COVID-19 Death Rate in Nursing Homes Plummets, but Experts Say It’s Still Too High

In addition, new data from the Centers for Disease Control and Prevention (CDC) — which features three weeks’ worth of more recent nursing home information than AARP’s analysis — shows early signs of resident and staff cases being on the rise once again. Cases among staff rose about 10 percent from the week ending March 27 to the week ending April 10. Resident cases also rose roughly 10 percent from the week ending April 3 to the week ending April 10.

“While it is only a small increase so far, we may be seeing the beginning of another wave in nursing homes,” says Ari Houser, co-author of the AARP analysis. He also notes that the most recent week of CDC data is typically an undercount, often revised upwards in later weeks as nursing homes submit more data. “So there’s likely a bigger increase than it appears at first glance,” he adds.

Lagging protections

The CDC began recommending boosters for nursing home residents last September, after studies showed that vaccination becomes less effective over time, especially in people 65 and older. When the highly contagious omicron variant emerged, CDC data showed that the rate of new COVID-19 infections in nursing home residents who got a booster was more than 90 percent lower than the rate among residents who were not fully vaccinated or who had only received their primary series of shots.

In March, as studies showed that booster effectiveness wanes after four months and second booster shots were authorized for everyone over age 50 and many immunocompromised people, CDC Director Rochelle Walensky, M.D., said another booster was “especially important” for people over 65 and people over 50 with chronic health problems — with both demographics highly represented in the nursing home population.

Still, 32 percent of nursing home residents nationwide hadn’t received their first booster as of mid-March, according to AARP’s analysis, with 12 percent of those residents still without their initial series of vaccinations. In Florida, Nevada, Arizona and Texas, more than 45 percent of nursing home residents remain unboosted. While in South Dakota, Vermont and Massachusetts, only 15 percent of residents haven’t gotten the extra shots.

As omicron surfaced in December, the CDC recommended that nursing home workers get boosters, but AARP’s analysis found that as of mid-March, only 42 percent of those employees nationwide had gotten an extra shot and that 12 percent of those workers remained unvaccinated. In Florida, Indiana, Louisiana, Missouri, Mississippi, Oklahoma and Tennessee, more than 75 percent of nursing home staff remained unboosted, compared with Massachusetts, Connecticut, California and Puerto Rico, where fewer than 20 percent of workers had not been boosted.

Federal data on second booster shots is currently unavailable.

While there was a national campaign, run by the federal government and pharmacy chains, to quickly inoculate the nursing home population when COVID-19 vaccines first became available, the administration of booster shots, which has been left to individual facilities and states to coordinate, has generally been much slower.

But experts say nursing home residents still remain highly vulnerable to the virus, due to their age, underlying health conditions and crowded living conditions. And, with the highly contagious subvariant of omicron, known as BA.2., raising concerns, they caution that getting the nursing home population vaccinated and boosted needs to be prioritized once again.  

“After an intense media spotlight on the tragedy that was taking place in nursing homes, it is fair to say the attention has shifted,” says Tricia Neuman, senior vice president and executive director of the Program on Medicare Policy at KFF. “In some respects, this makes sense because deaths among nursing home residents and staff have declined. But at the same time, it is important to do all that we can to keep the momentum going when it comes to vaccinations and boosters.”

“Unfortunately, we’re not out of the woods yet,” says Neuman, adding that 1,000 monthly deaths in nursing homes is not acceptable.

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 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.