En español | More than 91,000* residents and staff of nursing homes and other long-term care facilities have died from COVID-19, representing 40* percent of all coronavirus fatalities in the U.S., according to Kaiser Family Foundation’s most recent analysis released on November 9. Yet federal policymakers have been slow to respond to this crisis, and no state has done a good enough job to stem the loss of life. AARP has called for the enactment of a 5-point plan to protect nursing home and long-term care facility residents—and save lives—at the federal and state levels:
- Prioritize regular and ongoing testing and adequate personal protective equipment (PPE) for residents and staff—as well as inspectors and any visitors.
- Improve transparency focused on daily, public reporting of cases and deaths in facilities; communication with families about discharges and transfers; and accountability for state and federal funding that goes to facilities.
- Ensure access to in-person visitation following federal and state guidelines for safety, and require continued access to virtual visitation for all residents.
- Ensure quality care for residents through adequate staffing, oversight, and access to in-person formal advocates, called long-term care Ombudsmen.
- Reject immunity for long-term care facilities related to COVID-19.
The federal government has taken some action, such as requiring nursing homes to self-report COVID-19 cases and deaths at the federal level, ordering testing, and providing limited PPE and other resources to nursing homes as well as issuing guidance for in-person visitation to resume. But, as cases and deaths continue to rise more must be done. AARP continues to urge elected officials to take action to combat this national tragedy—and to ensure that public funds provided to nursing homes and other long-term care facilities are used for testing, PPE, staffing, virtual visits, and for the health and safety of residents.
COVID-19 cases across the U.S. are on the rise, reaching record highs in the last week. Nursing homes remain a hotbed for the virus; after declining in the summer, cases in nursing homes are beginning to rise again, among both residents and staff. AARP will continue to shine a light on what’s happening in nursing homes so that families have the information they need to make decisions, and lawmakers can be held accountable. For more information, visit aarp.org/nursinghomes.
AARP fought for public reporting of nursing home COVID-19 cases and deaths. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard to provide four-week snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.
This second dashboard aggregates and analyzes self-reported data from nursing homes available from the Centers for Medicare & Medicaid Services (CMS), covering three 4-week time intervals from mid-summer into fall:
- July 23 to August 23
- August 24 to September 20
- September 21 to October 18
The dashboard is specific to nursing homes and contains 5 key measures:
- Resident deaths per 100 residents
- Resident cases per 100 residents
- Staff cases per 100 residents
- Percentage of nursing homes without a one-week supply of PPE
- Percentage of nursing homes with staffing shortages
This dashboard data as well as 33 additional data points providing more information about each category will continue to be updated every month. It will continue to track trends over time and will evolve to include more categories to follow other measures of interest.
The AARP Public Policy Institute is analyzing data and reporting on key findings as the dashboard is reported over time. For the second dashboard, these include:
- At the national level, nursing home resident COVID-19 deaths and cases and staff cases had been declining during the summer. In the last four weeks, this is no longer the case. The rate of nursing home deaths is no longer declining, and resident and staff cases have begun to tick upward. Community spread of the virus continues to rise rapidly throughout much of the country; these rising infection rates present a considerable risk to nursing homes, residents, and staff.
- State trends vary dramatically; many states that had elevated death and infection rates in the summer have improved in the most recent four weeks ending October 18. However many other states – particularly in the Midwest – have rapidly increasing rates of deaths and cases in nursing homes.
- There is considerable variation across states. COVID-19 deaths in the September 21 to October 18 reporting period averaged 0.47 per 100 residents across the nation (about 1 out of every 215 residents). At the state level, the death rate was as high as 1.92 per 100 residents (about 1 out of 52), and several states reported no resident deaths in the last month.
- Direct care staff continue to be infected at a very high rate. In the four weeks ending October 18, more than one-quarter (26%) of nursing homes had at least one confirmed COVID-19 case among residents, and twice as many (53%) had at least one confirmed staff case; in the hardest-hit state, more than 90% of nursing homes had staff test positive for the virus. Per 100 nursing home residents, there were 2.8 COVID-19 resident cases and 2.7 staff cases, corresponding to a total of more than 60,000 cases nationally, up from 55,000 the preceding four weeks.
- In every state, nursing homes indicated a shortage of PPE (defined as not having a one-week supply of N95 masks, surgical masks, gowns, gloves, and eye protection during the last four weeks). Nationally, about one in five nursing homes (20%) had a PPE shortage during the four weeks ending October 18, a marginal improvement from 1 in 4 nursing homes during the previous month. In the highest performing state, 5% of nursing homes had a PPE shortage; in the lowest-performing state, 53% did not have a one-week supply.
Since the pandemic started, scant data has been available consistently to help gain a better understanding of the crisis in nursing homes and other long-term care facilities. The country counted mainly on the reporting of news media to glimpse the devastation caused by COVID-19. Organizations such as Kaiser Family Foundation and the COVID Tracking Project also began collecting and publishing important information from the states. It is important to note that each source collects data differently, so similar information may appear at odds due to how the measures are captured. Specific to nursing homes:
- In May, the Centers for Medicare & Medicaid Services (CMS) required nursing homes to self-report COVID-19 cases and deaths on at least a weekly basis; however, the required reporting was not retroactive. As a result, there is a significant undercounting of cases and deaths before June in this data source.
- Many states have also required self-reporting by nursing homes and/or other long-term care facilities, but the requirements vary widely. Some states combine data for nursing homes and other long-term care facilities such as assisted living; others combine resident and staff cases and deaths, while others provide limited or no data at all.
- Since June, the data reported by CMS and by individual states appear to be roughly comparable, though exact comparisons are difficult because of the inconsistency in state reporting.
*Kaiser Family Foundation: State Data and Policy Actions to Address Coronavirus