En español | More than six months after the coronavirus began its deadly rampage through American nursing homes, where it has claimed tens of thousands of lives, more than a quarter of facilities nationwide are reporting shortages of personal protective equipment (PPE) and staff, and almost half have staff infected with COVID-19, an exclusive new AARP analysis of recent government data shows.
In some states, the numbers are much worse. In Maine, New Mexico and New Hampshire, for example, at least half of nursing homes reported insufficient PPE, defined as having less than a one-week supply of N95 respirators, surgical masks, eye protection, gowns and gloves.
In South Dakota and Kansas, more than half of nursing homes reported a shortage of nurses, aides or both, based on their facility's needs and policies for staffing ratios. And in Alabama, Tennessee and Florida, more than 70 percent of nursing homes reported COVID-19 infections among staff.
The new analysis draws on self-reported data from nursing homes collected by the federal government over four weeks from late August to late September. While some states fared much worse than others, all 50 states and the District of Columbia had one or more nursing homes that reported inadequate PPE supply, staff shortages, staff infections and resident cases. Forty-seven states reported at least one COVID-19 death among residents.
The analysis found that more than 28,000 residents tested positive for COVID-19 during the four-week reporting period, and more than 5,200 residents died, showing that the virus is still raging in nursing homes. More than 84,000 long-term care residents and staff have died since January, and more than 500,000 residents and staff have contracted the disease, according to the Kaiser Family Foundation's tally, accounting for roughly 40 percent of the national death toll. Long-term care providers include assisted living, adult day care centers and more, while AARP's new analysis features just nursing home data.
"This is a nationwide crisis, and no state is doing a good job,” says Bill Sweeney, AARP's senior vice president of government affairs, adding that the results of AARP's analysis are “profoundly disappointing.”
"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.