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AARP Nursing Home COVID-19 Dashboard

The COVID-19 pandemic has swept the nation, killing more than 186,000 residents and staff of nursing homes and other long-term care facilities. 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. AARP’s Nursing Home COVID-19 dashboard has tracked five categories of impact since summer 2020, as well as vaccination rates of nursing home residents and health care staff, and is updated every month to track trends over time.

The PPE measures used throughout the dashboard have been discontinued as of the week ending 3/14/2021. We continue to track PPE shortages with a different measure that is not comparable to previous months. 

This page was updated on July 19 to correct errors in the CMS data for 3 nursing homes (in Connecticut, New Jersey, and Texas) about the number of staff or residents able to be vaccinated.

The AARP Public Policy Institute has been analyzing data on COVID-19 in nursing homes, tracking impacts, and reporting on key findings since June of 2020. More than a year and a half into the pandemic, this November 2021 dashboard, with data through mid-October, shows that COVID-19 continues to pervade nursing homes across the country, in some respects, as severely as ever.

  • Nationally, the rates of COVID-19 cases in nursing homes declined in four weeks ending October 17, 2021.
    • Compared to the previous four weeks ending September 19, the rate of resident cases fell by about one-quarter, from 1.8 to 1.4 new cases per 100 residents. Cases are still rising in many parts of the country – the rate of new cases rose in 18 states.
    • The rate of new cases among staff fell by about one-third, from 2.5 to 1.6 new cases per 100 residents. At the state level, 13 states saw a rise in cases from the previous four weeks ending September 19.
  • The rate of deaths remained approximately constant in the four weeks ending October 17, 2021. For the second consecutive month, more than 2,000 residents died from COVID-19. Death rates increased in 27 states compared to the previous four-week period.
  • The percentage of nursing homes reporting a shortage of nurses or aides increased again. In the most recent four weeks, 30% of nursing homes reported a shortage of nursing and/or aides, the highest rate reported since CMS began reporting data in Spring 2020 (higher than during the winter peak).
  • Vaccination rates continue to increase. As of mid-October, about 86% of residents and 74% of staff were fully vaccinated, up from 85% and 67% in mid-September. The month-to-month increase in staff vaccinations is the highest since we began tracking this data in June 2021. 
    • Despite these impressive topline vaccination numbers, there remain many vulnerable nursing home residents and unvaccinated staff who could put them at risk. More than 150,000 nursing home residents and nearly half a million direct care staff are not fully vaccinated.
    • Nearly half of US nursing homes (47%) have achieved the industry benchmark of 75% of staff fully vaccinated as of mid-October. 100% of reporting nursing homes in Hawaii and Rhode Island met this threshold, as did 99% of facilities in Connecticut and Massachusetts.
    • At the state level, the percentage of nursing home staff who have been fully vaccinated ranges from a low of 58% to a high of 97% in Rhode Island. The staff vaccination rate also exceeded 90% in California, Connecticut, Hawaii, Maine, Massachusetts, and Washington DC.

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 vital information from the states. It is important to note that each source collects data differently, so similar information may appear at odds due to variation in precise definitions, types of people and settings included in the measure, and the timeliness and completeness of data collection. Specific to nursing homes: 

  • Many states have 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.
  • In May 2020, the Centers for Medicare & Medicaid Services (CMS) required nursing homes to self-report COVID-19 cases and deaths on at least a weekly basis; these data are reported directly from nursing homes to the federal government and are consistent across all states.  However, the required reporting was not retroactive. As a result, there is a significant undercounting of cases and deaths before June 2020 in this data source.  
  • Beginning in June 2020, 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.
  • In May 2021, CMS issued an interim final rule and guidance requiring the reporting of nursing home resident and staff vaccination status. Vaccination data were first reported for the week ending May 30, 2021, and were mandated as of the week ending June 13, 2021.

More than 186,000 residents and staff of nursing homes and other long-term care facilities have died from COVID-19, representing about one-third of all coronavirus fatalities in the U.S. Yet federal policymakers were 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.
  • Hold long-term care facilities accountable when they fail to provide adequate care to residents. 

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, providing limited PPE and other resources to nursing homes, establishing requirements for education on and offering of COVID-19 vaccines to residents and staff, reporting of nursing home resident and staff vaccination status, requiring nursing homes staff vaccinations, and issuing guidance for in-person visitation to resume. AARP continues to urge elected officials to take action to combat this national tragedy, make sure it does not happen again, and 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. 

More than a year and a half into the pandemic, nursing homes continue to face chronic problems that leave residents and staff vulnerable to COVID-19 and other infectious disease outbreaks. While rising vaccination rates give us hope, there remain many vulnerable nursing home residents and many unvaccinated staff who could put them at risk.

The uptick in COVID-19 cases prompted AARP to call for requiring COVID-19 vaccinations for nursing home residents and workers in August. AARP has also been leading the way in helping Americans get the facts about the COVID-19 vaccines so they can decide what’s best for them and their families.

