By Ann Marie Gray, Professor of Social Policy and Co-Director of ARK (; Gemma Carney, Senior Lecturer in Social Policy at QUB; and Dr Paula Devine, Co-director of ARK, based at QUB

Globally COVID 19 has impacted disproportionality on older people and particularly on care home residents. 

Analysis of COVID 19 mortality in 21 countries during the first wave of the pandemic shows home residents account for 46 per cent of deaths. (1). In Northern Ireland nearly half of deaths were of care home residents. 

As the first wave of the pandemic emerged, UK governments sought to ‘protect the NHS’ by placing their focus firmly on hospitals with little mention of social care. 

Like many ageing societies, the Northern Ireland’s policy-making has failed to keep pace with demographic change. As a result, social care systems are under-funded and privatised, operating as a kind of poor relation to the core health system. (2)

Delays in providing PPE, staffing shortages and the problems accessing testing are indicative of the historic failure of governments throughout the UK to prioritise social care and had consequences with regard to the spread of infection.  

At the start of the first lockdown, across the UK, thousands of older people were discharged from hospital to care homes without being tested for COVID 19.  The extent to which this was a major source of infection is difficult to quantify. While there is some evidence that it represented an infection risk, particularly in March and April,  a report on hospital discharge in NI. (3)

Studies in Wales and Scotland (4) identified care home size as the strongest predictor of outbreaks. Rates of transmission in the community have been found to be an indicator of deaths in care homes (5) and there is a correlation between infections among care home residents and between the use of agency and bank staff.  Where staff received sick pay there were lower levels of infections in residents. (6)

There is no doubt that protecting care homes from COVID was a challenge. Nevertheless, when it came to emergency planning, care homes residents were overlooked. 

Other ‘risk factors’ associated with COVID, such as the prevalence of ageism in society underpin the high death toll. Excess deaths in care homes are likely to be impacted by the age discrimination faced by older people in relation to decisions on medical care and/or as a result of the scaling back of non-COVID related services. The Queen’s Nursing Institute reports how, at the height of the first wave of the pandemic, care homes were told to introduce blanket ‘do not resuscitate’ orders for all residents. The lack of protection afforded care home residents represents a basic violation of the human rights of care home residents. 

Now, as we are firmly in the second wave of the pandemic what has been learned and how prepared are care homes? Not much, it would seem.

As of November 18 there were confirmed outbreaks of COVID 19 in 163 of Northern Ireland’s 481 care homes.  Given the strong correlation between community transmission rates and care home infections, testing is an important measure in reducing the spread of infection in care homes. Testing staff every 14 days and residents every 28 days is unlikely to be sufficient.

The Association of Independent Care Providers has cited delays in staff testing results (they are not considered Pillar 1 frontline staff – yet another indication of the status of this sector) and the continued lack of a universal approach in terms of discharge pathways for people testing positive.  The care sector in Northern Ireland, as elsewhere in the UK is the hands of private care companies. 

This is not in and of itself a problem, but it does offer some explanation. The push for profit tends to necessitate larger homes and diminished security of tenure and continuity of care for residents. Operating outside the NHS also means that care homes were last in line for PPE and other crucial resources. The work of care staff might be better recognised but the poor pay (often minimum wage) and working conditions have not changed.  Despite efforts to recruit more care workers, providers have had little success and a reliance on bank and agency staff has remained. 

The lessons to be learned from the pandemic are not new – we need a properly funded, regulated and state-guaranteed system of social care. Residents of care homes should have the same status as any citizen using the NHS. Their carers should have the same status as ‘NHS heroes’ and their families deserve the opportunity to offer love and support when they are ill or frail.

Let’s hope that the legacy of the pandemic will be the abundance of political will needed to fix social care.

  1. Comas-Herrera and Fernadez,J.L (2020) England: Estimates of mortality of care home residents linked to the COVID-19 pandemic –
  2. Phillipson, (2020) Covid-19 and the crisis in residential and nursing home care,
  3. Department of Health (2020) Clinical Analysis of Discharge Patterns from HSC Hospitals in Northern Ireland,
  4. Burton,J et al, 2020 Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK, The Lancet, 1,1, 13-21
  5. Konetzka,T (2020) Submitted for the record at a hearing on: Caring for Seniors amid the COVID-19 Crisis, Before the United States Senate Special Committee on Aging, May 21, 2020 –
  6. ONS (Aug 2020) Impact of Coronavirus in Care Homes in England 26 May-19th June

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