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AARP Nursing Home COVID-19 Dashboard

 

Public Policy Institute, Updated June 20, 2024

The COVID-19 pandemic has swept the nation and its impact has been especially deadly for 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 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, updated every three months to track trends over time.
 

COVID-19 vaccination rates for nursing home residents and staff are declining

 

  • Take-up of the most recent COVID-19 vaccine remains much lower than needed, leaving most residents and staff without adequate protection from severe outcomes. 
    • As of the week ending 5/26/2024, less than one third of residents (30%) and only about one out of every 10 staff (10%) were up to date on COVID-19 vaccination.
    • Due to a quarterly change in the definition of “up to rate” (now requiring two doses of the most for people age 65 and older), the resident vaccination is actually down from 41% in mid-February.
  • These figures mark the third consecutive year of decline in vaccination rates:
    • One year ago, in May 2023, 55% of residents and 22% of staff were up to date on COVID-19 vaccination.
    • Two years ago, in May 2022, 72% of residents and 48% of staff were vaccinated and had at least one booster.
    • Three years ago, in June 2021, 78% of residents and 57% of staff were fully vaccinated.
  • There continues to be considerable variation between states.
    • Approximately one half of residents (50%) in South Dakota were up to date on COVID-19 vaccination, compared to only 1 in 6 residents (17%) in Arizona.
    • The rate of staff vaccination ranged from a low of 4% in Alabama, Arkansas, and Connecticut to a high of 43% in the District of Columbia.  Outside of DC, only Massachusetts (22%) and Hawaii (20%) exceeded 1 in 5 staff up to date.

COVID-19 cases and deaths are down significantly from winter peak; but are beginning to rise again

  • Cases and deaths declined throughout the late winter and early spring.  During the four weeks ending 5/26/2024, resident and staff cases and resident deaths were down almost 90% from the winter peak in December and January.
  • However, as the calendar turns to summer, cases and deaths are longer declining.  In the first two weeks of June, the rates of staff and resident cases have begun to rise again, increasing by about 30% compared to the four weeks ending 5/26/2024.

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 collected 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. CMS made booster data publicly available on December 10, 2021. Vaccination data are also available on Care Compare for individual nursing homes, including the percentage of residents and staff up to date. 
  • The CDC publishes a Nursing Home COVID-19 Data Dashboard and Nursing Home COVID-19 Vaccination Data Dashboard that are updated weekly and include several key data points at the state and national level. Although the AARP Dashboard and the CDC Dashboard use the same source data, there are some differences in methodology and data vintage that lead to some differences in the numbers reported by each dashboard.

Residents and staff in nursing homes were hit hard by the first year of the pandemic. 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 and booster status, requiring nursing home 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.

While high primary vaccination rates for residents and staff have given us hope, and have saved many lives, there remain many nursing home residents who are not vaccinated at all, and more than half are not up to date on COVID-19 boosters. Residents and staff who are not up to date are more susceptible to adverse outcomes from COVID-19 exposure, and staff who are not up to date could place residents at unnecessary risk.  Ensuring both residents and staff are up to date with their recommended COVID-19 vaccinations is urgently needed to protect this vulnerable population.

The uptick in COVID-19 cases in August 2021 prompted AARP to call for requiring COVID-19 vaccinations for nursing home residents and workers. AARP is now calling on nursing homes to require COVID-19 booster shots for residents and staff.

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 2021 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 for the foreseeable future. Everyone must work together to ensure continued vaccine and booster access and administration. AARP also noted the importance of access to vaccines and COVID-19 tests in a December 2021 letter to CMS supporting COVID-19 vaccination requirements for certain health care workers, including staff of nursing homes participating in Medicare and Medicaid.

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 nursing homes and lawmakers can be held accountable. For more information, visit aarp.org/nursinghomes

All data for the last three months (the most recent Dashboard update) are from analysis of data from the Centers for Medicare & Medicaid Services (CMS) Nursing Home COVID-19 Public File (downloaded most recently on 6/14/2024). These data are self-reported by facilities to the Centers for Disease Control and Prevention (CDC) weekly. 

Data were analyzed by the AARP Public Policy Institute.  From 2020-2023, data were analyzed by Scripps Gerontology Center at Miami University in Ohio, with 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. 
  • COVID-19 cases: Number of residents, or staff and facility personnel, with new laboratory positive COVID-19 test results, as reported by the facility. 
  • COVID-19 vaccinations: At this time, CDC is only tracking up-to-date vaccination status, the definition of which is revisited quarterly.  For the most recent dashboard month, someone is considered up to date if they are 65 or older and have at least two doses of an updated vaccine, or if they are under 65 and have at least one dose of an updated vaccine.

 

Inclusion Criteria

For the four-week measures, nursing homes were included only if the facility reported to CDC for all four weeks. (Nationally, 97% of facilities for the most recent four-week period; for states, ranging from 91% to 100%.) If a nursing facility reported but had missing data for a specific measure, 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. That is, most missing data are due to late responses, not because the measures were skipped entirely. In general, the response rate for the most recent week is 90-95%’ for the week previous to the most recent week, the response rate is about 98%; and for earlier weeks, the response rates are 99% or more.  Depending on the vintage of data available at the time of analysis, the dashboard may use a national sample of 90-100% of facilities with response rate varying by state.  

Vaccination data points are based on the most current week of data for each facility reporting at least one resident or staff present during the week, as long as it is within the last four weeks.  Facilities do not need to report for all four weeks to be included.  The Dashboard’s use of multiple weeks of data means that rates may be systematically different than what is reported elsewhere

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. The lower the response rate, the more uncertainty in the dashboard findings.

For the measures of cases and deaths “since 2020,” all nursing homes reporting at least one week of data are included.  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.  An estimated 16,000 deaths occurring prior to June 2020 are missing from the data set (and from the Dashboard calculations).  Vaccination data were first reported for the week ending May 30, 2021, and are mandated as of the week ending June 13, 2021.

aarp.org/nursinghomes 

aarp.org/ltsschoices

Find vaccination rates of both residents and staff at any Medicare-certified nursing home and compare it to state and national averages on the Medicare.gov Care Compare website.