Deaths in care homes, UK: 2015 to 2021 (final), 2022 (provisional)

• It is not currently possible to produce a UK-wide statistic on deaths in care homes because of definitional differences in the care types provided in care homes (such as care homes with nursing or respite care) and the care needs provided for (such as care for learning disabilities, dementia or those who are terminally ill).

• However, while absolute totals of deaths in care homes cannot be compared, it is possible to compare trends in care home deaths over time between the four nations.

• Since 2015, overall trends in care home deaths have followed a similar pattern across the UK, peaking in 2020 before reaching their lowest level in 2021.

• Since 2015, dementia and Alzheimer disease have been the leading cause of death in care homes every year in all four nations. In 2020, coronavirus (COVID-19) was the second leading cause of death in care homes for males and females in England, Wales, Scotland, and Northern Ireland.

This article examines the feasibility, complexity, considerations, and limitations of producing a UK-wide statistic of deaths in care homes, and includes data produced by the Office for National Statistics (ONS) for England and Wales, the National Records of Scotland (NRS) for Scotland, and the Northern Ireland Statistics and Research Agency (NISRA) for Northern Ireland.

This article analyses trends of all deaths in care homes that were registered from 2015 to 2022. The years 2015 to 2021 use final data, while 2022 uses provisional data. Caution should be taken when interpreting these analyses, as there are distinct differences between the four nations in how a care home is defined. This includes differences in defining the different care home types and the services they provide.

The term "care home deaths" used in this article refers to all deaths where the death occurred in a care home. This should not be confused with the term "care home resident deaths", which is a broader term used in other releases.

We currently publish other UK deaths registration statistics including our Deaths registered by area of usual residence, UK and our Deaths registered by single year of age, UK. These releases focus on the total population in each country and do not break down by different places of death.

The provision and management of adult social care is the responsibility of devolved authorities across the four nations. Different agencies are responsible for the production of statistics related to social care, including deaths registered in care homes. For example:

• at the Office for National Statistics (ONS), we publish weekly death registration figures datasets as well as annual death registration figures in our bulletins, covering care home deaths and care home resident deaths in England and Wales

• the National Records of Scotland (NRS) publishes weekly figures covering care home deaths in Scotland, as well as annual care home death registrations in Scotland

• the Northern Ireland Statistics and Research Agency (NISRA) publishes weekly death registrations on deaths in care homes and of care home residents, and annual death registration figures on deaths in care homes

The Office for Statistics Regulation (OSR) published a series of reviews on Adult Social Care in the UK. These reviews outlined gaps in published evidence in social care statistics across the UK, and a need for improved collaboration across the four nations when producing social care statistics. We have been working with the Welsh Government, NRS and NISRA to explore the possibility of producing a UK-wide statistic for deaths in care homes. However, there are several important points to consider when determining the feasibility of producing this statistic.

Death registrations

Across the four nations, there is a large degree of comparability in the production of mortality statistics; all figures are based on details collected when deaths are registered. It is a legal requirement in the UK to register a death, and so there is almost complete population coverage for deaths that occur. Deaths should be registered within five days of the date of death in England, Wales, and Northern Ireland, and within eight days of the date of death in Scotland.

We quality assure data for England and Wales, with similar quality assurance undertaken by NRS and NISRA for death registration data in Scotland and Northern Ireland respectively. Detailed mortality statistics are subsequently published for all nations on deaths registered in the reference period.

The definitions, classifications and methods used to produce published death statistics are broadly comparable across the four countries. For more information on deaths statistics in England and Wales, refer to our User guide to mortality statistics or our Mortality statistics in England and Wales Quality and Methodology Information (QMI). For Scotland, refer to the Quality of NRS data on vital events web page and the Quality of NRS data on deaths web page. For Northern Ireland, refer to the Quality Assurance of Administrative Data (QAAD) for deaths data in Northern Ireland web page and the Northern Ireland Deaths Background Quality Report.

Place of residence and place of death

Place of death is recorded as part of the death registration process for each of the four nations, which means that deaths that occur in care homes can be established. However, to determine if the deceased was a "care home resident", their place of residence must be recorded as a care home as part of their death registration. While place of residence is recorded in all four countries of the UK, the data processing in Scotland does not allocate an institution code to the place of residence address (only the place of death) and so it is not possible to identify care home residents who died in another location in Scotland. This means that currently, comparisons can be made between the four nations for deaths that occur in care homes only. Please refer to Table 1: Definitional and reporting differences between England, Wales, Scotland and Northern Ireland (Excel, 29.8KB).

