The COVID-19 Pandemic in UK Care Homes - Revealing the Cracks in the System

Hinsliff-Smith, K.
Gordon, Adam
Devi, Reena
Goodman, Claire
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Journal of Nursing Home Research
Peer reviewed
There are around 420,000 residents living in UK care homes. The majority are over 85, have multiple health conditions, live with frailty and are nearing the end of their lives. Up to 80% of residents live with dementia. Care homes are not part of the National Health Service (NHS). Care home places are funded through a complex mix of self-funding, means-tested support from local authorities, and continuous healthcare funding from the NHS. They are run by independent organisations. A third of providers are large for-profit chains, the remainder comprising not-for-profit third-sector organisations, or small private companies with only a small number of homes. The level of government reimbursement for long-term care homes in the UK is low by international standards, an issue highlighted by multiple public commissions3,4 but which has gone unaddressed by successive UK governments. Medical care to UK care homes is highly variable. In some areas, the NHS Care Home Vanguards have established dedicated General Practitioners with responsibility for each home and direct access to specialist multidisciplinary teams, with evidence that such approaches may minimise unnecessary admission to hospital5. But often, care is based on residents’ individual relationships with family doctors, with the result that access to medical care is variable and uncoordinated6. As the COVID -19 pandemic started, arrangements for medical care in English care homes were in the early stages of being standardised as part of the NHS England Enhanced Health in Care Homes project. There is a social dread surrounding care homes, perceived as places to avoid because of concerns about care quality and resistance to having to pay for social care when health care is free. Most of the coverage of care homes in mainstream media prior to COVID was negative, focussing on isolated scandalous cases of negligence or abuse, and rarely reporting on the exceptional work done by the sector daily. The workforce is not valued. There is no national accreditation for care home staff, opportunities for career progression are limited, staff are poorly paid and positions in care homes are often referred to as unskilled work.
open access article
older people, care homes, staff, residents, UK, relative visits, COVID-19
Devi, R., Hinsliff-Smith, K., Goodman, C., Gordon, A.L. (2020) The COVID-19 pandemic in UK Care Homes – Revealing the Cracks in the System. The Journal of Nursing Home Research Science, 6, pp.58-60.
Research Institute
Institute of Health, Health Policy and Social Care