Norwegian version

Elderly care during the pandemic: Norway and Denmark stand out

Two nursing home employees wearing face masks and visors.

Heidi Gautun, a researcher at NOVA, recently participated in an extensive mapping process together with experts from several other European countries. The organiser of the study was Vilans, the national Centre of Expertise for Long-term Care in the Netherlands (see accompanying fact box).

Norway and Denmark stand out

Norway and Denmark distinguish themselves among countries in Europe. Both countries had few deaths, both among the population as a whole and in elderly care institutions.

Facts about the mapping project

Vilans, the national Centre of Expertise for Long-term Care in the Netherlands, has compared different European countries’ approach to elderly care throughout the COVID-19 pandemic.

The Netherlands, Belgium, Denmark, Sweden, Germany, France, the UK and Norway are included in the mapping, which was carried out from November 2020 to June 2021.

The centre collected data by reviewing publications in international forums. In addition, experts from the eight countries were invited to collect and contribute information that may increase the understanding of the authorities’ elderly care policy in the different countries.

"Norway and Denmark acted quickly and implemented a national lockdown at an early stage of the pandemic, thereby preventing any major infection outbreaks in society as a whole, as well as in the elderly care institutions."

This was particularly fortunate at the start of the pandemic, when nursing homes in many countries lacked infection control equipment and test equipment.

"Of the two countries, Norway compares favourably to Denmark. Even so, Norwegian nursing homes desperately need more resources. Many staff members have faced an increasing workload and a great deal of mental stress during this period,"

Relieved the hospitals

Gautun points out that there may also be other reasons why Norway fared so well.

"Norway stands out in that we have, to a large extent, transferred tasks from the specialist health service and hospitals to the municipal health and care services. We have competent municipalities that are used to adapting quickly and carrying out new tasks."

This means that the nursing homes have relieved the hospitals during the pandemic. Compared with other countries, Norway also has more nurses on staff at elderly care institutions, as well as nursing home physicians who visit the homes regularly.

Portrait of Heidi Gautun.

Research Professor Heidi Gautun. Photo: StudioVest / NOVA

"There are major differences in staff levels, expertise and available equipment between municipalities and nursing homes, but many Norwegian nursing homes have been better prepared to implement infection control measures, test, isolate and even treat COVID-19 patients than those in other countries."

For example, the high death rate in elderly care institutions in Sweden is due to a high infection rate in society at large, but also to a very low level of expertise and poor quality of elderly care.

Not enough attention paid to the nursing homes

However, there are several things that Norway could have done differently in relation to elderly care during the pandemic.

The most important differences between the countries

The countries largely followed the same course at the start of the pandemic, but the level of restrictions in long-term care differed and the restrictions were eased at different times.

Norway and Denmark stand out with less spread of infection and few deaths in elderly care as a result of COVID-19. Both countries implemented a national lockdown quickly, which may explain these countries’ fortunate results.

The UK was the only country that did not introduce a national ban on visiting nursing homes and only advised people to refrain from visiting. The other countries had national bans on visits at the start of the pandemic, but lifted them at different times.

Testing capacity was upscaled in most countries, but testing policy differed. In countries like Belgium and the UK, all staff and residents were tested, while in the Netherlands and Germany, only people with symptoms were to be tested.

"The central health authorities in both Norway and other countries weren’t very concerned with elderly care institutions at the start of the pandemic. They mostly focused on the hospitals," Gautun explains.

She emphasises that, particularly in the beginning, there was a pressing need to ensure that not only hospitals, but also nursing homes, had enough infection control and test equipment. The municipalities and elderly care institutions also needed knowledge and guidance on how to handle the pandemic.

"This was a national crisis. Although the municipalities are responsible for elderly care, the authorities should have taken more control at the national level and not left everything up to the individual municipality."

Ban on visits had major consequences

After a few weeks or months, all countries, with the exception of the UK, introduced a national ban on visits.

Particularly from summer 2020, all countries have had debates on the consequences of the national bans on visits to nursing homes.

"The ban on visits has had major negative consequences for residents and next of kin. Do these consequences make up for the positive effects, namely preventing infection, illness and death?" Gautun asks.

The mapping shows that the length of the ban varied from country to country. In Norway, the national ban on visits lasted from 1 April 2020 to 27 May 2020.

"However, the ban on visits was upheld in some places, even after it was lifted nationally. At the same time, throughout the pandemic, and even now, the central health authorities have ordered the municipalities to organise visits in compliance with infection control measures," she says.

The strictness of the nursing homes’ rules has varied.

Only Denmark is back to normal

In the final expert group meeting before the summer, it emerged that only Denmark’s nursing homes have returned completely to normal. They have lifted all restrictions on visits. Norway still has national guidelines, but with local variations.

Lessons for the next pandemic

  • Take a uniform approach to the entire health and care service. Maintain a high national alert level that also includes nursing homes; measures should not target hospitals alone.
  • Keep infection control equipment in stock in nursing homes.
  • Improve the basic staffing level, particularly for nursing staff. This will make nursing homes more flexible and better equipped to handle unforeseen situations.
  • Reduce the use of part-time positions, to prevent staff from having to work in several locations and spreading infection between institutions. Use the same temporary staff in the same nursing homes.
  • Avoid over-burdening the municipalities with rules and guidelines that are replaced from day to day.
  • Improve the buildings to be able to separate clean and unclean zones and therefore, better facilitate visits. It is a good idea for the individual institutions to have permanent kitchen and cleaning staff who are given infection control training.

"Whether these guidelines do the nursing home residents more harm than good is a matter for debate," says Gautun. 
She says that we have inadequate knowledge about when and to what extent the different municipalities have eased restrictions in nursing homes.

"We need to obtain an overview. We must ensure that this does not become the new normal."

Need more resources to get back to normal

Gautun underlines the importance of allowing nursing homes to get back on their feet.

She refers to a report by the Centre for Care Research in 2021 (omsorgsforskning.brage.unit.no). It concludes that not only have the nursing homes needed extra resources due to infection outbreaks and treatment of infected residents, but also because the nursing homes have spent so much time on infection control measures and facilitating visits.

Several maps have shown that nursing homes were very short on staff even before the pandemic.

"The workload was already significant. After what they’ve gone through over the past year and a half, there is a risk that even more staff want to resign from their nursing home jobs."

No bonuses for nurses in Norway

In many of the countries that participated in the mapping, nurses were given COVID bonuses because of their extra workload during the pandemic. This did not apply to nurses working in nursing homes in Norway.

"There are no such national schemes in Norway, but some municipalities have implemented their own schemes," says Gautun.

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Published: 22/10/2021
Last updated: 26/10/2021
Text: Heidi Ertzeid
Photo: Berit Roald / NTB