Health and care services

Analysing discharges into care homes in the first surge

As concerns around the discharging of Covid-19 patients into care homes abound, a Department of Health report has found that discharges into such homes actually decreased during the first surge of the pandemic.

The study found that “the timing of outbreaks in care homes during the first surge does appear to correlate with overall hospital admissions rates for Covid-19 (which are an indicator of wider community transmission and infection levels)” rather than pointing to any correlation between hospital discharges and infection rates in care homes. Quarter two 2020 discharges to care homes numbered 129, down from the 233 seen in Q2 of 2019.

NISRA figures in late May 2020 showed that more than half of the 705 people who had died from Covid-19 in Northern Ireland at the time had been care home residents. At the time, there had been 137 confirmed outbreaks of Covid-19 in care homes, with three care homes reporting deaths in the double figures. In total, there have now been 545 cute respiratory outbreaks in care homes since 16 March 2020, with 46 of those outbreaks now concluded.

Speaking in November 2020, upon the publication of the report, Health Minister Robin Swann MLA said: “Care homes remain on the frontline in the battle against Covid-19. This research complements my Department’s Rapid Learning Initiative which also examined the first surge in the sector. It is vital that we keep adding to our learning as we continue to support care homes.”

The Rapid Learning Initiative found, among other things, that 59 per cent of care homes did not receive guidance on formulating Covid-19 individual resident risk assessment and care plans and that 44 per cent of care homes did not have access to staff resting at onset of first symptoms.

The report’s author, Niall Herity, a consultant cardiologist at the Belfast Trust, has previously provided the Department with analysis on elective care across Northern Ireland. His report found that there was a decline in the overall number of people discharged from hospitals, including to care homes, from March 2020 onwards, which reflected an overall decline in the numbers attending emergency departments. Among 465 people discharged into care homes during a two-week period studied where discharges to care homes were above the average, only five people (1.1 per cent) tested positive for Covid-19 within two weeks of their discharge.

The research found that “the timing of outbreaks in care homes during the first pandemic surge correlates much better with hospital admissions rates for Covid than with the number of people discharged to care homes”, which would align with similar analyses performed in Scotland and Wales. It is also states in the review that the research did “not support a view that ministerial or departmental communications drove consultants’ discharge decision-align during the first pandemic surge”.

Northern Ireland’s high infection and death rate amongst care home residents is also defended as having been largely in line with the worldwide experiences of the pandemic in care homes. “Given the diversity of countries, regions and healthcare systems, any variance in local policies, guidelines or communications would seem to be less plausible explanations of care home outbreaks and subsequent deaths than the virulence of the virus, its ability to spread rapidly in indoor settings and the innate clinical vulnerability of care home residents,” the review concludes.

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