over a month ago ,I published work via the COVID-19 Actuaries that predicted that care homes would account for half as much again as hospital deaths.

This week we have found that COVID-19 deaths in care homes in the UK are  running not at half but at more than hospital deaths and these deaths aren’t just “excess”;- many appear to have been avoidable.

Additional fatalities may have been caused by care home residents who did not seek or receive medical care for other health conditions for fear of contracting Covid-19 or over-burdening the NHS as well a lack of access to normal care.

Care homes have been running at 10% to 20% staff absence rates and many homes have been trying to isolate residents in their rooms to reduce infection spread, but this can also make their normal care more difficult and residents’ needs less visible.

The academics, who have been tracking virus death tolls in care homes globally since the start of the pandemic, cited concerns raised internationally about deaths being linked to the consequences of residents being isolated in their rooms, without adequate eating, drinking or medical support, and not to the virus itself.

Fundamental failings from being under-prepared

We have known for some time that the staff-absence rates in care homes result from staff having to self-isolate because they suspect (but do not know) they are infected.

Because we couldn’t test, many self-isolated unnecessarily leading to problems from under-staffing. The lack of tests at the early stage is now showing in reported excess deaths and these will finally be admitted as COVID-19 related deaths.

And then there is the human costs on carers, many of whom have to work in more than one care home (mostly because of poor pay and high demand). There is strong anecdotal evidence that movements in and out of residential care homes by carers is spreading the infection. This spreading happens because many carers are infected and this is because of inadequate protection – down to PPE.

Yesterday two workers came to move furniture out of an adjacent office to mine in WeWork Moorgate. They came in full body suits, had masks, gloves and total head protection. This was for the protection of these workers and had been provided by a thoughtful and financially strong employer. To get to that office they had to pass dozens of workers outside the building with no PPE on whatsoever.

The presence of these removal specialists- would have graced an ICU unit. All they were moving were files, computers and books. Watching them through the glass panels of our offices, I thought that this is how it must feel for carers in residential homes, when they watch NHS staff working in intensive care.

Taken together, the lack of testing , the lack of PPE and the lack of publicity around nursing homes has led to the situation we have today and the Government telling us that numbers dying in Care Homes is now falling, is no comfort at all to those residents and carers  who are no longer with us.

Most awful of all, many elderly patients have been taken off NHS wards into residential care – taking COVID-19 into the care system with them. Recent research from the Alzheimers Society suggests a third of our residential care homes have received people cleared out from the NHS to make way for COVID-19 cases.

If the stated aim of Government was to keep people safe and avoid deaths, then the situation in nursing homes shows them to have failed. By focussing throughout the early days of lockdown on hospital deaths, the Government not only missed the bigger problem, they helped make it worse,

What this tells us about our society.

There is a body of prejudice in this country against investing money in those in later age. You hear that prejudice in comments about people in nursing homes being at death’s door. Sadly there are some who don’t see these deaths as more than natural selection.

This is not “natural selection” it is geriatric genocide. It is the opposite of immunisation, it is cold and heartless cleansing of a part of society that has no economic function.

If we accept the argument that those in residential care homes would have died anyway, then we are on a slippery slope that can extend to other less economically viable sections of society.

Ros Altmann, Stuart McDonald and Debora Price have all written on these pages on the iniquity of considering deaths in care homes as of a lesser order to hospital deaths. I will add my voice to theirs.

What has happened and is happening in Care Homes is a national disgrace. That more people are dying in Care Homes than in hospitals is a terrible  indictment of our handling of this pandemic. That the LSE  estimate that over 22,000 people have already died in English and Welsh residential care is a terrible indictment of our handling of the pandemic. And the terrible conditions go on. This from the Guardian’s reporting of the LSE research

Asked to comment on the estimates, a spokesperson for the ONS said: “ONS is undertaking further analysis on all deaths of care home residents which will be published in the coming days.”

The figures came as the Alzheimer’s Society said care homes have been “left to fend for themselves” amid continuing shortage of personal protective equipment and testing for residents and difficulties isolating infected residents.

It said that of more than 100 homes surveyed last week, 43% were still not confident of their PPE supply, with one home resorting to taping bags around carers’ arms, feet and hair. Fifty-eight percent of homes said they were unable to isolate residents and a third said they have taken in Covid-19 positive patients discharged from hospital.

It is good that the Government announced yesterday another £600m in funding against the infection in care homes but Keir Starmer is right to remind Boris Johnson (as he did in parliament yesterday- May 12th) that in early March the Government were telling nursing homes it was “most unlikely” they would see deaths.

The neglect of residential care homes (and of carers whether in care homes or isolated at home) tells us that we as a society have much to learn. We care too little about our senior citizens and we need to move to a national care service, as the Labour Party has been calling for. And we need a Beveridge to make it happen.