Surging Cases and Deaths in Nursing Homes Suggest Another Winter COVID-19 Spike

Waning immunity, rising cases 

Last year’s federal vaccination campaign sent teams from CVS and Walgreens into the vast majority of the nation’s nursing homes to administer free vaccines to residents and staff. While staff uptake lagged, most of the country’s nursing home residents were fully vaccinated by the end of March

Over the summer, though, nursing homes experienced steeper increases in COVID cases and deaths than the rest of the country, as studies began to show that vaccination becomes less effective over time, especially in people 65 years and older.

In September, the CDC recommended a booster of the Pfizer vaccine for nursing home residents six months after completing their second shot. In October, the CDC also recommended Moderna and Johnson & Johnson boosters for residents.

While nursing home workers became eligible for boosters at the same time as residents, the CDC did  not officially recommend boosters for workers until late November, when the omicron variant emerged and all Americans 18 and older were told they “should” get a booster.

In the meantime, COVID-19 cases started rising again in the U.S. In nursing homes specifically, resident and staff cases increased each week nationally, from around 6,300 for the week ending Oct. 31 to 8,000 for the week ending Nov. 21, AARP’s analysis shows.

“It’s not looking good,” says Jennifer Schrack, an associate professor in the epidemiology of aging at the Johns Hopkins Bloomberg School of Public Health. “This virus is hard to predict, but we’re expecting a surge in January, especially because of this new variant.”

AARP’s analysis shows that booster uptake varies widely from state to state. Across Arizona’s nursing homes, just 17 percent of residents and 6 percent of staff were boosted as of Nov. 21, representing the lowest rate in the county. In Vermont, meanwhile, which reported the highest rates in the country, 70 percent of residents and 36 percent of staff were boosted. Coverage tends to be higher than average in the Northeast and Great Plains regions and lower than average in the South.  

“This is not a time for governments to wait to be asked for help,” Reinhard says. “This is a time we should assume nursing homes need help because that’s what this data is telling us.”

More facilities plan for boosters

The booster uptake rate for nursing home residents is similar to that of American adults 65 and over, says Jennifer Kates, senior vice president and director of global health and HIV policy at the Henry J. Kaiser Family Foundation. She notes the booster rate for nursing home residents and older Americans is much higher than that of the general population.

“But that doesn’t mean these rates aren’t concerning,” Kates says. “Remember, most nursing home residents were vaccinated very early on in the vaccine campaign. We know immunity wanes, and we also know that this population is very vulnerable to the effects of this virus.”

“We want to prevent any increased impact from happening, if possible,” she adds. “And it is possible with boosters.”

Ruth Katz, senior vice president for policy at LeadingAge, a national trade organization representing more than 5,000 nonprofit aging service providers, says most member facilities have either completed on-site booster clinics or have them scheduled for the next few weeks. While most members have had no issues in scheduling booster clinics, she says, some operators have been delayed due to the availability of their pharmacy partners and staffing shortages. 

“Some [nursing homes] have contacted their local CVS or Walgreens or another pharmacy and been told the wait for a booster clinic is six weeks,” Katz says. “So, I think the whole workforce problem in health care is having some effect.... It takes people to do this, and right now health care doesn't have a lot of people, so we have to be considerate of that.” 

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL), a national trade organization representing more than 14,000 nursing homes and long-term care facilities, said in a statement that the new booster data shows “progress” by nursing homes, given that boosters for all three vaccines were only approved in late October. “Industry leaders anticipate it may take until the end of December to see the majority of nursing homes complete an on-site booster clinic,” it said.

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..  .