Covid-19 in the community and outbreaks in long-term residential care in Ireland

Context: Long-term residential care (LTRC) has been disproportionately impacted by Covid-19, with two-thirds of Covid-19 deaths occurring in LTRC homes in Ireland. Objectives: The study aims to examine the factors associated with LTRC Covid-19 outbreaks in Ireland. Methods: We merged data on Covid-19 cases and deaths in the community and LTRC homes with LTRC home characteristics across Waves 1-3 of the pandemic. Analyses examined the impact LTRC home characteristics and proximity to high community Covid-19 rates had on the likelihood of Covid-19 outbreaks and severity of outbreaks in LTRC homes. Findings: 8,502 confirmed cases of Covid-19 among LTRC home residents were recorded. Two thirds of LTRC homes had a Covid-19 outbreak across the first three waves of the pandemic. Larger LTRC homes were three times more likely to have an outbreak than smaller homes. High local community Covid-19 rates significantly increased the probability of a LTRC home outbreak. Homes in areas with the highest community Covid-19 rates were almost seven times more likely to have an outbreak than LTRC homes located in areas with the lowest community Covid-19 rates. Limitations: No centralised dataset exists in Ireland that collects information on morbidity, dementia or cognitive status of had on residents. Implications: Covid-19 had a significant impact on LTRC in Ireland with very high rates of cases and deaths. Our findings suggest that while factors such as home size may have increased the probability of an outbreak, being located in areas with high levels of community Covid-19 cases was likely the key factor explaining LTRC outbreaks.