Covid-19 in Care Homes – What is an Acceptable Standard of Care?

The onset of Covid-19 in early 2020 has caused significant disruption to healthcare services throughout the UK and Ireland. The virus has had a particularly devastating impact on care homes. The pandemic has exposed many weaknesses in how health care is delivered in care homes and for elderly people in general. 

Residents in care homes are typically elderly and often have one or more physical or cognitive impairment. In addition, care homes are congregated settings where many vulnerable people are gathered within a relatively small area. The potential for the spread of infection within a care home setting is higher than any other healthcare setting and the consequences of contracting an infection are more stark given the vulnerability of care home residents.

The following statistics clearly demonstrate the disproportionate impact that the pandemic has had on care home residents in the UK and Ireland:

• 62.7% of deaths resulting from outbreaks of Covid-19 in Ireland have occurred in care homes (the closest comparator is hospitals with 22.94%);

• In Northern Ireland there have been over 1000 deaths from Covid-19  in care homes;

• In England, 47% of the total deaths from Covid-19 have occurred in care homes.

Guidance on infection control and healthcare for care homes has been introduced and updated at various stages over the last 15 months. The data set out above demonstrates that the measures were either not effective or, in the alternative, were not properly implemented. In either case, it is clear that the standard of care provided to many care home residents has been inadequate.

Following the Science

When assessing whether an adequate standard of care was met in these cases it is necessary to consider what information was available to the decision makers and service providers at the time. For example, our understanding of infection control is much better than it was in March 2020 as the science has evolved considerably within a short period of time.

However, this is not to say that deaths and infections that occurred early in the pandemic did not occur as a result of an inadequate standard of care. Care homes should already have had infection control procedures in place prior to Covid-19 to combat the myriad of different infections which generally arise in a congregated care setting. These measures should then have been amended and advanced as the science evolved.

The British Geriatric Society have published a comprehensive list of measures which have been proven to reduce the risk of Covid-19 in care homes and promotes the welfare of residents in general. The study can be viewed in its entirety at COVID-19: Managing the COVID-19 pandemic in care homes | British Geriatrics Society (bgs.org.uk). The study found that effective implementation of the following measures is necessary:

1. Adequate Infection Control policies;

2. Regular staff and resident testing;

3. Management and screening of admissions to care homes;

4. Implementation of safe visitation with residents family;

5. Early diagnosis of Covid-19 in residents;

6. Effective management and treatment of Covid-19 positive residents;

7. Implementation of advance care planning for residents;

8. Implementation of appropriate end of life care measures;

9. Ensuring that routine healthcare continues to be implemented.

Accountability

It is clear from the scale of death that care home residents have been failed by both the Government and certain service providers. Grieving families will understandably be seeking answers about the deaths of their loved ones.

We have been instructed in a number of wrongful death claims in Ireland against private and publicly run care homes. In each case, it will be necessary to assess the following:

1. Was a duty of care owed to the deceased?

2. Was this duty of care breached?

3. If so, did this breach cause or contribute to the death?

In most cases, there will be little doubt that the State and/or the care home owes their residents a duty of care. The questions of whether this duty was breached and whether that breach has caused or contributed to the death of a resident will require close analysis of all the evidence and input from medical and care experts.

It is clear from the evidence gathered to date that there have been failures by both the State and individual care homes and that, in many cases, the standard of care provided has not been acceptable.