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Worker Shortages in Nursing Homes Hit Pandemic Peak as COVID-19 Deaths Continue

But an AARP analysis of federal data shows that staff vaccinations are up significantly


Nearly a third of the nation’s 15,000 nursing homes recently reported a shortage of nurses or aides, according to a new AARP analysis of government data, raising concerns about resident care at a time when many facilities are still battling COVID-19. The numbers represent the worst staffing shortages since the government began collecting COVID-19 data from nursing homes in May 2020.

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Thirty percent of U.S. nursing homes reported staff shortages during a four-week period ending in mid-October, the analysis found. It also showed that there were more than 2,000 resident deaths from COVID-19 for a second month in a row.

In more welcome news, the national rate of COVID-19 infections in nursing homes declined after rising for a few months. And the rate of fully vaccinated nursing home staff climbed significantly more than it has over the past few months, following the adoption of more vaccine mandates. “There’s some good and some not so good news in this month’s data,” says AARP's Ari Houser, a senior methods adviser and coauthor of the analysis.

Low staffing levels in nursing homes, particularly among registered nurses, are associated with worse outcomes for residents, including more COVID-19 cases, deaths and a higher likelihood of an outbreak.

“Even on [a nursing home’s] best day, if you’re fully staffed, things can still go wrong,” says Lori Porter, cofounder and CEO of the National Association of Health Care Assistants. “But things will definitely go wrong if you’re staffed at a third of what you need.”

Staffing shortages are hitting some states particularly hard. In Alaska, 81 percent of nursing homes reported shortages, the analysis found, the highest rate of any state. In Maine, Washington and Minnesota more than 60 percent of facilities reported staff shortages, while in Wyoming, Kansas, North Dakota, Oregon and Wisconsin, more than 50 percent did. 

Worker shortages at their worst

When the coronavirus was crushing nursing homes last winter — infecting more than 200,000 residents and staff and killing 20,000 in just one month — the number of facilities nationwide reporting staffing shortages sat just below 30 percent.

Check the vaccination rates of your nursing home  

You can now find vaccination rates of both residents and staff at any Medicare-certified nursing home and compare it with state and national averages on’s Care Compare website.

  • Find a nursing home’s profile via the home page’s search function
  • Visit the “Details” section of its profile
  • Click the “View COVID-19 Vaccination Rates” button

In the latest four-week reporting period for AARP’s ongoing monthly analysis of federal nursing home data, which ran from mid-September to mid-October, the share of facilities reporting such shortages topped 30 percent for the first time. At the same time, COVID-19 nursing home infections were less than a sixth of what they were last winter.

AARP’s analysis of data from the Centers for Medicare & Medicaid Services (CMS) doesn’t say what’s causing the staffing shortages. But likely factors include the recent rise of COVID-19 cases in nursing homes due to the delta variant and increased worker burnout.

Trade organizations representing nursing homes, including the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and LeadingAge, say that vaccine mandates, including a new federal mandate that gives nursing homes until Jan. 4 to have all their employees fully vaccinated, are also contributing to staff departures.

“A hard deadline with no resources for providers or glide path for unvaccinated workers is likely to push too many out the door and ultimately, threaten residents’ access to long-term care,” said Mark Parkinson, president and CEO of AHCA/NCAL, in a statement. “Even a small percentage of staff members leaving their jobs due to this mandate would have a disastrous impact on vulnerable seniors who need around-the-clock care.”

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Other nursing home experts note that long-standing workforce issues, such as low wages, lack of benefits and poor workplace culture, are likely coming to a head after a grueling 20 months for long-term care workers. More than 186,000 residents and staff have died from COVID-19 in nursing homes, assisted living facilities and other long-term care settings. The figure accounts for about one-quarter of the U.S.’s entire COVID-19 death toll.   

Trouble in Montana and Wyoming

While the national death rate is only around one-tenth of what it was during last winter’s surge, 2,000 COVID-19 deaths over four recent weeks represents a six-fold increase in deaths since early summer, when the death rate hit a low for 2021. Then, about 1 in every 3,000 residents were dying from the virus over the course of four weeks. In the most recent four weeks, nearly 1 of every 500 residents died.

In some states, the death toll is much worse. Montana and Wyoming experienced the highest rates of resident deaths, resident cases and staff cases since last winter’s peak.

In Montana, which clocked the worst death rate in the nation, about 1 in every 58 residents died from COVID-19 over the most recent four-week period in AARP’s analysis, and about 1 of every 14 residents contracted COVID-19. It also reported the highest rate of staff infections, with around 1 worker for every 11 residents testing positive for the virus. 

Wyoming, meanwhile, had the highest rate of resident infections, with around 1 in every 12 residents testing positive, and was second to Montana in resident deaths, with around 1 in every 65 residents dying from COVID-19.

Montana’s and Wyoming’s death and case rates “would not look out of place in that winter period, when we were at the peak,” says Houser. “Their rates are really off the charts compared to the rest of the country. All this despite 90 percent of residents being fully vaccinated in both states.”

A jump in jabs

The analysis also revealed some positive trends. The national rate of resident infections declined to about 1 new case per 70 residents, a decline of about one-quarter compared to the previous four-week reporting period, which ended Sept. 19. Cases are still rising in many parts of the country, however, in 17 states and Washington, D.C.

The national rate of new COVID-19 cases among staff also fell by about one-third, to about 1 worker case per 60 residents. At the state level, 13 states saw a rise in cases from the previous four-week reporting period.

The national COVID-19 vaccination rate among residents increased from 85 percent in mid-September to 86 percent in mid-October. “Vaccination rates for flu, which nursing homes have been campaigning for decades, top out at around 75 to 80 percent,” says Houser. “So, this is really an unprecedented high. But even in the top states, five percent of residents remain unvaccinated, so there’s still room for improvement. And many of those vaccinated are now due for boosters.”

Multiple studies show that some populations vaccinated against COVID-19 — especially those who are at higher risk of COVID-19 or were vaccinated during the earlier phases of the vaccination rollout — are seeing protection against disease dwindle. As a result, the Centers for Disease Control and Prevention now recommends those who live and work in long-term care settings receive a booster shot.

The national rate of fully vaccinated staff also climbed significantly more than it has over previous months, jumping 7 percentage points in October, from 67 percent last month to 74 percent. It’s the biggest monthly increase in staff vaccinations since AARP began analyzing vaccination data in June.

Staff vaccination rates exceeded 90 percent in California, Connecticut, Washington, D.C., Hawaii, Massachusetts, Maine and Rhode Island. “Seven states, including the largest state, reaching this level shows it’s an attainable goal,” says Houser.

Still, less than half of all U.S. nursing homes have achieved the industry benchmark of vaccinating 75 percent of their workforce. Thirty states are also behind on that benchmark. And in Louisiana, Michigan, Missouri and Oklahoma only 58 percent of staff are fully vaccinated.

Overall, more than 160,000 nursing home residents and nearly 500,000 direct care staff nationwide are still not fully vaccinated.

“The percentages of people unvaccinated may not seem huge,” says AARP's Susan Reinhard, coauthor of the analysis and senior vice president and director of the AARP Public Policy Institute.“ But when you turn them into whole figures — half a million workers — that’s a lot of unprotected people.”

“I think it puts into perspective that we have more work to do.”

AARP's 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. Most nursing homes are federally certified and required to submit data to the government each week.

The ongoing analysis captures data only from federally certified nursing homes, not from all long-term care facilities — such as assisted living, independent living, memory care and others — as some other tallies do. An updated analysis will be released next month as new federal data becomes available. Read more about the analysis.

Emily Paulin is a contributing writer who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.

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