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COVID Surges Again in Nursing Homes, Mostly Among Unvaccinated, Analysis Finds

Where vaccination is low, cases are high and staffing shortages worsen

COVID-19 cases in U.S. nursing homes increased sixfold from mid-July to late August, to their highest levels since last winter’s horrific peaks, a new analysis of government data by AARP finds. It shows that cases were concentrated among the unvaccinated, with residents who were not fully vaccinated three times as likely to contract the virus as those fully vaccinated. As cases surged, so did staffing shortages, which also hit their highest levels since winter.

“This data shows that we’re certainly not finished with COVID, unfortunately,” says AARP's Susan Reinhard, senior vice president and director of the AARP Public Policy Institute and coauthor of the analysis. “We must keep attention on our nursing homes and not let the focus shift.”

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Resident deaths also jumped, tripling from about 1 in every 3,000 residents in the four weeks ending July 18 to about 1 in every 1,000 residents in the four weeks ending Aug. 22.

The analysis found that infections hit unvaccinated residents the hardest, mirroring how COVID-19 is spreading in general. Among those who were not fully vaccinated, about 1 in every 37 contracted the virus over the most recent four-week reporting period. Residents who aren’t fully vaccinated were three times as likely to contract COVID-19 as those who are fully vaccinated.

As a result, the unvaccinated in nursing homes face a similar likelihood of contracting the virus as they did in the summer of 2020, when COVID-19 vaccines were not yet available, the analysis reported. This time, the delta variant — which is more contagious and harmful than last year’s dominant alpha variant — is more likely to be the infector.

The findings are from AARP’s latest monthly analyses of COVID-19 data reported by the nation’s approximately 15,000 nursing homes to the Centers for Medicare & Medicaid Services (CMS). In the four weeks ending Aug. 22, around 1 in every 80 residents — vaccinated and unvaccinated — tested newly positive for the virus, while around 1 worker for every 50 residents did the same.

At least 150,000 nursing home residents have died from COVID-19 during the pandemic. In long-term care defined more broadly, including assisted living and other senior care facilities, more than 186,000 COVID-19 deaths among residents and staff have been reported, according to the Kaiser Family Foundation. That’s almost a third of the nation’s total COVID-19 fatalities.

Where vaccination is low, cases are high

Nationally, 84 percent of residents were fully vaccinated as of Aug. 22, AARP’s latest analysis found, but just 64 percent of workers were. In some states and facilities, the rates are much lower. In places with low staff vaccination rates, resident vaccination rates tend to be lower, too.

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“That really opens the door to infections,” says AARP's Ari Houser, a senior methods adviser and coauthor of the analysis.

Florida, which is home to more than 700 nursing homes, reported the second-lowest staff vaccination rate in the country, at 49 percent, and the third-lowest resident vaccination rate, at 74 percent. The state also reported the highest rate of resident cases and the second highest rate of staff cases in the country, the analysis found. About 1 of every 4 resident cases and roughly 1 of every 5 staff cases nationwide were in Florida, along with 1 of every 5 resident deaths.

“It’s bad across the board,” says Houser about the Sunshine State.“Remember, Florida is a very large state in terms of nursing home population. In small states, a few nursing home outbreaks can drive very high results. But Florida is big, which means a lot of nursing homes are being affected by COVID.”

Staffing shortages worsen

The percentage of nursing homes reporting a shortage of nurses or aides jumped to 27 percent from the previous monthlong period, the analysis found. This is the highest rate since late January, when COVID-19 was at its worst in nursing homes. The data doesn’t say what the cause is, but COVID’s comeback and new vaccine mandates are likely factors.

An increase in staff cases is likely to have an effect because infected staff can’t work, says AARP’s Houser. “But staff cases have been much higher over the course of the pandemic, so we can’t just attribute this to rising cases,” he says, pointing to other reasons, such as pandemic fatigue, that might be contributing. “After working under pandemic conditions for more than a year, and now with COVID-19 coming back, that can be demoralizing.”

What may also be contributing to shortages, Houser suggests, is the growing number of vaccine mandates. Nursing homes, some state governments and the federal government have recently announced such requirements for nursing home workers, which may have led to resignations among the vaccine-hesitant.

Washington state announced in early August that nursing home workers there must be vaccinated against COVID-19 by Oct. 18. The number of facilities experiencing staffing shortages jumped from 52 percent for AARP’s last reporting period to 57 percent — the worst in the country — for the most recent period, even though the staff infection rate is only slightly above the national average.

AARP called for mandatory COVID-19 vaccinations for nursing home workers and residents in mid-August, amid rising nursing home cases. "As the new variants are emerging, facilities cannot let preventable problems be repeated,” says Nancy LeaMond, AARP executive vice president and chief advocacy and engagement officer.

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 are 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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