COVID-19 deaths in U.S. nursing homes almost doubled during a four-week period ending in mid-September, with more than 2,100 dying over the course of roughly a month, according to a new analysis of government data by AARP. As infections and fatalities climbed, vaccinations among nursing home workers continued to lag, with only 67 percent of workers nationwide fully vaccinated as of Sept. 19.
Staffing shortages in nursing homes, the analysis found, also increased, reaching levels comparable to last winter, when the nursing home COVID crisis was at its worst.
While the COVID-19 death toll among residents in AARP’s latest four-week analysis is only around one-tenth what it was during last winter’s peak, it represents the highest four-week total since March. In just a month, the death rate jumped from around 1 in every 1,000 residents dying from the virus to 1 in every 520. Since midsummer, when the death rate hit a low of around 1 in every 3,000 residents, it has increased more than sixfold.
“It may seem low compared to the course of the pandemic” says AARP's Ari Houser, a senior methods adviser and coauthor of AARP’s monthly analysis on COVID-19 in nursing homes, “but more than 2,000 people dying from COVID in just one month is not a small number.
“Deaths and cases have risen significantly in the past few months, showing the pandemic is far from over.”
COVID-19 has killed an estimated 150,000-plus nursing home residents, accounting for more than a fifth of the U.S. death toll from the pandemic. As deaths rose in recent weeks, so did new resident infections, which topped 20,000 in the four weeks ending Sept. 19 — an increase of about 50 percent from the previous four-week reporting period that ended Aug. 22.
Staff member cases followed a similar trend, with new cases topping 27,000, up from 22,000 in the previous four-week period. Resident and staff infections are up about 10-fold since midsummer.
The virus also spread to more facilities than in previous months, with 27 percent of nursing homes nationwide reporting new COVID-19 infections among residents and more than 61 percent reporting new staff cases, the new analysis found. During the midsummer lows, only 4 percent of facilities reported new resident cases and only 14 percent reported new staff cases.
Cases were concentrated among the unvaccinated, the analysis found, with residents who are not fully vaccinated more than twice as likely to contract the virus as those who are fully vaccinated. “In fact, rates of new cases among unvaccinated residents and staff are higher than they were one year ago,” Houser says.
Deaths, infections concentrated in certain states
The analysis tracked state-level data over the four weeks, showing that Oregon reported the highest rate of resident COVID-19 deaths: 1 in every 167 residents. West Virginia reported the highest rate of new resident infections, with around 1 in every 16 residents newly infected. And Alaska topped the rate of new staff infections, with around 1 staff member for every 13 residents newly infected.
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 Medicare.gov’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
Florida is reporting alarming figures in its more than 700 nursing homes for a second straight month. It had more resident deaths over the four-week period — about 300 — than any other state, as well as the most new resident infections (about 2,700 cases) and staff infections (about 2,800 cases). It reported the second-lowest staff vaccination rate of any state, with just 53 percent of workers fully vaccinated as of Sept. 20. (Only Louisiana reported a lower rate.) Florida also reported the lowest resident vaccination rate of any state, with just 74 percent of residents fully vaccinated.
Nationally, 67 percent of nursing home workers were fully inoculated as of Sept. 19, representing an increase of around 3 percent since the previous reporting period. Meanwhile, the number of fully vaccinated residents increased by 1 percent, to 85 percent.
President Joe Biden announced in mid-August that U.S. nursing homes that receive federal Medicare and Medicaid dollars must require their workers to be fully vaccinated against COVID-19. A deadline and other details for the federal requirement are yet to be announced, but some state governments and nursing home operators have already imposed their own mandates.
AARP has called on facilities to require both workers and residents to be fully vaccinated against COVID-19. Nancy A. LeaMond, AARP executive vice president and chief advocacy and engagement officer, urged a faster uptake in light of AARP’s new analysis. “Tragically, we are still seeing far too many infections and deaths in these facilities,” she says. “It is past time to vaccinate all staff and residents and prevent yet another wave of this virus from taking more lives.”
Worker shortages almost at their worst
The ratio of nursing homes reporting a shortage of nurses or aides jumped to almost 1 in 3 — the second worst on record for the pandemic — the new analysis found. Staffing shortages of this magnitude were last reported when COVID-19 was surging toward its winter peak in December and January.
The shortages are hitting some states particularly hard, including Alaska, Maine and Washington, where more than 60 percent of nursing homes reported not having enough staff. While the data doesn’t say what’s causing the shortages, likely factors are COVID-19’s current comeback via the delta variant, the growing number of vaccine mandates, and worker burnout, as highlighted in AARP’s analysis from last month.
The results are causing many industry stakeholders to revisit long-standing staffing issues in long-term care, such as low wages, limited career growth opportunities and a lack of enforceable minimum staff-to-resident ratios. AARP has supported several provisions in the reconciliation bill now before Congress to help address these issues and ensure residents are receiving quality care.
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.