Why were care homes so badly affected by coronavirus?

In February and March 2020, coronavirus spread quickly through some care homes. Many residents were affected and significant numbers – including many people with dementia – died from severe COVID-19.

Some of the reasons that care homes were so badly hit are intrinsic to the residents, the virus and the environment. Measures can be put in place to help manage these and we are better prepared against coronavirus now, but the underlying reasons remain.

As outlined below, some of the other reasons that care homes were so badly hit were down to issues present at the time, early in the pandemic. These no longer apply, at least with the same force because of what has been learned about the virus since then. 

Features of care homes and coronavirus

Reasons why care homes were so seriously affected include:

• vulnerable residents – people in care homes, especially nursing homes, are often in their 80s or 90s. They are also often living with dementia, frailty or underlying health conditions, and sometimes all three. These factors make almost all care home residents at high risk of catching coronavirus and becoming seriously ill.
• the home environment – care homes are above all where people live, not like a hospital. Residents and staff are used to socialising and doing activities together. Providing personal care means that staff have to be in close contact with several residents over a day. All of this close interaction means that the virus spread quickly within the home, even when measures were put in place to help stop this. 
• features of the virus – coronavirus spreads in small droplets (when someone with the virus coughs, sneezes, talks or breathes out) and by contact with surfaces, such as in shared living areas. 
• The virus causes symptoms in older people that are different and so were easier for care home staff to miss. In some residents and staff, coronavirus infection causes no symptoms at all.

Issues early on in the pandemic

• stresses on staff – many homes had several staff members off sick with coronavirus or who were shielding. Absences put extra stress on top on protecting and supporting residents. Care homes are familiar with residents dying, but the way in which many residents died was particularly difficult for everyone connected with the home (residents, staff and friends/families).
• lack of testing – care homes struggled to get hold of enough coronavirus tests for residents or staff, and knowing who was infected. As a matter of policy, patients with COVID-19 were discharged from hospital at the start of the pandemic without first being tested. This policy has now changed, but it brought coronavirus into some homes for the first time.
• lack of support – care homes reported huge problems early in the pandemic getting hold of personal protective equipment (PPE). A lot of homes reported that supplies had been diverted to the NHS to meet increased demand there.

What was the impact for people affected by dementia?

About three-quarters of care home residents have dementia. The impact of coronavirus on them at the start of the pandemic was huge. 

The ways in which people with dementia have been affected by coronavirus include:

• deaths from COVID-19 and a higher number from causes not directly related to coronavirus (for example, dementia and diseases of the heart and blood vessels)
• grief for other residents (close friends) who have died
• worsening symptoms
• decline in mental and physical health
• fear and confusion about their own wellbeing
• picking up on stress and anxiety in care home staff
• feeling unsettled because the faces of familiar staff members are hidden by masks
• struggling to understand or comply with new restrictions within the home
• impacted by friends and family not being able to visit and not always understanding why.