AARP continues engaging with CMS to urge the agency to remain vigilant in efforts to protect long-term care facility residents and staff. A July AARP letter to CMS included recommendations that the federal government commit to working with states, long-term care facilities, and other entities, as needed, to ensure that those facilities can access and administer vaccines on a continuing basis for the foreseeable future. 

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

All nursing home data are from the Centers for Medicare & Medicaid Services (CMS) Nursing Home COVID-19 Public File (downloaded most recently on 11/2/2021). These data are self-reported by facilities to the Centers for Disease Control and Prevention (CDC) at least weekly. The five dashboard measures use this CMS data source.

The PPE measures previously used in the dashboard have been discontinued as of the week ending 3/14/2021. We continue to track PPE shortages with a different measure that is not comparable to previous months.

Several data points in the state fact sheets include general population state data (that is, not limited to nursing homes) as a denominator or stand-alone measure. These data are from the COVID Tracking Project (statewide positivity rate; downloaded most recently on 2/25/2021) and USAFacts (total deaths and cases in the state; downloaded most recently on 11/2/2021).

Data were analyzed by Scripps Gerontology Center at Miami University in Ohio; additional analysis and preparation of the dashboard by the AARP Public Policy Institute.

 

Key Definitions

  • COVID-19 deaths (residents): Total number of residents with suspected COVID-19 or a positive COVID-19 test result who died in the facility or another location as a result of COVID-19 related complications.
  • Total deaths (residents): This count includes new COVID-19 related deaths and non-COVID-19 related deaths. Includes residents who died in another location, such as a hospital.
  • COVID-19 deaths (staff): The number of deaths for staff and facility personnel with suspected COVID-19 or a positive COVID-19 test result.
  • COVID-19 cases: Number of residents, or staff and facility personnel, with new laboratory positive COVID-19 test results, as reported by the facility.
  • PPE shortage: Having an “urgent need” for each type of PPE, meaning that the nursing home will run out within seven days if additional supply is not found. For the “all PPE” measure, a shortage refers to having a shortage of one or more of the five categories: N95 masks, facemasks, eye protection, gowns, and gloves.
  • Staffing shortage: Identified staffing shortage for each personnel category based on facility needs and internal policies for staffing ratios for at least one week out of the four weeks in the reporting period.
  •  COVID-19 vaccinations: Count of individuals who have a completed vaccination, meaning that they have received all required shots; in the dashboard, we may refer to these as fully vaccinated. Individuals who are not fully vaccinated include those who are partially vaccinated, medically contraindicated, refused vaccination, or vaccination status unknown.

CDC has issued detailed instructions to nursing homes for reporting these data:

Inclusion Criteria

For the four-week measures, nursing homes were included only if the facility reported to CDC for all four weeks (nationally, 96% of facilities for the most recent four-week period, for states ranging from 80% to 100%). If a nursing facility reported but had missing data for a specific measure (this is rare), that facility is excluded from the calculation of that measure for the dashboard. 

Most nursing facilities with missing data are only missing the most recent week (ending 10/17/2021).  That is, most missing data are due to late responses, not skipped entirely.  To have the most current data possible, we must exclude those facilities that were late in reporting the most recent week of data as well as those with one or more weeks of non-response in earlier weeks.  

Vaccination data points are based on the most current week of data for each facility, as long as it is within the last four weeks.  Facilities do not need to report for all four weeks in order to be included; one week of good data is sufficient.  Facilities with missing or implausible data for each of the last four weeks are excluded from the calculation.

Aggregate counts of deaths and cases may be an undercount if there are facilities that are not reporting. Percentages or rates might be slightly biased if the average of non-reporting facilities differs significantly from the average of reporting facilities.

For the measures of cases and deaths “since 6/1/2020” and “since January 2020”, all nursing homes reporting at least one week of data are included. The national response rate is greater than 99% for both measures.

 

Comparability to Other Data Sources

The first reporting date for the CMS Nursing Home COVID-19 data was May 24, 2020, and includes all cases and deaths that were reported since the beginning of the year; however, retroactive reporting is not mandatory, and the accuracy of reporting at the state level is unknown.  Vaccination data were first reported for the week ending May 30, 2021, and are mandated as of the week ending June 13, 2021.

Data points that go back prior to the first reporting date, including the “since January 2020” counts of resident cases and deaths in the state fact sheets, may significantly undercount the total number of cases and deaths. At the national level, the CMS data source gives a significant undercount of the number of cases and deaths before June, compared to other sources that were reporting in real-time.

Since June, the CMS data are much more reliable and at the national level track well against data reported by the states (comparisons to individual states are difficult because each state categorizes and reports the data differently).

The state fact sheets include several measures of the percentage of total state deaths and cases that occurred among nursing home residents and nursing home staff. Because the denominator data is from a different source, the reported data may result in a percentage less than 0% or greater than 100%, which is impossible. The value of each such measure is capped at 100%, and values of less than 0% are marked as NA. These measures should not be used to compute the number of cases or deaths occurring outside of nursing homes.