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The COVID-19 pandemic is a wake-up call on the crisis in long-term care

The COVID-19 pandemic is a wake-up call on the crisis in long-term care

An old woman in a home wearing a mask against covid

The COVID-19 pandemic has exposed dysfunctions in many systems, including those that affect the lives of older people and their communities. COVID-19 has disproportionately affected older persons – nearly 9 out of 10 COVID-19 deaths in the UNECE region have been among those aged 65 and older. Estimates show that amongst COVID-19 deaths in the WHO/Europe region, the median age was 80 years, 96 per cent of all deaths had at least one underlying condition, and 20 per cent had dementia or another neurological disease. While older persons tend to be disproportionately affected in emergencies, our recent Policy Brief on Older Persons in Emergency Situations highlighted they are also often neglected in disaster risk reduction strategies and emergency preparedness, relief, and recovery.

Those living in residential care homes are particularly vulnerable as they tend to be in advanced age and with several underlying conditions. Across 21 countries, care home residents contributed 46 per cent of all COVID-19 deaths. Little is known about older persons living at home and in the community, but there is now evidence of high excess mortality also in the community. The high death rate among those needing long-term care is largely explained by difficulties in implementing physical distancing in care homes, late or insufficient access to testing and personal protective equipment, asymptomatic transmission, reduced access to healthcare, and late adaptation of guidance to recognise geriatric COVID-19 symptoms. But behind these proximate causes, there are some fundamental structural issues which resulted in international failures in long-term care, including: low political priority for long-term care; fragmented systems with responsibilities split between different government departments and levels; failures in health/long-term care coordination; weak regulatory oversight; lack of recognition of human rights; and under-recognition of care staff and the role and needs of unpaid carers. 

Adding to this, the situation of older people in need of long-term care has remained invisible in many countries where data on COVID-19 are not reported by age, or when deaths in care homes were not initially included in statistics. The lack of data is a reflection of the structural ageism in our societies. UNECE guidance for the inclusion of older people living in institutions in national social statistics, published in 2020, can help countries to address key data gaps.

Despite the vulnerability of older persons needing long-term care, they were overlooked in initial pandemic responses in most countries, which instead focused on hospitals. This collective failure across the region reflects a number of systemic problems related to long-term care systems that have long been known but were not sufficiently addressed, and that the pandemic has brought painfully to attention. These challenges need to be urgently addressed.

We must also learn from the impact of the isolation experienced by older persons following bans on visitors to residential care facilities or due to stay-at-home orders. We now know that these measures had devastating impacts on the health and well-being of older persons and caused significant suffering. As a result, in many countries adjustments have now been made to allow visits. We have also seen demonstrations of intergenerational solidarity such as school children having pen pals or other forms of communication with older persons, and young people delivering food packets and medicines to older persons in the community. There have been innovative solutions to help older persons connect with their loved ones, for example via digital technologies or facilitating safe meetings for those in residential care institutions. Networks of volunteers have also stepped up to actively support older people in the community through visits, phone calls, and ensuring access to professional services when needed.

Critical reflection and the sharing of insights and promising practices between governments, research, and civil society networks is vital for improving emergency preparedness, response, and recovery, and for addressing some of the fundamental ageist and structural issues around long-term care. Through its Standing Working Group on Ageing, UNECE offers a unique regional platform for these discussions and to share resources, which I encourage all governments and stakeholders to make the most of. We must continue sharing lessons learned as the crisis evolves.

In the spirit of collaboration, we recently launched a Joint Programme on Ageing, in partnership with the United Nations Population Fund, the World Health Organization, the Office of the United Nations High Commissioner for Human Rights, and HelpAge International, with the goal to uphold the rights and dignity of older persons through health, social care, and enabling environments in Europe and Central Asia. One of our first activities is an assessment of the impact of COVID-19 on long-term care for older persons in Kazakhstan, which could be used as a potential model for other countries in the region to follow.

We are all experiencing some level of “pandemic fatigue”. But there are glimmers of light at the end of the tunnel, with the roll-out of COVID-19 vaccines that I am proud UNECE is supporting through coldchain logistics developed by countries through our UN transport agreements. As many governments prioritize older persons among the at-risk populations to receive the first vaccinations, I hope that this may mark a turning point in the political attention given to their specific needs and vulnerabilities, and our collective responsibility to address them. At the international level, we must not lose sight of the moral imperative for solidarity and equality in the distribution of vaccines. Protection from the virus cannot be a luxury for those who can afford it.

Looking ahead, we must use the lessons learned from the crisis to better respond to the needs of older people. As we begin this new year, we also embark on a Decade of Healthy Ageing (2021-2030) – a call to action to improve the lives of older people and their families by changing how we think, feel and act towards ageing; fostering the abilities of older people; delivering person-centred integrated care; and providing access to long-term care for older people who need it.

Despite the acute challenges that the pandemic has thrown our way, we must now take this opportunity to rebuild in a more age-inclusive manner. Reforming long-term care systems to ensure ageing with dignity, and decent work for those involved in long-term care must be at the heart of these efforts.   

Regions: European Union