Definitions

To produce a UK-wide statistic, there needs to be consistency in the definition of a care home across the UK. However, there are currently differences as to what constitutes a "care home" in each of the four nations. Consequently, there is considerable variation in the types of services provided and the needs that are cared for. For further information, please refer to Table 2: Definitional and reporting differences between England, Wales, Scotland and Northern Ireland (Excel, 29.8KB).

These definitional differences mean that, at present, a direct comparison of care home deaths between the four nations to produce a UK statistic is not possible.

Access to adult social care and funding

The devolved responsibility of social care in the UK means that each of the four nations have different frameworks to accessing adult social care along with different funding arrangements. For example, Northern Ireland provide free domiciliary care for individuals assessed as requiring additional care. Differences in care home access, management, and funding may affect care home populations, and should be considered when interpreting the results in this article.

Reporting differences

When comparing weekly figures, there are reporting differences that need to be taken into consideration. For example, there are inconsistencies in how weeks are defined (such as week number assigned) which may affect comparability. More information is available in Section 10: Data sources and quality.

When comparing deaths registered involving coronavirus (COVID-19), it is important to note that each of the devolved administrations were responsible for issuing their own guidance and legislation. This means that different restrictions and lockdown measures may have been implemented at different times.

Summary

The fundamental issue around comparability between the four nations is the differences in definitions of what constitutes a "care home" in each nation. If these definitions were comparable, this would make the production of UK-wide statistics in care homes possible.

While data cannot be directly compared at this time, we are able to compare trends in deaths in care homes across the four nations. We can provide an overview of care home deaths in the UK and analyse any differences in trends to improve understanding.

We do not recommend comparing absolute totals between nations because of the definitional differences outlined in Section 3: Feasibility of a UK-wide statistic on deaths in care homes. For instance, the definition for Scotland includes hospices whereas England, Wales and Northern Ireland do not. However, general trends in care home deaths over time across the four nations can be compared. When comparing trends of deaths in care homes, there have been similar patterns in the proportion of deaths registered that have occurred in care homes in all four nations since 2015 (Figure 1).

Between 2015 to 2020, the proportion of deaths in care homes in each of the four nations were stable. In all four nations, the highest proportion of deaths in care homes was in 2020 (23.6% in England, 18.4% in Wales, 24.5% in Scotland and 20.0% in Northern Ireland).

This pattern is also observed when care home deaths are further broken down by sex (Figure 2). As seen for the total population, the proportion of deaths in care homes was stable between 2015 and 2020. It then decreased to its lowest point in 2021 for males in England (14.5%), Scotland (14.4%) and Northern Ireland (11.3%), and in all nations for females (25.9% in England, 20.0% in Wales, 25.0% in Scotland and 21.0% in Northern Ireland). Across all four nations, females have a higher proportion of deaths in care homes compared with males.

Figure 2: England, Wales, Scotland, and Northern Ireland observe similar patterns in the proportion of deaths in care homes between 2015 and 2022, when broken down by sex

Percentage of total deaths that were registered in care homes by country and by sex, 2015 to 2022

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Notes

1. These figures are based on the date the death was registered rather than occurred.

2. Figures for 2015 to 2021 are final. Figures for 2022 are provisional.

3. "Care home deaths" refers to all deaths where the death occurred in a care home (Excel, 29.8KB).

4. Figures for England and Wales exclude deaths of non-residents.

5. Figures for Scotland and Northern Ireland include deaths of non-residents.

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.xlsx

For all countries, there were lower total deaths registered in 2021 in care homes when compared with 2020. Several factors may have contributed to lower total deaths in 2021 compared with 2020, including changes in care home occupancy, availability of vaccinations and availability of personal protective equipment (PPE).

Differences between the four countries can be explained by differences in how each country defines a care home and the care they provide. However, trends in the proportion of deaths in care homes are still comparable despite these differences. For further information on interpreting these results please see Section 3: Feasibility of a UK-wide Statistic of deaths in care homes.

