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Nursing Homes Reach 2 Million COVID-19 Resident Cases Since Pandemic’s Onset

AARP analysis finds deaths rose in December, January

More than 2 million COVID-19 infections among nursing home residents have been confirmed since the pandemic began four years ago, and about 188,000 of them have died from it, according to a new AARP analysis of federal data.

Nursing homes hit that 2 millionth resident case in mid-February, and deaths peaked during December and January, the analysis found. Staff have also been affected, with nearly 1.9 million confirmed cases of COVID-19 since the start of the pandemic.

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Meanwhile, vaccination rates for the most recent COVID-19 vaccine remain much lower among residents and staff than with previous vaccines and boosters. That leaves staff and residents without adequate protection from “severe outcomes,” the analysis notes.

“It just shows that this is an ongoing concern in facilities. There is a seasonal pattern, but it’s by no means going away,” says Ari Houser, a senior methods adviser at AARP and coauthor of the analysis.

The approximately 1.2 million current nursing home residents in the country are among the most vulnerable to COVID-19 because they tend to be much older and more frail than the general population, and reliant on staff to help with daily activities, Houser says.

“They have this combination of age, vulnerability and exposure that’s really unmatched,” he says.

A winter surge of COVID-19 deaths

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

The four-week period from mid-December to mid-January showed the highest rates of nursing home resident deaths, resident cases and staff cases since the same period a year earlier.

“That’s really the big peak every year,” Houser says, noting that the holidays bring people together, the cold weather keeps people inside, and other illnesses spike.

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This pattern underscores the need for residents to get vaccinated in the fall to ensure they have full protection when COVID-19 cases typically surge in December and January, he says.

About 3,000 nursing home residents died from COVID-19 from mid-November until mid-February, the period covered by the analysis. Nursing homes also saw about 50,000 resident cases of COVID-19 and 40,000 staff cases per month during the 13 weeks covered by the analysis.

In a statement to AARP, the Centers for Medicare & Medicaid Services (CMS) notes that the agency communicates regularly with nursing homes to discuss strategies around successful vaccine uptake and mitigating the spread of COVID-19. The agency oversees most of the nation’s 15,000 nursing homes.

CMS notes that vaccinations are the “strongest protection from infection and severe illness.” ​

The analysis comes two weeks after a federal government report highlighted lessons learned from the pandemic for nursing homes and found that CMS should do more to prevent staffing shortages in nursing homes and strengthen infection controls to better protect residents after the COVID-19 pandemic.

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Stalled vaccination rates in nursing homes

Nursing home resident deaths from COVID-19 and cases of it are decreasing as spring approaches, the latest analysis finds. The rate of resident deaths decreased by about a third, or 35 percent, when comparing the totals from mid-December through mid-January with mid-January through mid-February. The rate of resident and staff cases dropped by 43 percent when comparing those time frames.

Vaccination rates saw a slight increase for both residents and staff, but still lagged, according to the AARP analysis. Fewer than half of nursing home residents, or 41 percent, and about 1 in 8 staff, or 12 percent, were up to date on their COVID-19 vaccinations, the analysis found. That’s an increase from mid-November, when the last analysis showed 27 percent of nursing home residents and 7 percent of staff were current on vaccinations. However, it’s lower than one year ago: In February 2023, 53 percent of residents and 22 percent of staff were current on COVID-19 vaccinations.

Priya Chidambaram, a senior policy manager with the Program on Medicaid and the Uninsured ​at health policy nonprofit KFF, who also tracks COVID-19 in nursing homes, says several reasons contribute to lower vaccination rates among nursing home residents and staff, including that nursing homes now coordinate their own vaccination clinics, which can be less consistent than when clinics were federally supported. Also, she cites a KFF study that found 52 percent of people who were previously vaccinated had not gotten the latest vaccine because they said they are not worried about getting COVID-19. However, she says, vaccines are a “key strategy to preventing respiratory illnesses in these really vulnerable populations.”

COVID-19 vaccination rates of nursing home residents and staff vary among states, the analysis finds. Nursing homes in Arizona reported that 23 percent of their residents were vaccinated, which was the lowest rate in the country among nursing home residents. Vermont nursing homes reported a 69 percent vaccination rate for their residents, the highest rate in the country, according to the analysis. Vermont, South Dakota (67 percent) and North Dakota (63 percent) were the only states to have more than 60 percent of residents current with vaccines.

Nursing home staff vaccination rates also varied in states. Arkansas had the lowest rate in the country, with nursing homes reporting a worker vaccination rate of 4 percent. Washington, D.C., nursing homes reported the highest worker vaccination rate, at 46 percent. D.C., Massachusetts (23 percent) and Hawaii (20 percent) were the only places where at least 1 in 5 staff members were up to date on their vaccinations.

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