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AARP Nursing Home COVID-19 Dashboard

The COVID-19 pandemic has swept the nation, killing more than 136,000 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. This dashboard looks at five categories of impact and will be updated every month to track trends over time.

 

Dashboard data and state fact sheets with 33 additional data points providing more information about each category, can be downloaded here.

*Due to inconsistent data, the percentage of nursing homes with PPE shortages are not reported for Maryland in the most recent Dashboard.

The AARP Public Policy Institute is analyzing data and reporting on key findings as the AARP Nursing Home COVID-19 Dashboard is reported over time. This January 2021 dashboard release (with data for the four weeks ending December 20, 2020) marks exactly three months since the first dashboard was released (with data for the four weeks ending September 20, 2020). The COVID-19 situation in nursing homes has changed dramatically over this time period:

  • Between September and December 2020, COVID-19 deaths and cases in nursing homes have each increased nearly fourfold. The resident death rate increased from 0.48 per 100 residents in the four weeks ending September 20 to 1.88 per 100 residents in the four weeks ending December 20. New resident cases increased from 2.6 to 10.8 per 100 residents, and new staff cases also rose from 2.5 to 9.3 per 100 residents.
  • Counting both residents and staff, there were nearly 20,000 COVID-19 deaths and more than 200,000 new confirmed COVID-19 cases in nursing homes in the four weeks ending December 20. These are by far the highest numbers since the federal government began collecting and reporting these data in late May.
  • COVID-19 is now a nationwide issue with significant impact in nearly every state.  Previously, the national trend had been largely driven by a series of regional outbreaks, but the most recent data shows that the virus is out of control in nearly every state. 
    • Every state except Hawaii has rates of new resident and staff cases that are higher than the national average for the four weeks ending September 20.
    • Every state except Hawaii, Washington DC, and Florida has a rate of nursing home resident deaths due to COVID-19 that is higher than the national average for the four weeks ending September 20. 
    • Every state except Hawaii has seen an increase in the rate of new staff cases between September and December 2020.
    • The rate of new resident cases has risen in every state except Hawaii and Florida, and the rate of resident deaths has risen in every state except Hawaii, Florida, and South Carolina. It is notable that Florida and South Carolina were experiencing a summer surge during the first Dashboard release; but deaths and cases have risen in these states during the last month.
  • COVID-19 is not only rampant in nearly every state, it is knocking on the door of nearly every nursing home.  In the four weeks ending December 20, 87% of nursing homes (7 out of 8) had at least one confirmed staff case. Over this same period, more than half of nursing homes (59%) had at last one confirmed resident case, and dating back to the beginning of 2020, 90% of nursing homes (9 out of 10) have had a resident with COVID-19.
  • In every state, nursing homes continue to indicate 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 18% of nursing homes had a PPE shortage during the four weeks ending December 20.  While this is another slight improvement (from 19% in the previous Dashboard), it still means that nearly 1 in 5 nursing homes do not have an adequate supply of PPE during a time when cases and deaths are at record highs. There is considerable variation in PPE supply among states: the proportion of nursing homes without a one-week supply of PPE ranged from less than 1 in 20 (5%) to more than half (55%).

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.

More than 136,000 residents and staff of nursing homes and other long-term care facilities have died from COVID-19, representing about 40 percent of all coronavirus fatalities in the U.S. 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 and deaths have surged in nearly every state. 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 12/31/2020). 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.

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 12/29/2020) and USAFacts (total deaths and cases in the state; downloaded most recently on 12/29/2020).

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 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 deaths (staff): The number of deaths for staff and facility personnel with suspected COVID-19 or a positive COVID-19 test result.
  • COVID 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 no supply, or not enough supply of each type of PPE for at least one week for conventional use, for at least one week out of the four weeks in the reporting period. For the “all PPE” measure, a shortage refers to having a shortage of one or more of the five categories: N95 masks, surgical masks, 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.

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

Inclusion Criteria

For the four-week measures, nursing facilities were included only if the facility reported to CDC for all four weeks (nationally, 93% of facilities for the most recent four-week period, for states ranging from 75% 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 12/20/2020).  That is, most missing data are due to late responses, not skipped entirely.  In order 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. 

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 “since 6/1/2020” and “since January” measures, all nursing homes reporting at least one week of data are included. The national response rate is 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 since the beginning of the year that were reported; however, retroactive reporting is not mandatory, and the accuracy of reporting at the state level is unknown.

Data points that go back prior to the first reporting date, including the “since January” 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 numerator and denominator data are from different sources, the reported data may result in a percentage greater than 100%, which is impossible. The value of each such measure is capped at 100%. These measures should not be used to compute the number of cases or deaths occurring outside of nursing homes.