Figure 3: 2020 did not have the highest proportion of deaths for all age groups across the four nations

Percentage of total deaths that were registered in care homes by country, by sex and by age group, 2015 to 2022

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Notes:

1. These figures are based on the date the death was registered rather than occurred.

2. Figures for 2015 to 2021 are final. Figures for 2022 are provisional.

3. "Care home deaths" refers to all deaths where the death occurred in a care home (Excel, 29.8KB).

4. Figures for England and Wales exclude deaths of non-residents.

5. Figures for Scotland and Northern Ireland include deaths of non-residents.

Download the data

.xlsx

There are similar patterns in the proportion of deaths registered that have occurred in care homes in all four nations since 2015. This can be observed across all age groups when comparing trends for overall deaths in care homes between the four nations (Figure 3).

However, when broken down by age group, 2020 did not have the highest proportion of deaths for all age groups in all countries between 2015 and 2020. Only males and females aged 75 to 84 years and females aged 85 years and over had the highest proportion of care home deaths in 2020 compared with the preceding years in all four nations.

Scotland registered a higher proportion of care home deaths across all age groups when compared with England, Wales, and Northern Ireland between 2015 and 2020. This difference is more pronounced in those aged 0 to 64 years and those aged 65 to 74 years. This can be explained by the inclusion of hospices in Scotland's care home definition; please see Table 2: Definitional and reporting differences between England, Wales, Scotland and Northern Ireland (Excel, 29.8KB).

The term "Deaths involving coronavirus (COVID-19)" refers to deaths registered that had COVID-19 mentioned anywhere on the death certificate.

The UK government announced a UK-wide lockdown on 23 March 2020. However, since this date there have been differing lockdown measures implemented both between and within the four nations, with devolved administrations responsible for issuing their own guidance and legislation. In addition, there were also differences in various policies including COVID-19 testing and personal protective equipment (PPE) and visiting policies. These contributory factors influence the comparability of data between the four nations; therefore, caution needs to be taken when interpreting the data.

The first reported care home death involving COVID-19 was reported in Week 12, 2020 for England and Scotland, and Week 13, 2020 for Wales and Northern Ireland. England, Wales, Scotland, and Northern Ireland observe a similar pattern for the proportion of care home deaths registered that involved COVID-19 since the start of the coronavirus pandemic. In all countries, there were sharp increases at the beginning of the pandemic and again in late 2020 and early 2021. Scotland and Northern Ireland registered their highest proportion of weekly deaths in care homes involving COVID-19 at the start of the pandemic (Scotland, Week 18, 2020, 49.4%; Northern Ireland, Week 18, 2020, 50.0%). England registered their highest proportion in early 2021 (Week 4, 2021, 48.9%), as did Wales (Week 3, 2021, 58.4%).

Further comparisons of COVID-19 deaths registered weekly and annually, including by sex and by age group, are available in our accompanying dataset.

The leading cause of death groupings for the Office for National Statistics (ONS), National Records of Scotland (NRS) and Northern Ireland Statistical Research Agency (NISRA) are based on a list developed by the World Health Organization (WHO). This categorises causes of death using the International Classification of Diseases, 10th Edition (ICD-10) into groups that are epidemiologically more meaningful than single ICD-10 codes. This is for the purpose of comparing the most common causes of deaths in the population.

Figure 5: Dementia and Alzheimer disease was the leading cause of death in care homes in England, Wales, Scotland, and Northern Ireland every year since 2015

Percentage of care home deaths registered with dementia and Alzheimer disease as the leading cause of death, by sex and by country, 2015 to 2022

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Notes:

1. These figures are based on the date the death was registered rather than occurred.

2. Figures for 2015 to 2021 are final. Figures for 2022 are provisional.

3. "Care home deaths" refers to all deaths where the death occurred in a care home (Excel, 29.8KB).

4. Figures for England and Wales exclude deaths of non-residents.

5. Figures for Scotland and Northern Ireland include deaths of non-residents.

6. The International Classification of Diseases 10th Edition (ICD-10) definitions are available.

Download the data

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For all four nations, dementia and Alzheimer disease was the leading cause of death in care homes for both males and females every year since 2015. This accounted for a higher proportion of deaths registered in care homes for females compared with males. The proportion of deaths where dementia and Alzheimer disease was cited as the leading cause has remained stable. It decreased to its lowest point in 2020 for males in all nations (England: 27.8%, Wales: 29.1%, Scotland: 22.9%, Northern Ireland: 26.5%) and for females in Scotland (30.8%) and Northern Ireland (37.6%) (Figure 5).

