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COVID-19 Nursing Home Deaths Climb Ahead of Expected Winter Surge

Only 27 percent of residents and 7 percent of workers up to date on vaccinations


COVID-19 cases and deaths are climbing once again in U.S. nursing homes as vaccination rates hit new lows, according to a new AARP analysis of federal data. These long-term care facilities have seen significant increases in infection since summer and are likely to see even more as the country reenters a historically troublesome period for COVID-19: winter.

COVID-19 deaths among nursing home residents over a four-week period ending Nov. 19 were more than four times higher than those recorded over a four-week period ending June 25, according to the analysis by the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio. Roughly 1,000 residents died from the virus over that November period.

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More than 185,000 nursing home residents have died from COVID-19 since it first appeared in the U.S. in 2020, accounting for roughly a sixth of the country’s entire COVID-19 death toll even though nursing home residents make up less than 1 percent of the total population. As of mid-November, roughly 9,000 residents have died from the virus so far in 2023, according to the Centers for Disease Control and Prevention (CDC).

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Infections among nursing home residents over the four-week period ending Nov. 19 were also quadruple those recorded over the four-week summer period ending June 25. Roughly one in every 24 residents nationwide tested positive for COVID-19 during the most recent period studied, with more than a third of facilities nationwide reporting at least one resident case.

As cases among residents have risen, cases among nursing home workers have followed a similar trend; worker infections over the four-week period ending Nov. 19 were also quadruple those recorded over the four-week summer period. Approximately one staff member for every 37 residents tested positive in the most recent four-week period studied, with nearly half of all facilities nationwide reporting at least one case among staff.

State data from the AARP analysis shows that Wyoming reported the highest infection rates among both residents and staff for the four-week period ending Nov. 19, while Alaska reported the highest death rate among residents. However, nearly every state has seen significant increases in both infection and death compared to the summer period ending June 25, with only Hawaii and Florida reporting decreases. 

The worst is likely yet to come, according to AARP’s Ari Houser, a senior methods adviser and coauthor of the analysis. “In each of the previous three years, the most severe COVID-19 impacts happened in late fall and early winter following the Thanksgiving, Christmas and New Year’s holidays,” he says. “We expect to see an additional surge over the next several months.”

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Vaccination rates hit new lows

In September, the CDC recommended an updated COVID-19 vaccine to everyone 6 months and older who received their last COVID-19 vaccine at least two months before. Health experts stressed the importance of older adults and immunocompromised people — both of which are highly represented in the nursing home population — getting the new vaccine as quickly as possible given their risk of severe disease and death from COVID-19 and the looming respiratory virus season.

But AARP’s new analysis shows that uptake of the new vaccines among the nursing home population has been much lower than previous vaccines and boosters, leaving most residents and staff without adequate protection.

As of Nov. 19, only about a quarter of nursing home residents nationwide were up to date with the most recent vaccine, and only 7 percent of workers were up to date. In November 2021, almost 90 percent of residents were vaccinated and roughly 40 percent were boosted. At that time, roughly 80 percent of staff nationwide were vaccinated thanks in large part to a federal mandate requiring nursing home workers get the initial series of COVID-19 vaccines. Roughly 15 percent of workers were also boosted.

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Despite the current low vaccination rates for residents, AARP’s analysis found those rates are rising, albeit slowly. Between mid-October and mid-November, the resident vaccination rate increased from 17 percent to 27. Meanwhile, the staff rate only moved one percentage point: from 6 to 7 percent.

Large variations in up-to-date vaccination rates continued between states, as was seen throughout the pandemic. The rate of residents who had received the new vaccine ranged from a low of 10 percent in Arizona to a high of 55 percent in South Dakota. Only North Dakota and South Dakota reported that more than half of residents were up to date. Worker up-to-date vaccination rates ranged from a low of 2 percent in Arkansas to a high of 18 percent in New Mexico. Just six states exceeded a rate of 10 percent.

Nursing home experts say a mix of reasons is likely to blame for low up-to-date vaccination rates, including vaccine hesitancy, pandemic fatigue and confusion around what shots are needed. Many government requirements that nursing home workers be vaccinated and/or boosted ceased with the end of the public health emergency in May. Also, vaccine campaigns run by either the federal or state governments to quickly deliver shots to nursing homes have waned.

“Given the severe impact COVID-19 has had on nursing home residents and staff over the last few years, it remains important to make available and encourage vaccination among nursing home residents and staff to help ensure their health and well-being,” says Rhonda Richards, AARP senior legislative representative for health and family issues.

AARP’s ongoing analysis of COVID-19 in nursing homes, conducted by the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio, draws primarily on data from the Nursing Home COVID-19 Public File by the Centers for Medicare & Medicaid Services. Most U.S. nursing homes are federally certified and required to submit data to the government each week. Read more about the analysis here.

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