Heat-related deaths in social care in England: can the Care Quality Commission ratings system be used to identify care homes that would benefit most from heat adaptation measures?

Background

The health impacts of rising temperatures in care home settings are of growing concern. We seek to characterise the risk of heat-related mortality in nursing and residential care home settings in England and to assess potential modification of heat effects by Care Quality Commission (CQC) ratings.

Methods

Heat episode analysis was used to assess excess mortality during the heatwave of 16–20 July 2022. Daily time-series regression analysis employing Distributed Lag Non-linear Models was used to assess short-term associations between daily mean temperature and daily number of deaths in care home residents during 2022–24, adjusting for season and day-of-week effects.

Results

Nursing home deaths increased by 34.1% (95% CI 21.1, 48.2) and residential care home deaths by 13.0% (0.1, 27.0) during the July 2022 heatwave. During 2022–24, the relative risk of death on a day of 25°C compared to a day of 16°C was 2.09 (95% CI 1.68, 2.60) among nursing home residents and 1.56 (1.24, 1.96) in residential care homes. There was a gradient of increasing heat-related mortality risk associated with poorer CQC rating, although almost all CQC categories were associated with raised risks. Heat-related mortality risk in care homes was greatest in the West Midlands and London regions.

Conclusions

Our findings indicate a growing need for heat stress to be recognised as an important risk factor for care home residents. Urgent and wide-scale improvements in heat adaptation strategies are needed in care homes across England to help improve the resilience of the social care system to climate change.