En español | More than 4 in 10 Medicare beneficiaries who resided in a nursing home last year had or likely had COVID-19, according to a sweeping new study released Tuesday by the inspector general of the U.S. Department of Health and Human Services (HHS). Minority residents on Medicare were significantly more likely than white residents on Medicare to have or likely have contracted the virus.
The study, which analyzed the Medicare claims of 3.1 million Medicare beneficiaries who resided in nursing facilities and skilled nursing facilities in 2020, highlights the pandemic's disproportionate toll on the country's seniors in nursing homes, where more than 130,000 residents have died from the virus so far. It found that some 763,000 Medicare beneficiaries in nursing homes were confirmed positive for COVID-19 in 2020, and an additional 533,000 likely had it. COVID-19 was suspected in that latter group, but not confirmed by a positive test result, mainly due to a shortage of tests during the early months of the pandemic.
Overall, 42 percent of beneficiaries suffered confirmed or likely COVID-19, the study found. “For context, about 6 percent of the nation's population were reported to have been infected by the end of December,” the authors wrote, citing data from the COVID Tracking Project.
"These are really sobering numbers,” says Nancy Harrison, a deputy regional inspector general at HHS. “These are mothers, fathers, aunts, uncles, loved ones, friends and the devastation they face really demands we examine what happened.”
Medicare is a federal health insurance program that subsidizes healthcare for people age 65 or older, younger people who qualify on the basis of disability, and those with End-Stage Renal Disease. Its beneficiaries make up the majority of the nursing home population.
The study found that the overall mortality rate for Medicare beneficiaries in nursing homes — which includes not just COVID-19 deaths, but all deaths — rose by a third from 2019 to 2020, the year the U.S. pandemic started, jumping from 17 to 22.5 percent. Every month of 2020 had a higher mortality rate than the corresponding month a year earlier.
"It's clear the pandemic had far-reaching implications for all nursing home beneficiaries, beyond those who had or likely had COVID,” says Harrison. Many residents suffered and died from other non-COVID conditions as a result of the pandemic's condition, which is “the untold story,” she says.
Minorities fared worse
The study analyzed racial and ethnic data in Medicare claims to show that 51 percent of Black beneficiaries in nursing homes in 2020 had or likely had COVID-19 throughout the year, while 41 percent of white beneficiaries did. Hispanic and Asian beneficiaries also suffered higher rates of COVID-19 or likely COVID-19 than white beneficiaries, with 49 percent of Hispanics and 47 percent of Asians claiming the diagnoses.
The mortality rates for minority groups also increased by more than that of white beneficiaries. The percentage of Asian beneficiaries who died in nursing homes increased by 10 percentage points, from 17 percent in 2019 to 27 percent in 2020. Both Hispanic and Black beneficiaries saw mortality rates jump from 15 to 23 percent between 2019 and 2020, while the mortality rate for white beneficiaries increased from 18 to 24 percent.
The findings echo those of other research showing that racial and ethnic minorities have experienced higher rates of COVID-19 infection, hospitalization and deaths in the U.S. compared to white individuals in nursing homes and in society at large.
Those enrolled in both Medicare and Medicaid — government insurance for low-income Americans — were much more likely to contract COVID-19 than Medicare-only beneficiaries. Fifty-six percent of “dually eligible” beneficiaries — who generally are poorer, are sicker and spend longer periods of time in nursing homes than other Medicare beneficiaries — had or likely had COVID-19 in 2020, compared to 29 percent of Medicare-only beneficiaries.
"Our analysis makes clear that the pandemic has not impacted Americans equally in nursing homes,” Harrison says.
Filling the gaps
The federal government started requiring all federally certified nursing homes to report their weekly COVID-19 data to the Centers for Disease Control and Prevention (CDC) in May 2020. That data forms the Nursing Home COVID-19 Public File, which is published by the Centers for Medicare & Medicaid Services (CMS) and is a leading resource for tracking the pandemic's toll on nursing homes.
While nursing homes had the option to report data retrospectively back to January 2020 when submitting their first reports, they were not required to. The file is therefore incomplete. To help fill in the gaps, the HHS Office of Inspector General analyzed Medicare claims dating back to January 2020. It found that the number of infected or likely infected beneficiaries in nursing homes grew exponentially in the spring of 2020, with COVID-19 or likely COVID-19 diagnoses increasing almost tenfold from March to April. On average, more than 4,700 new cases were reported per day in April, up from 492 per day in March.
April infection rates contributed to almost 1,000 more beneficiaries dying per day in April 2020 compared to the previous year. More than 80,000 beneficiaries died that month.
Harrison says the new data could “strengthen and broaden” the CMS analyses of what really happened in nursing homes during the early stages of the pandemic: “You can't really understand the true toll of the pandemic without including April.”
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.