When trying to work out what went wrong or right in our attempts to protect and care for people with dementia in care homes during the time of Covid, there is a real problem finding a way around the data. Of course numbers matter, but how they are collected is crucial. Few of us are expert at fiddling around with spreadsheets to see what they mean. But there could also be a problem because the data set is deeply flawed. The numbers might be right, but the wrong numbers have been collected.

Care homes are not all the same

One perhaps deliberately confusing thing is when the authorities collect and display differences between care homes on the basis of the financial model of the home. This suggests that all private care home businesses are the same, or all charitable care homes are the same. Everyone should know that private care home businesses vary from single operators to big corporates. Comparison could be made between your village convenience store owner and Philip Green. Both retail business, both private, quite different. Lumping all "private" care homes together is classifying them on the basis of their back room functions, not the quality or standard of care they provide.

Is it a Care home or a Nursing home?

Some of the commentators don't distinguish between care homes and care homes with nursing. None of the analysis that I've seen appears to consider information about the age profile and premorbid conditions of the resident population. If private care homes are to be judged on numbers of deaths alone, it would create a perverse incentive to transfer dying residents to hospital. Care homes pride themselves on their palliative care. But if they are to be shamed for allowing people to die in what has become their own home, what can they do?

Data collection and analysis of care home deaths is not adequate

An example of this is the Scottish Government website which does not distinguish between people dying of "suspected Covid" and "Covid". Of course there may have been problems testing everyone, so far. But on the other hand they could try to gather the level of certainty the death was classified. (ie who said it was Covid? was this after the resident died? and on what basis if no testing was done?) They distinguish between care homes in terms of size, but ignore other significant factors such as whether the resident has access to their own toilet and shower. This is not as common as you’d hope. It would be helpful to know how many of the deceased had been recently transferred from hospital by sector.

This is not meant to imply that the Scottish Government is in any way negligent, but if the decision makers, like the press, are dependent on such "rough numbers" when considering policies like nationalising care homes, or sending in the NHS to "fix them", they're possibly wildly badly informed

Skewed data doesn’t adequately reflect reality of care homes

The collection of data is at the behest of the politicians in each part of the UK. They each have a particular political viewpoint, to which they are entitled. How they see the figures will be shaped by their political view, and none of them that I know have any experience working in the NHS or a care home.

If you want to have a sensible discussion about what was happening you’d need to have more information. I hear well publicised, poorly evidenced arguments using the government data, which constantly reflect badly on private care homes. The halo effect of negativity because some of them do not pay their tax in the UK (which people who love the NHS rightly disapprove of) is a condemnation which is entirely unrelated to the quality of care in their homes.

Because quality matters. Even rich, tax avoiding care homes want to provide good care because that’s how they make the money that they can send to the Caymen Islands. Bad care loses custom. Bad care can’t get LA contracts. Bad care costs more than good care (once you have reached a certain basic level) because of accidents, incidents, complaints and staff recruitment issues. And most of the profit comes from the value of the building, not the caring business. So whatever you want to attack them for, don't make it the quality of care because you will be wrong.

Result: Data Trap

Many journalists do not realise that the data set is a trap for them, and on top of that, they draw false conclusions from the flawed data that is there.  The care home business is not simple, and commenting without experience or understanding is not going to help anyone

 If you would like more information, you can buy my book Dementia, the One Stop Guide or Care Homes: When, Why and How to Choose a Care Home. I am available for consultancy for families or organisations. And if you have any further queries or questions, or suggestions for something you’d like to see me write on, please contact me via the Contact Page

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