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.