HIGHER rates of advanced dementia may have led to larger care homes experiencing more Covid-related deaths, according to a sector expert.

The Care Inspectorate released new data yesterday giving the fullest picture yet of the death toll in individual care homes across Scotland.

It found mortality rates were around six times higher in homes with the biggest capacity.

Those that were privately run were also more likely to experience Covid-related deaths.

There were 2.1 virus deaths per 100 places in homes with up to 20 beds, compared with 12.6 deaths per 100 places in facilities with more than 80.

Of those run by the private sector, 60.8 per cent reported at least one death, compared with 50.8%  of homes run by local authorities.

The data was disclosed after the information commissioner ruled that National Records of Scotland (NRS) breached FOI rules by refusing to reveal how many people had died of Covid in each of the country’s care homes.

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Donald MacAskill, Chief Executive of Scottish Care said he welcomed plans by the care watchdog to carry out further analysis of death risk relative to the size of care homes.

He said a number of factors may have contributed to larger homes experiencing higher mortality rates including the number of residents with advanced dementia for whom it would be more difficult to enforce isolation and social distancing restrictions. 

They would also be more likely to be cared for in nursing homes, which he said tended to be larger than residential homes.

He said: “There may be many reasons why care home size may be a factor.
“The relationship between the rates of the virus in the community and care home outbreaks is a recognised and a close one.

“ In larger care homes there will inevitably be more staff and as a result there is a likely to be a related increase in risk and outbreaks when there are high levels in the community.

“Larger care homes tend to be predominantly nursing rather than residential homes.

"Residents in nursing homes are always those who have greater acuity and frailty and sadly it is this population which was and is most at risk from this virus. 

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“The majority of people with advanced and late-stage dementia, including those whose conditions causing behavioural distress and agitation, live in nursing homes and often in specialist dementia areas. 

“The management of individuals with dementia in terms of isolation and restriction has proven to be singularly challenging in the pandemic. 

“More work needs to be undertaken to map their particular experience during the pandemic.” 

However Mr MacAskill said the difference in death rates relative to size had not been so marked during the second wave and said it was not simply a case of building smaller homes.

“Things like size of communal spaces, door access, huge issues around ventilation, ability to self-isolate and separate staffing areas  are all contributors. Many of these things can be achieved in a large complex in just as much as in small areas. 

“But probably one thing is clear and that is that aged care facilities in future need much more fiscal investment than has been the case in last few decades. 

Erskine care home recorded the highest number of Covid-related deaths at 33, while 31 elderly people died at Darnley Court home in Glasgow, run by HC-One.

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HC-One ltd, which runs 42 Scottish homes, had the  highest number of deaths at 338 while associate company HC-One Oval Ltd (14 homes) had 214.

It was followed by Advinia Homes, which has 11 homes and recorded 198 deaths and Barchester Healthcare, which had 132.

The care watchdog was notified about 3,774 Covid-related deaths from March 16, 2020 to March 21, 2021 in all care homes and 3,761 of those who died were elderly. Glasgow had the highest death toll at 537, followed by Edinburgh (385) and South Lanarkshire (291).

Midlothian recorded the highest death rate, with more than 18 deaths per 100 care homes places.

Nicola Sturgeon has admitted that older people may have died as a result of the government’s decision to discharge them from hospitals into care homes as it readied the NHS for coronavirus patients.

Boris Johnson's former aid Dominic Cummings has claimed that infection spread “like wildfire” in care homes because Matt Hancock falsely claimed that patients were being tested for coronavirus before being discharged from hospital.

The Care Inspectorate said there appeared to be no correlation between care home ratings before the pandemic and the likelihood of deaths.