On 3 July we saw the publication of the results of the Vivaldi study – a large scale survey which looked at the prevalence of COVID-19 across 9,081 care homes in England and sought to identify key factors affecting the risk of infection among residents and staff.
Result of the survey
The survey was conducted between 26 May and 20 June, and focussed on an estimated 293,301 residents and 441,498 staff (including cleaning, catering and admin staff) in a subset of homes providing care to the elderly (65 and over) and dementia patients.
Of the 5,126 care homes which responded, 56% reported at least one confirmed case among residents and/or staff, with the study estimating that across all 9,081 care homes 11% of residents and 4% of staff had tested positive for COVID-19. As the results of the study were based on confirmed cases of infection at the time of the survey and did not include suspected cases or cases where a positive test result had yet to be returned, these figures are likely to represent an underestimate of the proportion of infected residents and staff.
The study identified a number of common factors affecting the risk of infection for both residents and staff, the most relevant being;
- The prevalence of infection in one group vis a vis the other;
- The use of bank/agency carers;
- Frequency of care staff working across multiple sites; and
- Regional differences
In the case of regional differences, the study found that residents in London had higher rates of infection than any other region with the exception of the West Midlands. By contrast, London had the lowest rates of staff infections of all regions, but this was thought to be due to other factors which had not been incorporated into the study.
The Role of agency workers and staff working across multiple locations
The study found that the two factors which most affected the risk of infection in residents and staff were the use of bank/agency workers, and the extent to which staff worked across multiple locations.
With respect to the risk of infection amongst care home residents, the use of bank/agency staff was the factor responsible for the single biggest increase in risk – 1.58 times higher if agency staff were used at least a few times a week, rising to 1.65 times if agency staff were used most or all the time. The use of agency staff most or all of the time was associated with an even higher 1.88 increase in the risk of infection among staff.
While staff working across multiple locations did not materially increase the risk of infection for residents (and in fact significantly decreased the risk if staff worked across multiple sites most or all of the time), it more than doubled the risk of infection for staff – an average of 2.4 times – when workers worked across locations most or all of the time. It was also the single biggest factor once the regional differences mentioned above were disregarded. Also of note is the study’s finding that for every additional infected staff member working at the care home, the risk of infection for residents increased by 11%.
Therefore, while having staff work frequently across multiple locations appears to actively decrease the odds of infection in residents, it’s conversant impact on the risk of infection to staff – potentially leading to the need to employ agency workers to cover staff shortages – means that care providers should try to limit this practice as much as possible..
Although 88% of survey respondents reported never having staff who worked across more than one location, the study found that only 44% of the care homes surveyed had never employed bank or agency staff, thus highlighting a significant vulnerability for a majority of care homes in a sector which relies heavily on agency workers who are often required to visit multiple care homes and homes in the community in the course of a single day. The Vivaldi study’s findings are consistent with the Public Health England study conducted between 11 and 13 April 2020 using genome tracking, which found that temporary care workers were unwittingly spreading the infection.
The role of sick pay
The role of agency workers in spreading COVID-19, and their contribution to increased risks of infection among both residents and staff is further exacerbated by fact that many such workers are employed on zero hours contracts and/or low pay, meaning that they often feel unable to take time off work, even when they feel unwell or suspect that they may have the virus. The Vivaldi study found some evidence to suggest that rates of infection in residents were lower in care homes where staff received sick pay, possibly because staff were able to self isolate if they fell ill and were not forced to continue working in order to avoid financial hardship.
The vast majority (93%) of the care homes surveyed reported offering such pay, however there is no information on the rates of pay offered and the ONS has suggested that the number of care providers paying more than statutory or poverty sick pay is low. Anecdotal evidence suggests that many agency workers are still having to choose between continuing to work and risk infecting their patients, or falling into significant financial difficulties on an income of just £95 per week if they are required to take time off work.
An unsupported sector?
The results of the Vivaldi study are further evidence of the weaknesses of a social care sector that has been systematically diminished and defunded, and which now relies heavily on a temporary workforce which may in turn be undermining its ability to confront the current public health crisis and protect those most at risk from the virus.
The study also highlights the extent to which the government response to the COVID-19 pandemic has neglected the social care sector and failed to make adequate provision to reflect the particular vulnerabilities of its users and workforce. The action plan for adult social care published by the Department of Health on 16 April made no mention of restricting staff movement between homes in its chapter on controlling the spread of infection, and the Health Secretary has yet to mandate that care providers pay workers in full for any absences.
Comprehensive reform of and reinvestment in the social care sector is now long overdue and is surely a prerequisite to ensure a resilient system which can protect both those in its care and those who deliver its services.
Written by Katherine East at BLM