En español | American nursing homes reported their highest COVID-19 death rate since they began submitting data to the government in late spring, a new AARP analysis of federal data shows. Over four weeks, from mid-October to mid-November, 8,436 residents died from the virus. Looking back to the beginning of June in four-week increments, the previous peak was 8,009 resident deaths, captured from June 1 to June 28.
"It's beyond outrageous at this point,” says AARP's Bill Sweeney, senior vice president of government affairs, of the new figures. “We expected that cases would probably go up as the weather got colder, but these numbers are out of this world. It's extremely upsetting.”
What's more, he says, is that the worst is yet to come, given the soaring COVID-19 infection rates that the AARP analysis also found. The latest monthly case rates smash through previous highs, with more than 61,000 new resident cases and more than 58,000 new staff cases reported from mid-October to mid-November.
New infections for both nursing home residents and staff members doubled from the previous four-week reporting period and easily surpassed the nation's former four-week highs of nearly 38,000 new cases for residents, and more than 41,000 new cases for staff, both from mid-summer. Given the time lag that occurs between case surges and increases in reported deaths, Sweeney anticipates — with support from experts — that the death rate will continue to rise.
"We're on track to be in a devastating place in a couple of months,” Sweeney says, noting that the effects of the Thanksgiving holiday are yet to be analyzed by AARP. “I'm worried about how many people in nursing homes are going to lose their lives over the holiday season. It's going to be a really awful situation for families, and it just didn't have to be this way.”
The worst recorded rate of staffing shortages among U.S. nursing homes throughout the pandemic was also from mid-October to mid-November, with 29 percent of facilities reporting a shortage of direct care workers (nurses and/or aides). Supplies of personal protective equipment (PPE) was the only category of the analysis that saw improvements, with the number of nursing homes reporting less than a one-week supply of N95 respirators, surgical masks, eye protection, gowns and gloves dropping to less than one-fifth.
A stack of struggling states
Alongside the alarming nationwide findings, a stack of individual states in the Midwest and West saw dire trends of their own, the analysis shows.
Montana, North Dakota, South Dakota, Wisconsin and Wyoming reported record-breaking rates of resident deaths, resident cases and staff cases that exceed the highest rates reported by any state in any of the previous four-week reporting periods going back to June 1.
South Dakota's situation proved particularly devastating in the latest reporting period, with the state clocking the highest resident death rate and case rate in the nation. Nearly a quarter of all nursing home residents in South Dakota contracted the virus from mid-October to mid-November, according to the analysis, and nearly 1 in every 20 residents died from it.
The analysis also identified a list of surge states — including Colorado, Iowa, Illinois, Nebraska, New Mexico and Ohio — that experienced double the amount of resident deaths, resident infections and staff infections from mid-October to mid-November, when compared with the previous month. Their skyrocketing rates have put them all above the national average in all three categories.
Some other states — including Arkansas, Indiana, Kansas, Kentucky, Minnesota, Missouri, North Dakota and Tennessee — didn't see a doubling of their deaths and cases in the most recent month. This was, in large part, because their rates rose so rapidly between mid-September and mid-October that they are still seeing increases and tracking above the national averages.
North Dakota, which reported the highest monthly staff infection rate from mid-September to mid-October, more than doubled that rate between mid-October and mid-November; for every four nursing home residents in the state, there is one staff member infected with COVID-19, the analysis shows.
As for five Sunbelt states — Alabama, Arizona, Georgia, Mississippi and Texas — their death and case trends are no longer in decline, as they have been for the past few months since overcoming severe summer peaks. Instead, cases and deaths are rising again — and quickly. In Georgia, for instance, both the monthly death rate and case rate among residents doubled from the mid-September-to-mid-October reporting period and also from the one from mid-October to mid-November.
Are we in the clear yet?
Given the calamity occurring in long-term care facilities — which have experienced more than 106,000 deaths among residents and staff throughout the pandemic, or roughly 40 percent of the nation's COVID-19 death toll — residents and staff are looking toward the COVID-19 vaccine for relief.
On Dec. 10, a vaccine advisory committee voted in favor of granting emergency use authorization to Pfizer’s vaccine, which was found to be 95 percent effective in late-stage trials. The CDC has recommended that the limited number of first-round doses should go to long-term care residents and staff, in addition to health care workers, if the U.S. Food and Drug Administration officially issues emergency authorization, which it is expected to on Dec. 12.
But AARP's Sweeney warns that vaccines are not yet solving long-term care community problems — and may not for a while.
"We're seeing so much excitement around the globe about the vaccine, but the vaccine may still be months away for people in long-term care,” he says. “As we're seeing in this four-week snapshot, the number of people who could lose their lives while waiting for a vaccine is truly stunning.
"The things we all do in our daily lives to prevent the community spread of COVID will also prevent the spread of it in nursing homes,” Sweeney continues, highlighting the strong correlation between increased community transmission of the virus and increased nursing home outbreaks. “So, it's really on each of us to maintain social distancing, wear masks and take care in order to save lives.”
The analysis, conducted by the AARP 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 & 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 six consecutive four-week periods — June 1 to June 28, June 29 to July 25, July 26 to Aug. 23, Aug. 24 to Sept. 20, Sept. 21 to Oct. 18 and Oct. 19 to Nov. 15 — 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 categories of COVID-19 impacts — resident cases, resident deaths, supply of PPE, 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 third in a series of monthly AARP analyses. An updated analysis will be released next month, as new federal data becomes available.