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COVID-19 Deaths in Nursing Homes Plummet, Staff and PPE Shortages Persist

Infection and death rates are still higher than those of summer 2020, an exclusive AARP analysis finds

New COVID-19 cases and deaths in U.S. nursing homes have declined significantly from their winter peaks, but the numbers are still higher than during last summer’s surge, and staffing and personal protective equipment (PPE) shortages persist, according to a new analysis of federal data by AARP.

Over four weeks between mid-January and mid-February, 1 in every 100 nursing home residents — more than 10,000 people — died, the analysis found. It’s a sobering figure but represents about half the death rate of the previous four-week period, which ran from mid-December to mid-January.

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New COVID-19 cases in nursing homes also fell. New resident cases were cut by more than half, with the infection rate among residents dropping to 3.5 cases per 100 residents in the January-to-February period, down from more than 9 cases per 100 residents in December and January. New staff cases also declined by more than half.

Still, the COVID-19 death rate among residents for the latest reporting period is more than twice the rate reported between mid-August and mid-September of 2020. And the most recent case rates are about 30 percent higher than the rates during that period from last summer.

While shortages of staff and PPE decreased slightly from the previous monthly period, around 1 in 9 nursing homes still reported not having a week’s supply of PPE. More than 1 in 4 nursing homes reported a shortage of nurses or aides.

Residents and staff in long-term care have suffered almost 175,000 deaths over the course of the pandemic, according to the COVID-19 Tracking Project, accounting for about 35 percent of COVID deaths.  

“We’re not out of the woods yet,” says Rhonda Richards, AARP’s senior legislative representative, of the new analysis. “Continued infection control is really important to prevent against possible future outbreaks and ensure the continued well-being of residents.”

Vaccinations and herd immunity

The declines in COVID-19 cases and deaths are consistent across nearly all states, the analysis found. A combination of the newly authorized COVID-19 vaccines, tighter state and county restrictions over the winter, and high levels of natural herd immunity within nursing homes all appear to be contributing factors.

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A federal program tasked with vaccinating the majority of America’s long-term care residents and staff is slated to wrap up at the end of the month. Uptake among residents appears to be high, according to a survey by the Centers for Disease Control and Prevention, while staff uptake was much lower

The new analysis paints a clear picture that “the vaccine is making a difference,” says Mike Wasserman, a geriatrician and past president of the California Association of Long Term Care Medicine. “The risk of transmission appears to be dramatically reduced,” he says, “as is the risk of severe illness is you are vaccinated.”

Many facilities have likely developed some herd immunity, with almost 1.2 million infections reported in nursing homes over the course of the pandemic, according to data from the federal Centers for Medicare & Medicaid Services (CMS). 

“The current decline began before there were a meaningful number of people protected by the vaccines,” says AARP’s Ari Houser, a coauthor of the new analysis. “That’s largely due to the virus burning through affected nursing homes over the last few months, as we have seen in previous spikes. So many people have already gotten COVID that we have reached a point where the pool of people in nursing homes who can get newly infected is much smaller,” he says, adding that “vaccines have likely steepened the decline only in the last few weeks.”

While the declines are welcome, Jennifer Schrack, an associate professor at the Johns Hopkins Bloomberg School of Public Health who specializes in the epidemiology of aging, says that there are still many unknowns around COVID-19 in long-term care settings. “People have to remember that this is still a new disease,” she says. 

“We don’t know how it’s going to behave. We don’t know how variants are going to behave. It still remains to be seen whether older people, such as nursing home residents, take to the vaccines as well as other people.

The recent drops in cases and deaths are “very encouraging,” Schrack adds, “but [the virus] is not gone. It’s OK to be optimistic, but we still have to be diligent.” 

Because nursing home residents tend to be at higher risk of severe illness and death from COVID-19, facilities should continue to take extra precautions, she says. That includes mask wearing, social distancing and regular screening and testing for COVID-19.

But AARP’s analysis found that PPE and staffing shortages persist in nursing homes. Some states fared worse than others, with 33 percent of facilities in Maine reporting a lack of PPE and 46 percent of facilities in Kentucky reporting a lack of staff.

“At this point, over a year into the pandemic, all facilities should have the PPE they need to prevent the spread of the virus,” says AARP’s Richards. AARP has called for the federal government to work with states to “ensure that every facility has access to personal protective equipment and testing and is taking additional steps to help ensure the correct and consistent use of PPE.”

Richards says that quality care and proper infection control can’t be implemented without enough staff, noting that long-term staffing shortages have only been exacerbated by the pandemic, at a time when adequate staffing is needed most. 

“The staff are the ones who care for residents — if they’re not there, or they’re overburdened from being the only one there — early warning signs of COVID infections may get missed,” she says. “Then, if a resident does come down with COVID, staff are critical to providing that additional needed 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 CMS. Nursing homes are federally certified and are required to submit data to the government each week. 

The ongoing analysis focuses on five key categories of COVID-19 impacts: resident cases, resident deaths, supply of personal protective equipment (PPE), staff cases and staff shortages. It captures data only from federally certified nursing homes, not from all long-term 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.

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