Nursing Home Deaths From COVID-19 Surge as Vaccinations Lag

COVID-19 protections lagging

The recent increases in cases and deaths track with similar surges in past years of the pandemic, says AARP’s Ari Houser, a senior methods adviser and coauthor of the analysis. In the last three years, nursing homes have seen a winter peak in COVID-19 impacts, but also a late summer or fall spike in August or September. “This seasonal pattern that we have observed during the last three years appears to be occurring again,” he says.

This time around, death rates appear to be lower than those reported at this time during past years: During four-week periods from late July to late August in 2021 and 2022, roughly 1,000 monthly deaths were reported. AARP’s recent count is roughly a third of that. But Houser warns that this figure is likely a “more severe undercount than usual,” due to nursing homes lagging in submitting their COVID-19 data to the government. Also, the recent surges “are not done yet, and there is every reason to also expect a larger wave in the winter,” he says.

For example, two weeks of more recent data from the Centers for Disease Control and Prevention (CDC) shows that both cases and deaths continued to rise in nursing homes from Aug. 20 through to Sep. 3, making nine consecutive weeks of rising resident cases and 11 straight weeks of rising staff cases. Also, while deaths are currently tracking lower, other impacts, including infection rates, are tracking at similar or worse levels than past years.

Priya Chidambaram, a senior policy analyst at health policy nonprofit KFF, who also tracks COVID-19 in nursing homes, agrees that the death rates are “concerning.”

“Any number of preventable deaths is never acceptable,” she says, “and, ultimately, these numbers can be mitigated further if more work is done to protect this population.”

Tackling lagging vaccination rates in these facilities is critical, Chidambaram adds. As of late August, only about 62 percent of residents nationwide were up to date on their shots, AARP’s analysis found. That rate “falls far short” of earlier COVID-19 inoculation rates for nursing home residents, AARP’s Houser says, which peaked at 88 percent fully vaccinated in May 2022, and 75 percent boosted in October 2022.

In some states, the number of residents up to date on shots as of late August was particularly low. Arizona reported that number at only 44 percent of nursing home residents, while Alabama and Nevada each reported that only 51 percent of those residents were up to date. South Dakota reported the highest rate of nursing home residents up to date at 79 percent.

Up-to-date vaccination rates among nursing home workers, who can spread the virus to residents, also lagged, with just 25 percent of workers nationwide having received their recommended number of shots. In states like Alabama, Arizona and Mississippi, less than 15 percent of workers were up to date. Meanwhile, Washington, D.C., reported the highest rate of staff up to date with COVID-19 vaccines at 57 percent.

AARP’s ongoing analysis, 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.

A new vaccine on the way

Nursing home residents are among the most vulnerable to severe disease and death from COVID-19. More than 180,000 nursing home residents have died from the virus during the pandemic, accounting for roughly a sixth of the country’s entire COVID-19 death toll despite the fact that nursing home residents make up less than 1percent of the U.S. population.

Nursing home experts say a mix of factors is likely to blame for low up-to-date vaccine rates, including high rates of vaccine hesitancy, pandemic fatigue, confusion around what shots are needed. Also, many government mandates that required nursing home workers to be vaccinated and/or boosted ceased with the end of the public health emergency in May.

Some others in the nursing home population may not be up to date on shots because they’ve been holding out for the updated COVID-19 vaccines that target the new strains of the virus, experts noted.

On Tuesday, after an independent body of scientific advisers reviewed vaccine data, the CDC recommended the new shots to everyone 6 months and older who received their last COVID-19 vaccine at least two months ago.

Some advisers 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 the current increases in COVID-19 infections and the looming respiratory virus season. A few advisers were even reluctant to recommend the new vaccines to all Americans, worried it might compromise the message that vulnerable populations are in greatest need.

The new vaccines will be available later this week, with nursing homes being directed to their existing pharmacy partners to secure the new shots. In late 2020 and early 2021, the federal government contracted pharmacy chains to conduct on-site vaccine clinics at most of the nation’s nursing homes to get residents and workers their primary series of shots quickly, though a similar campaign is not expected for this latest round of vaccines.

The new COVID-19 shots will join two other major vaccines also now available: the flu vaccine, recommended for everyone aged 6 months and older, and the respiratory syncytial virus (RSV) vaccine, recommended for everyone 60 and older, in consultation with a health care provider.