En español | Nursing home deaths from COVID-19 remain sharply down from their winter peaks, but the declines have now plateaued and more than 800 residents and staff members each month continue to die from the virus, according to an exclusive new analysis of federal data by AARP.
There was little change in the national rates of COVID-19 infections and deaths in nursing homes from mid-March to mid-May, the analysis shows, even as rates in the wider community continued dropping. More than 10,000 residents and staff members are becoming newly infected each month.
Experts say that limited vaccine uptake among long-term care workers, worker shortages and the recent relaxation of nursing home restrictions might be causing the plateau, although more data and analysis are required.
Since the pandemic hit, COVID-19 has killed more than 184,000 residents and staff of long-term care, which includes nursing homes, assisted living facilities and other residential settings. Those deaths constitute almost a third of America's entire COVID-19 death toll, according to the Kaiser Family Foundation.
In nursing homes, the infection and death rates peaked last winter, when close to 20,000 residents and staff were reported dead from COVID-19 in just four weeks from mid-December to mid-January; 1 in every 51 residents died from the virus.
Then, cases and deaths started to plummet, dropping more than 90 percent by mid-March, with the arrival of vaccines, tougher restrictions from governments, and high levels of natural immunity from months of high infection rates. Though the situation has improved, nursing home advocates say current COVID-19 rates in nursing homes shouldn't be accepted as the new normal.
"I certainly hope they're not,” says Charlene Harrington, a nursing home researcher at the University of California, San Francisco. “There's something terribly wrong if it is.”
Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, says that “ten thousand deaths a year, just from COVID — that's a big number. Too big.”
Visits and vaccine hesitancy
The federal government asked the country's 15,000-plus nursing homes to loosen visitation restrictions in March. Citing widespread vaccinations of residents, drops in COVID-19 infections among residents and staff, and the tolls of separation and isolation on residents and their families, the federal Centers for Medicare & Medicaid Services (CMS) said facilities should allow indoor visits “regardless of vaccination status of the resident or the visitor."
The resulting uptick in visitors could, in part, be contributing to the halt in COVID-19 declines, according to Jennifer Schrack, an associate professor in the epidemiology of aging at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
"Every visitor is another potential exposure, particularly those who are not vaccinated,” she says. “They have to really consider carefully if they're going to visit their loved one, and if they do, they should wear [personal protective equipment] and be very cautious, even if their loved one is vaccinated. … Low risk doesn't mean no risk.”
Unvaccinated staff, which could represent nearly half of the nursing home and assisting living workforce, may be an even bigger factor.
"I think we've reached the threshold where most of the staff who wanted to be vaccinated are,” Schrack says. “The vaccination rate is still going up, but at a much, much slower rate than it was earlier this year, which aligns with this sort of steady state we're seeing."
Staff members have close contact with residents around the clock — bathing, dressing and feeding them — which means more potential exposure than from visitors. Additionally, at least a fifth of all nursing homes nationwide have reported a shortage of nurses or aides every month for the past year, according to AARP's new analysis, which raises the COVID-19 threat further. When facilities are short-staffed, workers are assigned more residents to care for, which can increase spread of the virus if a worker is unknowingly infected.
The CMS is slated to release official vaccination data for the nation's nursing homes this month. It released a memo in May that requires all facilities to offer COVID-19 vaccines to all residents and staff and to publicly report vaccination rates.
What's the new normal?
It's too early to consider the current steady state of COVID-19 deaths and infections in nursing homes as their new normal. “What seems to be the case is that [COVID-19] is going to become like a seasonal flu of sorts,” Schrack says, “but we're still figuring out exactly what those numbers will look like and how to deal with them.”
UCSF's Harrington is challenging the long-term care industry to resist using prior flu deaths and cases in nursing homes as a benchmark for COVID-19 impacts.
Before the pandemic, a Centers for Disease Control and Prevention study reported that about 90 percent of flu-related deaths in the U.S. occur among people age 65 years and older, many of whom live in nursing homes. The flu has killed between 12,000 and 61,000 Americans annually since 2010.
But before the pandemic, 8 out of 10 nursing homes were cited for infection control breaches, which can promote the flu's spread, according to a report by the U.S. Government Accountability Office, a federal watchdog agency.
"I don't think the flu rates were acceptable” Harrington says, “and I certainly don't think these COVID rates are acceptable, either. This pandemic has taught us that we need to do better with infection control across the board … to say COVID in nursing homes is just going to be endemic is just not right.”
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. Most 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, 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.
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.