Mortality Differences between Nursing Homes and Home Care in Europe

The Covid-19 pandemic has particularly affected the elderly living in facilities for dependent elder-care (EHPADs). The high mortality observed in these establishments raises the question of their role in the health of residents. In this article, we use data from the European SHARE survey to estimate whether there was excess mortality in EHPADs even before the pandemic. Controlling for a number of important attributes of the elderly population (socio-economic status, state of health, and the presence of potential informal caregivers) inside and outside EHPADs, we postulate that the difference in mortality between these two groups should be ascribed to the way in which these institutions are designed and administered. Using matching methods, we observe excess mortality in Belgium, Sweden, Germany, Switzerland, Estonia, and the Czech Republic, but not in France, the Netherlands, Denmark, Austria, Italy, or Spain. This raises the question of how these institutions are organized and managed, as well as how they are designed and funded.