COVID-19 infections in U.S. nursing homes quadrupled between mid-April and mid-May, and the death rate in the facilities is rising once again, a new monthly AARP analysis of federal data shows. At the same time, uptake of COVID-19 booster shots has slowed, leaving some 330,000 residents and more than a million workers without an extra shot.
AARP’s analysis found that the rates of U.S. nursing home residents and workers testing positive for COVID-19 during the period between mid-April and mid-May are comparable to those recorded during COVID-19’s first summer in 2020, when vaccines weren’t available, and during the peak of the delta wave, in the summer and fall of 2021. The infection rate among residents jumped from around 1 in every 200 during the four weeks ending on April 17 to 1 in every 44 for the four weeks ending on May 22. Infection rates among workers were similar.
COVID-19 deaths among residents also increased, from around 300 nationally during the four weeks ending in mid-April to more than 500 for the four weeks ending in mid-May. Reports from the Centers for Disease Control and Prevention (CDC), which include data from two additional weeks beyond AARP’s analysis, show that resident deaths have continued to rise since then. And the figure is likely to be revised upwards in coming weeks, as nursing homes submit more data.
Booster uptake in nursing homes, meanwhile, has slowed to a crawl. About 72 percent of residents and 48 percent of staff nationwide had received at least one booster dose as of mid-May, up slightly from 70 percent and 46 percent, respectively, as of mid-April. Those slight upticks represent the lowest monthly increases since booster data became available last fall.
Booster rates slow among U.S. nursing home population
“They’re by far the smallest jumps we’ve seen,” says AARP’s Ari Houser, a senior methods adviser and coauthor of AARP’s monthly analyses. “Which is worrying, because they’re still well below where they should be, particularly in some states.”
Florida, the state with the fourth highest population of nursing home residents, reported that just 57 percent of residents had been boosted as of mid-May — the lowest rate in the country. Mississippi and Missouri reported that only 27 percent of workers had been boosted.
Massachusetts, South Dakota and Vermont, meanwhile, reported that 88 percent of residents had received an extra dose — the highest rates in the country. Massachusetts, which is requiring nursing home workers to be boosted, reported that 96 percent had received an extra shot. California and Connecticut, which have similar mandates for workers, reported booster rates of 86 and 89 percent, respectively.
The federal government is requiring only an initial series of COVID-19 vaccinations — not boosters — for all staff of Medicare- and Medicaid-funded health care facilities, which includes the vast majority of the country’s nursing homes. Eighty-nine percent of workers had received their initial series as of mid-May, the analysis found, while 88 percent of residents had.
AARP called on nursing homes to require boosters among both residents and staff in January, saying boosters are “necessary to remain protected.”
Check the vaccination rates of your nursing home
You can now find vaccination and first (not second) booster rates of both residents and staff at any Medicare-certified nursing home and compare it with state and national averages on Medicare.gov’s Care Compare website.
- Find a nursing home’s profile via the home page’s search function
- Visit the “Details” section of its profile
- Click the “View COVID-19 Vaccination Rates” button
The need for boosters
America’s long-term care facilities, including nursing homes, assisted living facilities and other senior care settings have been ravaged by the pandemic, suffering more than 200,000 COVID-19 deaths among residents and staff. The facilities account for roughly a fifth of all U.S. COVID-19 fatalities, with more than 170,000 of those deaths attributed specifically to nursing homes.
The CDC began recommending boosters for nursing home residents last September, as studies showed that vaccination becomes less effective over time, especially for people 65 and older.
A recent CDC study of vaccination data from the nation’s 15,000 nursing homes found that an additional or booster dose of a COVID vaccine provided 47 percent greater protection against infection when omicron was the dominant strain. Given residents are at high risk for illness and death from COVID-19, efforts to maximize booster coverage among them “are critical,” the study concluded.
The CDC recommended boosters for nursing home workers in December last year, amid the omicron wave. Studies have shown that boosters provide significantly more protection against omicron than just initial-series vaccinations.
Second booster shots have since been authorized for everyone over age 50 and many immunocompromised people, after data from Israel showed increased protection from a fourth dose against COVID infection and severe illness. CDC Director Rochelle Walensky, M.D., said second boosters are “especially important” for people over 65 and those over 50 with chronic health problems — both highly represented in the nursing home population.
Federal data on second booster shots in nursing homes is currently unavailable.
Vaccine hesitancy, confusion around booster eligibility and effectiveness, and pandemic fatigue are likely contributing to slower booster uptake, experts say. Also, while there was a federal program to quickly administer the initial series of vaccinations to the nursing home population when they first became available, the administration of boosters has been left to individual facilities or state or local health departments in some states.
Staffing crisis continues
AARP’s analysis also found that staffing shortages in nursing homes, which one expert called a “staffing apocalypse,” show no signs of letting up.
Thirty-one percent of U.S. nursing homes reported a shortage of nurses or aides in the four weeks ending in mid-May, the same rate as the previous four-week period. It represents a significant drop from the 39 percent of facilities reporting the shortages during the peak of the omicron wave, but the shortfalls remain higher than at any point before 2022.
In Alaska, 93 percent of nursing homes reported a lack of staff. In Maine, Minnesota, Washington and Wyoming, more than 60 percent of facilities said they were short.
“We’re in the biggest workforce crisis in long-term care service that I’ve ever seen,” says Robert Applebaum, a researcher at the Scripps Gerontology Center at Miami University in Ohio, who has studied long-term care for 40 years.
“[Staffing] has been a long-standing problem for the industry,” he says. “But, unfortunately, it's now a problem on steroids.”
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.