Hospital admissions from care homes in England during the COVID-19 pandemic: a retrospective, cross-sectional analysis using linked administrative data.

Fiona Grimm,Karen Hodgson,Sarah R Deeny,Richard Brine

doi:10.23889/ijpds.v5i4.1663

Fiona Grimm, Karen Hodgson + Show 2 more

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https://doi.org/10.23889/ijpds.v5i4.1663

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Abstract

BackgroundCare home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic.ObjectivesTo examine trends in the number of hospital admissions for care home residents during the first months of the COVID-19 outbreak.MethodsRetrospective analysis of a national linked dataset on hospital admissions for residential and nursing home residents in England (257,843 residents, 45% in nursing homes) between 20 January 2020 and 28 June 2020, compared to admissions during the corresponding period in 2019 (252,432 residents, 45% in nursing homes). Elective and emergency admission rates, normalised to the time spent in care homes across all residents, were derived across the first three months of the pandemic between 1 March and 31 May 2020 and primary admission reasons for this period were compared across years.ResultsHospital admission rates rapidly declined during early March 2020 and remained substantially lower than in 2019 until the end of June. Between March and May, 2,960 admissions from residential homes (16.2%) and 3,295 admissions from nursing homes (23.7%) were for suspected or confirmed COVID-19. Rates of other emergency admissions decreased by 36% for residential and by 38% for nursing home residents (13,191 fewer admissions in total). Emergency admissions for acute coronary syndromes fell by 43% and 29% (105 fewer admission) and emergency admissions for stroke fell by 17% and 25% (128 fewer admissions) for residential and nursing home residents, respectively. Elective admission rates declined by 64% for residential and by 61% for nursing home residents (3,762 fewer admissions).ConclusionsThis is the first study showing that care home residents’ hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19.

Highlights

IntroductionCare home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic
This is the first study showing that care home residents’ hospital use declined during the first wave of COVID-19, potentially resulting in substantial unmet health need that will need to be addressed alongside ongoing pressures from COVID-19
The proportion of emergency admissions that were potentially avoidable was broadly similar to the previous year

Summary

Introduction

Care home residents have complex healthcare needs but may have faced barriers to accessing hospital treatment during the first wave of the COVID-19 pandemic. Worldwide the COVID-19 pandemic has resulted in substantial excess mortality among people living in care homes [1]. In England, there are two main types of care homes: residential care homes, which provide accommodation and help with personal care (such as washing, dressing and taking medication), and nursing homes, which provide 24-hour support from qualified nurses. Multimorbidity, functional dependence and cognitive impairments are highly prevalent in both populations, resulting in complex healthcare needs [5, 7, 8]. Local health systems were asked to provide enhanced primary and community care services to residents of care homes, intended to reduce reliance on acute hospital care [11]. Measures included personalised care and support plans for residents, and patient reviews during remote weekly ‘check ins’ [12]

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