Nursing Home COVID-19 Cases Quadruple as Booster Rates Slow

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.”

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.