In 2020 and 2021, coronavirus (COVID-19) was the second leading cause of death in care homes for males and females in England, Wales, and Northern Ireland. For Scotland, COVID-19 was the second leading cause of death for males and females in 2020 only. In 2021, COVID-19 was the third leading cause of death for female care home deaths but was not present in the top three leading causes of death for males in Scotland.

When broken down by age groups, dementia and Alzheimer disease is the leading cause of death in males and females aged 65 to 74 years, 75 to 84 years, and 85 years and over in England, Wales, and Northern Ireland. This trend encompasses all years from 2015 to 2022. For Scotland, dementia and Alzheimer disease is the leading cause of death in those aged 75 to 84 years and aged 85 years and over only from 2015 to 2022. In all four nations, the leading cause of death for those aged 0 to 64 years varies. This is most likely to be because of the low counts of deaths registered in care homes for this age group.

Further breakdowns of leading cause of death are available in our accompanying dataset.

Care home deaths

The term "care home deaths" used in this article refers to all deaths registered where the place of death was recorded as a care home. This should not be confused with the term "care home resident deaths" which includes all deaths where either the death occurred in a care home, or the death occurred elsewhere but the place of residence of the deceased was recorded as a care home. For care home definitions, refer to Table 2: Definitional and reporting differences between England, Wales, Scotland and Northern Ireland (Excel, 29.7KB).

Coronavirus (COVID-19)

COVID-19 refers to the "coronavirus disease 2019" that can affect the lungs and airways. It is caused by a type of coronavirus.

Deaths involving COVID-19

The term "involving COVID-19" refers to deaths that had COVID-19 mentioned anywhere on the death certificate.

This article provides information concerning deaths in care homes registered from 2015 to 2022. When interpreting these mortality statistics, please note that: 

• death statistics are compiled from information supplied when deaths are certified and registered as part of civil registration, a legal requirement 

• this release provides summary figures on selected leading causes of death, where individual causes are aggregated using a list developed by the World Health Organisation (WHO), and then modified for use

• caution should be taken in the interpretation of these analyses because of the differences in the type of care home and services provided between each nation. This is because of the devolved nature of adult social care in the UK

There are differing week endings across the four nations; see Table 3: Definitional and reporting differences between England, Wales, Scotland and Northern Ireland (Excel, 29.7KB). There are also different bank holidays, with Scotland and Northern Ireland having additional bank holidays. This may affect the ability to directly compare deaths in care homes across the four nations week-on-week.

Collaboration 

In the development of this article, we have worked with departments across the UK including the Welsh Government, the National Records of Scotland (NRS) and the Northern Ireland Statistics Research Agency (NISRA). We also worked with the care inspectorates for each nation, including the Care Quality Commission (England), the Care Inspectorate Wales (Wales), the Care Inspectorate for Scotland (Scotland), and the Regulation and Quality Improvement Authority (Northern Ireland).

Analysis of care home deaths for England and Wales is published by the Office for National Statistics (ONS), while analysis of care home deaths in Scotland and Northern Ireland are published by NRS and NISRA, respectively.

ONS

For further information on care home deaths data in England and Wales, see our Deaths of care home residents, England and Wales QMI and our Deaths of care home residents: quality assurance of administrative data methodology.

NRS

For further information on the production of death statistics in Scotland refer to the Deaths – Background Information web page and the Quality of National Records of Scotland Data on Deaths web page.

NISRA

For further information on collection, quality and analysis of death data in Northern Ireland, refer to the Quality Assurance of Administrative Data (QAAD) for Deaths Data in Northern Ireland web page, the Northern Ireland Deaths Background Quality Report and the Cause of Death Information in Northern Ireland: A user guide (PDF, 743KB).

While a UK-wide statistic on deaths registered in care homes is not possible at this time, work is ongoing to address the UK-wide evidence gaps outlined in the reviews by the Office for Statistics Regulation (OSR).

A social care landscape interactive tool is now available, where official statistics relating to adult social care from all four nations are compiled and compared.