The impact of the COVID-19 pandemic, and care home closures on timing of mortality in residents of English LTCFs

Background In the UK, mortality incidence of residents in long-term care facilities (LTCFs) was high during the first two waves of the COVID-19 pandemic. Prior to the pandemic, mortality risk was greater amongst new LTCFs admissions compared to longer term residents. Following the re-opening of these facilities to new residents after the second wave of the pandemic, we hypothesised that this difference would be more pronounced. We aimed to establish whether this occurred by comparing mortality risk in new admissions with existing residents. Methods Data were accessed from the VIVALDI study, a prospective cohort study set up to investigate COVID-19 in English LTCFs. Residents aged over 65 were included and analysis performed over the Delta (16th May 2021-19th December 2021) and Omicron (19th December 2021-31st March 2022) waves of the pandemic. Classification into new and existing residents was based on presence in the LTCF before or after 24th April 2021. Mixed effects Cox regression models were used, with separate hazard ratios associated for existing vs new residents estimated for each calendar month. Results 11,532 residents were observed during the Delta wave and 9,801 during the Omicron wave. Mortality hazard ratios for existing care home residents compared to new care home residents stabilised after September 2021, following a period of reduced risk between May (HR: 0.23 95% CI: 0.11-0.47) and August (HR: 0.37, CI:0.29-0.47) 2021. No mortality displacement was observed in the Omicron wave. Conclusions Mortality rates amongst existing residents were lower than anticipated between May and August 2021 but increased and stabilised by September 2021, providing evidence for mortality displacement within this population. Improved monitoring of infection outcomes for LTCF residents that consider time since admission would help improve our understanding of the dynamics and composition of LTCF populations in non-pandemic periods.