Sweden's Healthcare Inspectorate (IVO) was asked in June to review how the care sector had coped with the coronavirus after an earlier review exposed “serious flaws” in one in ten care homes.
This included sick care home residents not being given an individual doctor's assessment regarding their diagnosis and treatment, meaning that some were not given the appropriate care, according to IVO.
IVO's general director Sofia Wallström said that Sweden's care home deaths were primarily concentrated in 40 of the 290 municipalities.
“It is probably these municipalities that had problems with limiting the spread of infection and giving care to the elderly. It could also mean that the other 250 did something right — or that the spread of infection wasn't as significant, but there are some that had high spread of infection and still a low death toll,” she said.
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In 91 care homes, the problems were judged to be of such a serious nature that the inquiry will continue to investigate these facilities.
The watchdog strengthened their tip-off and reporting functions early on in the pandemic with the aim of “reducing the threshold” for care and medical workers to report problems.
They received around 4,400 tips, more than a third relating to the coronavirus outbreak and 171 of a “serious” nature according to Wallström. Of these, more than half related to the 40 worst affected municipalities.
One problem the watchdog raised was that some municipalities may have introduced unnecessarily strict measures in an early stage. As regions prepared for a heavy strain on hospitals and the medical sector, some issued instructions that the requirement for an individual doctor's assessment be removed for people living in care homes.
“In some cases these were never implemented, others took them away quite quickly, but it happened, and [authorities] went quite far at an early stage,” said Wallström. In some cases, this meant that decisions were made on a general basis, and were not the best option for the individual patient.
She added that over the course of the pandemic, municipalities have increased access to healthcare at home, mobile medical teams, and access to doctors in care homes.
In the 40 worst-hit municipalities, 40 percent of the municipalities said they were unable to give patients an individual doctor's assessment. In other municipalities, this figure was lower at around 30 percent.
Wallström named lack of individual assessment as one of the serious flaws.
“It's not surprising that there are several municipalities which have had problems handling this situation,” said Wallström, pointing to the wide scale of the outbreak.
“What's important from IVO's perspective is identifying which municipalities and which care homes had the most serious care homes, and we can act, but also need to understand what determines if things go better or worse.”
“Every avoidable death is a failure, every avoidable injury is a failure,” she said.
Health Minister Lena Hallengren said that a key task for Sweden's newly appointed coronavirus commission would be ascertaining what proportion of deaths could have been avoided.