IMPACT OF COVID-19 PANDEMIC ON CARE HOME PATHWAYS, OUTCOMES AND SAFETY OF CARE

Lead Research Organisation: Lancaster University
Department Name: Medicine

Abstract

The COVID-19 pandemic seriously affected care home residents leading to a doubling in the number of deaths with the North East being particularly badly affected. This research will seek to understand how residents who fell ill (with COVID-19 or non-COVID-19 conditions) during the pandemic were managed and whether this was different from 'normal' circumstances. Were more residents cared for within homes and not taken to Emergency Departments? Were residents transferred back from hospital with COVID-19 symptoms? Did COVID-19 change how decisions were made by care home staff?
First we will gather data for individuals in the North East which includes data collected while in care homes, Emergency Department visits and other hospital admission data. This unique dataset will allow us to examine changes and outcomes of care for residents from before, during and after the easing of lockdown. Subsequently we will interview care home staff and community clinical staff to understand how their decision making changed during the pandemic and how this affected care home residents. We will collate the findings to develop recommendations for future guidance and policy on how care homes react in pandemic outbreaks and on broader strategies for health provision for the care home population.

Technical Summary

Deaths in care homes from all causes more than doubled at the April peak of the COVID-19 pandemic. Our objective is to evaluate the impact of the pandemic on health service provision and outcomes and provide evidence required to inform the future effective, safe management of care home residents. This novel research is possible because of our unique dataset that links digital information on care home residents with their health service record. We will analyse linked care home, community, Emergency Department and hospital admissions data from the North East (n=68 homes, >2500 residents) from before, during and after easing the lockdown period. The North East has the highest proportion of affected care homes. We will analyse and describe the changes for all care homes on a range of outcomes, including hospital admissions, discharge, readmission, mortality and infection levels. We will undertake a series of interviews with staff from a range of care homes and community clinical teams to understand changes in decision making and referral patterns, specifically exploring how different management strategies between care homes may have led to differing outcomes. The research will address research priority gaps reported to SAGE, and deliver an in-depth understanding of pathways of care between care homes and secondary care settings, leading to policy recommendations for future outbreaks and health service provision. Feasibility is underpinned by a rich dataset, an existing team with appropriate expertise, close connections to key stakeholders, and connections and a platform for dissemination.
 
Description There have been key findings from the qualitative component of the work which relate to how COVID impacted staff in the Care Home sector that have been discussed in the outputs and will not be detailed further here.
In addition there are key findings about the healthcare received by residents such as evidence that dementia patients are being moved frequently between care homes and hospitals in a way that is unlikely to promote good health outcomes. These outcomes are in a peer currently under review and therefore are not listed in the outputs above.
Finally we have provided input into a range of discussions about the use of routinely collected data with groups such as HDRUK.
Exploitation Route The research can help share the way healthcare provision is provided.
Sectors Healthcare

 
Description This section will be evolved next year as although we have contributed to policy discussion as detailed in the outputs the outcomes of the engagement are not yet clear.
First Year Of Impact 2022
Sector Healthcare
Impact Types Policy & public services

 
Description Abstract submitted to All Parties Group on End of Life Care
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description All-Party Parliamentary Group (APPG) on Hospice & End of Life Care
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
URL https://loom.ly/6pYAJx4
 
Description Interim report
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description Involvement in the Adult Social Care working sub group of SAGE
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Impact I was involved in various conversations that influenced government decisions during the COVID pandemics.
 
Description Policy brief on Emotional Impact of COVID-19 pandemic on staff working in Care Homes
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description DSI: Lancashire and South Cumbria NHS Secure Data Environment Research Director Role
Amount £77,211 (GBP)
Organisation Lancashire Teaching Hospitals NHS Foundation Trust 
Sector Public
Country United Kingdom
Start 07/2023 
End 03/2025
 
Description Lancaster and South Cumbria Secure Data Environment - Research Infrastructure Engineer
Amount £70,094 (GBP)
Organisation Lancashire Teaching Hospitals NHS Foundation Trust 
Sector Public
Country United Kingdom
Start 11/2023 
End 05/2024
 
Title COVID in Care Homes 
Description Linked routinely collected data from secondary care and care homes. 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? No  
Impact NA 
 
Description COVID in Care Homes 
Organisation Bradford Teaching Hospitals NHS Foundation Trust
Country United Kingdom 
Sector Public 
PI Contribution We lead the project.
Collaborator Contribution The partner brings clinical expertise.
Impact NA
Start Year 2020
 
Description COVID in Care Homes 
Organisation County Durham and Darlington NHS Foundation Trust
Country United Kingdom 
Sector Public 
PI Contribution We lead the project.
Collaborator Contribution They bring data and clinical expertise.
Impact NA
Start Year 2020
 
Description COVID in Care Homes 
Organisation Durham University
Department Department of Mathematical Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution We lead the project.
Collaborator Contribution One of the Co-Is on the bid is from this institution. They bring statistical expertise.
Impact NA
Start Year 2020
 
Description COVID in Care Homes 
Organisation Newcastle University
Department Population Health Science Institute
Country United Kingdom 
Sector Academic/University 
PI Contribution We lead the project.
Collaborator Contribution The partner brings clinical expertise.
Impact NA
Start Year 2020
 
Description COVID in Care Homes 
Organisation Newcastle upon Tyne Hospitals NHS Foundation Trust
Country United Kingdom 
Sector Academic/University 
PI Contribution We lead the project.
Collaborator Contribution Data experience.
Impact NA
Start Year 2020
 
Description COVID in Care Homes 
Organisation University of Sheffield
Department School of Health and Related Research (ScHARR)
Country United Kingdom 
Sector Academic/University 
PI Contribution We lead the project
Collaborator Contribution One of the Co-Is on the bid is from this institution. They bring clinical expertise.
Impact NA
Start Year 2020
 
Description Blog release 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact We submitted a blog and project summary https://ltccovid.org/2021/02/03/impact-of-the-covid-19-pandemic-on-care-home-pathways-outcomes-and-safety-of-care/.
Year(s) Of Engagement Activity 2020
URL https://ltccovid.org/2021/02/03/impact-of-the-covid-19-pandemic-on-care-home-pathways-outcomes-and-s...
 
Description Patient and Public Advisor involvement 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact We ran a small zoom workshop for a PPI panel to update the about the progress of the research and take feedback.
Year(s) Of Engagement Activity 2021,2022
 
Description Press Release EUSEM 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Press release from conference lead to various other reports of the activity. From the RiceMasonNoble Science Communication Consultancy company.
"The main coverage was from various media outlets using the press release that was posted on Eurekalert. There was coverage in the US, UK, Australia, India and Venezuela. There were 13 stories. Medical Express has the highest number of potential viewers ("impressions") at 1.54 million. The total number of impressions for all 13 stories was 4.8 million. The advertising value equivalent (i.e. how much you would have to pay to get this amount of media coverage via advertising) is €118,700 ."
Year(s) Of Engagement Activity 2022
URL https://eusem.org/news/802-digital-technology-linking-care-homes-to-clinical-advice-hubs-reduces-a-e...
 
Description Public Lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Public Lecture: "The impact of the Covid-19 pandemic on people in Care Homes" Online Public Lecture, Lancaster University, May 2021.
Year(s) Of Engagement Activity 2021
 
Description Stakeholder engagement 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact We ran two stakeholder events in 2022 to update people of the progress of this and another project.
Year(s) Of Engagement Activity 2022