Exclusive: Nearly Half of U.S. Nursing Homes Have Staff Infected With COVID-19

"While the pandemic has been unexpected to all of us, basic infection control should have been going on in nursing homes for a long time,” he says. “These are places where people are vulnerable to infection, whether it's COVID or something else, so for these facilities to still not have basic PPE, even now, with a deadly virus in the air, is outrageous and unacceptable.”

Staff infections nearly match resident infections

For months, providing adequate PPE and developing plans to mitigate staffing shortages have been “core principles” set out by the Centers for Disease Control and Prevention (CDC), for COVID-19 infection control in nursing homes, which generally house older adults with underlying conditions who are at increased risk of infection and severe illness from the disease. PPE helps stop the transfer of infectious droplets through the air, while adequate staffing ratios mean better care and less person-to-person contact.

Yet in 18 states, more than 30 percent of all nursing homes reported PPE shortages, and in 26 states and the District of Columbia, more than 30 percent of nursing homes are experiencing staff shortages. N95 respirators were the most in-demand PPE item across the country, with 11 percent of all nursing homes reporting shortages. And nursing home aides (certified nursing assistants, nurse aides, medication aides and medication technicians) were the most in-demand staff, with 27 percent of all nursing homes reporting shortages.

Just as alarming is the number of staff infections. The national total of COVID-19 cases among staff over the four weeks of data almost matched that of residents: 26,945 for staff versus 28,405 for residents. But only a quarter of all U.S. nursing homes reported resident cases within their facilities, meaning staff infections are far more widespread, present in double the amount of facilities.

Studies show that infected staff are one of the greatest drivers of infections among residents. Sweeney calls the staff COVID-19 infections a “truly a shocking issue.”

"These are folks who are not getting paid well at all, who don't have access to sick leave and who may be working between multiple homes to make ends meet, unknowingly transmitting the virus from nursing home to nursing home,” he says.

Many nursing assistants make less than $15 an hour, and there's high staff turnover. About 700,000 certified nursing assistants (CNAs) work at nursing homes, according to the National Association of Health Care Assistants, making up the overwhelming majority of care workers at nursing homes.

"I'm not blaming the staff — they're doing their very best — but I do blame the nursing home industry and companies that were too slow to provide the testing, the support and the compensation that's needed to attract and retain high-quality staff,” Sweeney says.

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 August 24 to September 20, in which 95 percent of the nation's 15,366 nursing homes submitted data for all four weeks.

The analysis focuses on five key COVID-19 categories — resident cases, resident deaths, PPE supply, staff cases and staff shortages — and only captures data from federally certified nursing homes, not all long-term facilities, as some other tallies do. Compared to COVID-19 cases and deaths, less attention has been paid to PPE supply, staffing levels and staff infections in nursing homes, due to limited available data. Going forward, AARP plans to release a new analysis on these five topics each month, as new federal data become available.