Why keeping care homes open matters: lessons from Covid-19 for local authorities and care providers

By Igor Shagalov and Leonid Polishchuk

The Covid-19 pandemic placed extraordinary strain on adult social care. Few areas were hit harder than care homes, which experienced more than a fifth of all UK Covid-related deaths. Alongside the clinical risks, residents faced strict lockdowns, prolonged isolation, and separation from their families, often with devastating consequences for their wellbeing.

As local authorities and providers look ahead to future resilience planning, an important lesson from the pandemic is now becoming clearer: care homes that allowed safe visits and maintained community links had significantly better outcomes than those that closed their doors completely. New evidence, including our own analysis of more than 8,000 English care homes, suggests that openness and family involvement were not simply “nice to have” — they were protective.

This has important implications for local authorities’ commissioning, regulation, safeguarding, and preparedness responsibilities.

What happened when care homes closed?

During 2020–21, care homes across England were strongly advised to restrict or fully suspend visits from relatives, friends and volunteers. While these measures aimed to prevent infection, they also created unintended harms:

Residents experienced rapid physical and mental decline, often visible only when visits resumed.

Families were unable to monitor care quality, raise concerns or provide essential emotional support.

Staff shortages intensified without help from “essential caregivers” who often play a vital informal role.

Homes became more isolated from the community networks that normally help keep practice transparent and safe.

Civil society groups, including John’s Campaign, repeatedly highlighted these risks. Many relatives felt that blanket bans infringed residents’ rights and ignored the realities of social care, where wellbeing depends as much on relationships as on clinical care.

What the evidence shows: openness protected residents

Our analysis of mortality across English care homes between 2020 and 2022 adds new evidence to this debate. We compared outcomes for homes that followed strict closure policies with those that maintained some form of visiting, even limited or highly controlled.

The findings are striking:

Care homes that allowed visits had 21% lower mortality than homes that remained closed.

In communities with higher trust and cohesion, the benefits were even greater — around one-third lower mortality in open homes located in these areas.

These differences remained even after accounting for key characteristics such as home size and staffing levels.

This does not mean that precautions were unnecessary, or that opening was risk-free. But it does show that complete closure came with significant health and wellbeing costs — and may have worsened outcomes for many residents.

Why openness matters for care quality and safety

Several practical mechanisms help explain why maintaining connections produced better results:

1. Essential emotional and social support

Visits from family and friends help maintain cognitive and physical functioning. Residents who remained connected were less likely to experience the severe loneliness and decline reported in fully locked-down homes.

2. Informal care and help with basic needs

Essential caregivers often support feeding, mobility, personal care and reassurance — tasks that were extremely difficult to cover during staff shortages, sickness absences and high turnover.

3. Natural oversight and safeguarding

Visitors act as an informal but vital protective factor. Their presence helps spot early signs of neglect or deterioration and reinforces good practice. In closed homes, these safeguards disappeared.

4. Stronger community relationships

In areas where people trust one another and local networks are active, community involvement amplified the positive effects. Homes benefitted from volunteers, local organisations and stronger partnerships with families.

For ADASS members, particularly those involved in commissioning, quality assurance and safeguarding, these findings highlight the importance of protecting visiting rights and enabling community support even in crisis situations.

What this means for local authorities

Local authorities have a central role in shaping the visiting landscape in care homes, both during emergencies and in routine practice. The pandemic showed that inconsistent guidance and risk-averse interpretations often resulted in over-protection at the expense of residents’ wellbeing.

Going forward, local authorities can strengthen resilience by:

1. Embedding family and caregiver involvement into emergency plans

Relatives and essential caregivers should be recognised as partners in care, not discretionary visitors. Local guidance should reflect this and support providers to maintain safe access wherever possible.

2. Supporting providers to balance infection control with residents’ rights

During crises, decision-making must avoid defaulting to full closure. Instead, local authorities can help providers develop proportionate, flexible approaches: scheduled visits, testing protocols, designated caregiver schemes, outdoor visits and use of PPE.

3. Using social capital and community activity as part of risk assessment

Areas with strong community cohesion may be better positioned to sustain safe openness. Local authorities can incorporate these factors into planning and support providers accordingly.

4. Strengthening community partnerships

Voluntary organisations, faith groups, local charities and neighbourhood networks can play a major role in supporting care homes — particularly when staff capacity is stretched. Embedding these relationships before a crisis makes mobilisation much easier when pressures arise.

5. Reflecting openness and community involvement in commissioning frameworks

Specifications and monitoring approaches can explicitly recognise the value of maintaining resident-family connections and community participation. These can become part of quality assurance, not just emergency response.

What providers can take forward

For care homes, the pandemic demonstrated that wellbeing and safety are inseparable. Providers can integrate this learning by:

Developing visiting policies that assume access by default, with restrictions used only when clearly necessary.

Building family partnership policies, including essential caregiver schemes and shared decision-making.

Strengthening links with local organisations who can support activity, mental stimulation, advocacy and companionship.

Training staff to work collaboratively with families, even in complex or high-risk periods.

Many homes that maintained openness during Covid did so through creativity, flexibility and determination — lessons that can inform sector-wide improvements.

Looking ahead: a more balanced approach to risk

The sector’s experience during Covid-19 shows that protecting residents requires more than infection control. Psychological wellbeing, family contact, community support and transparency are equally vital to safety.

For future emergencies, a more balanced risk approach is needed — one that considers both the dangers of infection and the harms of isolation. The evidence indicates that when families and communities remain involved, outcomes are better, and homes are more resilient.

As local authorities and providers plan for future crises, the priority should be clear:

keep care homes safely open wherever possible and treat families and communities as essential partners in care.

About the authors

Dr Igor Shagalov is a Research Associate at the Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science. His work focuses on social care and health policy, including care home markets, regulation and community involvement.

Dr Leonid Polishchuk is a Research Associate at Indiana University. He is an economist specialising in institutions, governance and social trust.