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New Report: Nursing Homes Record Lowest Rates of COVID-19 Infection and Death

'While this trend is good, we're not done yet'

The nation's 15,000-plus nursing homes have reported their lowest rates of COVID-19 infections and deaths since the federal government started requiring nursing homes to submit COVID-19 statistics, a new AARP analysis of federal data shows.

Over a four-week period ending March 21, some 2,000 residents — or roughly 1 in every 500 — died from COVID-19. It is by far the lowest monthly death rate on record, the analysis found. That's less than half of the previous lowest rate, which was recorded in the fall. And it represents a drop of 90 percent from the winter death peak between mid-December and mid-January, in which more than 20,000 residents — nearly 1 in every 50 — died from the virus.

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More than 182,000 residents and staff in long-term care facilities, including those in nursing homes and assisted living facilities, have died from COVID-19 amid the pandemic, accounting for a third of U.S. coronavirus fatalities. More than 131,000 were nursing home residents, according to AARP's analysis.

A combination of high levels of natural herd immunity among nursing home communities from widespread outbreaks over the last year, tighter state and county restrictions enforced during the winter surges, and the strong uptake of the COVID-19 vaccines among residents appear to be driving the recent declines. A federal program — which partnered with CVS, Walgreens and other pharmacy chains to provide on-site vaccinations at over 63,000 U.S. long-term care facilities — has completed more than 99 percent of its nursing home clinics.

The new figures represent “important progress,” says Megan O'Reilly, AARP's vice president of government affairs on health and family, after a “deeply concerning and devastating year for long-term care.”

But the pandemic's tragic toll on long-term care residents and staff shows that efforts to support and reform facilities must continue, O'Reilly adds. “The pandemic has demonstrated that we have inherent challenges in our long-term care system — with staffing and infection control — and these issues need longer-term solutions,” she says. “While this trend is good, we're not done yet.”

Dramatic declines

COVID-19 infections among residents followed a similar trend to the declining death rate, the analysis found, with fewer than 1 out of every 200 residents testing positive for the virus. That's a 96 percent decline from the peak infection rate between mid-November and mid-December, when more than 1 in every 10 residents became newly infected. The most recent resident case rate is about one-fifth the level of the previous lowest rate, recorded in June 2020.

The rate of new staff cases also plummeted, from nearly one staff infection per every 10 residents between mid-November and mid-December to roughly one staff infection for every 130 residents. The new staff infection rate is about one third the level of the previous lowest rate, which was also recorded last spring.

The drops are consistent across nearly all states, the analysis shows, and are “likely to continue to fall.”

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"If you look at this month's data on a weekly basis, the number of resident deaths and cases in the most recent week of data were each about half as high as in the first week,” says Ari Houser, a senior methods adviser at AARP and coauthor of the analysis.

"So there's a real downward trajectory here, and not just from month to month, but from week to week,” Houser says. “We're seeing marked improvements and we expect — and hope — we'll see even lower rates next month.”

Shortages improve but persist

AARP also found that the percentage of nursing homes experiencing staffing shortages decreased for the third month in a row but continues to be an ongoing problem, with 22 percent of homes nationwide still reporting a lack of sufficient nurses or aides.

An adequate staffing ratio is critical to proper infection control and resident care, says Charlene Harrington, a nursing home researcher and professor emeritus at the University of California, San Francisco. “When you're short-staffed, workers are just running from patient to patient — trying to feed them, take them to the toilet, the basic things,” she says. “And things like handwashing go out the window."

And while COVID-19 may appear to be less of a threat in nursing homes now than it has been in previous months, “it's not gone,” says Jennifer Schrack, an associate professor at the Johns Hopkins Bloomberg School of Public Health who specializes in the epidemiology of aging. “And low risk doesn't mean no risk.”

The analysis also found that roughly 10 percent of nursing homes nationwide reported not having a week's supply of personal protective equipment (PPE) on hand during the four-week period ending March 7. While this number has improved substantially over the course of the pandemic, dropping from around 30 percent in the summer months, 1 in 10 nursing homes with an inadequate supply of PPE is unacceptable, says Rhonda Richards, AARP's senior legislative representative.

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

Restrictions loosen but remain

The Centers for Medicare & Medicaid Services (CMS) recently updated its nursing home guidance to allow easier in-person visitation while continuing to emphasize infection prevention and control practices for facilities, visitors and others. The CMS cited the widespread vaccinations among residents and the declining COVID-19 infection rates.

"Facilities should allow indoor visitation at all times and for all residents [regardless of vaccination status],” the agency said. There are some exceptions, including for residents with COVID-19.

The CMS also moved to permit “close contact,” including a hug or hand-holding, for fully vaccinated residents. Both the resident and visitor, however, are required to wear a well-fitting face mask at all times during the visits.

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 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, 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.

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