New research by the Health Foundation shows that the amount of hospital care received by those living in care homes in England rapidly declined in the first three months of the pandemic in 2020 and was substantially lower than in the same period in 2019.  

The research, which is due to be peer reviewed, provides the first comprehensive and national analysis of all hospital care provided to care home residents during the first wave of the pandemic. It appears to substantiate concerns that care home residents (including those in nursing homes and residential care) may have faced barriers to accessing hospital treatment as the NHS rapidly reorganised to free up hospital capacity to care for critically ill COVID-19 patients. 

Emergency hospital admissions from care homes for conditions other than COVID-19 – including stroke and heart attack – decreased by 36% (13,191 fewer admissions) between March and May 2020, indicating that significantly fewer care home residents received potentially lifesaving treatment during the first phase of the pandemic.  

Over the same period, routine elective admissions for care home residents - which includes care such as cataract surgery, some cancer treatment and hip replacements - fell by 63% (3,762 fewer admissions). This is compared to a 56% reduction in routine admissions for the general population, which suggests that those living in care homes who often have complex health needs and require high levels of hospital care – were particularly hard hit by the reduction in services. 

Some hospital admissions may have been avoided through increased provision of NHS care in the community, and the perceived risk of infection in hospitals may also have led to changes in patient and carer preferences for hospital admission. 

With the NHS under ongoing pressure from COVID-19, the scale of the reduction in hospital admissions will mean that many care home residents will still be waiting for care and many are likely to be sicker as a result. The researchers note that a significant amount of the unmet need is for conditions that are likely to have a significant impact on people’s quality of life. For example, there was an 81% reduction in admissions for cataracts procedures and cancer admissions fell by 49%, compared with the previous year. 

Understanding the full impact of the pandemic on care home residents has been hampered by lack of data. Whether or not someone lives in a care home is not consistently recorded in routine hospital data. Using innovative data science methods to tackle this problem, researchers at the Health Foundation were able to match all hospital activity to care home addresses, while maintaining individual residents’ privacy.

The level of unmet need within care homes will now be placing additional strain on the NHS alongside ongoing pressures from COVID-19. The scale of the unmet need in care homes is likely to be contributing significantly to the overall backlog of demand for NHS services in England that has increased over the course of 2020 and now stands at 4.5 million people who are waiting for hospital treatment – the highest level since comparable records began in 2008. 

Sarah Deeny, Assistant Director of Data Analytics at the Health Foundation, said: 

‘Despite the falling numbers of COVID-19 cases, hospitals are still struggling to provide care for other conditions. That the majority of care home residents have now been vaccinated is a substantial achievement and a very positive development. But there is now an urgent need to address the substantial backlog of care among residents, alongside the country as a whole. It is vital that we  ensure that those living in care homes are receiving appropriate hospital treatment.’

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