Implementing long-term surveillance in care homes

Abstract

In attempting to mitigate and minimise the harms caused by the pandemic, ongoing surveillance of COVID-19 infections among residents of care homes has been widely implemented. Such surveillance has allowed for close monitoring of infection rates and vaccine efficacy, and marks an improvement from the poor data infrastructure that existed in the UK care sector. From basic information on the numbers of residents in homes to the rates of hospital admissions and deaths, data from care homes is alarmingly scarce and the few data that are available are hampered by access barriers and a lack of standardised approaches to collection and dissemination. This deficiency of data is a long-standing issue, pre-dating the pandemic. However, the lack of routine surveillance and routine data collection in care homes cannot be blamed on feasibility issues. The Royal College of General Practitioners Research and Surveillance Centre regularly collects and monitors data on communicable and respiratory diseases from more than 1700 primary practices across England and Wales. The weekly reporting on respiratory disease outbreaks stands in stark contrast to the absence of systematic and centralised data on care homes, revealing the reality of the matter—that long-term surveillance is viable but is simply not done in the care sector. The low priority of care homes for surveillance reflects, in part, the ageism infiltrating health care. Infection outbreaks are viewed as commonplace for care homes, on the basis of the underlying assumption that older people will inevitably succumb to infections. Measures to prevent and track infections in the residents, which requires resources, is seen as futile. Given such endemic ageism, making the case that ongoing surveillance is necessary for safeguarding the wellbeing of residents might not be sufficient to galvanise policymakers and funding bodies. However, the downstream effects on the health of the wider population, as well as on health-care systems and thereby the economy, might be sufficiently persuasive. As care homes house the most clinically vulnerable individuals, infections are likely to emerge in these settings first. Therefore, surveillance in care homes can prove an effective early warning system for impending outbreaks, allowing for prompt responses to thwart the progression of infection. Additionally, compared with younger people, older people account for a large proportion of hospital and emergency care admissions and on average have longer hospital stays. Preventing infections in residents can reduce the number of transfers to hospital and thereby halt the trend in increasing hospital admissions. Outbreaks in care homes should not be considered inevitable, and their prevention could save lives both within care homes and in the wider community, thereby relieving encumbered health-care systems. Moreover, as outbreaks require homes to shut down to visitors and to suspend new admissions, thereby decreasing revenue, their prevention would also benefit residents, families and providers. Despite these benefits, implementing continued surveillance in care homes is no small feat. Establishing these systems from scratch in the absence of centralised datasets, paired with funding deficits that have only worsened during the pandemic, create a challenging setting for surveillance programs. Moreover, these programmes require acceptance and commitment from residents, their families, funders, and care home providers and staff; while routine testing was accepted as a necessity amidst the urgency of the pandemic, whether such testing continues to be recognised as such once the urgency settles has yet to be seen. The regular testing for COVID-19 in care homes provided a model of how surveillance for infections might be executed over the long term. However, as COVID-19 restrictions are now being eased and funding for surveillance research is gradually cancelled, the future of surveillance in care homes is uncertain. As we look ahead, it is therefore of utmost importance that we capitalise on the atypical priority granted to surveillance in care homes during the pandemic to ensure that it becomes a permanent fixture in the care sector. Although the pandemic might have stimulated commitment to protecting our most vulnerable population it has, more importantly, shown that such commitment should have been present long before. The detrimental toll on care home staff and residents must not be in vain—we must harness the positive lessons of the pandemic to demand continued surveillance and thereby ultimately to transform the care sector. For more on the changes in surveillance funding see https://www.theguardian.com/world/2022/mar/12/dismay-as-funding-for-uks-world-beating-covid-trackers-is-axed For more on the changes in surveillance funding see https://www.theguardian.com/world/2022/mar/12/dismay-as-funding-for-uks-world-beating-covid-trackers-is-axed