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Exclusive: Nursing Home Cases Skyrocket in 12 States Where COVID Is Surging

National nursing home case count also ticking up for the first time in months

Female nursing home resident getting a covid test from a worker wearing p p e

Tempura/Getty Images

En español | COVID-19 infections in America's nursing homes are back on the rise, according to an exclusive new AARP analysis of government data, with a dozen states concentrated in the Midwest and West experiencing sharp upticks. While resident and staff infections have risen by 8 percent nationally between late September and late October, these 12 surging states have seen nursing home resident cases spike by 40 percent or more, while nursing home staff infections have ballooned by at least a third.

More than half of the nation's 15,000-plus nursing homes are reporting COVID-19 infections of one or more staff members, the analysis shows, with more than a quarter reporting infections in at least one resident. Since a similar AARP analysis a month ago, almost 600 more facilities are reporting new staff infections and more than 200 are reporting new resident infections.

The U.S. had seen a decline in nursing home cases and deaths in the final weeks of summer and early weeks of fall. The new increase in spread suggests that nursing homes are feeling the effects of the surging community transmission that's occurring all over the country.

The upward infection trends are “terrible news” and “really shocking and truly outrageous,” says Bill Sweeney, AARP's senior vice president of government affairs, given the turmoil that long-term care has already been through.

Long-term care facilities, including nursing homes, assisted living, adult day centers and others, have experienced more than 91,000 resident and staff deaths since January — roughly 40 percent of the national death toll — according to the Kaiser Family Foundation's tally. More than 600,000 residents and staff have contracted the disease.


Trouble in the Midwest

The new analysis, which captures data from three four-week intervals between July and October, found that the 12 surging states — Delaware, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, North Dakota, South Dakota, Wisconsin and Wyoming — had each at least doubled their COVID-19 infections among nursing home residents and staff over that period and are now tracking above the national averages in both categories.

In Montana, the surge has been huge, with resident cases increasing 32-fold from the July-August reporting period to the September-October period; seven infections monthly leaped to 207. In Delaware, resident cases jumped 13-fold, from 14 to 179. Missouri, which was already tracking above the national average in resident infections in July-August, still reported a doubling of resident cases from then to September-October, climbing from 1,196 to 2,481.

In South Dakota, staff infections soared, increasing sevenfold from the July-August reporting period to the September-October one; 51 cases jumped to 363. North Dakota, which was already tracking above the national average in staff infections in July-August, more than tripled its staff infections in the September-October reporting period; 165 cases moved to 578. The state is now clocking the highest staff infection rate in the country: 12.5 infected staff per 100 residents.

The increases in staff infections appear to go hand-in-hand with increases in staff shortages. All 12 states with surging staff cases saw increases in the percentage of facilities reporting such shortages. In North Dakota, the number of nursing homes experiencing staffing shortages jumped from 35 percent in the July-August reporting period to 55 percent in the September-October one.

“It's a real warning sign, these increases in the Midwest, for states not to get complacent,” says Sweeney. “This virus is not over yet. It’s still killing hundreds of people every day, and those lives should not be lost in vain.” 

Community spread leads to nursing homes

The analysis shows dramatic differences in the results across states. While some Midwestern states are reporting increased infections, some Sunbelt states that saw drastic increases in infection in the summer reported declines in September and October. But many nursing home experts, medical professionals and resident advocates warn that what's happening in the surging states is a sign of things to come. With all states trending upward in new COVID-19 cases, it may be a matter of time before similar surges start occurring in nursing homes all over the country.

"The virus gets introduced into these facilities through community networks of transmission,” says Justin Lessler, an associate professor of epidemiology at the John Hopkins Bloomberg School of Public Health. “So, if the virus is transmitting more efficiently in the community, no matter what measures we take to protect these facilities, the chance of the virus getting in is going to increase because the people who work there, and visitors — they're all more likely to become infected."


Winter's cold weather is predicted to further fuel the spread of the virus. “We know that the weather will force people inside,” Lessler says, “and we know the virus transmits more efficiently when people are in close quarters, and the way air moves inside may also contribute to transmission."

The AARP analysis shows that the 12 surging states are faring much worse than others, but many states tracking below the national averages in nursing home infections still have cause for concern. In Rhode Island, resident infections are still tracking below the national average. But from the July-August reporting period to the September-October period, the rate of infection more than doubled; 77 cases jumped to 171.

"The pandemic is ever changing,” Sweeney says. “Dramatic shifts are occurring … the states that are appearing to be doing well this month may not be in the same place next month."

The analysis, conducted by AARP's Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio, draws primarily on data acquired from the Nursing Home COVID-19 Public File by the Centers for Medicare and Medicaid Services (CMS). Nursing homes are federally certified and are required to submit data to the government each week. The AARP analysis uses data from three consecutive four-week periods — July 26 to Aug. 23, Aug. 24 to Sept. 20, and Sept. 21 to Oct. 18 — in which around 95 percent of the nation's 15,000-plus nursing homes submitted data for each reporting period.

The analysis focuses on five key COVID-19 categories — resident cases, resident deaths, supply of personal protective equipment, staff cases and staff shortages — and only captures data from federally certified nursing homes, not all long-term facilities, as some other tallies do. This is the second in a series of monthly AARP analyses. An update on these key COVID-19 categories will be released next month, as new federal data becomes available.

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